ADA guidelines to help you take care of yourself

Earlier this year, in its revised Standards of Medical Care in Diabetes, the American Diabetes Association (ADA) sharpened its recommendations on several aspects of diabetes management—and self-management. The updated guidelines feature the following additions.

Diabetes self-management education for all

The ADA now recommends that qualified healthcare professionals provide diabetes self-management education when a person is first diagnosed, and then whenever necessary after that. This will teach the person how to control blood glucose (sugar) levels, prevent diabetes complications, and have a good quality of life.

On a related note, the ADA recommends a hemoglobin A1c goal below 7% for people with diabetes, although a person should strive to bring it as close to normal (below 6%) as possible without provoking dangerous low blood sugar. The A1c test result reflects blood glucose levels over the previous 2 to 3 months.

Updated guidelines

The ADA updated its position on the following matters of nutrition.

• People with diabetes should receive individualized medical nutrition therapy, preferably from a registered dietitian with a special understanding of diabetes. The nutrition therapist would evaluate the person’s current food intake, blood glucose control, lifestyle, and readiness to make dietary changes, and would educate the person on dietary matters.
• Monitoring total grams of carbohydrate intake, by using “exchanges” or carbohydrate counting, remains key to diabetes control. Of help, too, may be an understanding of the glycemic index, which ranks foods by how quickly they raise blood glucose.
• Low-carbohydrate diets (less than 130 grams of carbs per day) are not advised.
• People who have diabetes plus any degree of chronic kidney disease should limit their protein intake to 0.8 gram per kilogram of body weight (1 kilogram equals 2.2 pounds).
• Saturated fat should account for less than 7% of total calories consumed, and trans fats should be kept to an absolute minimum.
• Sugar substitutes are safe if consumed within the daily levels set by the U.S. Food and Drug Administration.
• All overweight or obese (severely overweight) adults with type 2 diabetes should lose weight, mainly by cutting out 500 to 1,000 calories per day (but taking in a minimum of 1,200 to 1,600 calories per day). In addition, it is important to gradually increase physical activity.
• Certain individuals may be candidates for drug therapy or surgery to help lose weight.
• The effectiveness and long-term safety of antioxidant supplements such as beta-carotene and vitamins E and C have not yet been established. As a result, the ADA does not recommend the use of these supplements. Chromium supplements are not recommended, either.

From Diabetes Care