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Fuadiyah Nila K., S.Gz, MPH Leny Budhi Harti, S.Gz Jurusan Gizi FKUB.

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Presentasi berjudul: "Fuadiyah Nila K., S.Gz, MPH Leny Budhi Harti, S.Gz Jurusan Gizi FKUB."— Transcript presentasi:

1 Fuadiyah Nila K., S.Gz, MPH Leny Budhi Harti, S.Gz Jurusan Gizi FKUB

2 Diet Diabetes Mellitus

3 Nutrition Care Process (ADA,2003) Relationship between Patients/client/group and Dietetics Professional Nutrition assessment obtain/collect timely and appropriate data analyze/interpret with evidence-based standards document Nutrition diagnosis identify & label problem determine cause/ contributing risk factors cluster signs & symptoms/ defining characteristics document Nutrition interventions plan nutrition Intervention -Formulate goals & determine a plan of action implement nutrition intervention -Care is delivered & actions are carried out document Nutriton monitoring & Evaluation monitor progress measure outcome indicators Evaluate outcomes document Practice Settings Social Systems Economics Health Care Systems Code of Ethics Skills & competencies Dietetics Knowledge CommunicationCollaboration Critical ThinkingEvidence-based Practice

4 X X Asuhan Gizi Standard -Sosio Kulture - Ekonomi Keluarga - Kebiasaan -Sosio Kulture - Ekonomi Keluarga - Kebiasaan Asuhan Gizi Individual Nutritional Care Process X X Pantang Makanan Pengaturan Diet

5 she has type 2 diabetes 1 year ago Lena has been overweight for a few years. She is 52 years old, and she found out that she has type 2 diabetes 1 year ago. She has been seeing a doctor at her physician’s office for nutrition information, and the doctor has referred her to a registered dietitian (RD) in the outpatient clinic at the nearby hospital. Kulkarni, KD.Clin. Diabetes 23:

6 Lena brings her food records to her initial visit with the RD. The RD reviews the records, which consist only of Lena’s food choices with no portion sizes or amounts consumed listed. The RD recommends that Lena consider weighing and measuring her portion sizes and writing them down along with her food choices. The RD provides Lena with a copy of the American Diabetes Association (ADA) basic carbohydrate counting pamphlet1 and uses food models to demonstrate appropriate portions of the foods Lena might select. Kulkarni, KD.Clin. Diabetes 23:

7 Content : 1. Definition of carbohydrate counting 2. Level of carbohydrate counting 3. Indication of using carbohydrate counting 4. Why should people with diabetes use carbohydrate counting???? 5. Steps to count carbohydrate counting

8 Definition of carbohydrate counting  Carbohydrate counting is a meal-planning approach and not a specific diet  It places emphasis on the total amount of carbohydrate consumed, rather than on the source or type of carbohydrate consumed Kulkarni, KD.Clin. Diabetes 23:

9 Level of carbohydrate counting Carbohydrate counting BasicAdvance understanding the relationship among food, physical activity, and blood glucose levels includes understanding pattern management and how to use insulin- to-carbohydrate ratios Kulkarni, KD.Clin. Diabetes 23:

10 introduces patient to the concept of carbohydrate counting and for carbohydrate consistency Level of carbohydrate counting Carbohydrate counting Level 1 Level 2 Level 3 Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48

11 Focuses on the relationships among food, diabetes medication, physical activity and blood glucose level and Level of carbohydrate counting Carbohydrate counting Level 1 Level 2 Level 3 Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48

12 how to match short- acting insulin to carbohydrate using carbohydrate-to- insulin ratios. Level of carbohydrate counting Carbohydrate counting Level 1 Level 2 Level 3 Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48

13 Level 1 / Basic Carbing Goals 6 1. Carbohydrate Counting: Getting Started, The American Diabetes Association and The American Dietetic Association, Practical Carbohydrate Counting, American Diabetes Association, Using Carbohydrate Counting in Clinical Practice, JADA, 1988, v98, n8 Regulate blood glucose by balancing carbohydrate intake with the diabetes medication and physical activity Achieve and maintain consistency of carbohydrate intake at meals and snacks at similar times each day Eating similar amounts of carb foods at each meal or snack helps “even out” the ups-and-downs in your blood glucose level.

