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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