“Every 17 seconds, an American is diagnosed with diabetes; if the current trend continues, one in three Americans will have diabetes by 2050” (Dudek, 2014).
This is a frightening reality. With the increase in processed and convenience foods, as well as the increase in “screen time”, more and more Americans are at risk for developing diabetes. Although there are attempts at shifting the direction towards a healthier lifestyle, advancements in technology have led us to become more sedentary. Having the right balance between what we eat and how we move is the most effective way to prevent the development of this metabolic disease.
Mr. K is a 65-year-old Caucasian male with a new onset of type 2 diabetes. He is a retired middle class office manager who is set in his ways. His BMI is 27 kg/m2 and he has a past medical history of hypertension. Mr. K has some difficulty hearing which, in addition to him being set in his ways, may present some challenges in teaching.
Today, Mr. K is joined by his wife, as well as his adult children who all live within 10 miles of him. It is important to speak clearly at a slightly higher volume, and to enunciate so the client might better understand what he can anticipate. His wife and children are eager to know how they can help him to live with diabetes. Although Mr. K might be inflexible, his family has helped him to accept his diagnosis and be open to adjusting his current diet.
Teaching Plan
Mr. K, now that you understand what type 2 diabetes is and how it can affect you and your body, it is important to modify your eating habits in order to have better control of the disease. It is my job to make sure you leave here feeling comfortable with the information and confident in your meal planning. Our objectives for today include having you create a meal plan with appropriate portions and understanding how to count carbohydrates.
Since coronary artery disease is the leading cause of death for those with diabetes, it is important to follow a diet that will prevent or reduce the buildup of plaque in the arteries. This means increasing the amount of fiber in your diet and decreasing or eliminating saturated fat, trans fat, and cholesterol. HDL, or good cholesterol, is synthesized by the liver and so does not need to be consumed through the diet.
Although there are no specific food limitations for a diabetic diet, you should plan to eat as any healthy person would. Lean proteins, nonfat and low-fat dairy products, fruits, and vegetables are all recommended in addition to regular exercise to lose or maintain a healthy weight. Blood glucose and medications should be carefully monitored during any type of therapy to prevent any complications.
When planning meals, there should be a balance between carbohydrates, fats, and proteins. Carbohydrates should make up about 45% to 60% of your total daily caloric intake. These should come from fruits, legumes, grains, and milk. Fats will be 20% to 35% of calories and should be limited to polyunsaturated fatty acids, which can be found in fish for example. Proteins should be 15% to 20% of total daily calories. These can be found in meat, soy, beans, and nuts. Diabetics with kidney failure should take in a smaller amount of protein.
Every individual has different caloric needs, whether he or she is diabetic or not. This can be determined through weight loss/gain goals, food preferences, eating pattern, and ability to make changes in the diet. One way to plan a meal is through an exchange list. An exchange list “groups foods into lists that, per serving size given, are similar in carbohydrate, protein, fat, and calories based on rounded averages” (Dudek, 2014). These lists allow users to exchange different foods within the carb, fat, and protein groupings. For example, in the carb group, there are subgroups that include starch; fruit; milk; sweets, desserts, and other carbs; and nonstarchy vegetables. Since each listed item is about 15 grams of carbs, any of the items can be exchanged with another. The same goes for the items in the fat and protein groups. There are limits to how many items can be exchanged in each category, and it is important to weigh or measure the portions accurately until they can be easily estimated. Exchange lists are an easy way to choose food items, however, it does not allow for as much flexibility as carbohydrate counting.
Carb counting is similar to the exchange list in that a list of food is provided, but the focus is mainly on carbs as opposed to fat and proteins. Again, each carb choice is equal to 15 grams of carbs. According to Dudek, adults can have a choice of three to five carb choices per meal and one to two choices for snacks, equaling (2014). When using this method, users must be attentive to their food choices while matching carb intake to insulin and medication dosages and peaks. The benefit of this method is that users will feel that they have more power over their diet as well as better control over their glucose.