Program Planning Considerations for Prediabetic/Diabetic Patients

Joseph Stapleton, MS RD LDN CPT

Within CoreLife we have developed a special prediabetic/diabetic clinical pathway.  While many core pieces of our care delivery remain similar to our general weight loss patients, there are some specific differences tailored to the needs of the diabetic or prediabetic patient.

One of the main similarities is that many of our daily intake recommendations remain unchanged. This occurs because our ideal macro-nutrient ratio for most of our patients already lines up with the ratios most commonly cited in diabetes studies and recommended by diabetes educators.

For those that don’t have specific allergies, dietary restrictions (e.g.,veganism), or issues such as kidney disease we guide our patients towards an ideal macro-nutrient ratio comprised of protein, fat, and carbohydrates. However, all of our plans and programs are individualized, so we start by evaluating the patient’s current intake pattern, also factoring in their readiness to change. We then adjust their initial goal accordingly to ensure that it’s achievable and not too drastic of a change from the dietary standard to which they are accustomed. The goal is adjusted over time as new habits are formed to ultimately get as close as possible to the ideal ratio.

One difference in pathway for our diabetic patients is an increased fiber intake goal. For non-diabetics under 50, we recommend 35g/day for men and 25g/day for women. With our diabetic patients we recommend an increase (if tolerated) to 40g/day and 30g/day, respectively.

We also encourage all of our patients to consider tracking and logging their intake, whether it is through an app on their smartphones, a fitness tracker, or a simple diary on paper.  Patients who can make logging a habit tend to hold themselves accountable more reliably; this is especially important for our diabetic patients.

While our non-diabetic patients understand that individual meals or snacks can be a little off as long as they still achieve their goals for the overall day, our diabetic patients need to be more careful to control their blood sugar levels. We set goals for the maximum number of carbohydrates consumed per meal and per snack. The exact grams for each will depend on the individual’s overall calorie goal and recommended number of snacks for their schedule and lifestyle.

It is important to note that many of our patients are beginning organized exercise programs for the first time in their lives. Whether they are exercising with our trainers in our studio or on their own we recommend a pre-workout protocol to avoid hypoglycemic complications.

Example Protocol

Check sugars 30 minutes before exercise and consume a snack with 15 grams of carbohydrates if sugars are less than 100mg/dL.
Check again after 30 minutes and if sugars remain below 70 mg/dL, postpone exercise. During a longer bout of exercise another 15g carbohydrate snack may be necessary during the activity.
A snack containing both carbohydrates and protein needs to be consumed after the workout, as exercising can still influence blood sugar levels hours after resolution of the activity.

When significantly reducing overall intake, insulin-dependent diabetics also need to adjust their medication dosages. We strongly encourage these patients to regularly test their blood sugar levels so they can adjust their insulin accordingly.

If a patient were to report that they take a set dosage of insulin every day without testing their levels, we would require them to meet with their prescribing doctor to go over our intake goals optimized for the patient’s weight loss so they can be prescribed a new appropriate daily dosage.

For more in depth program information, please contact David DeLeonibus daved@corelifemd.com   410.903.7092

Examples of individual goals for diabetic patients

 

  • 45-year-old male, 6’0”, 303 lb, sedentary occupation and lifestyle. Currently not exercising. Eats 3 meals and 3 snacks per day.

 

RMR x Activity Factor = Maintenance Calorie Goal Calorie reduction for safe weight loss = Calorie goal for weight loss Protein goal via % of calories Fat goal via % of calories CHO goal via % of calories
2300kcal 1.2 2760kcal 500 2260kcal 170g (30%) 75g

(30%)

225g (40%)

 

Patient would be recommended to consume no more than 55g CHO per meal and 20g CHO per snack.

 

  • 50-year-old female, 5’0”, 150 lb, lightly active lifestyle. Vegan. Attends group training exercise classes 2-3 times per week. Eats 3 meals and 3 snacks per day.

 

RMR x Activity Factor = Maintenance Calorie Goal Calorie reduction for safe weight loss = Calorie goal for weight loss Protein goal via % of calories Fat goal via % of calories CHO goal via % of calories
1547kcal 1.375 2195kcal 500kcal 1695kcal 106g (25%) 56g

(30%)

190g (45%)

 

Patient would be recommended to consume no more than 47g CHO per meal and 16g CHO per snack. Patient would also be taught to time her snacks on workout days around her activity to maintain blood sugar.

 

  • 29-year-old female, 5’3”, 215 lb, sedentary. Not currently exercising. Eats 3 meals and 2 snacks per day.

 

RMR x Activity Factor = Maintenance Calorie Goal Calorie reduction for safe

weight loss

= Calorie goal for weight loss Protein goal via % of calories Fat goal via % of calories CHO goal via % of calories
1993kcal 1.2 2392kcal 500kcal 1892kcal 142g (30%) 63g

(30%)

189g (40%)

 

Patient would be recommended to consume no more than 50g CHO per meal and 20g CHO per snack.