What to eat, Diabetics

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Introduction:
What to eat when your stomach is not working right can be challenging for anyone, but is particularly so for individuals with Type I 1 diabetes mellitus, who are also faced with a slow-emptying stomach (gastroparesis).

Wide swings in blood glucose levels can be an early sign of gastroparesis in someone with diabetes mellitus. Others may experience digestive symptoms that punctuate life's routines, rob one's appetite, or develop into patterns of nausea and vomiting.

Dietary manipulation can greatly assist you in regaining blood glucose control. Proper use of your insulin or diabetic medication is also of utmost importance. Your diabetologist, or primary care physician, dietitian, diabetes nurse specialist, and diabetes educator are your best resources.

For those who are experiencing moderate to more severe digestive symptoms, eating may become inconsistent from meal to meal, day to day, or week to week, depending upon the frequency and intensity of digestive distress. Getting a handle on good blood glucose control - while still attempting to eat enough calories in order to maintain your weight - may seem daunting. Our aim is to provide you with knowledge and suggestions to aid your efforts as you work towards optimal management with your medical team.

In general:
Little research is available in the area of diet and gastroparesis. What works for one person may not work for all. Therefore, some basic guidelines, trial and error, and patience will serve you well as your guide.

Let's begin! Tips for eating -- Gastroparesis and Diabetes:
Get a registered dietitian who is a diabetes educator with experience in diabetes to help you troubleshoot. To locate one near you, access the websites of one of the organizations below depending on whether you live in Canada or the United States.

Don't abandon principles of good nutrition - remember your food guide!

Learn more about diabetic gastroparesis here

Tighten up blood -glucose control! Work with your diabetologist or primary care physician, dietitian and/or diabetes educator -to learn to adjust insulin types or oral diabetic medications based upon expected number of carbohydrate choices for each meal, taking into account blood -glucose readings. Gastroparesis may mean that your doctor advises taking short-acting insulin or - diabetes medication -with your meal.

Insulin requirements may actually increase if liquid nutritional supplements are used.

Report any problems to your diabetologist or primary care physician right away in order to rework your insulin or oral diabetes medication regimen.

Be consistent with the amount of carbohydrates you eat with each meal! It is the overall amount of carbohydrate, not the type of carbohydrate that impacts your blood -glucose levels.

Generally eat smaller meals more frequently. Usually 210 to 240 grams of carbohydrates are needed each day. Setting a goal for 6 small meals a day then works out to be about 2 to 3 carbohydrate choices (-35-40 grams of carbohydrates) at each meal.

Pay attention to your daily symptom pattern. Go for an easy walk if symptoms allow. Remember, regular exercise helps to improve blood –glucose control.

Try to keep your day to a routine. Added stress brings on increased symptom severity, which may throw off your ability to eat.

Keep a record of blood -glucose levels and bothersome foods.

Regular dental checkups are a must! Stomach acid is damaging to teeth if vomiting, regurgitation or acid reflux is a regular problem.

Positioning: After eating, stay sitting! Or go for an easy walk if you feel up to it.

Review all medications with your doctor, especially any over-the-counter purchases. Many medications can slow down digestion.

Food odors trigger nausea. Go with a fried-food-free household! Invite the rest of the household to go with cold cuts, outdoor BBQ and low-odor, cooked foods. Also, if you just don't feel hungry, warm broths go down fairly easily and are an excellent source of fluids. Find low-odor foods that do not trigger your nausea. Shakes and smoothies may be a good choice.

Avoid smoking, alcohol, coffee, spicy foods and mints. All of these things can irritate the lining of the stomach, and cause more acid reflux.
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Review of Essential Nutrients:
Calories - are the units of energy found in our food. Our body converts the protein, carbohydrates, and fats we eat into usable energy, which we measure in calories. To lose weight, we need to eat fewer calories. To gain weight means eating more calories.

•  Proteins - are needed every day to maintain growth or repair muscle and tissues in our bodies. The average adult needs about 50 to 60 grams of daily protein.
Examples: meats, fish, poultry, milk, eggs. (Click here to view a table of examples)

•  Carbohydrates - found in starchy foods and the natural sugars in fruits and vegetables, represent the easiest nutrient class for our bodies to digest and utilize as energy. From the abundant choices we have, meeting daily carbohydrate needs is easy.
Examples: toast, crackers, potatoes, rice, pasta, fruits and vegetables.

