Diet and Health Guidelines to Lower Risk of Diabetes

Presented by Janice Hermann, PhD, RD/LD

OCES Adult and Older Adult Nutrition Specialist

CarbohydratesBody breaks down carbohydrates (complex

and simple) into monosaccharidesMaltose = glucose + glucoseSurcrose = glucose + fructoseLactose = glucose + galactose

Fructose and galactose converted in the body to glucose

Glucose is form body uses for energy

Blood Glucose RegulationBlood glucose level must be closely regulatedHormones control blood glucose levels:

InsulinGlucagon

Blood Glucose RegulationWhen blood glucose levels are high

Pancreatic beta cells release insulin which helps glucose enter body cells so glucose can be:Used for energyStored as glycogen in liverConverted into triglycerides for storage

When blood glucose levels lowPancreatic alpha cells release glucagon:

Signals liver to release glucose from liver glycogen

Figure 4.8a

Blood Glucose Regulation: Insulin

Blood Glucose Regulation: Glucagon

Figure 4.8b

Blood Glucose Regulation

What Is DiabetesDiabetes is a condition that results in high

blood glucose levelsWhen someone has diabetes the body:

Makes little or no insulin,Doesn’t use insulin properly, or Both

As a result, body cells don’t get energy they need, and blood glucose levels stay high

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Diabetes SymptomsSymptoms are caused by high blood

glucose, may include:Frequent urinationIncreased hungerIncreased thirstBlurred visionFeeling tiredIrritability

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Types of DiabetesPre diabetesType 1 (5-10%)

Body doesn’t make insulinMust take insulinDevelops rapidly

Type 2 (90-95%)Body doesn’t make enough insulin, or the body

doesn’t respond to insulinWeight control may helpMay still need medicationDevelops slowly

Gestational

Types of DiabetesPre Diabetes

Overweight increases risk of developing type 2 diabetes by decreasing body's ability to use insulinInsulin resistanceBody produces insulin; however, body cells resist action of

insulinBlood glucose levels begin to increase

Impaired glucose tolerance and/or impaired fasting glucose

Types of DiabetesPre Diabetes

At first, body responds to insulin resistance by having beta cells produce more insulin to keep blood glucose levels downCan lead to high blood insulin levels Body may be able to keep blood glucose levels down by

producing extra insulin for several yearsEventually beta cells begin to wear out and

produce less insulin, which can potentially lead to development of type 2 diabetes

Types of Diabetes

Pre DiabetesWhere extra weight is carried is a factor in

insulin resistanceUpper body fat cells are more likely to be large insulin

resistant fat cellsLower body fat cells are more likely to be smaller and

respond normally to insulin

Types of DiabetesType 1 (5-10%)

Autoimmune disorder: defect in which immune cells attack and destroy the insulin producing pancreatic beta cells

SymptomsHigh blood glucoseIncreased urinationIncreased thirstWeight loss DehydrationFeeling tiredIrritability

Types of DiabetesType 2 (90-95%)

Usually develops after 40 years of age as the pancreatic beta cells progressively lose function with ageMost people with type 2 diabetes are overweight

However, type 2 diabetes is also being seen in overweight childrenClosely related to overweight and inactivity

Estimates are 30 to 50 percent of people with type 2 diabetes are undiagnosed

Types of DiabetesGestational Diabetes

Glucose intolerance that develops during pregnancy (usually 2-3 trimester)7% of all pregnancies

Insulin antagonist hormone levels increase and insulin resistance occurs

Blood glucose control usually returns to normal after delivery

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Diabetic Complications

High blood glucose can damage:Nerves, eyes, kidneys, heart, and blood vessels

This damage can lead to:Blindness, high blood pressure, heart disease,

kidney disease, and amputationsKeeping blood glucose in control can stop or

prevent development of diabetic complications

Screening RecommendedPeople with impaired glucose tolerance and/or impaired

fasting glucose People over age 45 People with a family history of diabetes People who are overweight People who do not exercise regularly People with low HDL cholesterol or high triglycerides,

high blood pressure Certain racial/ethnic groups (Non-Hispanic Blacks,

Hispanic/Latino Americans, Asian Americans, Pacific Islanders, and American Indians and Alaska Natives)

Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

Screening RecommendedChildren and Adolescents should be screen if

overweight or at-risk-for-overweight and if have two of the following risk factors:Family history of diabetes Low HDL cholesterol or high triglycerides, high blood

pressure Certain racial and ethnic groups (e.g., Non-Hispanic

Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives)

Signs of insulin resistance (acanthosis nigricans – gray/brown skin pigmentation)

Preventing DiabetesType 1 Diabetes

No nutritional recommendations can be made for prevention of type 1 diabetes

Research is investigating if breast feeding over bottle feeding may be beneficial

Preventing DiabetesType 2 Diabetes

Weight management (diet and physical activity)Diabetes Prevention Program (oral medication vs

lifestyle intervention)31% decrease in progression to diabetes in medication

group58% decrease in progression to diabetes in lifestyle

groupModest weight loss (5-10%)Modest physical activity (30 minutes daily)

Diabetes TreatmentGoals of diabetes treatment are to achieve:

Control blood glucoseControl blood lipidsControl blood pressurePrevent or delay large and small blood vessel

and nerve damageDiabetes Control and Complications Trials have

shown controlling blood glucose is effective in preventing or delaying diabetic complications

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Diabetes TreatmentThe goal of diabetes treatment is to keep

blood glucose in control through: Diabetic Meal Physical Activity

Plan

Medication

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Diabetes Health Care TeamPeople with diabetes should receive medical

care from a physician-coordinated team. Such teams may include, but are not limited to:

Physician Mental Health Professional

Nurse Ophthalmologist/OptometristDietitian PodiatristPharmacist DentistDiabetes Educator DermatologistExercise Physiologist

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Diabetes Health Care TeamMost important person on a diabetes health

care team is the person with diabetesA lot of diabetes care is self-care. The person

with diabetes is the one who knows:How feelsIf following meal planIf physically activeIf taking medicationIf testing blood glucose andIf problems start to occur

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Standards of CareTaking care of diabetes will allow people with

diabetes to enjoy life with few complicationsThe American Diabetes Association provides

standards of care for people with diabetesFor detailed information on standards of

diabetes care contact local American Diabetes Association at www.diabetes.org

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Standards of CareAfter being diagnosed with diabetes, people

with diabetes should work with their physician and health-care team to make a diabetes care plan

A diabetes care plan needs to be individualized to fit the person’s lifestyle

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Standards of CareA diabetes care plan should be

individualized and include information on:Visiting your doctor Eye care

Management goals Foot careMedications Dental careDiabetic meal plan Other professionalsPhysical activity Sick day planGlucose testing Stress management

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Standards of CareVisiting doctor

Every 3- 6 monthsReview blood glucose recordsA1c Blood pressureWeightFoot check

Blood Glucose Goals Normal Goal*Fasting or before meals <100 mg/dl 70-130

mg/dl2 Hr Post Meal <140 mg/dl <180 mg/dlHbA1c <6% <7%

*varies

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Standards of CareVisiting doctor

Every yearTotal cholesterol, LDL cholesterol, HDL cholesterol,

triglyceridesKidneys (urine analysis for protein in urine)Dilated eye examReview meal planFlu shotUpdate with diabetes educator

Blood Lipid and Blood Pressure GoalsLipids

Cholesterol < 200 mg/dlLDL Cholesterol < 100 mg/dlHDL Cholesterol > 40 mg/dl (men) > 50 mg/dl (women)Triglycerides < 150 mg/dl

Blood PressureSystolic <130 mm Hg

Diastolic < 80 mm Hg

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Standards of CareDiabetes management goals

