a. Since diabetes is a disorder of the body’s metabolism, the diabetic must maintain a carefully balanced routine of diet, exercise, and medication (insulin or oral hypoglycemic agents).

Diet is the most important factor in the control of diabetes.

(1) Diet is calculated by the patient’s physician and is based on the age, sex, health, activity level, and dietary habits of the patient.

(2) Diet consists of controlled amounts of carbohydrate, protein, and fat calories.

(3) Dietary allowances are normally divided among 3 meals and one or more snacks. For example: breakfast, lunch, dinner, and an evening snack.

b. The American Diabetic Association (ADA) has devised a diet using six “exchange lists” that outline equivalent foods that may be exchanged for one another. This allows the patient a variety of food selections and menu choices in meal planning.

(1) Foods may be exchanged within each list, but foods cannot be exchanged from one list to another.

(2) The six exchange lists are:

(a) Milk.

(b) Vegetables.

(c) Fruits.

(d) Breads.

(e) Meats.

(f) Fats.

c. Illness, injury, infection, pregnancy, stress, overexertion, and strenuous exercise are all capable of disrupting the metabolic balance of the diabetic. Therefore, alterations in dietary requirements and medication dosages will be necessary. The status of the hospitalized diabetic patient should be evaluated regularly, as the metabolic balance may get out of control rapidly. Evaluation is routinely accomplished by scheduled testing of the patient’s urine, and occurs as a part of daily nursing care.

d. Nursing implications.

(1) Test urine on schedule and use the correct procedure. (Refer to para 1-1-67d.)

(2) Reinforce dietary instruction provided by the dietician. Emphasize the consequences of deviation from the prescribed diet.

(3) Note and document what the patient has eaten at each meal. Failure to consume the full meal provided will result in a metabolic imbalance that could lead to a hypoglycemic reaction.

(4) Do not permit the patient to eat anything other than his prescribed diet. Extra, unauthorized food may precipitate a hypoglycemic reaction.