•  Fat - is vital to good health, and makes food taste good! All fats, from any source, provide the most concentrated supply of calories. One gram of fat has more than double the calories as that in an equal amount of protein or carbohydrates. Fat can be a wonderful source of calories in underweight individuals.
Examples: butter, mayonnaise, margarine, vegetable oil.

•  Vitamin and mineral supplements - These nutrients do not supply calories, but are essential to healthy functioning. Eating a wide variety of foods insures that you will get the necessary range of daily nutrients. Some people with gastroparesis tend to restrict their diets greatly, based upon personal experience gained from learning which foods create fewer symptoms for them. In doing so, you may run into problems with vitamin and mineral deficiencies. Ask your doctor or dietitian regarding simple, routine blood work to monitor your vitamin and mineral levels. Vitamin and mineral supplements are best in a chewable or liquid form, and should be done under the guidance of a physician and registered dietitian. The most common nutrient deficiencies seen in patients with gastroparesis are iron, vitamin B12 (cyanocobalamin), vitamin D and calcium.

The Basic Principles:
Water and Fluids - Anything liquid will supply the body with needed water. People suffering from gastroparesis quickly learn what beverages taste best to them. Persistent vomiting makes staying hydrated difficult. Remember to take sips of simple juices or sodas or any other fluid that is appealing. Many sufferers just want to curl up and not make the effort to grab a drink. Note: dehydration can make your symptoms much worse and cloud your reasoning. Fluid replacement is very important.

Volume - Eating enough may be a challenge. Many people with gastroparesis experience a feeling of fullness after a few bites of food; for others, the rapid eating of a large meal - by sheer volume alone - may inhibit stomach emptying. So, go easy and go slowly with volume. Take frequent "mini-meals", selecting good quality food choices.

Liquids vs. Solids - In general, liquids - no matter what the nutrient content - will empty from the stomach much more easily than solids. (See a list of examples from the tables listed  below).

When is it time to switch to liquid nutritional supplements?

• Digestive symptoms remain so severe as to cause food avoidance;

• Vomiting up undigested food hours after eating, thus leading to weight loss;

• Blood -glucoses still widely fluctuating;

• Ending up in the hospital or emergency department too frequently.

These are the times you need to consider switching to a liquid-based meal approach.

See: options while on a liquid diet

Play with your food!
As mentioned above, when symptoms are bad, stick to complete liquid meals. Add liquid nutritional supplements to ensure adequate calories, and as an easy way to get calories in without preparation when feeling poorly. See the tables below for suggested commercial meal replacements. Once you have gained back some control over your symptoms, step up to thinned-down, puréed foods. Just about any food item can be blenderized, so making something apart from the rest of the family meal isn't necessary. As blended foods are tolerated, you may progress to soft foods; you can even try baby foods. Another trick - for those who experience a worsening of symptoms by evening or an increasing sense of fullness later in the day, try reserving more solid foods for breakfast while moving to more liquid foods as the day progresses. Keep the foods simple - soft and easy to chew.

Fiber - is found in many fruits, vegetables and grains, and normally acts to slow down stomach emptying. For gastroparesis sufferers, this may hamper the ability to eat enough calories due to feeling overly full after a few bites of food. If so, it may be helpful to avoid high fiber foods and commercial fiber/bulk-forming laxatives.

Fat - Any type of fat will slow stomach emptying. For this reason, many doctors and dietitians will recommend curtailing the amount of fat in your foods. However, fat found in a liquid form - as in milkshakes, whole milk, nutritional supplements and liquid meal replacements - can usually be managed without increasing symptoms. Many of the liquid nutritional supplements come in choices of low-fat, moderate-fat and high-fat formulations. There are no hard and fast rules on high-fat or low-fat liquid drinks that work best for slow stomachs. Experiment! Try different nutritional liquid meals, milkshakes, etc. and find what works best for you. For someone who is seriously underweight, fats should not be restricted. They are an enormously rich source of calories. So be open to exploring and exploiting your options.

Tables* showing examples of:

Clear liquids

Full liquids

Blenderized foods

Fat-free protein sources

Commercial nutritional supplements

Fiber foods

Examples of a semi-liquid meal plan

Recipes for smoothies, shakes, and fruit blends

* We gratefully acknowledge the University of Virginia Health Systems Digestive Health Center of Excellence for providing these tables. 

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