Nutritional considerations in type 1 diabetes mellitus
- Linda M Delahanty, MS, RD
Linda M Delahanty, MS, RD
- Assistant Professor in Medicine
- Harvard Medical School
- David K McCulloch, MD
David K McCulloch, MD
- Clinical Professor of Medicine
- University of Washington
- Section Editors
- Irl B Hirsch, MD
Irl B Hirsch, MD
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- University of Washington School of Medicine
- Timothy O Lipman, MD
Timothy O Lipman, MD
- Section Editor — Nutrition
- GI-Hepatology-Nutrition Section
- Washington DC Veterans Affairs Medical Center
Diet and physical activity are critically important in the treatment of type 1 diabetes. Basic principles of nutritional management, however, are often poorly understood, by both clinicians and their patients.
The nutrition prescription for patients with type 1 diabetes should aim to optimally manage the "ABCs" of diabetes control: glycated hemoglobin (A1C), blood pressure and low-density lipoprotein (LDL)-cholesterol. The prescription must also be tailored for the individual patient to address diabetes complications and other concomitant conditions. The nutritional goals for people with type 1 diabetes are to:
●Maintain as near-normal blood glucose levels as possible, by integrating insulin therapy into each individual's diet and physical activity patterns.
●Achieve optimal blood pressure and lipid levels.
●Provide adequate calories for achieving and maintaining a reasonable body weight, normal growth, and development.
- Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013; 36:3821.
- Delahanty LM, Halford BN. The role of diet behaviors in achieving improved glycemic control in intensively treated patients in the Diabetes Control and Complications Trial. Diabetes Care 1993; 16:1453.
- Delahanty L, Simkins SW, Camelon K. Expanded role of the dietitian in the Diabetes Control and Complications Trial: implications for clinical practice. The DCCT Research Group. J Am Diet Assoc 1993; 93:758.
- Implementation of treatment protocols in the Diabetes Control and Complications Trial. Diabetes Care 1995; 18:361.
- Anderson EJ, Richardson M, Castle G, et al. Nutrition interventions for intensive therapy in the Diabetes Control and Complications Trial. The DCCT Research Group. J Am Diet Assoc 1993; 93:768.
- The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med 1993; 329:977.
- Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353:2643.
- Rabasa-Lhoret R, Garon J, Langelier H, et al. Effects of meal carbohydrate content on insulin requirements in type 1 diabetic patients treated intensively with the basal-bolus (ultralente-regular) insulin regimen. Diabetes Care 1999; 22:667.
- Wolever TM, Hamad S, Chiasson JL, et al. Day-to-day consistency in amount and source of carbohydrate intake associated with improved blood glucose control in type 1 diabetes. J Am Coll Nutr 1999; 18:242.
- Nuttall FQ. Carbohydrate and dietary management of individuals with insulin-requiring diabetes. Diabetes Care 1993; 16:1039.
- Pastors JG, Waslaski J, Gunderson H. Diabetes meal-planning strategies. In: Diabetes Medical Nutrition Therapy and Education, Ross TA, Boucher JL, O'Connell BS (Eds), American Diabetes Association, Chicago, IL 2005.
- Brooks GA, Butte NF, Rand WM, et al. Chronicle of the Institute of Medicine physical activity recommendation: how a physical activity recommendation came to be among dietary recommendations. Am J Clin Nutr 2004; 79:921S.
- American Diabetes Association. Physical activity/exercise and diabetes. Diabetes Care 2004; 27 Suppl 1:S58.
- Wasserman DH, Davis SN, Zinman B. Fuel metabolism during exercise in health and diabetes. In: Handbook of Exercise in Diabetes, Ruderman N, Devlin JT, Schneider SH, Kriska A (Eds), American Diabetes Association, Alexandria, VA 2002. p.63.
- Ness-Abramof R, Apovian CM. Drug-induced weight gain. Drugs Today (Barc) 2005; 41:547.
- Weight gain associated with intensive therapy in the diabetes control and complications trial. The DCCT Research Group. Diabetes Care 1988; 11:567.
- Adverse events and their association with treatment regimens in the diabetes control and complications trial. Diabetes Care 1995; 18:1415.
- Polonsky WH, Anderson BJ, Lohrer PA, et al. Insulin omission in women with IDDM. Diabetes Care 1994; 17:1178.
- Biggs MM, Basco MR, Patterson G, Raskin P. Insulin withholding for weight control in women with diabetes. Diabetes Care 1994; 17:1186.
