Nutrition at School for Kids with Diabetes Lisa Emmert, MS, RD, LD, CDE Arkansas Children’s...

Nutrition at School for Kids with Diabetes

Lisa Emmert, MS, RD, LD, CDEArkansas Children’s Hospital

Nutrition Education• Inpatients:

– 3 day inpatient education– Involves nutrition education, social work, diabetes

educator, 4 Adolescent nursing staff, and child life

Nutrition Education• Day 1:

– Which foods are carbohydrates?– Why count carbohydrates?– Insulin to carbohydrate ratio– Reading labels– Resources for carb amounts

• www.calorieking.com• www.dlife.com/nutrition• www.nutritiondata.com (recipe evaluation)

– Emphasize measuring portions

Nutrition Education• Day 2

– Starchy/non-starchy vegetables– Protein and fats– Free foods– Sweets

• Day 3:– School lunch/breakfast– Snacking– Resources

Education Materials• Our own departmental handbook• Calorie King books• “Pink Panther Book” from the Barbara

Davis Center (in Denver, CO)

Carbohydrate Counting• Can be counted using exchanges, carb choices, or

grams of carbohydrate. • We most often use grams of carbohydrate.

Food Labels

• Focus on 2 things: total carbohydrate and serving size.

Carb Counting Resources• Websites:

– www.calorieking.com– www.dlife.com/nutrition– www.nutritiondata.com– www.allrecipes.com– www.cookinglight.com

•  Cell Phone Apps– GoMeals– Carb Counting with Lenny– SparkPeople– Calorie King

Carb Counting Resources• Check with your food service director

or dietitian• Network with other school nurses• Google search

Insulin to Carb Ratio

If ratio is:1 unit of insulin (novolog) per 15gms carbohydrate

And patient eats:• Ham & cheese sandwich 30gms• Medium orange 15gms• 8 oz. Whole milk 12gms

57 gms

57 ÷ 15 = 3.8Round to 4 units

What About Protein?

• Meat, cheese, eggs, cottage cheese

• Do not have to count, unless breaded

• Meals should contain a source of protein to help stabilize blood sugars

What About Fat?

• Do not need to count carbs for fats

• However, some fat-free items (such as salad dressing) DO have carbohydrate.

Condiments

• Do count the following:– Ketchup– Barbecue sauce– Honey mustard– Sweet and sour sauce

Free Foods

• Free foods have less than 5 gm CHO and 20 calories per serving.

• Examples are sugar free jello, dill pickles, and sugar free popsicles.

Snacking

• Not usually required with pumps or MDI

• If snack is desired give insulin only for snacks that go over the insulin to carb ratio

• For example, if ratio is 1:15, snacks of 15 gm or more require insulin, those less than 15, do not require insulin

Meal Patterns• Some kids with type 1 may have a specific

meal pattern.• This is usually related to their insulin

regimen• Important to be consistent with carbohydrate

intake and meal timing• May need snacks to prevent hypoglycemia.

Meal Plan for Type 1 DiabetesBks Snack Lunch Snack Dinner Snack

Grams of carbo-hydrate

60 15 60 30 60 30

Meal Plan for Type 2 Diabetes

Bkst Lunch Snack Dinner

Grams of Carbohydrate

45 45 15 45

Ounces of protein

1 3 XX 3

Fat Servings

1 1 XX 1

Thank You!