Medical Nutrition Therapy for Diabetes Mellitus
Manual of Clinical Nutrition Management C- 2 Copyright © 2 013 Compass Group, Inc.
may be appropriate for individual patients. Postprandial glucose may be targeted if A1C goals are not met despite reaching
preprandial glucose goals.
bPostprandial glucose measurements should be made 1-2 hours after the beginning of the meal, generally peak levels in patients with
diabetes.
Source: American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care. 2013; 36(suppl 1):S21.
Nutritional Adequacy
The nutrition prescription can be planned to meet the Dietary Reference Intakes as outlined in Section IA:
Statement on Nutritional Adequacy.
How to Order the Diet
The physician may specify one of the following:
Consistent-carbohydrate meal plan: The meal plan incorporates consistent carbohydrate intake (15 g
of carbohydrate per meal or snack), fat intake modifications, and consistent timing of meals and snacks,
not specific energy levels. The plan provides four carbohydrate selections (60 grams) at breakfast
and five carbohydrate selections (75 grams) at lunch and dinner with the remaining selections
from vegetables, lean meats, and appropriate fats. This diet is the standard hospital meal plan for
people with diabetes and does not include in-between or evening snacks. The meal plan provides
1,500 to 1,800 kcal/day, with approximately 50% of the energy from carbohydrate, 20% from protein,
and 30% from fat (<7% saturated and trans fat combined) (2-4).
If the patient requests additional food, select choices from the vegetable and lean meat groups. Between-
meal snacks are given based on the individual patient’s nutrition needs and preference or to complement
medical treatment (eg, medications) to optimize blood glucose levels; thus, snacks are not automatically
provided to patients. Food intake frequency (for example, three meals vs smaller meals and snacks) is
not associated with long-term differences in glucose levels, lipid levels, or insulin responses in type 2
diabetes mellitus (2). Therefore, division of food intake should be based on the individual’s preferences.
Conditions for which an evening snack may be warranted include pregnancy, lactation, diabetes in a
person with higher energy and protein needs, or prescription of medications that increase the risk of
hypoglycemia. Nutrition prescription per a registered dietitian’s recommendations: The dietitian plans an
individualized diet, taking into account the patient’s energy and protein needs, fat restrictions, food
preferences, and eating habits. Snacks are planned for patients taking insulin or are served according to
facility protocols. Meal plans based on exchange lists or carbohydrate counting may be used with this
order. Individualization of the meal pattern is emphasized, rather than a specific standard macronutrient
distribution. Fat content of the diet is manipulated according to the blood glucose, lipid, and body weight
goals. Protein, carbohydrate, and mineral content of the diet may be manipulated to achieve individual
metabolic and clinical goals.
Regular diet: This may be considered as an option for patients with increased needs for energy and
protein because of other medical conditions, such as pressure ulcers, cancer, burns, sepsis, or surgery.
Note: “No concentrated sweets” is not recommended, since it conveys the impression that simply avoiding
sweets will in itself promote good control of blood glucose (2,3).
See Section III: Clinical Nutrition Management
Diabetes Mellitus: Considerations For Acute Illness
Diabetes Mellitus: Gastrointestinal Complications
Diabetes Mellitus: Oral Glucose-Lowering Medications And Insulin
Diabetes Mellitus: Considerations For Exercise
Diabetes Mellitus: Fat Replacers And Nutritive/Nonnutritive Sweeteners
Nutrition Intervention and Planning for Medical Nutrition Therapy
Carbohydrates and Diabetes
The following terms are preferred when describing carbohydrates: sugars, starch (eg, amylase, amylopectin,
modified starches), and fiber (eg, cellulose, hemicellulose, pectins, hydrocolloids) (1). Regulation of blood
glucose levels to achieve near-normal levels is the primary goal in the management of diabetes (1). Dietary
techniques that limit hyperglycemia following a meal are important in limiting the complications of diabetes