2Eating! Can’t live with it, can’t live without it! Constant opportunity for changeMajor factor in health, wellness, & happiness.Can be a major stressor!Focus on the positive
3ObjectivesList diet and nutrition goals for patients with both Type 1 and Type 2 diabetes.Explain role of carbohydrate, protein, and fat in meal planning and glucose control.Explain basic concept of consistent carbohydrate diet and use of carbohydrate counting.Identify additional diet modifications to address cardiac risk reduction.
4Type 1 Diabetes Use of daily insulin Goals for diet education: Coordinate meal plan with insulin treatmentUse of carbohydrate counting for intensive insulin therapy programsAlter intake as needed for activity levelIdentify/reduce risk of hypoglycemia
5Type 2 DiabetesMay be diet and exercise controlled, using oral medications, or insulin treated.Goals for diet education:Weight control or weight lossUse of carbohydrate counting for consistent carbohydrate diet or insulin programAddress co-morbid conditions and risk factors
6The Basics Carbohydrate Digests quickly, from 15 minutes to 2 hours Has direct effect on postprandial blood glucose levels, more carbs = higher glucoseShould provide about 50% of total caloriesSources: grains, beans, vegetables, milk, fruit, sweets and added sugars
8The Basics Protein Digests more slowly, 3-5 hours Can aid in prolonged post-meal satietyMay help prevent between meal and nocturnal hypoglycemiaSources: meat, fish, poultry, eggs, cheese, nuts/peanut butter, soy products
9The Basics Fat Digests the most slowly- several hours Promotes prolonged satietyType of fat consumed affects cardiac riskShould be less than 30% total caloriesSources: butter, margarine, oils, mayo, salad dressing, cream cheese, nuts, seeds, gravy
11Carbohydrate Counting Identify carbohydrate sourcesEstimate or measure portion sizeQuantify carbohydrate intake for that meal or snack in either carbohydrate servings or grams of total carbohydrateThere are no “good carbs” or “bad carbs”
12What is one serving of carbohydrate What is one serving of carbohydrate? (one serving = 15 grams carbohydrate)1 slice bread1/2 hamburger bun or English muffin1/2 cup potato, corn, peas, cooked cereal1/3 cup rice or pasta1 small fresh fruit, 1/2 cup canned fruit or juice1 cup milk or yogurt1 tablespoon sugar, honey, jam, maple syrup
13Sample Meal Example 1/2 cup oatmeal 1 hard boiled egg 1 slice whole wheat toast1 teaspoon margarine1/2 cup orange juiceWhich are the carbs? How many servings? How many grams total carbohydrate?
14Sample Meal Example 1/2 cup oatmeal = 1 serving (15 g) 1 hard boiled egg = protein1 slice whole wheat toast = 1 serving (15 g)1 teaspoon margarine = fat1/2 cup orange juice = 1 serving (15 g)Total is 3 servings or 45 grams carbohydrate
15Sample Meal Example 2 3 ounces roast chicken 1 cup cooked rice 1/2 cup green beans1 cup tossed salad1/2 cup applesauce1 cup 1% milk
16Sample Meal Example 2 3 ounces roast chicken = protein 2/3 cup cooked rice = 2 servings (30 g)1/2 cup green beans = 1/3 serving (5 g)1 cup tossed salad = 1/3 serving (5 g)1/2 cup applesauce = 1 serving (15 g)1 cup 1% milk = 1 serving (15 g)Total is 4 2/3 servings or 70 grams total carb
17Using a label to Count Carbs 1. Serving size, #of servings2. Total gramsof carbohydrate
18How much carbohydrate to eat? 1200 kcal = grams = 10 servings1500 kcal = grams = servings1800 kcal = grams = 15 servings2000 kcal = grams = servings*Amounts and types of protein and fat can greatly affect total calorie intake.
19Not only how much, but when... Goal is to spread carbohydrate servings out consistently over the day3-5 servings per meal1-2 servings per snackPatient has freedom to change food choices and amounts eaten while staying within recommended carbohydrate intake
20Example of 1500 kcal diet (Total of 12-13 carb servings or 187 g per day) Breakfast: 4 carb servings (60 g)1 cup oatmeal, 1 cup skim milk, 2 Tbs raisinsLunch: 3 carb servings (45 g)sandwich, small salad, 1 small fresh fruitDinner: 4 carb servings (60 g)chicken, 1 cup pasta, broccoli, 1 cup skim milkSnack: 1 carb serving (15 g)1 cup low fat yogurt
21Weight LossWeight loss of just 7-10% of a patient’s current weight can help lower glucoseSlow and steady wins the race!Helpful modifications are low fat intake and high fiber intakeExercise: 5-7 days/week with goal of 150 minutes/week or 10,000 steps per day
22High Fiber IntakeCan increase satiety, slow carbohydrate digestion and modify postprandial glucoseIntake of at least 25 grams/day, up to 35 grams/day to optimize cardiac benefitsCan subtract from total carbohydrate gramsSources of fiber: whole grains, beans, nuts, seeds, fruits, vegetables
23Low Fat IntakeAll patients with diabetes are at increased cardiac risk- more aggressive with cholesterol and blood pressure controlTotal fat <30% kcal, sat fat <10%, trans fat 0%Decrease added fats- 100 kcal/tablespoonOpt for unsaturated fat- oils, nuts, margarine
24“Let nothing that can be treated by diet be treated by any other means “Let nothing that can be treated by diet be treated by any other means.” Maimonides