The Diabetes Champion

Your Role in Medical Nutrition Therapy

Do you know? Based on statistics from

the Centers for Disease Control website, 17.0 million people in the United States, approximately 6.2% of the population, have diabetes. Of this 17 million people, 11.1 million are diagnosed and 5.9 million are undiagnosed.

Why are we concerned?

Cost of care

Complications of the disease

Quality of life

Objectives: The RN will be able to

identify patients nutrition learning needs

The RN be able to identify the foods that are classified as carbohydrates

The RN will learn the relationship between foods, macronutrients, and blood glucose control

The RN will be able to reinforce medical nutrition therapy for diabetes

Factors that affect Blood Glucose

Insulin and medications

Emotions

Activity

Sickness

DIET

What Carbohydrate Counting is Not

Based upon a system of food exchanges

Inflexible

Difficult to follow

Without consideration for each person’s individualized needs

The ADA Nutritional Guidelines Goals:

Focus upon achieving optimal metabolic outcomes as related to glycemia, lipid profiles, and blood pressure

Promote consumption of a healthy diet consisting of multiple servings of fruits, vegetables, whole grains, low-fat dairy products, fish, lean meats, and poultry

Provides guidelines so that the patient can Maintain a consistent day-to-day carbohydrate intake at meals and snacks

Enables the patient to Consume a calorie level to promote achievement of ideal body weight

Glucose Targets

RMC, AACE, AADE

ADA

Before Meals 70 to 110 90-130

2 hours post meals

less than 140 less than 180

A1C Less than 6.5%

less than 7%

Meal Planning

True/False

All white foods are bad for you?

People with diabetes can never eat sugar

Karo Syrup will cause diabetes

People with diabetes should not eat bread

People with diabetes can eat from all groups of foods

What nutrient drives serum glucose?

Classification of Foods

Vitamins and mineral provide the nutrients we need for metabolic functions, but no calories (energy)

The amount of carbohydrate, fat, and protein a food contains determine it’s food class and total calories (according to the portion size)

Carbohydrate, fat, and protein provide calories (energy) and also play significant roles in achievement of good health

Food Classifications

CHO grams

Protein grams

Fatgrams

Carb Group

12 to 15 g 3 to 8 g 1 to 8 g

Protein Group

0 g 7 g 0 to 8g

FatGroup

0 g 0 g 5 g

Carbohydrate Another name for

starches and sugar

Body uses for energy

100% of most types of CHO turns into glucose within 1 to 2 hours of eating

Provides 4 calories per gram

Protein Little impact on

glucose

Builds and repairs muscles, skin, all cells

Includes both animal and vegetable sources

Can be too high in fat

Provides 4 calories per gram

Fat Small amounts needed

for healthy skin and vitamin transport

Heart Healthy vs. Not Heart Healthy

Provides 9 calories per grams

Carbohydrates Include: Starches (whole grain

and refined) including snacks

Starchy vegetables

Fruits and fruit juices

Milk, yogurt, and “milk like (soy)” foods

Foods that contain sugars

Simple vs. Complex

What does the word sugar mean to you?

What type of sugars are used in food?

What words come to your mind?

These words mean simple CHO or sugars

High Fructose Corn Syrup

Sucrose

Corn Syrup

Manitol

Sorbitol

Dextrin

Crystallized Cane Sugar or Evaporated Cane Sugar

Invert Sugar

Molasses and Honey

Simple carbohydrates are:

Chemically very simple

Easily digested and absorbed by your body

Move quickly into your blood stream

Limit to less than 10% of total CHO intake

Tip 1: It’s easier to say no once in the store than 50 times at home!

Complex Carbohydrate Starches and Fiber

More complex chemically

Spend longer time in digestion and absorption

Contribute to energy, slowly and healthfully

Complex Carbohydrate Provide rich sources of vitamins and

minerals, especially in the low carbohydrate vegetables

Excellent source of fiber, most people need between 3 to 5 grams in a serving

Choose whole grain over refined CHO

Great Sources of Complex Carbohydrate Include:

Tip 2

Portion Size Matters!

Why carbohydrate counting? Carbohydrate is the nutrient that affect serum glucose

It’s a precise method to limit carbohydrate

Carbohydrate counting controls portion size

Portion size is how carbohydrates are controlled and counted

Portion estimation can be used once the patient learns portion control as opposed to always weighing or measuring foods

Its portable, no measuring cups or scales

Portion size examples:

One cup= 1 baseball or a fist

½ cup= ½ a baseball

Piece of fruit a tennis ball

1 oz cheese 4 dice

3 oz meat a deck of cards

1 tablespoon a book of matches

Label Reading

Counting Carbohydratesper serving- one Serving= 15 grams

 

 

 

 

Label Reading Tip

Tip 3 Always look for total carbohydrate

If the item contains 5 grams of fiber of more, subtract 5 grams of carbohydrate from the total

So---- if a product has 20 grams of carbohydrate per serving and 5 grams of fiber, you will count the total carbohydrate grams as_______.

