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Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648 ...

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Gary Scheiner MS, CDE Gary Scheiner MS, CDE Owner & Clinical Director Owner & Clinical Director Integrated Diabetes Services LLC Integrated Diabetes Services LLC (877) 735-3648 (877) 735-3648 www.integrateddiabetes.com www.integrateddiabetes.com [email protected] [email protected] Use of Glycemic Index In Diabetes Management
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Page 1: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Gary Scheiner MS, CDEGary Scheiner MS, CDEOwner & Clinical DirectorOwner & Clinical Director

Integrated Diabetes Services LLCIntegrated Diabetes Services LLC(877) 735-3648(877) 735-3648

www.integrateddiabetes.comwww.integrateddiabetes.comgary@[email protected]

Use of Glycemic Index In Diabetes Management

Page 2: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.
Page 3: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs

Carbohydrate…….rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols….moderate digestion, partial absorption as glucose (50%) Protein……………..slow digestion, partial conversion to glucose* (~40%)  Fat……………………slow digestion, little conversion to glucose** (0%)

Timed Effect on Blood Sugar Levels

* In absence of dietary carbs ** may cause insulin resistance in large qty

Page 4: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

MEET THE CARBS!

Fruit Fruit Juice Candy Regular Soda Punch Wine

Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar

Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly

Page 5: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

MEET THE CARBS!

• Potatoes• Rice• Noodles/Pasta• Cereal• Oatmeal• Bread

• Tortillas• Pancakes• Waffles• Crackers• Bagels• Pizza

• Beans• Corn• Pretzels• Chips• Popcorn• Beer

Page 6: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

The “fate” of dietary carbohydrates

 

 

Simple Carbohydrates (sugars)

Complex Carbohydrates (starches)

BloodGlucose

Page 7: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Does the Type of Carbohydrate Matter?

Glycemic IndexGlycemic Index

• All carbs (except fiber) convert to All carbs (except fiber) convert to blood glucose eventuallyblood glucose eventually

• G.I. Reflects the magnitude of blood G.I. Reflects the magnitude of blood glucose rise in the first glucose rise in the first 2 hours2 hours

• G.I. Number is % of rise relative to G.I. Number is % of rise relative to pure glucose (in dextrose form) pure glucose (in dextrose form)

Page 8: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Glycemic Index (contd.)Glycemic Index (contd.)

Example:

SpaghettiGI = 37• 37% of spaghetti’s

carbs turn into blood glucose in the first 2 hours.

• The rest will convert to blood glucose over the next several hours.

Page 9: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Glycemic Index (contd)Glycemic Index (contd)

0 hrs 1 hr 2 hrs 3 hrs 4 hrs 5 hrs 6 hrs

High GI

Med GI

Low GI

Page 10: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Glycemic Index ValuesBREAD/CRACKERSBagel 72Crispbread 81Croissant 67French baguette 95Graham Crackers 74Hamburger bun 61Kaiser roll 73Melba toast 70Pita bread 57Pumpernickel 51Rye, dark 76Saltines 74Sourdough 52Wheat Thins 67Wheat Bread, 68White Bread 71 CAKES/COOKIES/MUFFINSAngel Food Cake 67Banana Bread 47Blueberry Muffin 59Chocolate Cake 38Corn Muffin 102Cupcake with icing 73Donut 76Oat Bran Muffin 60Oatmeal cookies 55Pound Cake 54Shortbread cookies 64Vanilla wafers 77 CANDYChocolate 49Jelly beans 80Lifesavers 70M & M, peanut 33Nestle Crunch 42Skittles 69Snickers Bar 40Twix Bar 43   

CEREALS/BREAKFASTAll-Bran 42Bran Chex 58Cheerios 74Corn Flakes 83Cream of Wheat 70Crispix cereal 87Golden Grahams 71Grape Nuts 67Oatmeal 49Pancakes 67PopTarts 70Puffed Wheat 67Raisin Bran 73Rice Krispies 82Shredded Wheat 69Special K 66Total 76Waffles 76 COMBINATION FOODSChicken Nuggets 46Fish fingers 38Macaroni & Cheese 64Pizza (cheese) 60Sausages 28Stuffing 74Taco shells 68 DAIRYChocolate milk 34Custard 43Ice cream, vanilla 62Ice Cream, choc. 68Milk, skim 32Milk, whole 27Pudding 43Yogurt, low fat 33

FRUITS & JUICESApple 38Apple juice 41Banana 55Cantaloupe 65Cherries 22Cranberry Juice 68Fruit cocktail 55Grapefruit 25Grapes 46Kiwi 53Mango 56Orange 44Orange juice 52 Peach 42Pear 37Plum 39Raisins 64Watermelon 72 LEGUMESBaked beans 48Black beans 30Black-eyed Peas 42Butter beans 30Chick peas 33Lentils, red 25Lima Beans 32Pinto Beans 45Red kidney beans 19 PASTA/RICEBrown Rice 55Couscous 65Fettucini 32InstantRice 87Long grain Rice 56Macaroni 45Spaghetti, white 41Spaghetti, wheat 37Tortellini 50Risotto 69

SNACK FOODSCorn Chips 74Granola Bars 61NutriGrain bars 66Peanuts 15Popcorn 55Potato Chips 54Pretzels 81Rice Cakes 77 SOUPSBlack Bean 64Green Pea 66Lentil 44Minestrone 39Split Pea 60Tomato 38 SPORTS BARS/DRINKSGatorade 78Power Bar 58 SUGARS & SPREADSGlucose tablets 102Corn syrup 62Honey 58Strawberry Jam 51Syrup 66Table Sugar 64

VEGETABLESFrench fries 75Potato, baked 85Potato, instant 83Potato, mashed 91Potato, boiled 88Carrots, boiled 49Carrots raw 47Corn 46Sweet potato 44Tomato Juice 38

Page 11: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

What About MIXED Meals?

