Diabetes and Breathing

COPD or any breathing condition for that matter... a diet higher in fat is beneficial as when fat is metabolized in the body it produces 30% less carbon dioxide compared to carbohydrates. This also benefits individuals with breathing problems b/c their caloric intake is usually low b/c they just can't eat very much without becoming out of breath... so the higher fat diet provides the additional calories needed to sustained the labored breathing and prevent weight loss. Further, when protein is metabolized in the body it produces 20% less carbon dioxide compared to carbohydrates. So this helps with breathing but also it is important to maintain the lean body mass of the patient b/c they don't move around much due to breathing their muscles atrophy and extra protein can help in this regard as well. So a good ratio of CHO:FAT:PRO might be 45:35:20 or around there. You should also consider a multivitamin/mineral supplement to ensure the micronutrient needs are being met especially calcium and vit D b/c since they don't move much they begin to lose bone strength. Finally, some type of progress resistance training program the client can tolerate needs to be developed mainly to main muscle and bone strength.

As far as Diabetes Type 2 goes... yes the individual should be encourage to eat 3 meals a day and a bed time snack with at least 4 hours between each meal for the reason you described... once you have finished eating it takes 2 hours for the food to be digested and release as sugar in to the blood and another 2 hours for the sugar to be moved from the blood to the various tissues in the body to be used for energy or for storage.

This is why it is important to test blood sugar levels before eating to know what the starting point was and then 2 hours after eating to see at what level the blood sugar peaked. If the blood sugar 2 hours after eating is above 140 mg/DL than there are 4 explanations: 1. Blood sugar before eating was higher than 110 - which you will know if they tested their blood before they ate but if they didn't then that is one explanation, 2. They ate too much - they did not control their portion sizes, 3. The ate the wrong type of food eg. simple carbohydrates or what they ate doesn't work for their body, 4. Their medication dosage is not enough and they need it increased or another one added. You can also recommend this strategy to clients when they as you, "Can I eat this?" You can say take your fasting blood sugar and make sure its between normal range of 70-100 mg/Dl and then eat the food in question as part of a meal and take your blood sugar 2 hours later. If it exceeds 140 mg/Dl then either you had too much of it and have less next time and try again and if the same thing happens again then their body can't tolerate that particular food.

Another challenge dietitians deal with when managing patients with diabetes is hyperglycemia in the morning before breakfast. When this happens b/c they started off the day with high blood sugar and then they ate breakfast their blood sugars are going to remain elevated for the entire day. In this type of situation you should be looking at their bed time snack. You should find out when they are having it, how much and what they are eating. Many times the morning blood sugars are elevated b/c the bed time snack was not taken at the right time or small quantity or poor quality. So what happens over night is the liver starts to release sugar into the blood stream to make up for the lack of not having has a proper bed time snack. The liver continues to release sugar into the blood stream