The Death of the “1800-Calorie ADA Diet”
- Irl B. Hirsch, MD, Editor
A patient of mine was recently admitted into the hospital with pneumonia. The patient also had type 2 diabetes, and over the years he had worked quite diligently to maintain excellent glycemic control. Unfortunately, he developed metastatic cancer and likely only has a few months to live.
His wife called me extremely concerned about his diabetes treatment while he was hospitalized. Besides having all of his insulin stopped (he was receiving ∼20 units of insulin lispro with meals and 30 units of insulin glargine at bedtime), the family was quite concerned about the diet ordered for him. He had received an 1800-calorie diet, presumably endorsed by the American Diabetes Association (ADA) because it was ordered as an “1800-calorie ADA diet.”
When I asked his wife what the problem with the food was, she explained that he had been consuming many more calories lately to try to maintain both his nutritional status and hydration as well as possible. At home, he was drinking not only high-calorie supplements, but also non-diet drinks for extra calories. All of this time at home, he had maintained his glucose levels between 100 and 200 mg/dl to avoid glycosuria, calorie wasting, …
