For individuals managing diabetes, maintaining stable blood glucose levels is paramount, especially within the structured environment of a hospital. This article delves into the guidelines and considerations for diabetic diets in hospital settings, aiming to provide a comprehensive understanding for patients, healthcare providers, and dietitians alike.
Understanding Diabetes and Its Dietary Implications
If you have diabetes, your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps glucose get into your cells. With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose builds up in your blood and causes high blood glucose levels. Prediabetes means that your blood glucose levels are higher than normal but not high enough to be called diabetes. If you have prediabetes, you are more likely to develop type 2 diabetes. The glucose in your blood comes from certain foods called carbohydrates, or "carbs." Foods that are high in carbs include candy and sweets, sodas, breads, tortillas, and white rice. The more carbs you eat, the higher your blood glucose level will be. Whether you have type 1 or type 2 diabetes, making the right food choices is an important way to keep your blood glucose at a level that is healthy for you. When you control your blood glucose, you lower your chance of having serious health problems from diabetes, such as vision loss and heart problems. And if you have prediabetes or are at risk for diabetes, eating foods that keep your blood glucose levels healthy may help prevent type 2 diabetes later on.
Whether you have type 1 or type 2 diabetes, making the right food choices is an important way to keep your blood glucose at a level that is healthy for you. When you control your blood glucose, you lower your chance of having serious health problems from diabetes, such as vision loss and heart problems. And if you have prediabetes or are at risk for diabetes, eating foods that keep your blood glucose levels healthy may help prevent type 2 diabetes later on.
The Role of Medical Nutrition Therapy (MNT) in Hospitalized Patients
Medical nutrition therapy (MNT) plays an important role in management of hyperglycemia in hospitalized patients with diabetes mellitus. The goals of inpatient MNT are to optimize glycemic control, to provide adequate calories to meet metabolic demands, and to create a discharge plan for follow-up care. All patients with and without diabetes should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. The use of a consistent carbohydrate diabetes meal-planning system has been shown to be effective in facilitating glycemic control in hospitalized patients with diabetes. This system is based on the total amount of carbohydrate offered rather than on specific calorie content at each meal, which facilitates matching the prandial insulin dose to the amount of carbohydrate consumed.
MNT is defined as a process of a nutritional assessment and individualized meal planning in consultation with a nutrition professional. The goals of inpatient MNT for patients with diabetes are to help optimize glycemic control, provide adequate calories to meet metabolic demands, address individuals needs based on personal food preferences, and provide a discharge plan for follow-up care [20-22]. Individuals with diabetes should receive MNT as needed to achieve treatment goals, preferably provided by a registered dietitian familiar with the components of diabetes MNT. Individualized MNT during hospitalization, along with intensive medical management, is generally required for patients with diabetes to achieve blood glucose targets [23]. MNT in the hospital can be challenging in the presence of acute medical illness, poor appetite, inability to eat, increased nutrient and calorie needs due to catabolic stress, and variation in diabetes medications.