Both short and long-term goalsDiabetes management goals are individualized

depending on diabetes control and other health conditions

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Standards of CareIf need medications, education needed to:

Learn how to use themHow they work with diet and physical activityWhat to do if blood glucose goes too high or low

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MedicationInsulinOral mediationsTaking medication does not replace healthful

habits, still need to follow diabetic meal plan and participate in physical activity

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Standards of CareA diabetic meal plan individualized to fit

person’s lifestyle, diabetes, and other health conditions - education is needed to:Know how the diet works with medication and

physical activityHow to follow the diabetic meal plan at home,

at work, and when eating outKnow whether alcohol fits into the meal planWhat to eat when sick, on how being sick

affects blood glucose

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Diabetic Meal PlanA diabetic meal plan focuses on providing a

healthy diet that:Controls blood glucose and Prevents diabetic complications

Diabetic Meal PlanThere is no one specific diabetic meal plan, a

diabetic meal plan is developed to meet your own special needs:Individual food likesDaily scheduleMedications usedOther health issues:

Glucose controlWeightBlood lipidsBlood pressure

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Diabetic Meal PlanA healthy diet includes a variety of foods

from all the food groups. In general, a diabetic meal plan is:Low in fatModerate in proteinHighs in complex carbohydrates like beans,

vegetables and grains (such as breads, cereals, noodles, and rice)

ConsistencyA diabetic meal plan provides a consistent

amount of carbohydrate from day to day, spaced evenly throughout the day to prevent wide changes in blood glucose

Some methods used to provide the consistency of a diabetic meal plan are:Plate methodDiabetic pyramidDiabetic exchange systemCarbohydrate counting

Consistency

Eating too much carbohydrate at one time can raise blood glucose too high.

Eating too little carbohydrate can lead to hypoglycemia, especially for people taking oral diabetic medication or insulin.

ConsistencyTo be consistent, it's best to:

Eat about the same number of calories each dayEat meals and snacks about the same time each daySpread meals and snacks throughout the dayNever skip mealsWatch portion sizes

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Individual ConsiderationsWeight lossCarbohydrateAlcoholFatSodiumProtein

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Weight LossFor many people with type 2 diabetes losing

weight is a big part of diabetes treatmentLosing weight can help body cells use insulin

betterFor people who are trying to lose weight their

diabetic meal plan will be moderately lower in calories and fat to help with weight loss

Losing weight and lowering fat intake can also help lower blood cholesterol and blood pressure

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Weight LossThe best way to lose weight is to:

Follow a healthy eating plan, moderately lower in calories (about 500 calories less per day) and

Increase physical activity (60 minutes per day)Healthy weight loss is slow

Maximum recommended weight loss is 1 to 2 pound per week

Many times, just a 10% weight loss can bring blood glucose into control for people with type 2 diabetes

Carbohydrate

Dietary carbohydrates include: Simple SugarsComplex Carbohydrates

Grains, Fruits, Milk and VegetablesFiber

During digestion all carbohydrates except fiber break down into simple sugars

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CarbohydrateIn the past, people with diabetes were told to

avoid sugarNow known that complex carbohydrates and

sugars have a similar effect on blood glucose levels The total amount of carbohydrate is the

issue, not just sugarPeople with diabetes can have sugar, but the

carbohydrate from foods containing sugar must be worked into the meal plan

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CarbohydratesThere are some problems with foods high in

sugarFoods high in sugar often don't provide other

important nutrients needed every dayFoods high in sugar are also often high in fat

Glycemic Index

Glycemic index is the blood glucose response to a food, this varies based on:Amount of carbohydrateNature of the starchCooking and processingFood form and particle sizeSeverity of glucose intoleranceFasting and pre-meal glucose concentration

Glycemic IndexHowever, although different carbohydrates

have different glycemic responses (glycemic index), there is limited long-term benefits of low glycemic index diets on blood glucose control (A1c).

Therefore there is insufficient evidence to recommend low glycemic index diets as a strategy in diabetes meal planning.

