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Diabetic nutrition, diet, and weight control are the foundation of diabetes management. The most objective in dietary and nutritional management of diabetes is control of total caloric intake to maintain a reasonable body weight and stabilize the blood glucose level. Success of this alone is often with reversal of hyperglycemia in type 2 diabetes. However, achieving this goal is not always easy. Because nutritional agreement of diabetes is so complex and a registered dietitian who understands diabetes management has major responsibility for this aspect of therapeutic plan. Nutritional management of diabetic patient includes the following goals stated by American Diabetes association, Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications, 2002:
Provide all the essential food constituents like vitamins and Minerals needed for optimal nutrition.

Meeting Energy needs

Maintaining reasonable weight

Avoidance of huge daily fluctuations of blood glucose level, with blood glucose level close to normal as is safe and practical to reduce risk or prevent the possibility of complications

Decrease serum lipid levels to reduce the risk of macro-vascular complication

For those diabetic people who require insulin to help control blood glucose levels, maintaining as much consistency as possible in the amount of calories, and carbohydrates ingested at the different meal time is essential. Additionally, precision in the approximate time intervals between meals with the addition of snacks as necessary helps in preventing the hypoglycemic reaction and maintaining the overall glucose control.For obese with type 2 diabetes, weight loss is the key treatment. Obesity associated with an increase resistance of insulin is also a main factor in developing type 2 diabetes. Some obese who requires insulin or oral anti diabetic agents to control blood glucose levels may be able to reduce or eliminate the need for medication through weight loss. A weight loss as small as 10% of total weight may significantly improve blood glucose. In other instances wherein one is not taking insulin, consistent meal content or timing is not as critical. Rather, decreasing the overall caloric intake assume most importance. However, meals should not be skipped. Pacing food intake throughout the day places more manageable demands on the pancreas.Long-term adherence to meal plan is one of the most challenging aspects of diabetes management. For the obese, it may be more realistic to restrict calories only moderately. For those who have lost weight, maintaining the weight loss may be difficult. To help diabetic people incorporate new dietary habits into lifestyle, diet education, behavioral therapy, group support and ongoing nutrition counseling are encouraged.Diabetic Nutrition Meal Plan
Diabetic Meal plan must consider one’s own food preferences, lifestyle, usual eating times, ethnic and cultural background. For those who are under intensive insulin therapy, there may be greater flexibility in timing and content of meals by allowing adjustments in insulin dosage for changes in the eating and exercise habits. Advances in insulin management permit greater flexibility schedules than previously possible. This in contrast to the older concept of maintaining a constant dose of insulin and requiring the a diabetic person to adjust his schedule to the actions and duration of the insulin.The first step about meal planning is thorough review of a diet history to identify eating habits and lifestyle. A careful assessment of weight loss, gain or maintenance should also be undertaken. In most circumstances, those with type 2 diabetes requires weight reduction.Diabetic meal Planning [The Making]In teaching about meal planning, you must coordinate with a registered dietitian and if possible he must use educational tools, materials and approaches so you can fully grasp the idea of your nutritional requirements. Your initial education approaches the significance of consistent eating habits, the relationship between the food and insulin and the provision of an individualized meal plan. Then in-depth follow-up sessions which focuses on management skills, such as eating at the restaurants, reading food labels and adjusting the meal plan for exercise, illness and special occasion. An instance like there is an aspect of meal planning such as the food exchange system which may be difficult to learn or understand. You may ask him every meeting for clarification or might as well, leave him a message. Just remember that the food system provides a new way of thinking about the food rather than a new way of eating. Simplification as much as possible grants a good understanding during the teaching session and provides an opportunity to assess doubts and a need for repeat activities and information.Caloric Requirements
Caloric requirements or your calorie-controlled diets are planned by means of calculating your energy needs (individual energy needs that varies in every person) and your caloric necessity based on your age, gender height and weight. Activity element is factored in to provide actual number of calories required for maintenance.In the Diabetic Exchange List compiled by American Dietetic Association and American Diabetic association 2008, the appropriate amount of calorie controlled diets are depicted but you must approach a registered dietitian to closely assess you with your current eating habits and achieve realistic and individualized goals. This is so important because practically, developing a meal plan should be based on individual’s usual eating habits and lifestyle to effectively control the glucose level as well as the weight loss maintenance. The priority for a young patient with type 1 diabetes, for example, should be a diet with enough calories to maintain normal growth and development. Initially, the target aim may provide a higher calorie to regain lost of weight.Here is a reliable and simple Food Exchange List For Diabetic Meal Planning I got from Diabetes Teaching Center at University of California, San Francisco via Google.Please Take note of all these and believe that there’s no harm in trying!Diabetic Nutrition Caloric Distribution
Diabetic nutrition in your diabetic Meal Plan also focuses on the percentage of calories that come from carbohydrates, proteins and fats. In general, carbohydrates have the greatest effect on blood glucose levels because they are more quickly digested and converted than other foods.CarbohydratesThe American Diabetes Association recommends that for all levels of caloric intake, 50% to 60% of calories should be derived from carbohydrates, 20% to 30% from fats and remaining 10% to 20% from protein. Carbohydrates are consisted of sugar and starch. Most of the carbohydrates that are generally consumed came from starch, fruits and milk. Vegetable has also some carbohydrate. All carbohydrates should be eaten in moderation to prevent postprandial high glucose level. Foods high in carbohydrates such as sucrose are not totally eliminated from the diet but should be taken up in moderation up to 10% total calories only because these foods are typically high in fats and lack in vitamins, minerals and fibers.Carbohydrate counting method is very important because it makes you conscious about your approximate amount of serving. The more carbohydrates you ingested, the more your blood glucose goes up. It is also a tool use in diabetic management because carbohydrates are the main nutrients in the food that influence the blood glucose level. This technique provides flexibility in food choices, can be less complicated and allows more accurate management with multiple daily insulin injections. When developing a diabetic meal plan using carbohydrate counting, all food sources should be considered. Once digested, 100% of your carbohydrate intake are converted to glucose. Around 50% of protein foods (meat,fish and poultry) are also converted to glucose. The amount of carbohydrates in foods is measured in GRAMS so you have to know which foods contain carbohydrates,learn to estimate the number of grams of carbohydrates in each food you eat and sum up all the grams of carbohydrates from every food you eat in order to get your total intake in a day. Examples of common food that contains carbohydrates; potatoes, legumes (e.g peas), corn, grains, dairy products (e.g milk and yogurt), snack foods and sweets (e.g cakes, cookies, deserts), and Juices (soft drinks, fruit drinks, energy drinks with sugar).Lets say, you aim 50% of your total calories must come from carbohydrates. One gram of carbohydrates is about 4 calories. So, divide the number of calories you want to get from carbohydrates by 4 to get the number of grams. Example, you aspire to eat 2000 calories a day and get 50% of calories from carbohydrates.Computation:
0.50 x 2000 calories = 1000 calories

