Diabetes and Nutrition

Diabetes and Nutrition
Lesson 2 Expand Your Options, Improve Your Choices

Objectives Meal Plans for Diabetes General Nutrition Recommendations
Diabetes Pyramid/My Pyramid Exchange list Plate Method Carbohydrate Counting General Nutrition Recommendations Reading the Food Label

Managing Diabetes Successfully
Involves three things: Food Exercise Medication

Did You Know?? Food raises blood glucose
Exercise and medication lowers it Balance these three to keep blood glucose level close to normal.

Diabetes Facts You don’t need special foods
Food choices can make a difference in blood Glucose control. You don’t need special foods The foods that are good for you are good for everyone Eat a variety of foods that contain the right amount of nutrients

The Diabetes Pyramid Similar to My Pyramid, The diabetes pyramid divides foods into six groups. The base of the pyramid is the grains, beans and starchy vegetables group while at the top is the fats, oils, sweets and alcohol group. The pyramid gives a range of servings to eat and the range is based on calories. It is important to note that the exact number of servings and calories you need to eat will depend on diabetes goals, nutrition needs and lifestyle factors. The diabetes pyramid’s food groups are based on the amount of carbohydrate/protein content of the food. Let’s take a closer look at the pyramid…. Grains and Starches (6-11 servings/day); Vegetable Group (3-5 servings/day); Fruits (2-4 servings/day); Milk & Milk Products (2-3 servings/d); Meat & Meat Alternatives (4-6 ounces/d); Fats, Sweets, and Alcohols (Sparingly used)

A healthy daily meal plan includes at least…
Healthy Food Choices A healthy daily meal plan includes at least… 2 to 3 servings of nonstarchy vegetables 2 servings of fruit 6 servings of grains, beans, and starchy vegetables 2 servings of low-fat or fat-free milk About 6 ounces of meat or meat substitutes Small amounts of fat and sugar

The Plate Method The plate method is a very easy method of meal planning for diabetes because you do not need specific measuring cups or spoons or scales. All you really need is your dinner plate. We recommend using a 8-9 inch dinner plate, but if you notice some of our dinner plates today are inches in size. When we eat on a bigger plate we tend to eat more servings of foods which could affect your diabetes. In addition to the plate you will need a small glass that holds 1 cup and a small dish that holds a ½ cup (usually a bread plate or saucer works well). The glass is used to measure liquid and the plate is for your fruit serving.

Which Plate is Better?? A 10 inch dinner plate-a typical dinner plate
A 8 inch dinner plate-this is the recommended plate to use

The Plate Method When placing your food on the plate try to fill the half of the plate with vegetables. You need to have at least 2 different ones like broccoli and carrots for an example. Having a variety of vegetables will help you get all the vitamins, minerals and fiber you need daily. Be aware that starch vegetables like corn, potatoes and peas need to go in the starch section of your plate. Now we will move on to filling the other half of our plate. One fourth of the other half of our dinner plate is where our breads/starches/grains will go and the other half will be your serving of meat/meat alternatives. A three ounce portion is the size of a deck of cards so please take that into consideration. Rounding out our plate will be 1 cup of fat free or skim milk along with a ½ cup of fruit.

Fruit = Milk = Starch Sometimes, if you want an extra starch during a meal, you just need to omit a fruit or milk from that meal.

Visualize Portion Sizes
1 cup pasta/rice is about the size of a fist. 1 oz of cheese is about the size of your thumb. 1 or 2 oz of crackers, nuts, or snack crackers equals a handful. 1 fruit is about the size of a tennis ball. Sometimes we are in a situation where we can not pull out the measuring cups, spoons, or scales to measure the portion sizes of foods. Knowing some small visuals that represent portion sizes can help you when you find yourself in those situations.