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Artificial SweetenersThe American Diabetes Association considers

FDA approved artificial sweeteners safe in moderation

Although artificial sweeteners do not provide significant calories, foods containing them may not always be lower in calories than similar products that contain sugars.

Sugar Alcohol

Sugar alcohols, are a group of low calorie, carbohydrate based sweeteners. They provide the taste and texture of sugar with about half the calories

Since sugar alcohols are only partially absorbed by the body they provide fewer calories than sugar

In large amounts sugar alcohols can cause gastrointestinal problems, such as diarrhea.

Sugar AlcoholsSome common sugar alcohols include:

ErythritolHydrogenated Starch Hydrolysates (Polyglycitol

and Polyglucitol)IsomaltLactitolMaltitolMannitolSorbitolXylitol

Fiber

Dietary fiber has many important health benefits

Soluble fiber delays glucose absorption and has been promoted to help with blood glucose control

FiberEarly short-term studies using > 30 g

fiber/day suggested a positive effect of fiber on glucose control

However, later studies have shown larger amounts of fiber, approximately 50 g/day, are necessary to have beneficial effects on blood glucose and cholesterol

It is unlikely people could maintain a fiber intake of 50 g/day

FiberTherefore, there is no reason to recommend

people with diabetes consume greater amounts of fiber than the general public

The Adequate Intake for dietary fiber is 14 grams dietary fiber per 1,000 caloriesEqual to 28 grams fiber for a typical 2,000 calorie

dietGuidelines for increasing dietary fiber are:

Go graduallyDrink plenty of water

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AlcoholMost people in good diabetes control can

safely have a drink with a meal every so oftenAlcohol can cause low blood glucose,

especially for people using medicationIt is important to test blood glucose level,

before, during and after drinkingNever drink an alcohol beverage on an empty

stomach

Alcohol and HypoglycemiaDiabetic medications increase the risk of

alcohol related hypoglycemia because these work to remove glucose from the blood

Normally when blood glucose start to fall, the liver releases glucose into the blood to keep the blood glucose from going too low

When alcohol is consumed, the liver works to clear the alcohol and doesn’t release glucose into the blood

As a result, if blood glucose is falling one can quickly go into hypoglycemia

Alcohol and HypoglycemiaAlcohol after hard physical activity

increases the risk of hypoglycemia:Physical activity helps to lower blood glucoseAfter physical activity the body replaces muscle

glucose with glucose from the bloodThis can cause blood glucose levels to start

falling. If the liver doesn’t release glucose hypoglycemia can occur

Alcohol and HypoglycemiaGlucagon shots are used to treat sever

hypoglycemia caused by too much insulin, they will not help sever hypoglycemia caused by alcohol.

Glucagon works by causing the liver to release more glucose into the blood. But the liver will not release more glucose into the blood while clearing alcohol.

Alcohol Not RecommendedAlcohol is not recommended:

If blood glucose is not in control.If trying to lose weight.If have diabetic nerve damage.

Alcohol can increase symptoms of nerve damage. If have high blood pressure

Alcohol can raise blood pressure.If have high triglycerides

Alcohol promotes the liver to make more triglycerides.

Guidelines for AlcoholNever drink on an empty stomach Limit to 1 drink/day for women and 2

drinks/day for menTest blood glucose before having a drink and

following to watch for falling blood glucoseTest blood glucose before going to sleep to

see if a snack is needed to avoid going into hypoglycemia while sleeping

Guidelines for AlcoholWear a medical diabetes identification

braceletSymptoms of hypoglycemia include slurred

speech and confusionThese symptoms are similar to symptoms of too

much alcohol

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FatIncreased risk of high blood cholesterol,

triglycerides and heart disease is a diabetes complication

If a person is at risk for high blood cholesterol their diabetic meal plan may be modified to be low in fat, saturated fat and trans fat

Weight loss also helps lower blood cholesterol and triglycerides for people who are over weight