Summary: the key to carbohydrate control is

Following the meal plan each day, limiting the total carbohydrate to only the allowed number of servings

Eating at the same time each day

Checking blood sugar level each day and according to plan

Planning ahead for any special event each day

Or tip 4: Consistency

Consistency

Consistency

Which means the same amount of CHO at each meal and snack

“My Doctor told meto stop having intimate dinners for four….unless there were three other people”

Orson wells

Meal Planning

CarbohydrateCountingMethod

1800 kcal210 grams of carbohydrate

Meal

BCHO

4PR0

1 oz

Fat

2

FreeFoods of choice

L 4 3 oz

2 1&1/2 cups

D 4 3 oz

2 1&1/2 cups

Snack 2 Asdesired

Tip 5

Use this phone number to remember the basic meal plan:

444-133-2222

Or

4 carbohydrates with each meal (444)

1 ounce of protein at Breakfast3 and 3 at Lunch and Dinner (133)And

2 fats with each meal (222) adding 2 Carbs for as snack (2222)

Meal Planning Basic Principles

Keep all food portions moderate in size

Make meal size similar from day to day

Eat meals and snack at the same time everyday

Eat 3 meals everyday

Choose foods in the “sweets” category less often

Meal Planning Basic Principles Space meals about 5 hours apart

Match meal times to your activity and medication action time. Manage carbohydrate intake

Limit refined carbohydrate foods:

White bread, pasta, rice, crackers and cerealAdded sugars or corn syrup

Plan meals with high fiber foods:

Solid fruit rather than juice.Cooked and raw vegetables.Cooked dried beans, peas, or lentils.Whole grains—“Make half your grains whole!”

Meal Planning Basic Principles

Solid fruit rather than juice.

Cooked and raw vegetables.

Cooked dried beans, peas, or lentils.

Whole grains—Make half your grains whole!

Plan meals with high fiber foods

Many tips for portion control

Don’t purchase foods that tempt you

Use smaller plates, bowls, glasses

Take ½ of restaurant food home

Avoid all you can eat buffets

Take only one portion, and

Considerations for Sick Days

Illness raises glucose, continue meds Increase glucose monitoring to every

2 to 4 hours Increase fluid intake Follow meal plan if able If unable to tolerate solid food, swicth

to regular sugar liquid items at meals, and sugar free items between meals

Considerations for Sick Days Cont’d

If glucose > 250m usual carb is not needed but get at least 140 grams carb daily

For nausea and vomiting, sip small amounts of fluids

Check urine for ketones DM1 with urination & gluc > 250 DM2 if vomiting or too sick to get out of bed

or if glucose is >250 & insulin is used

Carbohydrate adjustment for exercise

If at risk forhypoglycemia:

intensity duration glucose +carb

low tomoderate

30 min or less

< 100 10 to 15 grams CHO

low tomoderate

30 min or less

> 100 0 CHO

moderate 30 to 60 minutes

< 100 25 to 50 g CHO before+ 15g/hr

100-179 15 g/hour

180-249 0 g CHO

Planning Protein

When planning ameal the protein is always the “center of the plate”

Vegetables

MilkFruit

Bread/ Starch

Meat/Protein

Choose lean cuts of meat Limit red meat to three times weekly Cook by baking, broiling, stewing, braising,

or grilling Save fatty meats such as ribs for very special occasions

Tip 6 And don’t forget about vegetable sources of protein such as peas, beans, soy

Think Heart Smart

Heart Smart Fats Include:

Mono-unsaturated such as: *Nuts and seeds *Avocados *Olive oil *Canola oil *Peanut oil *Tube or squeeze margarine

Heart Smart Fats Include:

Omega-3 fatty acids such as :

* Fish (salmon, mackerel, tuna)* Walnuts* Flaxseed

*Fortified Foods

Fats not heart smart: Butter Margarine Shortening Lard Full fat dairy products Any fat that is a solid at room temp Coconut, palm, palm kernel oil Shelf stable food such as pastries, chips, cake mixes, donuts, snacks

Type II Diabetes Mellitus is improved by weight loss

Multitude of studies support gradual weight loss

Even 10 to 15 pound weight loss has proven to improve serum glucose levels

The patient is best treated with a lifestyle approach.

Very low carbohydrate diets are problematic.

Meal Planning and Learning Readiness:

Patient interview role play

Let’s count carbs

In summary:Make change one step at a timeSet goalsCount those carbsPractice Happy Heart HabitsNever give up- if you eat that piece of candy, get back on the wagon and move forward! Work towards ideal body weight