Diabetes & Coeliacs

The role of the dietitian is well documented in diabetes management and there are nutrition guidelines and recommendations for dietetic intervention in diabetes care (1,2). Nutrition advice must be adapted to the specific needs of the individual which may change with time and circumstances; for example age, pregnancy, nephropathy, intercurrent illness, and other conditions, such as coeliac disease. As there is a link between coeliac disease and Type 1 diabetes it is important that advice can be tailored to suit both conditions.

• Energy balance and body weight
• Protein
• Dietary fat

Energy balance and body weight

For those who are overweight (BMI > 25kg/m2), caloric intake should be reduced and energy expenditure increased so that BMI moves towards the recommended range.

Prevention of weight regain is an important aim once weight loss has been achieved. Those patients who are unable to lose weight should be strongly encouraged to prevent further weight gain.

Diabetic patients have a high proportion of intra-abdominal fat and associated increased health risks related to insulin resistance and associated dyslipidemia and hypertension. Waist circumference is therefore an important tool for assessing risk and for monitoring progress.

Even modest weight loss of under 10% body weight improves insulin sensitivity, in addition to other health parameters, and should therefore be set as an initial goal for patients needing to lose weight.

Protein

In patients with no evidence of nephropathy, protein intake may provide 10-20% of total energy.

In patients with type 1 diabetes and evidence of established nephropathy, protein intakes should be at the lower end of the acceptable range (0.8g/kg normal body weight/day).

Patients with diabetes, especially when poorly controlled or on haemodialysis, have increased protein turnover and their protein requirements may be greater than the recommended daily allowances. Protein intake should not be reduced below 0.6g/kg body weight/day.

Dietary fat

Saturated and trans fatty acids should provide less than 10% total daily energy. A lower intake may be beneficial if LDL-cholesterol is elevated.

Monounsaturated fats are preferable fat sources and may provide up to 20% total energy, provided total fat intake does not contribute more than 35% total energy.

Consumption of two to three servings of fish (preferably oily fish) each week will ensure an adequate intake of n-3 fatty acids. Plant sources of n-3 fatty acids include soya oil, walnuts, linseeds, and some green leafy vegetables.