Exchange List for Meal Planning
Oldest method for meal planning. Based on Dietary Guidelines and My Pyramid. Includes a variety of foods. Emphasizes label reading and most exchanges are listed under the food label. The exchange list system is the oldest meal planning method for diabetes and any type can use this system. The exchange list system is based on the dietary guidelines and My Pyramid. The lists have been updated to include a variety of foods and food types. Each meal is planned according to the number of exchanges for each meal. The exchanges are based on serving size; the amount of calories, fat and sugar per serving per meal that needs to be consumed. The exchange list emphasizes label reading and helps diabetics read the food label. Many packaged foods will list the exchanges for a serving of that item underneath the Nutrition Facts Label and the ingredient list. The exchange system is the most widely used meal plan for diabetics. The exchange list food categories are: starches; fruit; milk; sweets and desserts; meat and meat substitutes; fats; free foods; combination foods; fast foods and alcohol.

Carbohydrate Counting
Newest method of meal planning. Type 1 or Type 2 can use. Requires reading the food label. Requires constant blood sugar monitoring. When reading the food label, look at total carbohydrate grams only. Carbohydrates are found in milk, breads/starches, fruit and starchy vegetables only! CHO counting is the newest method in diabetes meal planning. It has been around for almost 10 years and is most widely used for patients who are type 1 diabetics. Most kids and some adults use the CHO counting method for meal planning because it is easy to use in a variety of settings. Research has shown that CHO counting is more accurate at preventing roller coaster blood sugar levels. It is easier when eating out or away from home because you are concerned with the grams of carbohydrates in that food. It is important to know that carbohydrates are only found in starches, fruits, milk, sweets and some vegetables. CHO’s are not present in meat, fish and poultry or fats. A meal plan outlines the number of CHO choices a person can eat for meals and snacks. One example is a 45 g CHO for B, L, and D and 15 g CHO for snacks or 60 g/meal and 30 g/snack. Your dr. or dietitian will work the meal plan out with you. It is important to note that the CHO counting method requires diligence and constant monitoring of blood sugars. Diabetics who require insulin will base the amount of insulin that needs to be given on how many carbohydrates they ate. When reading the food label you go by the total amount of carbohydrates per serving of product. Any diabetic whether type 1 or type 2 should know the carbohydrate count for 1 serving of every food group.

Know Your Carbohydrates
Food Grams of Carbs/Serving Starch/Bread 15 grams Fruit Milk 12 grams Vegetables 5 grams Meat 0 grams Fat CHO’s we eat come from three food groups: starch, fruit, and milk. Vegetables also contain some CHO. Three servings of vegetables also contain 15 grams thus you would need to count these as 1 CHO choice. One or 2 servings of vegetables have very little carbohydrates in them and should not be counted. It is more important to know your CHO allowance for each meal and snack than it is to know your total for the day. The amount of CHO eaten at each meal should remain consistent. Here is an example to show you how carbohydrate counting can make meal planning easier. Let’s say your dinner meal plan contains 5 CHO servings or 75 grams of CHO. This is based on a meal plan of 3 starch servings, 4 protein, 1 vegetable, 1 fruit, 1 milk and 3 fat. The label on a frozen dinner says it contains 62 grams of CHO. All you would need to do is figure out how many grams of CHO you would need to make 75.

More on Total Carbs… When a food has 5 g or more of fiber per serving:
Helpful for carb counters. Look at the total carbohydrates not the grams of sugar. Total carbohydrates include: sugar, complex carbohydrates, and fiber content. When a food has 5 g or more of fiber per serving: subtract half the fiber grams from the total grams of carbohydrate for a more accurate estimate of the carbohydrate content. If you are counting carbohydrates then you can plan out how much you will or will not eat and know the number of CHO’s you have consumed. When carbohydrate counting look at the total grams of carbohydrate rather than the grams of sugar. Total carbohydrates on the food label include sugar, complex carbohydrates, and fiber. Only looking at the grams of sugar you can exclude certain nutrients and/or certain food groups. The grams of sugar and fiber are counted as part of the grams of total carbohydrate. When a food has 5 g or more of fiber per serving: subtract half the fiber grams from the total grams of carbohydrate for a more accurate estimate of the carbohydrate content.

