Dialysis

While survival on dialysis continues to improve, diabetic patients still do less well than non-diabetic patients (6). Results from the Italian Cooperative Peritoneal Study Group Registry show the 10-year patient survival for the 301 diabetic patients to be less than half that of the 1689 non-diabetic subjects (20.6 vs 55.6 ) (7). Higher mortality rates among diabetic patients receiving HD also occur (8), but with good glycaemic control these rates can be improved (9). Peritoneal dialysis is the...

The Optimal Mix Of Dietary Carbohydrate And Fat For

The diet for the diabetic mother needs to limit excess maternal-foetal transfer of glucose. As post-prandial hyperglycaemia is the time of maximal maternal-foetal glucose transfer, treatment interventions need to target this period (6). Controversy exists on how best to achieve this. Some authorities recommend limiting carbohydrate at the expense of increasing dietary fat, while others favour high-carbohydrate diets with a low glycaemic response. It is the authors' belief that promoting diets...

The Satiety Value Of Highcarbohydrate Diets

The satiating capacity of high-carbohydrate diets may be the major explanation for weight control benefits. The energy density of foods strongly influences the amount of food people consume and consequently influences body weight (61). High-fat foods are energy dense, very palatable and less satiating, a combination which makes them easy to 'passively overconsume' (62). On the other hand, less refined, 'natural' high-carbohydrate foods (legumes, wholegrains, fruits and starchy vegetables) are...

Energy Gains and Losses from Glucose Fluxes During Dialysis

Energy requirements for CAPD patients are partially met from absorbed dialysate glucose. Requirements from dietary intake are therefore lower at 30 kcal kg body weight (25 kcal kg if obese) and 25-30 kcal kg body weight if older than 65 years (21). Patients absorb approximately 70 of dialysate glucose, amounting to 300600 kcal or 2.5-17 g of glucose per hour during dwell times (22) (See table 15.4). Bag volumes range from 1 to 3 litres, with higher dextrose concentrations and larger volumes...

References

Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus progressive requirement for multiple therapies. UK Prospective Diabetes Study (UKPDS) Group. J Am Med Assoc 1999 281 (12) 2005-2012. 2. The Diabetes Control and Complications Trial Research Group The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New Engl...

Morbidity And Mortality

Transplantation provides the best renal replacement option for diabetic patients with ESRF, improving the quality of life (3,4), and resulting in less neuropathy and anorexia. Unfortunately, renal transplantation does not improve pre-existing metabolic conditions such as dyslipidaemia or bone disease. These continue to progress and contribute to the long-term morbidity and mortality. The medications used to prevent graft rejection also contribute to metabolic risk factors, including weight gain...

List of Contributors

Nutrition and Dietetic Department, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK Human Nutrition Unit, Department of Biochemistry, University of Sydney, NSW 2006, Australia Research Dietitian, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK Nutrition and Dietetic Department, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK CLEATOR, JACQUELINE Diabetes and Endocrinology Clinical Research Group, Clinical Sciences Centre, University Hospital Aintree, Longmoor...