DIABETES GLOBAL SCENARIO About 347 million people worldwide have diabetes There is an emerging global epidemic of diabetes that can be traced back to rapid increases in overweight, obesity and physical inactivity Diabetes is predicted to become the seventh leading cause of death in the world by the year 2030 Total deaths from diabetes are projected to rise by more than 50% in the next 10 years
DIABETES INDIAN SCENARIO An estimated 57 million Indians will have diabetes by 2025 An important factor contributing to increased prevalence of T2DM in Asian Indians is excessive insulin resistance Insulin resistance is highly prevalent in Asian Indians which results in decreased glucose transport in muscle resulting in hyperglycemia Indians seem to have a genetic predisposition towards insulin resistance with a low BMI and high central adiposity
MANAGEMENT OF DIABETES Objectives for the management of Diabetes are: To provide relief from symptoms. Prevention of complications. Approaches for Diabetes management are: Diet management Exercise Drug therapy.
There is not eating pattern & supports its implementation
MEDICAL NUTRITION THERAPY IN DIABETES Medical Nutrition Therapy is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a registered Dietitian.
BENEFITS OF MNT MNT provided by Registered Dieticians (RDs) is a nutrition centered care plan that focuses on the assessment, nutrition diagnosis, treatment plan, evaluation and continued monitoring of a patient. MNT has been shown to be effective in wellness, disease prevention and disease management. MNT improves the health and quality of life for individuals with certain disease conditions and can reduce hospitalization
EMPHASIS ON NUTRITION ADA GUIDELINES
GOALS OF MEDICAL NUTRITION THERAPY 1. Attain individualized glycemic, Blood pressure & Lipid goals. HbA1C < 7% Blood Pressure < 140/80mmHg LDL Cholesterol < 100 mg/dl Triglycerides < 150 mg/dl HDL cholesterol > 40 mg/dl for Men HDL cholesterol > 50 mg/dl for Women 2. Achieve & maintain body weight goals 3. Delay or prevent complications of Diabetes 4. Improve health through healthy food choices & physical activity 5. Address individual nutritional needs taking into considerations personal & cultural preferences and lifestyle 6. For the young with type 2 diabetes, to facilitate changes in eating and physical activity habits that reduces insulin resistance & improve metabolic status 7. To provide self management education for treatment of hypoglycemia 8. To decrease risk by encouraging physical activity & promoting food choices that facilitate moderate weight loss or at least prevent weight gain
WHY MEDICAL NUTRITION THERAPY??? Glycemic Variations Diet Restrictions CVDs Diabetes Weakness Obese & Poor QOL Nutritional Imbalance
SIGNIFICANCE OF NUTRITION IN DIABETES Nutrition is a critical part of diabetes care. Balancing the right amount of carbohydrates, fat, protein along with fibre, vitamins and minerals helps us to maintain health and a healthy lifestyle. Major concern of Nutrition Therapy is Metabolic normalization and reduction of cardiovascular risk factors Objective of Diabetic Nutrition Calorie intake needs to be restricted to decrease weight & risks of vascular complications
MEDICAL NUTRITION THERAPY & GRADUAL MNT is recommended for all people with diabetes as an effective component of overall treatment plan Diabetic Individuals should receive individualized MNT as needed to achieve treatment goals, preferably provided by an RD Gradual provides complete nutritional treatment plan to achieve treatment goals by providing an effective supplementation.