14 Who Can Use Carbing  Carbohydrate counting can be used by anyone with diabetes, not just people taking insulin

15 Why Should People with Diabetes Use Carbohydarte Counting???? Food contains many nutrients such as 1. Macronutrients : carbohydrate, protein, and fat 2. Micronutrients : vitamins and minerals

16 Why Should People with Diabetes Use Carbohydarte Counting????

17  In fact, % of the carb you eat appears in your bloodstream as blood glucose within a few hours after you have eaten.  Protein and fat have much less effect on your blood glucose Why Should People with Diabetes Use Carbohydarte Counting???? Bolderman, K.M, Educational Information From BD Medical Diabetes Care

18 Steps to Count Carbohydrate Counting 1. Step 1 : Make healthy food choices 2. Step 2 : Focus on carbohydrate 3. Step 3 : Set carbohydrate goals 4. Step 4 : Determine carbohydrate content 5. Step 5 : Monitor effect on blood glucose level Canadian Diabetic Association, 2005

19 Step 1 Make healthy food choices  Enjoy a variety of vegetables, fruits, whole grains,  Use added fats in small amounts.  Choose portion sizes Canadian Diabetic Association, 2005

20 Steps to Count Carbohydrate Counting 1. Step 1 : Make healthy food choices 2. Step 2 : Focus on carbohydrate 3. Step 3 : Set carbohydrate goals 4. Step 4 : Determine carbohydrate content 5. Step 5 : Monitor effect on blood glucose level Canadian Diabetic Association, 2005

21 Step 2 Focus on Carbohydrate

22

23 Steps to Count Carbohydrate Counting 1. Step 1 : Make healthy food choices 2. Step 2 : Focus on carbohydrate 3. Step 3 : Set carbohydrate goals 4. Step 4 : Determine carbohydrate content 5. Step 5 : Monitor effect on blood glucose level Canadian Diabetic Association, 2005

24 Step 3 : Set Carbohydrate Goals  dietitian will help to set a goal for grams of carbohydrate at each meal and snack  This may be the same from day to day or may be flexible, depending on patient needs Canadian Diabetic Association, 2005

25 Step 3 : Set Carbohydrate Goals Perhitungn zat gizi yang diperlukan pasien Energi Distribusikan dalam 24 jam Komposisi zat gizi sesuai dengan kebiasaan Perhitungan jumlah karbohidrat per sajian Analisis zat gizi dari kebiasaan makan pasien Jumlah energi Distribusi energi selama 24 jam Analisis terhadap komposisi zat gizi Perhitungan KH setiap sajian Perencanaan sesuai dengan kebiasaan dan budaya makan pasien Pilih obat yang diperlukan sesuai jumlah karbohidrat

26 Jumlah energi Distribusi energi selama 24 jam Analisis terhadap komposisi zat gizi Perhitungan KH setiap sajian Step 3 : Set Carbohydrate Goals Analisis zat gizi dari kebiasaan makan pasien Food record

27 Food Record

28

29

30  Energi dari hasil record : Kkal  Distribusi energi : - pagi :.....% - snack :.....% - siang:.....% - malam:.....%  Komposisi zat gizi : - protein:....% - KH:....% - Lemak:....%  Serving KH per sajian

31 Perhitungn zat gizi yang diperlukan pasien Energi Distribusikan dalam 24 jam Komposisi zat gizi sesuai dengan kebiasaan Perhitungan jumlah karbohidrat per sajian Perhitungn zat gizi yang diperlukan pasien

32  Status Gizi  IMT  IMT = BB (kg)/ {TB (m)}²  Berikut ini pembagian IMT berdasar standard Asia menurut IOTF, WHO (2000) : =30 = Obese II

33 Perhitungan Kalori  BMI  Normal : 25 – 30 cal/kg BW  Kurus : > 40 cal/kg BW  Overweight : < 20 cal/kg BW (BMI requiring and /obese 130 g/day of CHO)

34 Perhitungn zat gizi yang diperlukan pasien Energi Distribusikan dalam 24 jam Komposisi zat gizi sesuai dengan kebiasaan Perhitungan jumlah karbohidrat per sajian Perhitungn zat gizi yang diperlukan pasien Distriusi kalori dalam 24 jam  disesuaikan dengan kebiasaan makan pasien

35 Perhitungn zat gizi yang diperlukan pasien Energi Distribusikan dalam 24 jam Komposisi zat gizi sesuai dengan kebiasaan Perhitungan jumlah karbohidrat per sajian Perhitungn zat gizi yang diperlukan pasien

36  Karbohidrat sebesar 45-65% total asupan energi.  Protein sebesar 10 – 20% total asupan energi.  Asupan lemak sekitar 20-25% kebutuhan kalori. Perhitungn zat gizi yang diperlukan pasien Perkeni, 2006

37 Perhitungn zat gizi yang diperlukan pasien Energi Distribusikan dalam 24 jam Komposisi zat gizi sesuai dengan kebiasaan Perhitungan jumlah karbohidrat per sajian

