7.0.0.0 Med­i­cal Nu­tri­tion Ther­a­py in Hosp.

The goals of med­i­cal nu­tri­tion ther­a­py in the hos­pi­tal are to pro­vide ad­e­quate calo­ries to meet metabol­ic de­mands, op­ti­mize glycemic con­trol, ad­dress per­sonal food pref­er­ences, and fa­cil­i­tate cre­ation of a dis­charge plan. The ADA does not en­dorse any sin­gle meal plan or specified per­cent­ages of macronu­tri­ents. Cur­rent nu­tri­tion rec­om­men­da­tions ad­vise in­di­vid­u­alization based on treat­ment goals, phys­i­o­log­i­cal parame­ters, and med­i­ca­tion use. Con­sis­tent car­bo­hy­drate meal plans are pre­ferred by many hos­pi­tals as they fa­cil­i­tate match­ing the pran­di­al in­sulin dose to the amount of car­bo­hy­drate con­sumed (59). Re­gard­ing en­ter­al nu­tri­tion­al ther­a­py, di­a­betes-‍specific for­mu­las ap­pear to be su­pe­ri­or to stan­dard for­mu­las in con­trolling postpran­di­al glu­cose, A1C, and the in­sulin re­sponse (60). When the nu­tri­tion­al is­sues in the hos­pi­tal are com­plex, a reg­is­tered di­eti­tian, knowl­edgeable and skilled in med­i­cal nu­tri­tion ther­a­py, can serve as an in­di­vid­u­al in­pa­tient team mem­ber. That per­son should be re­spon­si­ble for in­te­grat­ing in­for­ma­tion about the pa­tient’s clin­i­cal con­di­tion, meal plan­ning, and lifestyle habits and for es­tab­lish­ing re­al­is­tic treat­ment goals after dis­charge. Or­ders should also in­di­cate that the meal de­liv­ery and nu­tri­tion­al in­sulin cov­er­age should be co­or­di­nat­ed, as their variabil­i­ty often cre­ates the pos­si­bil­i­ty of hy­per­glycemic and hy­po­glycemic events.