PRESENTING Medical Nutrition Therapy for people with Diabetes
GRADUAL
WHAT? Gradual is an Medical Nutrition Therapy for people with Diabetes Gradual follows ADA recommendations on MNT and its Gradual Release Energy System (GRES) helps manage glucose levels effectively thus minimising Hyper / Hypo glycemic responses Fortified with micronutrients which further helps in attaining diabetes management goals
WHY? - Follows ADA guidelines on Medical Nutrition Therapy - Helps in stabilizing high glycemic variance - Releases energy gradually through GDF Gradually Digestive Fibres (Proprietary Ingredient) - Helps in giving instant energy & weight loss through MCT - Helps achieve proper nutritional balance - Improves Quality of Life
What Gradual Offers GREAT TASTE Features GREADUAL RELEASE ENERGY SYSTEM LOW SFA, HIFH MUFA, SUGAR FREE, TRANS FAT FREE ADVANTAGE OF MCTs, FIBRES OMEGA 3 FATTY ACIDS COMPLETE, BALANCED, LOW CALORIE NUTRITION CONVENIENT PRESENTATION SPRAY DRIED POWDER Benefits EASY ACCEPTANCE AMONGST PEOPLE WITH DIABETES IMPROVED GLYCEMIC RESPONSE - FREEDOM FROM HYPO/HYPER GLYCEMIA GOOD FOR DIABETES MANAGEMNT & CVD GOOD FOR WT. MANAGEMENT, DIABETES MANAGEMNT & CVD GOOD FOR DIABETES MANAGEMNT & CVD COMPLIANCE WITH ADA DIETARY RECOMMENDATIONS, EASY ACCEPTANCE BETTER MISCIBILITY, TASTE & STABILITY
GRADUAL Role of individual components of Gradual
GRES Gradual Release Energy System GDF are short chain polymers of glucose that are resistant to digestion in the human digestive system GDF are not digested or absorbed in the human small intestine, and thus pass to the large intestine. There the undigested GDF are fermented by the colonic bacteria where they yield short chain fatty acids, lower the ph, and gaseous by products. Research studies have shown improved laxation with the consumption of GDF
GRES Gradual Release Energy System GDF is patented soluble dietary fibre and evidence indicates that it may help control postprandial glycemia. GDF consumption does not lead to an enhanced insulin response; rather, it gets attenuated GDF also attenuates the triacylglycerol response to ingested fat, which being structurally different, suggests a mechanism other than enzyme inhibition Foods with a low glycemic index or load can help to normalize the fasting blood glucose concentration, improve glycated protein concentrations, and elevate insulin sensitivity in diabetic and non diabetic subjects
GRES Gradual Release Energy System
Glycated albumin & glycosylated hemoglobin which are indicators of intermediate & long-term glycemic control, improved over time and in relation to placebo treated subjects Glycosylated hemoglobin change over 12 weeks in Test and Control groups. Values are expressed as means ± SE Glycated albumin change over 12 weeks in Test and Control groups. Values are expressed as means ± SE
MCT MEDIUM CHAIN TRIGLYCERIDES Medium-chain triglycerides (MCTs) are fats with an unusual chemical structure that allows the body to digest them easily. Most fats are broken down in the intestine and remade into a special form that can be transported in the blood. But MCTs are absorbed intact and taken to the liver, where they are used directly for energy.
MCT MEDIUM CHAIN TRIGLYCERIDES
MCT MEDIUM CHAIN TRIGLYCERIDES
MCT MEDIUM CHAIN TRIGLYCERIDES
These are polyunsaturated fatty acids (PUFAs) with a double bond (C=C) at the third carbon atom from the end of the carbon chain. The three types of omega-3 fatty acids are 1. ALA - Alpha linolenic acid (found in plant oils) 2. EPA - Eicosapentaenoic acid (found in marine oils) 3. DHA - Docosahexaenoic acid (found in marine oils) Omega 3 fatty acids has anti-inflammatory, inflammation-resolving, anti arrhythmic & anti thrombotic effects as well as a regulation of transcription factors, gene expression & membrane fluidity
Alpha-linolenic acid (ALA): A large amount of ALA is sometimes used strictly for energy purposes. Our bodies can take ALA and use it to produce energy for our cells. In some situations, most of the ALA that we consume will get used in this way. Eicosapentaenoic acid (EPA): Proper function of our inflammatory system depends on the presence of messaging molecules called prostaglandins. Many of these prostaglandins are made directly from EPA. Equally important, most of the prostaglandins made from EPA tend to be anti-inflammatory in their effect. Docosahexaenoic acid (DHA): Proper function of our nervous system including our brain depends on the presence of DHA. DHA is particularly important to brain function