1000 / 4 = 250 grams of carbohydrates

Take note that there are people who has lower tolerance of physical activity and there are also those who needs low-calorie diets and therefore, the carbohydrates need in every person really varies. In order to further master your caloric intake and your diet, feel free to contact a professional dietitian.In terms of estimation on the amount of carbohydrates in every serving, you can refer to Food Exchange List or here are some examples taken from the food exchange list:These Foods contain 15 grams of each serving:
Biscuit – 1 (1 1/2 inches across)

Bun (hot dog or hamburger) – 1/2 bun

Pancake (1/4 inch thick) – 1 (4 inches across)

Pita bread – 1/2 pocket ( 6 inches across)

Waffle -1 (4 inch square or 4 inches across)

Cooked barley 1/3 cup

Cooked Pasta – 1/3 cup

Cooked quinoa 1/3 cup

Cooked white or brown rice – 1/3 cup

Cassava – 1/3 cup

Corn 1/2 cup

Green Peas – 1/2 cup

Animal Crackers 8 crackers

Rice cakes, 4 inches across 2

Dried Apple 4 rings

blueberries 3/4 cup

dates 3

Fruit cocktail 1/2 cup

Mango juice 1/2 cup or 1/2 small

papaya 1 cup cubed (8oz)

Grape Juice – 1/3 cup

Although carbohydrate counting is now commonly used for blood glucose management of type 1 and type 2 diabetes, to some extent it affects the blood glucose to different degrees regardless of equivalent serving size. Thus, you have to be consciously noticing the fluctuations of your own blood glucose level and take action against any warning signs.Diabetic Food Pyramid
The Diabetic Food Pyramid is another tool use to develop meal plan. It is commonly utilize for those with type 2 diabetes who have difficulty in abiding with calorie controlled diet. The food pyramid is consist of six food groups: 1.Breads, grains and other starches; 2. Vegetable (non-starchy vegetables); 3. Fruits; 4. Milk; 5. Meat, meat substitutes and other proteins; and 6. Fats, oils and sweets. The pyramid shape was chosen to emphasize that the foods in the largest area, the base of the pyramid (Starches, fruits and vegetables) are the lowest in calories and fats and highest in fiber and should make up the basis of the diet. For those with diabetes and as well as the general population, 50% to 60% of daily caloric intake must be from these three groups. As you move up the pyramid, foods higher in fats (particularly saturated fats) are illustrated; these foods should account for a smaller percentage of daily caloric intake. The very top of the pyramid comprises of fats, oils and sweets that should be sparingly by the people with diabetes to attain weight and blood glucose control and to reduce the risk of cardiovascular disease.Fats and Diabetes
The recommendation regarding the fat content for the diabetic diet include both reducing the total percentage of calories from far sources to less than 30% of the total calorie and limiting the amount of saturated fats to 10% of total calories. Additional recommendations include limiting the total intake of dietary cholesterol to less than 30 mg/day. This approach may reduce risk factors such as elevated serum cholesterol levels, which are associated with the development of coronary heart disease, the leading cause of death and disability among people with diabetes. The meal plan may include the use of some non animal sources of protein to help reduce saturated fats and cholesterol intake. In addition, the amount of protein intake may be reduced to those who have early signs of renal disease.Fiber Has a Lowering Glucose power
The use of fiber in diabetic diets has received an increased attention as the experts study the effects on diabetes of a high carbohydrate, high fiber diet. This type of diet plays a role in lowering the total cholesterol and low-density lipoprotein cholesterol in the blood. Increasing fiber diet may also improve blood glucose and decrease the need for exogenous insulin.There are two types of dietary fibers: soluble and insoluble. Soluble fibers in foods such as legumes, oats and some fruits plays more of a role in lowering blood glucose and lipid levels than does insoluble fiber. Soluble fiber is thought to be related to the formation of a gel in the gastrointestinal tract. This gel slows stomach emptying and the movement of food in the upper digestive tract. The potential glucose lowering of the fiber may be cause by the slower rate of glucose absorption from the foods that contain soluble fibers. Insoluble fiber is found in whole grain breads and cereals and in some vegetables. This type of fiber plays more roles in increasing stool bulk and preventing constipation.One risk involving the increase of fiber intake is that it may require adjustment of insulin dosage or oral anti diabetic agents to prevent hypoglycemia. If fiber is added or increase in the meal plan, it should be done gradually and with the actual consultation with a dietitian.Misleading Labels
Food labeled as “sugarless” or “sugar-free” may still provide calories equal to the equivalent sugar-containing products if they are made with nutritive sweeteners. Hence, for weight loss, these products may not always be useful. Additionally, you must ‘not’ consider them as “free” to be eaten in unlimited quantity because they may elevate your blood sugar. Foods labeled “dietetic” are not necessarily reduced calorie foods. They may be lower in sodium or have other special dietary uses. They may still contain significant amounts of sugar or fats. Snack foods with labels like “Health Foods” may often contain carbohydrates like honey, brown sugar, and corn syrup. Additionally, these supposedly healthy snacks frequently has saturated vegetable fats, hydrogenated vegetable fats or animal fats which may be contraindicated if you have elevated blood lipids level.So read the nutritional labels carefully to count the nutrients that your food contains… Sweeteners
Using sweeteners can be acceptable for the diabetic people especially if it assists their overall dietary adherence. Moderation in the amount of sweetener used is encouraged to avoid potential adverse effect. There are two main types of sweeteners: nutritive and non-nutritive. The nutritive sweeteners contain calories and non-nutritive sweeteners have few or no calories in the amounts normally used.Nutritive sweeteners include fructose (fruit sugar), sorbitol and xylitol. They are not calorie free; they provide calorie in amounts similar to those in sucrose (table sugar). They cause less elevation in blood sugar levels than sucrose and are often in “sugar-free” foods. Sweeteners containing sorbitol may have a laxative effect. Non-nutritive sweeteners have minimal or no calories. They are used in food products and are also available for table use. They produce minimal or no elevation in glucose level. Saccharin contains no calories. Aspartame (Nutra Sweet) is package with dextrose; it contains 4 calories per packet and losses sweetness with heat. Acesulfame-K (Sunnette) is also package with dextrose; it contains 1 calorie per packet. Sucralose (Splenda) is a newer non-nutritive, high intensity sweetener that is about 600 times sweeter than sugar. The Food and Drug administration has approved it for use in baked goods, non alcoholic beverages, chewing gums, coffee, confections, frosting and frozen dairy products.