Sample 1800 calorie Carbohydrate Counting Meal Plan
Breakfast:  2 servings of starch, 1 fruit serving, 1 milk serving, 1 meat serving, 1 fat serving. Lunch:  2 starch servings, 1 fruit servings, ½ milk serving, 2 vegetable servings, 2 meat servings, 2 fats. Dinner:  2 starch servings, 1 fruit serving, 2 vegetable servings, 3 meat servings, 2 fats. Snack:  1 starch serving, 1 fruit serving, ½ milk serving. This meal plan is approximately 60 g of carbohydrates per meal and 30 g of carbohydrates per snack.

Examples of One Carbohydrate Choice Snacks
1 ounce granola bar 3 graham crackers with 1 tbsp. peanut butter 3 cups popped non-fat popcorn 6 animal crackers 1 small muffin A 3 inch cookie 1 medium apple, orange, pear 12-15 cherries or grapes ¼ cup dried fruit 1 cup soy milk ¾ to 1 cup yogurt ½ cup sugar free pudding All of these provide approximately 15 g of CHO.

Portion Control Is The Key To Managing Your Diabetes
Which will have the greater effect on your blood sugar, 1 tsp of sugar or ½ cup potatoes?? Potatoes have 15 g of Carbohydrate, while 1 tsp. of sugar has only 4 g of carbohydrate. Therefore, potatoes have 3 times the effect on blood sugar than table sugar would. The amount of food you eat is closely related to blood sugar control. If you eat more than is recommended on your meal plan, your blood sugar goes up. Foods containing CHO’s have the most impact on blood sugars, the calories from all foods will affect your blood sugar.

2008 ADA Recommendations for General Meal Planning for Persons with Diabetes
Meal plan should include fruits, vegetables, legumes, low-fat dairy products, lean meats, and whole grains. You can eat sugar containing foods, but your meal plan will be adjusted. Monitor carbohydrate intake. Consume grams of fiber. Avoid Skipping meals. The 2008 American Diabetes Association Nutrition Recommendations are as follows: 1. your daily diet and meal plan should include fruits, vegetables, legumes, low-fat dairy products, lean meats, and whole grains daily. 2. monitor your carbohydrate intake daily. 3. some sugar containing foods may be eaten but you may have to delete some foods from your meal plan to compensate for those foods eaten. 4. try to consume g of fiber daily. 5. Never skip meals and try to not skip meals.

More Recommendations Sugar alcohols and artificial sweeteners are safe. Limit saturated fat intake. Limit trans fat intake. Eat fish at least 2x’s per week. Moderate alcohol intake. Consume a meal plan that if low in fat, cholesterol, sodium, and calories Increase physical activity or exercise. Continuously monitor blood sugar levels. Check with physician for vitamins. Lose weight if you are told to. Sugar alcohols and artificial sweeteners are safe to use within normal limits. Limit saturated fat intake to less than 7% of total calorie intake per day. Limit intake of trans fats to 2 grams or less per day. Eat fish 2 times or more per week. Moderate your alcohol intake Type 2 DM should consume a low-fat, low-calorie, low chol and low sodium diet. All DM patients should increase exercise to improve blood sugar, lipid levels and help achieve weight loss. Monitor your blood glucose levels to see how certain foods affect your blood sugar levels. It is recommend to eat something and test 2 hours after eating it to see how it affects your blood sugar levels. If you are lacking certain vitamins a MVI may be needed check with your physician. A 10% weight loss will help improve lipid and blood sugar levels.

Alcohol Limit/control your intake of alcohol.
Ask yourself the three questions to determine if you can drink. Is my diabetes under control? Does my doctor agree that I do not have any other problems that alcohol can affect? Do I know how alcohol can affect my diabetes and me? Most diabetics have a limit on alcohol intake. People with diabetes should ask their physician the risks and/or precautions before drinking. If you would like to drink, there are 3 questions you should ask yourself: Is my diabetes under control? Does my doctor agree that I do not have any other problems that alcohol can affect? Do I know how alcohol can affect my diabetes and me? If you say yes to all three questions, then it’s okay to have an occasional drink. An occasional drink is defined as no more than 1 per day for women and 2 for men per day.

