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Noninsulin-dependent diabetes mellitus (NIDDM), or Type II diabetes, is characterized by two primary defects: insulin resistance and insulin secretion. The two major goals of management of NIDDM are to achieve near normal metabolic control and to prevent/delay the microvascular and macrovascular complications of diabetes. Nutrition, exercise, and, if necessary, medication are the three primary treatment modalities used in NIDDM. Treatment regimens need to be individualized and developed with consideration for diabetes management goals and quality-of-life issues. Lean individuals with NIDDM should be encouraged to maintain their body weight and modify food composition and eating pattern to minimize glucose excursions. The primary treatment goal for an obese individual with NIDDM is weight loss. The process of teaching nutrition and meal planning involves developing a cooperative alliance, gathering information, setting realistic goals, intervention, and maintaining change. Nutrition intervention involves providing information in stages, beginning with "survival skill" information and progressing to in-depth information. The dietitian's responsibility is to promote continuity of learning by introducing new ideas and concepts and altering the learning environment. Dietitians can expand their role in the 1990s to that of a diabetes educator taking a leadership role to ensure that the individual with NIDDM receives comprehensive and individualized care.

The effect of different temporal patterns of calorie intake on plasma glucose, serum insulin, and insulin secretion rates was examined in six patients with moderately well controlled non-insulin-dependent diabetes mellitus (NIDDM). Patients were studied on three separate occasions over 26 h. Total calories and food composition (50% carbohydrate, 15% protein, and 35% fat) were kept constant, but the pattern of calorie intake was varied. In study A (similar meal size), calories were distributed as 30, 40, and 30% at breakfast, lunch, and dinner, respectively. In study B (3 snacks, 3 meals), each subject ate three meals of 20, 20, and 30% of calories for breakfast, lunch, and dinner, respectively, and three snacks, each comprising 10% of calories, presented 2.5 h after the meal. In study C (large dinner), 10% of calories were consumed at breakfast, 20% at lunch, and 70% at dinner. Glucose, insulin, and C-peptide concentrations were measured at 15- to 30-min intervals. Insulin secretion rates were calculated from C-peptide levels with individually derived C-peptide clearance parameters. The different eating patterns were associated with only modest differences in overall levels of glucose and insulin secretion. Daytime insulin secretion was lowest when most of the daily calorie intake occurred in the form of a large dinner. Overnight levels of glucose and insulin secretion rates did not differ for the three eating patterns, and the morning glucose levels were also unaffected by the pattern of calorie intake on the previous day. A morning rise of glucose of greater than 0.28 mM occurred consistently only when dinner was of moderate size (30% of total calories).(ABSTRACT TRUNCATED AT 250 WORDS)

The primary goal of diabetes management is to maintain blood glucose as near to normal as possible. Composition, size, and spacing of meals and snacks all have a substantial impact on blood glucose fluctuations and can be altered to improve glycemic control. Recent research studies focusing on the blood glucose response of various carbohydrate containing foods have found that responses vary considerably. Because the glucose response is influenced by numerous factors, it is difficult to predict how specific individuals will respond to a particular food. A technique known as self-blood glucose monitoring can be used by patients with diabetes to quantitate their own postprandial glucose rise from various foods. The technique itself is portable and relatively simple and is an accurate means of obtaining blood glucose values without using a clinical laboratory. Self-blood testing provides the patient with immediate feedback on the impact of dietary manipulation. Blood glucose records can be used in conjunction with diet records to make adjustments in the type and amount of food or insulin dose that would elicit the best glycemic response. The dietitian thus plays an integral role in identifying patterns in the blood glucose profile and assisting the patient in making intelligent dietary choices to improve diabetes control.