• Tends toward G.I. of primary food in meal (i.e. bread in sandwich)

• Eating low-g.i. food first lowers G.I. of entire meal

Page 12: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

G.I. Is NOT An Exact Science!

Vaai@bL$

• Food combinations• Quantity being consumed• Time since last meal• Recent & planned physical activity• Individual food sensitivities• The winner in the 3rd race at Belmont

Page 13: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

G.I. Gereralization

Slow Stuff Average Stuff

Fast Stuff

PastaLegumes

Salad VeggiesDairy

Chocolate

FruitJuicePizzaSoupCake

Breads/CrackersSalty Snacks

PotatoesRice

CerealsSugary Candies

Page 14: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

If All Carbs Turn Into Glucose Eventually, Why Is Glyemic

Index Important?

Page 15: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

1. Satiety• Low G.I. =

Slower Gastric Emptying

• Leads to Less Consumption, Smaller Portions

• Less Tendency to “Graze”

Page 16: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Low Glylcemic-Index Foods Are More Satisfying!

Jackie Scheiner

Age 1

Page 17: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

2. Mealtime Insulin Timing

• Goal is to match insulin action to food’s effects, prevent high & low BG

– High G.I.: 15-30 min prior

– Moderate G.I.: 0-15 min prior

– Low G.I.: 0-15min after

Page 18: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Normal Pump Bolus with Low-G.I. Meal:

• Insulin peaks too early (hypoglycemia)• Insulin dissipates too soon (hyperglycemia)

Page 19: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Square/Extended/Long Bolus• Entire bolus is delivered gradually over 30min – 8 hrs• 1 -2 hours is common

Insulin Pump Options

Page 20: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Dual/Combo/Combination Bolus• Part of bolus delivered up-front, remainder over time• 30% Up-Front is common, remainder over 2 hrs

Insulin Pump Options

Page 21: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

3. Reducing Post-Meal Spikes

• Glucose variability is associated with increased complication risk, emotional distress, and diminished physical & intellectural performance

• Injected/infused “rapid” insulin is much slower than insulin produced by the pancreas

• The amylin hormone is lacking or deficient

Page 22: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

3. Reducing Post-Meal Spikes

LOW G.I. FOODS PRODUCE FLATTER BGs!

Diabetes Self-Management, August, 2006

Page 23: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Factors that lower G.I.Factors that lower G.I.

Fiber Fat Temperature• Solid (vs. liquid)• Acidity• Non-Processed• Type of carb

Fastest Glucose

Dextrose

Starch (branched-chain)

Sucrose/Corn Syrup

Fructose

Starch (straight-chain)

Lactose

Galactose

Slowest Sugar Alcohols

Page 24: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Starch Structure Affects G.I.

“branched chain” G – G – G – G – G - G G – G / \ /G – G G G – G – G G – G – G \ / \ / G – G – G – G – G – G G – G – G – G – G – G \ \ G – G – G G – G – G – G – G

“straight chain”G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G

Page 25: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Examples: Use of GIExamples: Use of GI

Meal High-GI Options Lower-GI Options

Breakfast Cereal

Bagel/Toast

Waffle

Pancakes

Muffins

Oatmeal

Milk

Whole Fruit

Nuts

Yogurt

Page 26: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Examples: Use of GIExamples: Use of GI

Meal High-GI Options Lower-GI Options

Lunch White Bread Fries

Tortillas

Fast Food

Sourdough Bread

Pumpernickel

Carrots & Peas

Bean Salad

Soup

Page 27: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Examples: Use of GIExamples: Use of GI

Meal High-GI Options Lower-GI Options

Dinner (sides) Rice

Mashed Potato

Baked Potato

Rolls

Pasta

Beans

Sweet Potato

Tomato

Page 28: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Examples: Use of GIExamples: Use of GI

Meal High-GI Options Lower-GI Options

Snacks Pretzels

Chips

Crackers Doughnuts

Popcorn

Nuts

Ice Cream

Chocolate

Page 29: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

4. Treating Hypoglyemia

• High-GI foods convert to glucose rapidly (faster recovery)

• Lower-GI foods take longer to work, may lead to over-treatment and significant post-treatment hyperglycemia

Page 30: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Hypoglycemia Treatment

High-GI Foods• Dry Cereal• Pretzels• Graham Crackers• Vanilla Wafers• Jelly Beans• Gatorade• Regular (non-diet) Soda

Page 31: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Hypoglycemia TreatmentDEXTROSE Rules! (GI=100)

Dex Products•Glucose Tablets•Glucose Gel•Liquid Blasts

Dextrose-Sweetened Candies•Sweet Tarts•Smarties•Spree•Air Heads•Nerds•Runts

Page 32: Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648  gary@integrateddiabetes.com.

Glycemic Index References

Dr. Jennie Brand-Miller

The “New Glucose Revolution”Series


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