8
Nutrition Intervention
DM: Educate on Protein Intake and Hypoglycemia in Adults with
Diabetes
➤ The RDN should educate adults with diabetes that adding protein
to meals and snacks does not prevent or assist in the treatment of
hypoglycemia. Ingested protein appears to increase insulin response
without increasing plasma glucose concentrations. Therefore,
carbohydrate sources high in protein should NOT be used to treat or
prevent hypoglycemia. (Fair, Imperative)
DM: No Protein Restriction for Diabetic Kidney Disease (DKD)
➤ For adults with diabetes and DKD, the RDN does not need to prescribe
a protein restriction. While research reports mixed results regarding
the effects of the amount of protein on fasting glucose levels and A1C,
independent of weight loss, in adults with type 1 diabetes and type 2
diabetes and DKD, there was no significant impact of protein intake
(ranging from 0.7–2.0g/kg/day) on GFR. (Strong, Conditional)
DM: Type of Protein and DKD
➤ The RDN should advise adults with type 2 diabetes and DKD that the
type of protein (vegetable-based vs. animal-based) will not have a
significant effect on GFR. However, there may be an effect on fasting
glucose levels and proteinuria. While one study reports a positive
impact of soy protein compared to animal protein on proteinuria and
fasting glucose levels, independent of weight loss, in adults with type
2 diabetes and DKD, there was no significant impact of soy protein
consumption on GFR. (Weak, Conditional)
DM: Encourage Cardioprotective Eating Pattern
➤ The RDN should encourage consumption of a cardioprotective dietary
pattern, within the recommended energy intake. While research
reports no significant effect of differing amounts of saturated fat,
unsaturated fat and omega-3 fatty acids on glycemia or insulin levels,
independent of weight loss, modifications to decrease saturated fat
intake and increase unsaturated fat intake reduced total cholesterol
and LDL-cholesterol in three of six studies. (Strong, Imperative)
DM: Encourage Individualized Reduction in Sodium Intake
➤ The RDN should encourage an individualized reduction in sodium
intake. The recommendation for the general population to reduce
sodium to <2,300 mg per day is also appropriate for adults with
diabetes. For adults with both diabetes and hypertension, further
reduction in sodium intake should be individualized. (Fair, Imperative)