- Close EJ, Wiles PG, Lockton JA, et al. The degree of day-to-day variation in food intake in diabetic patients. Diabet Med 1993; 10:514.
- Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids, The National Academies Press, Washington, DC 2002.
- Escott-Stump S. Nutrition and Diagnosis-Related Care, 5th, Lippincott Williams & Wilkins, Hagerstown, MD 2002.
- Wolever TM. Carbohydrate and the regulation of blood glucose and metabolism. Nutr Rev 2003; 61:S40.
- Johnston CS, Buller AJ. Vinegar and peanut products as complementary foods to reduce postprandial glycemia. J Am Diet Assoc 2005; 105:1939.
- Delahanty LM, Nathan DM, Lachin JM, et al. Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial. Am J Clin Nutr 2009; 89:518.
- Jenkins DJ, Wolever TM, Taylor RH, et al. Glycemic index of foods: a physiological basis for carbohydrate exchange. Am J Clin Nutr 1981; 34:362.
- Wolever TM, Nguyen PM, Chiasson JL, et al. Determinants of diet glycemic index calculated retrospectively from diet records of 342 individuals with non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1994; 59:1265.
- Liu S. Insulin resistance, hyperglycemia and risk of major chronic diseases: a dietary perspective. Proceedings of the Nutrition Society of Australia 1998; 22:140.
- Liu S, Willett WC, Stampfer MJ, et al. A prospective study of dietary glycemic load, carbohydrate intake, and risk of coronary heart disease in US women. Am J Clin Nutr 2000; 71:1455.
- Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002; 25:148.
- Dumesnil JG, Turgeon J, Tremblay A, et al. Effect of a low-glycaemic index--low-fat--high protein diet on the atherogenic metabolic risk profile of abdominally obese men. Br J Nutr 2001; 86:557.
- Buyken AE, Toeller M, Heitkamp G, et al. Glycemic index in the diet of European outpatients with type 1 diabetes: relations to glycated hemoglobin and serum lipids. Am J Clin Nutr 2001; 73:574.
- Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care 2003; 26:2261.
- American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care 2014; 37 Suppl 1:S14.
- Franz MJ. Finding the right fit for meal planning. Diabetes Care 1993; 16:1043.
- Mannucci E, Rotella F, Ricca V, et al. Eating disorders in patients with type 1 diabetes: a meta-analysis. J Endocrinol Invest 2005; 28:417.
- Rydall AC, Rodin GM, Olmsted MP, et al. Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 1997; 336:1849.
- Peveler RC, Bryden KS, Neil HA, et al. The relationship of disordered eating habits and attitudes to clinical outcomes in young adult females with type 1 diabetes. Diabetes Care 2005; 28:84.
- Green JA. Meal planning approaches for nutritional management of diabetes. In: Handbook of Diabetes Nutritional Management, Powers MA (Ed), Aspen Pub, Rockville, MD 1987.
- Heller SR, Clarke P, Daly H, et al. Group education for obese patients with type 2 diabetes: greater success at less cost. Diabet Med 1988; 5:552.
- Kayman S, Bruvold W, Stern JS. Maintenance and relapse after weight loss in women: behavioral aspects. Am J Clin Nutr 1990; 52:800.
- Foster GD, Makris AP, Bailer BA. Behavioral treatment of obesity. Am J Clin Nutr 2005; 82:230S.
- Guare JC, Wing RR, Marcus MD, et al. Analysis of changes in eating behavior and weight loss in type II diabetic patients. Which behaviors to change. Diabetes Care 1989; 12:500.
- Jeffery RW, Wing RR, Thorson C, et al. Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. J Consult Clin Psychol 1993; 61:1038.
- Wing RR, Jeffery RW, Burton LR, et al. Food provision vs structured meal plans in the behavioral treatment of obesity. Int J Obes Relat Metab Disord 1996; 20:56.
- MEDICAL NUTRITION THERAPY
- CARBOHYDRATE CONSISTENCY
- Meal planning
- - Basic carbohydrate counting
- - Exchange system
- - Sample menus
- Insulin adjustments
- - Advanced carbohydrate counting
- - Elevated blood glucose levels
- - Treatment of hypoglycemia
- PHYSICAL ACTIVITY/EXERCISE
- WEIGHT MANAGEMENT
- Weight gain with intensive therapy
- Estimating desirable body weight
- Estimating caloric intake
- NUTRITIONAL CONTENT
- Glycemic index and glycemic load
- Alcohol intake
- Dietary recommendations
- MEAL-INSULIN TIMING
- EATING DISORDERS
- PROMOTING DIETARY COMPLIANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS