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    Diet therapy in type 2 Dm

    -Introduction : the aim of medical nutritional therapy is to optimize


    metabolic control and decrease the risk factors for diabetic
    complications through management of A1C and blood sugar as near as
    possible to normal value and within safe levels; also to reduce blood
    pressure and lipid, considering the quality of life and therapeutic needs
    of patient.The health care providers need to use evidence based
    medicine when educating diabetic patients and giving advice about
    carbohydrate, dietary fat, protein, micronutrients and energy balance
    and body weight .Also the health care team should document any
    step of Medical Nutritional Therapy (MNT) in patient’s record forms &
    evaluate the outcome using body weight, waist circumference,well
    being, Blood Pressure (BP) fasting & post-prandial blood glucose,
    A1C, serum lipids and albumin in urine.

    -The regulation of body weight :


    requires longterm regulation of energy balance. In order to prevent
    obesity, the two main management methods are to:
    1) Reduce energy density of the everyday diet
    2)Stimulate fat oxidation by promoting a sufficient level of physical
    activity.
    Diet type 2 Diabetics with Complications To reduce diabetes
    complication in a type 2 diabetic,a diet with a variety of nutrients, like
    the Mediterranean diet is an ideal choice.It is rich in whole grain and
    vegetables, fruits, legumes, a moderately high intake of fish,
    minimal red meat, nuts, and high MUFA/olive oil2.
    For patients with diabetes and symptomatic heart failure, dietary
    sodium in-take of <2,000 mg/day .In those with kidney
    involvement <2000mg/day or even lesser is advised. To prevent
    high blood pressure a diabetic along with his regular meal plan, should
    contain low sodium.Another good option to reduce kidney diseases and
    CVD is vegetarian food. A high carbohydrate and protein diet, rich in
    fibers is advised for advised in hypoglycemia.Pregnancy If you are a
    woman who is planning to become pregnant, with adequate
    support, you can aim to achieve healthy pregnancy and babies. This
    has to start prior to conceiving and early discussion with your
    diabetes care team is required.

    The aim of nutritional therapy in pregnancy would be to achieve


    nearnormal blood glucose levels and prevent hypoglycemia and
    hyperglycemia as both can harm the mother and baby. This will be
    the same if you are a diabetic becoming pregnant or if you develop
    diabetes during pregnancy.
    Nutritional Requirements :
    You should have a meal plan depending on your food and eating habits.
    Regular testing for blood glucose, ketones and daily food records are
    helpful for adjusting insulin and meal plans
    Aim to maintain consistency in time and amount of food to prevent
    fluctuations, especially if you are on medica-tions or insulin. Overall
    energy needs increase from the 2nd trimester on-wards, about 300
    kcal/day. Also aim for moderate amount of protein intake
    Aim for small to moderate amount of meals 3 times a day and about 2-
    4 snacks daily including an evening one. At least 175g of carbohydrate
    should be taken daily contri-buting to 40-45% of total energy
    intake.regular aerobic exercise is helpful to improve blood glucose
    levels. Most artificial sweeteners are safe to be tak-en in pregnancy.try
    to avoid alcoholic drinks. Breast feeding is recommended, and most
    women need less insulin during nursing. A carbohydrate containing
    snack before or during breast feeding is required to main-tain
    bloodglucose levels. An additional 200 calories is required above the
    pregnancy levels during the first 6 months.
    -journal of Army Medical College ChattogramVolume 2 Issue 1 June
    2019; 26-32.

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