Read also: Vegan Diet for Diabetes Management
Key Components of a Diabetic Diet in the Hospital
A diabetes diet is a healthy-eating plan that helps control blood sugar. A diabetes diet simply means eating the healthiest foods in moderate amounts and sticking to regular mealtimes. It's a healthy-eating plan that's naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains. If you have diabetes or prediabetes, your health care provider will likely recommend that you see a dietitian to help you develop a healthy-eating plan. The plan helps you control your blood sugar, also called blood glucose, manage your weight and control heart disease risk factors. When you eat extra calories and carbohydrates, your blood sugar levels rise. If blood sugar isn't controlled, it can lead to serious problems. These problems include a high blood sugar level, called hyperglycemia. You can help keep your blood sugar level in a safe range. For most people with type 2 diabetes, weight loss also can make it easier to control blood sugar. Weight loss offers a host of other health benefits. A diet for people living with diabetes is based on eating healthy meals at regular times. A registered dietitian can help you put together a diet based on your health goals, tastes and lifestyle. The dietitian also can talk with you about how to improve your eating habits. Make your calories count with nutritious foods. During digestion, sugars and starches break down into blood glucose. Sugars also are known as simple carbohydrates, and starches also are known as complex carbohydrates. Dietary fiber includes all parts of plant foods that your body can't digest or absorb. Fiber moderates how your body digests food and helps control blood sugar levels. Fruits. Eat heart-healthy fish at least twice a week. Fish such as salmon, mackerel, tuna and sardines are rich in omega-3 fatty acids. These omega-3s may prevent heart disease. If you are pregnant, are planning to get pregnant or are breastfeeding, do not eat fish that's typically high in mercury. Foods containing monounsaturated and polyunsaturated fats can help lower your cholesterol levels. Diabetes raises your risk of heart disease and stroke by raising the rate at which you develop clogged and hardened arteries. Saturated fats. Avoid high-fat dairy products and animal proteins such as butter, beef, hot dogs, sausage and bacon. Trans fats. Cholesterol. Cholesterol sources include high-fat dairy products and high-fat animal proteins, egg yolks, liver, and other organ meats. Sodium. Aim for no more than 2,300 mg of sodium a day. You may use a few different approaches to create a healthy diet to help you keep your blood sugar level within a typical range. The American Diabetes Association offers a simple method of meal planning. It focuses on eating more vegetables. Because carbohydrates break down into sugar, they have the greatest effect on your blood sugar level. To help control your blood sugar, you may need to learn to figure out the amount of carbohydrates you are eating with the help of a dietitian. You can then adjust the dose of insulin accordingly. A dietitian can teach you how to measure food portions and become an educated reader of food labels. A dietitian may recommend you choose specific foods to help plan meals and snacks. One serving in a category is called a choice. A food choice has about the same amount of carbohydrates, protein, fat and calories - and the same effect on your blood sugar - as a serving of every other food in that same category. Some people who live with diabetes use the glycemic index to select foods, especially carbohydrates. This method ranks carbohydrate-containing foods based on their effect on blood sugar levels. When planning meals, take into account your size and activity level. Breakfast. Lunch. Dinner. Snack. Embracing a healthy-eating plan is the best way to keep your blood sugar level under control and prevent diabetes complications. Aside from managing your diabetes, a healthy diet offers other benefits too. Because this diet recommends generous amounts of fruits, vegetables and fiber, following it is likely to lower your risk of cardiovascular diseases and certain types of cancer. If you live with diabetes, it's important that you partner with your health care provider and dietitian to create an eating plan that works for you. Use healthy foods, portion control and a schedule to manage your blood sugar level.
Carbohydrate Management: The Cornerstone
The amount of carbohydrates you eat will affect your blood glucose levels, so managing carbohydrate intake is important to keep these levels in range. Avoid sugary drinks and fruit juices when thirsty because these can cause spikes in blood glucose levels. However, sugary drinks can be helpful when treating hypoglycaemia. Carbohydrates include whole grains, such as bread, cereal, pasta and rice, and starchy vegetables, such as corn and peas.
A meal plan is your guide for when, what, and how much to eat. Your plan will help make sure you get the nutrition you need while keeping your blood sugar levels on target. Carbohydrates in the food you eat raise your blood sugar levels. How fast carbs raise your blood sugar depends on what the food is and what you eat with it. For example, drinking fruit juice raises blood sugar faster than eating whole fruit. You'll want to plan for regular, balanced meals to avoid high or low blood sugar levels. Eating about the same amount of carbs at each meal can be helpful. Keeping track of and limiting how many carbs you eat at each meal can help manage your blood sugar levels. Work with your doctor or a registered dietitian to find out how many carbs you should aim for. Then refer to this list of common foods that contain carbs and serving sizes. It's easy to eat more food than you need without realizing it. Foods higher in carbs include grains, starchy vegetables (such as potatoes and peas), rice, pasta, beans, fruit, and yogurt. Portion size and serving size aren't always the same. A portion is the amount of food you choose to eat at one time. These days, portions at restaurants are quite a bit larger than they were several years ago. One entrée can equal 3 or 4 servings! Studies show that people tend to eat more when they're served more food. If you're eating out, ask for half of your meal to be wrapped up to go so you can enjoy it later. At home, measure out snacks; don't eat straight from the bag or box. At dinnertime, reduce the temptation to go back for seconds by keeping the serving bowls out of reach.
Consistent Carbohydrate Meal Planning
There is no single meal-planning system that is ideal for hospitalized patients. However, it is suggested that hospitals consider implementing a consistent carbohydrate diabetes meal-planning system [25]. This systems uses meal plans without a specific calorie level but with consistency in the carbohydrate content of meals. The carbohydrate components of breakfast, lunch, dinner, and snacks may vary, but the day-to-day carbohydrate content of specific meals and snacks is kept constant [21, 25].
Prioritizing Whole Foods and Balanced Macronutrients
The foundation of a diabetes-friendly diet is built upon nutrient-dense “whole foods”. These foods provide essential vitamins, minerals, and antioxidants, reassuring you that you’re making the best choices for your health. A well-designed, diabetes-friendly diet contains a good balance of macronutrients, including carbohydrates, proteins, and healthy fats.
Read also: Foods for Pre-Diabetes
The Glycemic Index (GI) and Food Choices
The glycaemic index (GI) measures how quickly foods raise blood glucose levels. Low-GI foods are digested and absorbed more slowly, causing a slower, more gradual increase in blood glucose. Examples of low-GI foods include most fruits and vegetables, plain milk, nuts, legumes, pulses, wholegrain cereals, and wholegrain bread.
Plant-Based Diets: An Emerging Strategy
Research suggests that plant-based diets can improve insulin sensitivity, contribute to weight management, and lower the risk of type 2 diabetes by up to 35%. Vegetarian diets have a high fibre content, which helps regulate blood glucose levels.
Importance of Weight Management and Portion Control
Achieving and maintaining a healthy body weight is crucial in diabetes prevention and management. Portion control and consistent meal timing are part of maintaining stable blood glucose levels. Additionally, intermittent fasting can offer promising benefits for diabetes management and prevention. This eating pattern, which restricts food intake to specific hours, has shown results in promoting weight loss and improving blood glucose control. Studies have found that people with type 2 diabetes lose more weight through daily fasting periods compared to calorie restriction. For those with IH, intermittent fasting may help prevent type 2 diabetes by regulating insulin sensitivity.
Maintain a healthy weight. Losing 5-10 lbs. is often the first step in controlling diabetes. Eat three meals a day and an evening snack. Eat the same types of foods each meal. Choose a variety from each group. Limit desserts/sweets and sugars. Avoid syrup, candy, jellies, cookies, honey, and regular soda. Try the sugar free or diet types of these foods. Use sugar substitutes to replace sugar. Choose chicken without the skin, fish, and lean cuts of meats. Use canned fruits that are packed in its own juice and without sugar. Watch your weight. If you need to lose weight, do it slowly, usually 1-2 lbs. per week. Include exercise as part of your daily activity. Start an exercise program that is at least 30 minutes, 3-5 times per week. Include high fiber foods in your diet. Fiber will help control your blood sugars.
Individualized Approaches and Cultural Sensitivity
Recognising the diversity of cultural and personal food preferences, a diabetes-friendly diet should be adaptable and inclusive.
Read also: Manage Diabetes with This Indian Diet
Addressing Malnutrition in Hospitalized Patients
Malnutrition among hospitalized patients is associated with depletion of body mass, poor wound healing, impaired immune function, impaired ventilatory drive, and weakened respiratory muscles, leading to longer hospital stay [1, 2•] and increased infectious morbidity and mortality [3, 4]. Malnutrition in critically ill patients is common with a prevalence of 40% in intensive care unit (ICU) [5]. Improving the nutritional state can restore immunologic competence and reduce the frequency and severity of infectious complications in hospitalized patients [6-9].
Specialized Nutrition Support: Enteral and Parenteral Nutrition
Current nutrition guidelines state that any patient unable to consume adequate nutrients orally (≥ 60% nutrition needs) for at least 5 days in the critically ill, or 7 to 14 days in the general population, should be a candidate for specialized nutrition support [12]. Although the majority of non-critically ill hospitalized patients receive nutrition support as three discrete meals with or without scheduled snacks each day, some patients will require EN or parenteral nutrition (PN) support. Both EN and PN have been proven effective in preventing the effects of starvation and malnutrition in hospitalized patients; however, oral nutrition and EN are preferable to PN in clinical practice [12].
Enteral Nutrition (EN) Considerations
Increasing evidence indicates that early enteral feeding is safe and well tolerated, and results in reduction of wound morbidity and healing, fewer septic complications, diminished weight loss, and improved protein kinetics [27]. A “clear liquid diet” is the most frequently ordered postoperative meal regardless of early or delayed administration. Although generally well tolerated, this diet fails to provide adequate nutrients to the postsurgical patient.
Standard enteral formulas reflect the reference values for macro- and micronutrients for a healthy population and contain 1 to 2 cal/mL. Most standard formulas contain whole protein, lipid in the form of long-chain triglycerides, and carbohydrates. Standard diabetes-specific formulas provide low amounts of lipids (30% of total calories) combined with a high-carbohydrate (HCH) content (55% to 60% of total calories); however, newer diabetic formulas have replaced part of carbohydrates with monounsaturated fatty acids (up to 35% of total calories), 10 to 15 g/L of dietary fiber and up to 30% fructose [33, 34].
Based on these results, it is generally accepted that newer LCHM diabetic enteral formulas are preferable to standard HCH formulas in hospitalized patients with diabetes [33, 37]. Several studies in diabetic subjects have evaluated glycemic control among different EN formulas.
Use of EN support can be associated with adverse effects or risks including bacterial colonization of the stomach, high gastric residual volumes, and risk of aspiration pneumonia [41, 42]. In patients with diabetes, EN may aggravate hyperglycemia and worsening metabolic control.
Parenteral Nutrition (PN) Considerations
The beneficial effect of PN in improving the nutritional status of critically ill patients is well established [10]. However, recent randomized trials and meta-analyses have suggested that PN may be associated with increased risk of infectious complications and mortality in critically ill patients [6, 10, 47-49]. In addition, the use of PN has been linked to aggravation of hyperglycemia independent of a prior history of diabetes [2•, 46]. Hyperglycemia in such patients is associated with higher risk of cardiac complications, infections, sepsis, acute renal failure, and death [50-52].
One method of reducing PN-induced hyperglycemia is to reduce the amount of infused dextrose to 100 to 150 mg/day to meet metabolic demands of brain and basic cellular functions [26]. Insulin can be also added to the PN mixture but to date there are no randomized controlled studies that guide effective and safe administration of insulin in this group of patients.
The American Diabetes Association (ADA) and Nutrition Recommendations
Every year, the American Diabetes Association (ADA) publishes our Standards of Care in Diabetes (Standards of Care). The Standards of Care is a set of practice guidelines based on the latest scientific research and clinical trials. These guidelines are used by health care professionals to treat diabetes and its related health conditions. Every five years, a group of experts come together for an in-depth review of the nutrition guidelines in the Standards of Care. The result of this review is called the Nutrition Consensus Report. This is the foundation for the ADA’s recommendations for nutrition. The Nutrition Consensus Report identifies nutrition strategies that have been shown to help people reach or stay at their blood glucose (blood sugar) targets, reach weight management goals, and low risk for health conditions related to diabetes. The nutrition recommendations highlight that eating plans should be based on the needs of each person. Your own eating plan will be based on your own needs and preferences.
The current report outlines seven key meal patterns that have been shown to help manage diabetes. Work with your health care team to decide which meal pattern works best for you.
Practical Tips for Patients
If you do drink, you should drink moderately. If you have diabetes, it's important to eat the right amount of food every day. Your eating plan will include how much to eat, and help you choose the types of food for each meal or snack. Eating at the right times is also important. You will want to plan for regular, balanced meals to avoid blood glucose levels that are too high or too low for you. Eating healthy to control your blood glucose does take some effort. But the reward is a chance to live your healthiest life with diabetes.
Good nutrition is one of the most basic and important diabetes care tools. Eating right can help control blood sugar. And good control protects your long-term health. Think of this plan as only a temporary guide. Keep in mind that every person with diabetes should have a customized meal plan that provides more freedom in terms of food choices. Many effective meal plans involve tracking what you eat. Two of the most popular approaches are counting calories for regulating weight and counting carbohydrates for blood sugar control.
tags: #diabetic #diet #in #hospital #guidelines