FatFor all persons; recommended total fat,

saturated fat, and cholesterol intakes are:Total fat – Between 20 to 35 percent of caloriesSaturated fat - Less than 10 percent of caloriesCholesterol - Less than 300 milligrams per dayTrans fatty acid intake should be as low as

possible

FatIf LDL cholesterol is > 100 mg/dl, some

people may benefit from lower intakes:Saturated fat - Less than 7 percent of caloriesCholesterol - Less than 200 milligrams per dayTrans-fatty acid intake should be as low as

possible

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SodiumHigh blood pressure is a diabetes

complicationAs a result, if a person is at risk for high blood

pressure their diabetic meal plan may be modified to be low in sodium

SodiumHigh sodium intake may contribute to high

blood pressure in “salt sensitive” peoplePeople who have diabetes tend to be more

“sodium sensitive”

SodiumDietary Guidelines recommend

People reduce daily sodium intake to less than 2,300 mg (approximately 1 teaspoon of salt) and

Further reduce sodium intake to less than 1,500 mg sodium among those:51 years of age or olderof any age who are African American or have

hypertension, diabetes or chronic kidney diseaseWeight loss will also help lower blood

pressure for people who are over weight

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ProteinKidney disease is also a complication of

diabetesIf a person has kidney disease the protein

content of their diabetic meal plan may be modified

Protein

No evidence typical protein intake (15-20% of calories) must be modified if kidney function is normal

A higher incidence of protein in the urine has been observed with protein intakes greater than 20% of caloriesMay be an indication to keep protein intake

below 20% of calories

High Protein DietsHigh protein diets are promoted for weight

lossLong term effects of high protein weight-

loss diets on kidney function is a concernEffect of high protein diets, high in saturated

fat, on LDL cholesterol is a concern.Although initially weight may be lost,

unknown whether weight loss is maintained better than with other low calorie diets

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Standards of CareRecommendations for physical activity and

education on:Effect of physical activity on blood glucoseHow physical activity works with diet and

medicationWhat to do if change the level of physical

activity

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Physical ActivityPhysically active has many benefits:

Helps body cells take in glucoseLowers blood glucose levelsMay lower the amount of medication neededHelps with weight lossLowers blood cholesterolLowers blood pressureLower stress

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Standards of CareEducation on:

Self-testing blood glucose and urine ketonesKeeping blood glucose recordsHow to treat high and low blood glucose reactions

Glucose TestingIt is important to check blood glucose to see

how the treatment plan is workingTesting blood glucose helps people will learn

how the food they eat and physical activity affects their blood glucose level

If blood glucose is not in control it may mean a person needs to change their meal plan, physical activity, or medication.

Glucose TestingVarious glucose testing times

Before meals2 hours after mealsBedtimeDuring the night

Glucose Monitoring

Fasting glucose normal/HbA1C highAble to bring blood glucose down overnight, but

blood glucose high at other times, possibly after meals

Dawn phenomenonIncreased hepatic glucose output overnight (dawn

phenomenon)-common with type 2 diabetesEvening snackOral medication that affect liver glucose output

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Standards of CareEducation on eye complications and a plan

for seeing an eye doctor annually

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Standards of CareEducation on foot complications and a plan

for seeing a foot doctorEducation is also needed on what to do if a

person has a sore on your foot

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Standards of CareEducation on caring for teeth, gums, and

mouth and a plan for seeing a dentist

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Standards of CareEducation on how stress affects blood

glucose and a plan for seeing a mental health professional

Information on other health professionals a person may need to see

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Living With DiabetesA diabetes meal plan, medication and

physical activity program work together to keep blood glucose in control

Monitor blood glucose frequently to see how diabetes treatment plan is working

Keeping blood glucose in control will help individuals with diabetes feel better now and stay healthy in the future

Diabetic Meal Plan MethodsSome methods used to provide the

consistency of a diabetic meal plan are:Plate methodUSDA Daily Food Plan and MyPlateDiabetic exchange systemCarbohydrate counting

