From a physician:
Could I get a diet for a 15 year old, very active and compliant, newly diagnosed diabetic? He and his parents have become proficient with the glucometer and shots in 2 days, but the exchanges are overwhelming them. And we had to modify the diet because he's a trim 150 pounds and is usually very active. He was already used to home-cooking and drinks water and loves milk. I was hoping you had a simpler method to help him get his 2500 to 3000 calories a day. He used to eat a banana, an apple and a quart of milk for break at school while the others ate their chips and sodas, so he should adapt to an ADA diet well. We're still working on the 400+ glucose after eating with a 91 at 3 A.M. Any ideas would be greatly appreciated.
I would encourage you to send your patient back to the dietitian to clarify any misunderstandings on the Exchange Diet. There are other approaches, such as Carbohydrate Counting, which may work for him as well. However, without individualizing the meal plan to suit your patient's specific needs and lifestyle it is not likely to be successful. This often takes several visits to the dietitian. During the first visit a basic meal plan may be devised but much fine tuning, support and education needs to be done after that time to make a major lifestyle change, such as adjusting the way you eat.
Additional Comment from Dr. Lebinger:It is important to keep in mind that the purpose of the meal plan is to try to be consistent from day to day in how much carbohydrate you eat at the same time each day, and to make changes for activity.
People with newly diagnosed diabetes often don't realize that insulin requirements usually change frequently after diagnosis even after you have met with the dietitian and come up with an excellent individualized meal plan. That is why you need a diabetes team. The dietitian can help you with an individualized meal plan, but you will still need to work closely with the physician and nurse educator to adjust the insulin according to the blood sugars on this meal plan to try and maximize blood sugar control. It's a lot of time and effort initially, but will save you time and effort later on.
Original posting 15 Dec 96
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