Presentation on theme: "Elva McNurlin, RD, LD, CDE – SLMV Diabetes Educator Sarah Renaldi, MS, RD, LD – SLMV Clinical Dietitian Original Slides/Presentation By: Kate Waltz, RD,"— Presentation transcript:
Elva McNurlin, RD, LD, CDE – SLMV Diabetes Educator Sarah Renaldi, MS, RD, LD – SLMV Clinical Dietitian Original Slides/Presentation By: Kate Waltz, RD, CDN, CDE; Clinical Nutrition Bassett Healthcare
Eating! Cant live with it, cant live without it! Constant opportunity for change Major factor in health, wellness, & happiness. Can be a major stressor! Focus on the positive
Objectives List 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.
Type 1 Diabetes Use of daily insulin Goals for diet education: Coordinate meal plan with insulin treatment Use of carbohydrate counting for intensive insulin therapy programs Alter intake as needed for activity level Identify/reduce risk of hypoglycemia
Type 2 Diabetes May be diet and exercise controlled, using oral medications, or insulin treated. Goals for diet education: Weight control or weight loss Use of carbohydrate counting for consistent carbohydrate diet or insulin program Address co-morbid conditions and risk factors
The Basics Carbohydrate Digests quickly, from 15 minutes to 2 hours Has direct effect on postprandial blood glucose levels, more carbs = higher glucose Should provide about 50% of total calories Sources: grains, beans, vegetables, milk, fruit, sweets and added sugars
The Basics Protein Digests more slowly, 3-5 hours Can aid in prolonged post-meal satiety May help prevent between meal and nocturnal hypoglycemia Sources: meat, fish, poultry, eggs, cheese, nuts/peanut butter, soy products
The Basics Fat Digests the most slowly- several hours Promotes prolonged satiety Type of fat consumed affects cardiac risk Should be less than 30% total calories Sources: butter, margarine, oils, mayo, salad dressing, cream cheese, nuts, seeds, gravy
The Idaho Plate Method
Carbohydrate Counting Identify carbohydrate sources Estimate or measure portion size Quantify carbohydrate intake for that meal or snack in either carbohydrate servings or grams of total carbohydrate There are no good carbs or bad carbs
What is one serving of carbohydrate? (one serving = 15 grams carbohydrate) 1 slice bread 1/2 hamburger bun or English muffin 1/2 cup potato, corn, peas, cooked cereal 1/3 cup rice or pasta 1 small fresh fruit, 1/2 cup canned fruit or juice 1 cup milk or yogurt 1 tablespoon sugar, honey, jam, maple syrup
Sample Meal Example 1/2 cup oatmeal 1 hard boiled egg 1 slice whole wheat toast 1 teaspoon margarine 1/2 cup orange juice Which are the carbs? How many servings? How many grams total carbohydrate?
Sample Meal Example 1/2 cup oatmeal = 1 serving (15 g) 1 hard boiled egg = protein 1 slice whole wheat toast = 1 serving (15 g) 1 teaspoon margarine = fat 1/2 cup orange juice = 1 serving (15 g) Total is 3 servings or 45 grams carbohydrate
Sample Meal Example 2 3 ounces roast chicken 1 cup cooked rice 1/2 cup green beans 1 cup tossed salad 1/2 cup applesauce 1 cup 1% milk
Sample 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
Using a label to Count Carbs 1. Serving size, # of servings 2. Total grams of carbohydrate
How much carbohydrate to eat? 1200 kcal = 150 grams = 10 servings 1500 kcal = 187 grams = servings 1800 kcal = 225 grams = 15 servings 2000 kcal = 250 grams = servings *Amounts and types of protein and fat can greatly affect total calorie intake.
Not only how much, but when... Goal is to spread carbohydrate servings out consistently over the day 3-5 servings per meal 1-2 servings per snack Patient has freedom to change food choices and amounts eaten while staying within recommended carbohydrate intake
Example of 1500 kcal diet (Total of carb servings or 187 g per day) Breakfast: 4 carb servings (60 g) 1 cup oatmeal, 1 cup skim milk, 2 Tbs raisins Lunch: 3 carb servings (45 g) sandwich, small salad, 1 small fresh fruit Dinner: 4 carb servings (60 g) chicken, 1 cup pasta, broccoli, 1 cup skim milk Snack: 1 carb serving (15 g) 1 cup low fat yogurt
Weight Loss Weight loss of just 7-10% of a patients current weight can help lower glucose Slow and steady wins the race! Helpful modifications are low fat intake and high fiber intake Exercise: 5-7 days/week with goal of 150 minutes/week or 10,000 steps per day
High Fiber Intake Can increase satiety, slow carbohydrate digestion and modify postprandial glucose Intake of at least 25 grams/day, up to 35 grams/day to optimize cardiac benefits Can subtract from total carbohydrate grams Sources of fiber: whole grains, beans, nuts, seeds, fruits, vegetables
Low Fat Intake All patients with diabetes are at increased cardiac risk- more aggressive with cholesterol and blood pressure control Total fat <30% kcal, sat fat <10%, trans fat 0% Decrease added fats- 100 kcal/tablespoon Opt for unsaturated fat- oils, nuts, margarine
Let nothing that can be treated by diet be treated by any other means. Maimonides