Plate Method¼ plate: grains or starchy foods such as rice,

pasta, potatoes, corn, or peas¼ plate: protein foods such as meat, fish,

poultry, or tofu ½ plate: non-starchy vegetables

such as broccoli, carrots, cauliflower, salad and tomatoes

Add a glass of non-fat milk and a small roll or piece of fruit

USDA Daily Food PlanGuide for planning a healthful dietBased on 2010 Dietary GuidelinesTypes and amounts of food for a healthful dietLimits for fats, sugars and sodium

USDA Daily Food Plan: Food GroupsGrainsVegetablesFruitsDairyProtein foods

MyPlate

USDA Daily Food Plan Recommended Amounts USDA Daily Food Plan recommended amounts is

based on your estimated calorie needsYour estimated calorie needs is based on your:

GenderAgePhysical Activity

Web site: www.choosemyplate.gov

Estimated Calorie NeedsGender Age (years) Sedentary Moderately Active Active

Child 2-3 1,000-1,200 1,000-1,400 1,000-1,400

Female 4-8 1,200-1,400 1,400-1,600 1,400-1,800

9-13 1,400-1,600 1,600-2,000 1,800-2,200

14-18 1,800 2,000 2,400

19-30 1,800-2,000 2,000-2,200 2,400

31-50 1,800 2,000 2,200

51+ 1,600 1,800 2,000-2,200

Male 4-8 1,200-1,400 1,400-1,600 1,600-2,000

9-13 1,600-2,000 1,800-2,200 2,000-2,600

14-18 2,000-2,400 2,400-2,800 2,800-3,200

19-30 2,400-2,600 2,600-2,800 3,000

31-50 2,200-2,400 2,400-2,600 2,800-3,000

51+ 2,000-2,200 2,200-2,400 2,400-2,800

Daily Food Plan For Different Calorie Levels

Calories 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000

Grains (oz) 5 5 6 6 7 8 9 10 10

Vegetables (cups) 1 ½ 2 2 ½ 2 ½ 3 3 3 ½ 3 ½ 4

Fruits (cups) 1 ½ 1 ½ 1 ½ 2 2 2 2 2 ½ 2 ½

Dairy (cups) 2 ½ 3 3 3 3 3 3 3 3

Protein foods (oz)

4 5 5 5 ½ 6 6 ½ 6 ½ 7 7

Oils (tsp) 4 5 5 6 6 7 8 8 10

Solid Fats and Added Sugars (calories)

120 120 160 260 270 330 360 400 460

Sodium (mg) 2,300 2,300 2,300 2,300 2,300 2,300 2,300 2,300 2,300

Sodium if 51+, African American or have chronic disease

1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500 1,500

Grain GroupIn general 1 ounce from the grains group is:

1 slice of bread1 cup of ready-to-eat cereal½ cup of cooked rice, cooked pasta, or cooked

cereal

Consumer messageMake half your grains whole

Vegetable GroupIn general 1 cup from the vegetable group is:

1 cup of raw or cooked vegetables or vegetable juice

2 cups of raw leafy greens is considered as 1 cup from the vegetable group

Consumer messageMake half your plate

fruits and vegetables

Fruit GroupIn general 1 cup from the fruit group is:

1 cup of fruit or 100% fruit juice½ cup of dried fruit

Consumer messageMake half your plate

fruits and vegetables

Diary GroupIn general 1 cup from the dairy group is:

1 cup of milk, yogurt or soymilk1 ½ ounces of natural cheese2 ounces of processed cheese

Consumer message

Switch to fat-free or low-fat (1%) milk

Protein Foods GroupIn general 1 ounce from the protein foods

group is: 1 ounce of meat, poultry or fish¼ cup cooked dry beans1 egg1 tablespoon of peanut butter½ ounce of nuts or seeds

Consumer messageVary your protein

Fats, Sugars and SodiumAlthough not food groups the USDA Daily

Food Plan provides limits for fats, sugars and sodium.