38 Karbohidrat sebesar 45-65% total asupan energi Perhitungn zat gizi yang diperlukan pasien Dibagi dalam beberapa kali makan Pagi.....% =...g Siang Malam snack Sesuai dengan kebiasaan makan pasien KH per sajian

39 Perhitungan jumlah karbohidrat per sajian Perhitungn zat gizi yang diperlukan pasien Carbohydrate serving/ choice (carb serving/ choise) Carb grams

40 Carb Seving/ Carb Choise  1 carb serving/ choie = 15 g karbohidrat Kulkarni, KD.Clin. Diabetes 23:

41 Ex : untuk makan pagi, Tn. H membutuhkan 45 g karbohidrat 45g KH = 3 carb serving ↓ 2 slice of bread + ½ cup of fruit juice Carb Seving/ Carb Choise

42 How Can I Use Nutrition Facts on Food Labels?

43 Case Study  Tn. Han, usia 37 tahun. Penderita DM type 2. TB 155 cm, BB 75 kg. Bekerja sebagai pegawai yang sebagaian besar aktifitasnya dilakukan dengan duduk. Pulang dan pergi kerja diantar oleh sopir. Pemeriksaan gula darah puasa/dl, DG 2 JPP 310 mg/dl

44 Food pattern (Hasil Food Frequency Questionnaire/FFQ)  CHO yang paling sering: nasi, mie, roti  Protein hewani ayam, daging, telur  Protein nabati tempe dan tahu  Sayur jarang hanya 1x/hari  Buah frekuensi jarang, konsumsi dalam bentuk jus  Snack dalam bentuk makanan tinggi kalori

45 Stage 1  Nutritional Assessment  Antropometri : BB = 75 kg, TB= 155 cm  BBI = ( ) x 90% = 49.5 cm  IMT = 75/1.5 2 = 31 (0bese)

46 Record Hari 1 Waktu Makan Menu Bahan Makanan Portion Size Jml karbohidrat URTGram Serving Sarapan Nasi putih Ayam grg Tempe grg Pecel Teh manis Nasi Ayam Minyak Tempe Minyak Bayam Taoge Kcang tnh Gula pasir 1 gls 1 ptg sdg ½ sdm 2 ptg sdg ½ sdm ½ gls ¼ gls 2 sdm ½ - ½ - ½ g (…..%) 6.5 serv. Makan siang Tot Carb Makan malam Tot Carb

47 Hasil Record HariEP (gr)F (gr)CHO (gr) Hari Hari Hari Rata-rata intake

48 Stage 3  Nutrition Intervention  Perhitungan kebutuhan  20 Kal x 75 = 1500 Kalori  KH 55% = 55/100 x 1500 = 825 Kalori= gram  Lemak 25% = 25/100 x 1500 = 375 Kalori = 41.6 gr  Protein 20%= 20/100x1500= 300 Kalori= 75 gr

49 Stage 4  Meal planning (KH) sesuai dengan kebiasaan makan  Energi = 3346 Kalori, CHO= g yang terbagi dalam : Sarapan (%) = Snack (%) Makan siang (%) Snack (%) Makan malam (%)

50 Distribusi konsumsi KH dalam gr dan serving unit Waktu makan gram CHOUnit serving CHO Sarapan100.6 (26%)6.5 Snack65.5 (17%)4 Siang111.0 (29%)7.5 Snack15.4 (4%)1 Malam90.2 (24%)6 Total gram CHOUnit serving CHO 54(26%) (17%)2 60 (29%)4 8 (4%)1 49 (24%) Kebiasaan mkn = g CHOKebutuhan = g CHO

51 Steps to Count Carbohydrate Counting 1. Step 1 : Make healthy food choices 2. Step 2 : Focus on carbohydrate 3. Step 3 : Set carbohydrate goals 4. Step 4 : Determine carbohydrate content 5. Step 5 : Monitor effect on blood glucose level

52 Step 4 : Determine carbohydrate content 1. Write down what you eat and drink throughout the day 2. Be sure to note the portion sizes 3. Record the grams of carbohydrate in these foods and drinks.

53 Steps to Count Carbohydrate Counting 1. Step 1 : Make healthy food choices 2. Step 2 : Focus on carbohydrate 3. Step 3 : Set carbohydrate goals 4. Step 4 : Determine carbohydrate content 5. Step 5 : Monitor effect on blood glucose level

54 Step 5 : Monitor effect on blood glucose level  Work with your health care team to correct blood glucose levels that are too high or too low

55


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