Medical Nutrition Therapy

Individuals who have pre-diabetes or diabetes should receive individualized medical nutrition therapy (MNT), preferably administered by a registered dietitian, in order to achieve the treatment goals of energy balance and weight control. A modest weight loss can reduce insulin resistance, which is recommended for all overweight or obese insulin-resistant individuals; characteristics of high risk for diabetes. Low-carbohydrate or low-fat calorie-restricted diets are effective for weight loss in the short-term (up to one year), but lipid profiles, renal function and protein intake must be closely monitored on patients with diabetic nephropathy (deficient kidney filtration) while on low-carbohydrate diets.35

Glycemic control, the maintaining of normal blood sugar levels, can be achieved using carbohydrate counting, exchanges, or experience-based estimation: the latter utilizes patterns established through pre- and post-prandial glucose testing.36 Dietary fats should be minimized at less than 7% of total calories from saturated fats and little to none from trans fat, the highly damaging type of fat produced when unsaturated fat is subjected to the process of hydrogenation. For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone.35

The glycemic index, or GI, is a numerical system of measuring how fast a food or ingredient triggers a rise in circulating blood glucose within two to three hours after eating. The concept is that the higher the GI, the greater the blood sugar response reflecting a small rise from a low GI food and a spike from a higher GI food. A GI over 70 is considered high and a GI of 55 or less is low.37

The glycemic load, or GL, is a newer way to measure the impact of carbohydrate consumption. It gives a more practical approach than the glycemic index alone because it also tells you how much of that carbohydrate is in a specific food. For example, the carbohydrate in watermelon has a high GI. But since there isn’t a lot of the carbohydrate in the watermelon, its glycemic load is relatively low. A GL of 20 or more is high and a GL of 10 or less is low. It’s interesting to note that foods that have a low GL almost always have a low GI. Foods with an intermediate or high GL range from very low to very high GI.37

Additionally, sugar alcohols and non-nutritive sweeteners are generally considered to be safe when consumed within the acceptable daily intake levels established by the Food and Drug Administration (FDA). Daily intake of alcohol should be limited to a moderate amount of approximately one drink per day or less for adult women and two drinks per day or less for adult men.35