Diabetic ExchangesCarbohydrates

StarchMilkFruitOther CarbohydratesVegetables

Meat and Meat SubstitutesFats

Nutrient Content of ExchangesCarbohydrate Protein Fat

CarbohydratesStarch 15 g 3 g 0-1 gFruit 15 g 0 g 0 gMilk 12 g 8 g 0-8 g

Other Carbohydrates 15 g varies varies Non-starchy Vegetables 5 g 2 g 0 g

Meat and Substitutes 0 g 7 g 0-8 gFats 0 g 0 g 5 g

Diabetic Exchanges and Carbohydrate Counting

Exchange Groups Grams Carbohydrate Carbohydrate ChoicesStarch 15 1Fruit 15 1Milk 12 1Other Carbohydrate 15 1Vegetable 5

Starch Exchange: 1 carbohydrate choiceContains breads, cereals, grains, pasta,

starchy vegetables (potatoes, corn, green peas, sweet potatoes), crackers, and snacks

Dried beans and lentils count as a starch and a very lean meat exchange

Some starchy foods prepared with added fat count as a starch and a fat exchange

1 Starch Exchange Contains

15 g carbohydrate3 g protein0-1 g fat80 calories

In General 1 Starch Exchange Is:1/2 cup of cooked cereal, grain, or starchy

vegetable1/3 cup of cooked rice or pasta1 ounce of a bread product1/2 cup cooked dried beans or lentils

Counts as 1 starch and 1 very lean meat exchange3/4 to 1 ounce of most snack foods

Some snack foods count as 1 starch and 1 fat

Fruit ExchangeThe fruit exchange list contains fruits and

unsweetened fruit juices1 Fruit Exchange Contains

15 g carbohydrate0 g protein0 g fat60 calories

In General 1 Fruit Exchange Is:1 small to medium fresh fruit1/2 cup canned fruit1/2 cup fruit juice1/4 cup dried fruit

Milk ExchangeContains milk and yogurtCheese is not included in the milk exchange

Cheese is in the meat and meat substitute exchange

Three milk exchange categories:Fat-free/Low-fat (1/2% or 1%)Reduced-fat (2%)Whole Milk

1 Milk Exchange Contains

Fat-free Reduced-fat WholeCarbohydrate 12 g 12 g 12 gProtein 8 g 8 g 8 g Fat 0-3 g 5 g 8 g Calories 90 120 150

In General 1 Milk Exchange Is:1 cup milk2/3 cup of fat-free or low-fat flavored yogurt

with a non-nutrative sweetener

Other Carbohydrates ExchangeContains many foods that contain sugar

(such as sweets, candy, and desserts) which used to be restricted in a diabetic diet

Now known that carbohydrates (bread, rice, pasta, fruits and vegetables) and sugars have a similar effect on blood glucose levels

Other Carbohydrates ExchangeThe total amount of carbohydrate is the

issue, not just sugarBut the carbohydrate from foods containing

sugar must be worked into the meal planHowever, foods high in sugar often don’t

provide other important nutrients and may be high in fat

Other Carbohydrates ExchangeOne other carbohydrate exchange

contains:15 g carbohydrateProtein variesFat variesCalories varies

Portion size varies depending on the food

Non-starchy Vegetable ExchangeContains non-starchy vegetables and

vegetable juicesStarchy vegetables including potatoes, green

peas, corn and sweet potatoes are not in the non-starchy vegetable exchange but are in the starch exchange

1 Non-starchy Vegetable Exchange Contains:5 g carbohydrate2 g protein0 g fat25 calories

In General 1 Non-starchyVegetable Exchange Is:

1/2 cup cooked or canned vegetables1/2 cup vegetable juice1 cup raw vegetables

Meat and MeatSubstitute Exchange Has four categories based on fat content:

Very LeanLeanMedium-FatHigh-Fat

Some foods, such as hot dogs, count as a high-fat meat exchange and a fat exchange