The community mental heath team are there to help those who are suffering from mental health problems. The first port of call for anyone who thinks that they are suffering from some kind of mental health problem is your doctor who will be able to recommend the right sort of help.The community mental health team consists of a number of professionals who are trained in their specific areas and can include psychiatrists, psychologists, occupational therapists, social workers, and of course the community psychiatric nurse or CPN. Some specific problems or issues that can arise in addition to existing mental health problems or which can exacerbate or trigger mental health problems and which might need extra consideration include:o Financial problemso Physical disabilitieso Housing issueso Divorce or relationship problemso Childcare issuesCertain kinds of mental health problems may result in different needs and may therefore require some specialist help to deal with and these can include:o Elderly depression and dementiao Child or Teen depressiono Postnatal depressiono Bipolar disordero SchizophreniaObviously, finding one person fully qualified and skilled in all of these areas just isn’t possible so the community mental health team work together in order to ensure that the best advice and support is available as many of the professionals involved will be trained in specialist areas that allow them to offer a better service to people suffering from specific problems. So who is likely to be involved in the community mental health team?PsychiatristPatients can be referred to a psychiatrist by their doctor. After an initial assessment, the psychiatrist will recommend a suitable course of treatment and medication. If a mental health problem is particularly severe then they are also able to recommend that the individual be detained in hospital for a period of time. However, this is a last resort and also requires the approval of another doctor and a social worker who all agree that this is the best option for an individual concerned either for the individual’s safety or for the safety of others.PsychologistPsychologists have an understanding of human behaviour, emotions and how the mind works and although they cannot prescribe medication they can offer various types of psychological therapies. Patients can be referred to them by the doctor or other members of the community health team.The Key WorkerPeople suffering from mental health problems will usually be assigned a key worker, which can be anyone in the community mental health team. The key worker ensures that the individual gets the right kind of help that they need. They will regularly assess the progress of an individual and report back to the rest of the team.Community Psychiatric Nurse or CPNThe key worker will often be a CPN who will usually make regular visits to people with mental health problems in their own homes. They offer an important lifeline for people who are feeling isolated and alone with their mental health problems or who are experiencing particular difficulties. They are aware of the many issues surrounding mental health and can listen as well as help people talk through their problems in a setting in which they feel comfortable.The CPN will liaise with and work closely with other members of the team to make sure that any practical support and assistance is offered when needed. They monitor medication, make sure the individual knows how to take their medication and they also look out for additional symptoms or side effects of that medication. The family and loved ones of a person suffering from mental health problems often need additional support in order to understand mental illness and to be able to cope with it, the CPN can offer practical advice and guidance.Occupational TherapistsOccupational therapists help individuals to cope with practical issues on a day to day basis in areas such as dressing, toileting and feeding themselves and can help individuals regain some control of their lives.Social workersSocial workers can ensure that an individual gets access to various social services that will improve their quality of life and that they may be entitled to such as home help, respite care and perhaps admission to day or residential centres. They can also offer assistance in dealing with housing needs, financial difficulties or other social problems.The best careMany other people can be involved in the community mental health team including various support workers, therapists, counsellors, and of course loved ones. Together they all make sure that the individual suffering from mental illness gets the best care possible. Each team member can make a valuable contribution to the individual’s quality of life and can help them not only to cope with their illness on a day to day basis but to regain control over their lives and integrate with the rest of the community in a positive and productive way.