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LaeJu: Nutritional Considerations for Diabetic Patients on Diabetes Medication
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J Korean Diabetes 2014;15(1):35-40.

Published online: 10 January 2014

DOI: https://doi.org/10.4093/jkd.2014.15.1.35

Nutritional Considerations for Diabetic Patients on Diabetes Medication

Dal LaeJu

Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea

Copyright © 2014 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Individuals who have diabetes should receive individualized medical nutrition therapy (MNT) based on an assessment of the individual's current eating patterns, preferences, and metabolic goals. The dietician should be able to coordinate food choices with the type of diabetes medicine being taken. Knowledge of the actions, side effects, and contraindication of diabetes medicine can help the dietician coordinate appropriate MNT and physical activity, to assist the individual with diabetes to achieve optimal glycemic control without unwanted effects.
Carbohydrate consistency is important for diabetic patients on oral diabetes medications. The primary side effects with initial treatment of biguanides, α-glucosidase inhibitors, and incretin mimetics include gastrointestinal discomfort, which can be minimized by taking the medication with food, starting at a low dosage, and increasing the dosage slowly. Common side effects from use of insulin and insulin secretagogues (sulfonylureas and meglitinides) are hypoglycemia and weight gain. Consistent meal times and carbohydrate consistency are important to reduce risk of hypoglycemia. Energy restriction, reduced fat intake, regular physical activity, and avoidance of frequent hypoglycemia can be beneficial in preventing or limiting weight gain. The insulin regimen should be fitted to the meal plan and adjusted over time based on the results of blood glucose monitoring.

Keywords: Diabetes mellitus, Medicine, Nutrition therapy

References

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Table 1.
Nutritional implications related to oral glucose-lowering agents [2–5,10]
Medication class Potential for weight gain Potential for hypoglycemia Gastrointestinal side effects Nutritional implications
Sulfonylureas Yes Yes No Carbohydrate intake should be consistent day-to-day at meals and snacks. Energy restriction, reduced fat intake, and regular physical activity can be beneficial in preventing or limiting weight gain.
Meglitinides Yes Yes No Best if carbohydrate intake is consistent day-to-day at meals and snacks, but the medication can be adjusted for the amount of carbohydrate to be consumed. If meal is omitted, the corresponding dose should be omitted to prevent hypoglycemia. Energy restriction, reduced fat intake, and regular physical activity can be beneficial in preventing or limiting weight gain.
Biguanides No No Yes Best if carbohydrate intake is consistent day-to-day at meals and snacks. Not for use in people who consume alcohol daily. Gradually titrate to minimize gastrointestinal side effects when initiating use. Taken with food to reduce gastrointestinal upset Potential to decrease vitamin B12 and folate absorption.
Alpha glucosidase inhibitors No No Yes Best if carbohydrate intake is consistent day-to-day at meals and snacks. Gradually titrate to minimize gastrointestinal side effects when initiating use. If hypoglycemia occurs in combination therapy, it should be treated with glucose.
Thiazolidinediones Yes No No Best if carbohydrate intake is consistent day-to-day at meals and snacks. Energy restriction, reduced fat intake, and regular physical activity can be beneficial in preventing or limiting weight gain.
DPP-4 inhibitors No No Yes Best if carbohydrate intake is consistent day-to-day at meals and snacks, Gradually titrate to minimize gastrointestinal side effects when initiating use
GLP-1 analogues Decreased No Yes Gradually titrate to minimize gastrointestinal side effects when initiating use

DPP-4, dipeptidyl peptidase-4; GLP-1, glucagon like peptide-1.

Table 2.
Nutritional implications related to insulin regimens [2–5,10]
Insulin regimen Nutritional implications related to insulin regimen
Fixed insulin regimen – constant dose of basal insulin, may be combined with standard mealtime dose of rapid- or short-acting insulin. – premixed insulin may be used. · Keep meal times consistent. · Eat similar amounts of carbohydrates each day to match the set doses of insulin. · Insulin doses need to be taken at consistent times every day. · If short-acting insulin is combined with intermediate-acting insulin, snacks are helpful. · Do not skip meals to reduce risk of hypoglycemia. · It is helpful to exercise at consistent times.
Flexible insulin regimen – basal insulin(intermediate-acting or long acting) given once or twice daily in addition to bolus insulin (rapid- or short-acting insulin). – insulin pumps · Take mealtime insulin before eating. · If larger snacks (＞ 15 g carbohydrate) are eaten, an extra bolus of insulin can be injected pre snack. · Mealtime insulin dose can be changed based on insulin-to-carbohydrate ratio and correction factor. · Insulin can be adjusted to accommodate varying exercise times and amounts of exercise.
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