1 Meat and Meat Substitute Exchange Contains

Very Lean Lean Medium HighCarbohydrate 0 g 0 g 0 g 0 gProtein 7 g 7 g 7 g 7 gFat 0-1 g 3 g 5 g 8 gCalories 35 55 75 100

In General 1 Meat and Meat Substitute Exchange Is:1 ounce of meat, fish, poultry, or cheese1/2 cup dried beans, cooked (counts as a very

lean meat and a starch exchange)

Fat ExchangeContains margarine, butter, oils, and salad

dressingsContains monounsaturated fat,

polyunsaturated fat and saturated fat listsDiabetic meal plans low in fat or reduced in

calories will have the number of fat exchanges modified

1 Fat Exchange Contains:0 g carbohydrate0 g protein5 g fat45 calories

In General 1 Fat Exchange Is:1 teaspoon regular butter, margarine, or

vegetable oil1 tablespoon regular salad dressing

Free FoodsA food is considered free if it contains fewer

than 5 grams carbohydrate or 20 calories per serving

Example Meal Meal Number of ExchangesBreakfast 2 Starch

Meat Vegetable1 Fruit1 Milk1 Fat

Example Meal Meal Number of ExchangesDinner 3 Starch

3 Meat1 Vegetable1 Fruit1 Milk2 Fat

Carbohydrate CountingTwo ways to count carbohydrates

Carbohydrate gramsCarbohydrate choices

One carbohydrate choice is 15 grams carbohydrate

Carbohydrate Counting

Exchange Carbohydrate CarbohydrateGroups Grams Choices Starch 15 1Fruit 15 1Milk 12 1Vegetable 5Other Carbohydrates 15 1

Carbohydrate Grams or Choices For Calorie Levels

Calories 1800 1800% Carbohydrate 50% 60%Grams Carbohydrate 225 270Carbohydrate Choices 15 18

Example Meal Plan

Meal 225 g 15 Carbohydrate Carbohydrate

ChoicesBreakfast 45 g 3Lunch 60 g 4Snack 15 g 1Dinner 75 g 5Evening Snack 30 g 2

RecipesPink Cow Smoothie Exchanges Carbohydrate Choices1 C Raspberry Yogurt 1 milk 1 choice1 C Skim Milk 1 milk 1 choice1 Peach 1 fruit 1 choice1 Pkg Sweetener - -

Total 2 milk and 3 choices or 1 fruit exchange 45 g carbohydrate

Food Labels1 Cup Frosted Cereal 48 g carbohydrate3 carbohydrate choices 45 g carbohydrateor2 starch exchanges 30 g carbohydrate1 other carbohydrate ex 15 g carbohydrate Total 45 g carbohydrate

Food LabelsSugar Free Eskimo Pie 26 g carbohydrate2 carbohydrate choices 30 g carbohydrateor1 starch exchange 15 g carbohydrate1 milk exchange 12 g carbohydrate

Total 27 g carbohydrate

Food Labels: Fiber

Fiber is a type of carbohydrate that is not digested and absorbed like complex carbohydrates or simple sugars

If there is more than 5 grams fiber per serving subtract that from the total grams of carbohydrate to determine the amount of carbohydrate available

Food Labels: Sugar AlcoholsTo calculate the grams of available

carbohydrate in foods with more than 10 grams of sugar alcohol, subtract half the grams of sugar alcohol from the total carbohydrate grams

If all the carbohydrate in a food is from sugar alcohols and the total carbohydrate is less than 10 grams, it is considered a “free food”

Other Lifestyle FactorsEye CareFoot CareSkin CareMouth CareIllnessStressTravelMotivation

Living With Diabetes

Your diabetes meal plan, medication and physical activity program work together to keep your blood glucose in control.

Monitor your blood glucose frequently to see how you are doing.

Keeping your blood glucose in control will help you feel better now and stay healthy in the future.