Dietary Teaching for the Diabetic Client

  Type 1 indicates that they are dependent upon insulin to control their blood sugar.  Type II diabetics usually develop diabetes later on in life and they are prescribed oral hypoglycemic agents to control their blood sugar.  A healthy diet can make a positive impact on the diabetic's life expectancy.  Knowing what foods to eat and what foods to avoid is the cornerstone of managing diabetes, as well as tight glycemic control.  Therefore nutritional intervention is the responsibility of the nurse, to help promote the health and well being of the patient.  Nutritional recommendations for diabetic's is similar to that of the National Cholesterol Education Program. 

In the diabetic patient, their production of insulin (a necessary enzyme produced by the beta cells on the Islets of Langerhan within the pancreas) is insufficient.  In type I diabetes, insulin deficit occurs at an early age, whereas in type II diabetes this insulin deficiency takes years to deplete.  Lack of insulin allows proliferation of large amounts of glucose to travel freely throughout the blood stream.  Insulin administered subcutaneously or via pill form, helps to move glucose from the blood stream back into the cells.  

Levels of normal blood glucose levels range from 70 -120 mg/dl, although some literature suggests levels up to 145mg/dl as normal.  Excessive amounts of glucose in the blood stream can cause numerous health problems.  Diabetes has been directly related to some of the following illnesses; kidney disease, high blood pressure, peripheral neuropathy, glaucoma and heart disease.  Therefore it is essential for the diabetic patient to have a good understanding of the foods that will benefit them.  

Recommendations include choosing carbohydrates from grains, fruit and vegetables.  Consistency of carbohydrates eaten regularly for snack and at meal time is a crucial factor in glycemic control, more than the type of carbohydrate eaten.  Diabetics who receive either insulin or Lantus® (a long lasting insulin) at night should be instructed to eat a snack in the middle of the night to prevent a dramatic drop in blood sugar in the dawn hours.   

Hypoglycemia can be just a dangerous as hyperglycemia.  The signs and symptoms of each state mimic the other.  The rule of thumb is to treat the onset of either with a source of fast acting glucose source, such as a hard candy or fruit juice, and then check the blood sugar.   

Hypoglycemia can cause a coma.  The brain is the only organ in the body that utilizes pure glucose.  Therefore, by depleting the brains only source of food, the brain will cease to function.  So, it is better to treat with fast acting sugar first.  This is not going to raise the blood sugar appreciably if the blood sugar is already high.  However, if the persons blood sugar is very low, then the addition of a fast acting sugar can save their life immediately.   

Of course, in a hospital setting, the nurse would immediately check the client's blood sugar with a glucometer.  Sucrose can replace starch without effecting blood sugar levels dramatically.  The client should make a list of the foods that they are used to eating on a regular basis and with the help of the nurse re-structure their diet with choices from the food pyramid.   Allow the client to choose the foods that they want to substitute.  This is going to be their life diet, and it is very important that they be the one to structure how and what they eat. 

The patient should verbalize the benefits of the foods and what type of sugar source the foods represent.  Once the patient can express their dietary plan, and the type of foods that are beneficial as opposed to those foods that are merely empty calories, the patient will feel encouraged and become more involved in their blood glucose monitoring.  

References:   Dudek, Susan G., Nutrition Essentials for Nursing Practice 5^th Ed., Lippincott Williams & Wilkins, copyright 2006

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