Inositol : Inositol can enhance the sensitivity of insulin in human body, which is a favorable aspect for the control of diabetes. Another good aspect is that it can reduce the resulting factors for diabetes, including hyperinsulinemia and insulin resistance Vitamin D: Vitamin D insufficiency & deficiency in obese and diabetic individuals ranges from 80-90%. Given the high rates of vitamin D insufficiency in obese population & the observed benefits, clinicians may consider vitamin D supplementation in this population Vitamin C : Diabetic patients have lower dietary intake & lower plasma levels of vitamin C than healthy controls & its levels correlate inversely with BMI and deficiency of vitamin C is reported in 35-45% of obese individuals
Biotin: Increases hepatic glucose uptake & it also regulates transcription of the insulin receptor & improves pancreatic B-cell function Thiamine : Reduces reactive oxidative species in endothelial cells Selenium : Decreases hyperglycemia by increasing insulin production & Secretion Chromium Picolinate : Chromium picolinate being most bioavailable form of chromium enhances the biological action of Insulin. Chromium also helps insulin to binds with its receptors that line cell membranes and allow glucose to enter the cell to be converted into energy Zinc : Uncontrolled diabetes results in prolonged glycosuria, which leads to zinc deficiency
NUTRITION FOR DIABETES GRADUAL GLUCERNA D PROTEIN FRESUBIN DM SUPPLEMENT D 1 ENERGY Kcal 419 435 416 450 458 2 PROTEIN g 20.3 20.1 28 20.2 20 3 CARBOHYDRATES g 59.4 59.79 58 43.8 54 4 ADDED SUGAR g 0 0 5 DIETARY FIBER g 13 5.19 7 7.2 6 FAT g 15.1 14.61 8 20 18 7 SATURATED FAT g 2.8 1.17 0.4 3.5 1.2 MAJOR INGREDIENTS 8 MUFA g 9 12.02 5 9.3 11.2 9 PUFA g 1.3 1.92 2.6 7.2 4.8 10 O3FA mg 633 150 11 O6FA mg 523 12 TRANS FAT g 0 0 0 0 0 13 CHOLESTEROL mg 15 <10 0 0 14 FOS g 4 3 3.2 3.07 15 MCT g 1.2 16 TAURINE mg 40 30.6 39 53 17 CARNITINE mg 40 26.2 90 30 18 INOSITOL mg 330 305.7 360 320
NUTRITION FOR DIABETES GRADUAL GLUCERNA D PROTEIN FRESUBIN DM SUPPLEMENT D 1 VIT-A IU 1170 255 mcg RE 2500 479 mcg 1962 2 FOLIC ACID mcg 250 127 200 120 135 3 VIT-B1 mcg 700 582 2000 600 221mcg 4 VIT-B2 mg 0.7mg 0.65mg 2 0.78 0.2mg 5 VIT-B6 mg 1.5 1.52 1 0.72 0.75mg 6 VIT-B12 mcg 4 1.48 3 1.2 0.43 7 NIACIN mg 10 5.11 10 7.2 7 VITAMINS 8 PANTOTHENIC ACID mg 5 2.91 mg 5 2.1 0.92 9 BIOTIN mcg 20 13.8 100 22 5.5 10 Vit D mcg 600 IU Vit D2 4 250 IU 4.5 180 11 Vit E mg 7.5 10 50 18 12.4 12 Vit K mcg 20 30.6 50 36 20.1 13 Vit C mg 40 33.1 100 75 36
NUTRITION FOR DIABETES GRADUAL GLUCERNA D PROTEIN FRESUBIN DM SUPPLEMENT D 1 SODIUM mg 294 324 350 360 424 2 POTASSIUM mg 552 568 700 599 523 3 CHLORIDE mg 112 480 250 539 664 4 CALCIUM mg 477 258 800 360 200 5 PHOSPHORUS mg 190 258 600 300 180 6 MAGNESIUM mg 123 91 200 112 73 MINERALS 7 IRON mg 8.5 4.73 5 9 4.1 8 ZINC mg 16 2.5 15 4.5 2.8 9 MANGANESE mcg 1.5 1.16mg 2 mg 1.5 mg 0.45 10 COPPER mcg 662 764 2 mg 0.6 mg 160 11 IODINE mcg 98 58.2 100 60 27.6 12 SELENIUM mcg 29 16.4 70 30 10.1 13 CHROMIUM mcg 100 25.5 120 120 40 14 MOLYBDENUM mcg 33 35.3 35 45 35.1
GRADUAL ADHEARANCE TO ADA AS PER ADA GUIDELINES Protein (between 10-20%) SFA (<7%) MUFA+PUFA (13-28%) TFA (< 2mg/day) PUFA (<10%) Carbohydrate intake (<130gm per day) Cholesterol (<200mg per day) MUFA + Carbohydrate (between 60-70%) Sodium (<2300mg per day) GRADUAL 19.68% 5.83% 24.62% 0 6.05% 28.7 g/day 7.5 mg/day 66.50% 190.5 mg/day
GRADUAL - TECHNOLOGY Gradual has been prepared with special SPRAY DRIED TECHNOLOGY. This technology offers the following advantages. Gradual is very tasty and has vanilla flavour Gradual is easily SOLUBLE/MISCIBLE in water and milk Gradual formulation is more stable and has lesser chances of developing rancidity, lumps and /or water absorption.
When to take Gradual? - As a snack in the morning or in the evening - As a meal replacement in the afternoon or night - As a Enteral supplement for patients admitted in ICU/ITU Dosage - Gradual 25 gm (3 level scoops) should be taken atleast 2 times in a day
Direction for use To prepare 122 ml feed, put 100 ml normal water/milk in a glass. Slowly add 25 gm (approximately 3 level scoop) of Gradual powder and mix until dissolved. Storage Once opened, store under cool & dry conditions. Keep the lid tightly closed and use the contents within 10 days of opening the container
Gradual as an Enteral Feeding
Indications Long term diabetes Weakness Obese Diabetic patients IPD, ICCU & ITU patients