Diabetes Dietitian

Women with Diabetes at Greater Risk for Coronary Heart Disease

The British Medical Journal 2006:332(7533):73-8. reported that women with diabetes have a 50% greater risk of death due to coronary heart disease than men with diabetes. Researchers examined the incidence of death from CHD associated with diabetes. In patients with diabetes, the risk of fatal CHD was significantly greater (5.4%) than in those without diabetes ( 1.6%) This difference was evident in both women and men, but was more pronounced in women with or without diabetes. (7.7% versus 1.2%) In men, the incidence of coronary heart disease was 4.5% in patients with diabetes versus 2.0% in those without diabetes.

Are individuals with diabetes way ahead of the game when it comes to their daily diet?

The new 2005 dietary guidelines for Americans by the United States Departments of Agriculture and Health and Human Services were recently published. The guidelines encourage us to take responsibility for our health by promoting a healthy diet and an increase in our daily physical activity. This is the same message people with diabetes have been hearing for years.

These guidelines, more than ever before promote good nutrition by recognizing its important role in our health. As dietitians and diabetes educators we think most individuals with diabetes have all along been aware of the influence of diet on health and blood sugar control. In fact, most of you have already incorporated some of the guidelines into your daily diet, by making good choices as much of the time as possible. Lowering fat intake, especially saturated fat has always been emphasized. Choosing and preparing foods with less salt and limiting sugar intake is a given. Using complex carbohydrates and high fiber foods to lower post-meal blood sugars is something that has been around for years. And maintaining a healthy weight has always been the cornerstone of treatment especially in individuals with Type 2 diabetes. So maybe, just maybe, some of you have been eating healthy all along and have a jump start on the recommendation to make wiser food choices.

Here is a summary of the 2005 United States Dietary Guidelines:

Grains (6-11 servings)

Fruits (2-4 servings)

Vegetables (3-5 servings)

Protein (2-3 servings)

Dairy (2-3 servings)

The Annals of Internal Medicine, April 4, 2006/Volume 144, Issue 7, Pages 1-12 reported improvements in Diabetes Care from 1988-1994 and 1999-2002. Information was obtained from 2 national surveys. These included the National health and Nutrition Examination Survey conducted between 1988-1994 and a second conducted between 1999-2002.

Patients also conducted a second survey about health behaviors in 1995 and 2002. Patients participating in the study were evaluated using their blood cholesterol levels, blood sugar control, blood pressure, yearly eye and foot examinations, influenza vaccination, and aspirin use. They found that over the last ten years, patients with diabetes in America had an improvement in cholesterol control.

Despite this improvement, 2 out of 5 American adults with diabetes have poor cholesterol control, 1 out of 3 has poor blood pressure, and 1 out of 5 has poor blood glucose control. Although this study did not elaborate why diabetes care did not meet goals, it does show some improvement in cholesterol management. Improvement is still need in blood pressure control and blood glucose management.

Research from the Diabetes Control and Complications Trial stated that individuals with diabetes found that the most difficult aspect of diabetes care to be DIET. For this reason, the registered dietitian/certified diabetes educator (RD/CDE) is a crucial member of the health care team helping you manage your diabetes. The RD/CDE, will help you create a healthy meal plan. They can also teach you how to monitor your blood sugars and make evaluations that can aid in improving your diabetes control through your diet, exercise, or change in medication by your physician. Dietitians can help you learn how to fit favorite foods into your meal plan, treat high and low blood sugars, plan your snacks, shop, meal plan, and read nutrition labels. Most patients with diabetes see their registered dietitian/certified diabetes educator a minimum of twice yearly.

Good reasons to see a Registered Dietitian/Certified Diabetes Educator include:

1. Poor diabetes control
2. Too many low blood sugars
3. Increase or decrease in exercise
4. Difficulty following the meal plan
5. Need to gain or lose weight
6. Changes in your insulin regimen or oral medication changes
7. Pregnancy, growth needs, elevated cholesterol or lipid levels, other medical conditions requiring dietary change
8. Change in work situation requiring meal changes
9. Travel Needs