A Drink Is Defined As: Drinks are defined as 1 per day for women and 2 per day for men. A drink is: 12 oz. beer 1 ½ oz. spirits (whiskey, rum, etc) 1 oz coffee liqueur 5 oz. red, white or blush wine

Avoid Low Blood Sugar When Drinking
Never drink on an empty stomach. Limit yourself to 1 or 2 drinks. Test your blood sugar before you drink and once while drinking. Make sure to test before going to bed and eat a snack! Risks of drinking with diabetes can result in a low blood sugar, especially when drinking on an empty stomach. When drinking and you are taking long acting insulin or pills; alcohol increases the effects and makes the insulin and pills last longer and stronger. It is recommended that you do not do this. How to avoid low blood sugar levels when drinking: never drink on an empty stomach. Limit yourself to 1 or 2 drinks. If you just finished exercising, test your blood sugar before you drink and once while you are drinking. Make sure you test your blood sugar before you go to bed and sometimes you may need to eat a snack before going to sleep to prevent a low blood sugar during the night. Overall, try to be smart with your diabetes.

Reading Food Labels to Manage Diabetes
Opening Discussion Questions: What are the most important things you take into account when you buy foods? In the last year, have you made any changes in the foods you buy or eat for health reasons? Do you use the nutrition information on food labels? If so, what do you pay attention to most? Have you been surprised by any information you found on the Nutrition Facts label of a product? What did you discover and how did it influence your purchases? People look at food labels for different reasons. Many consumers would like to know how to use this information more effectively and easily. We are going to learn some label reading skills to make it easier for you to use nutrition labels to make quick, informed food choices that contribute to a healthy diet while managing diabetes. Food labels give much information needed to make wise food choices. They can help you compare similar food items to make the best selection. Let’s see how it works.

What’s on a Label? Serving Size Servings Per Container
Calories and Calories from Fat Nutrients with % Daily Value Footnote (Only found on larger packages) The information in the main or top section of the food label can vary with each food product since it contains product-specific information including: serving size, servings per container, calories and nutrient information. On larger packages, the bottom part of the label contains a footnote with Daily Values (DVs) for 2,000 and 2,500 calorie diets. The footnote provides recommended dietary information for important nutrients such as fats, sodium and fiber. This footnote is found only on larger packages and does not change from product to product.

Serving Size Stated in Household and Metric Measures
The first place to start when you look at the Nutrition Facts label is the serving size and the number of servings in the package. Serving sizes are standardized to make it easier to compare similar foods and will be provided in familiar units such as cups or pieces, followed by the metric amount (number of grams). A gram is a small unit of weight that weighs about the same as a small paper clip. (Pass around small paper clip for participants to feel the weight.) A milligram is much smaller. There are 1000 milligrams in one gram. There are about 28 grams in one ounce. One ounce weighs about the same as a stack of 5 quarters. (Pass around stack of 5 quarters for participants to feel the weight.) Serving sizes on food labels represent what people usually eat, not what is considered a serving on USDA’s MyPyramid. Keep this in mind when trying to follow MyPyramid’s recommendations for a healthy diet. When managing diabetes, if you use exchange lists, remember that the serving size on the food label may be different from that in the food choices lists. For example, the serving size for orange juice is 8 fluid ounces (1 cup) on a Nutrition Facts label and 4 fluid ounces (1/2 cup) in the food choices lists. Therefore, you would need to count it as 2 fruit choices.

Servings Per Container
Servings Per Container tells you how many servings are in a package. There are 2 servings in this package. The label shows that 1 cup is a serving. If you consume 2 cups you are having two servings. The size of the serving on the food package influences the number of calories and all of the nutrient amounts listed on the top part of the label. Look at the serving size and then ask yourself, “How many servings am I consuming?” Did you eat ½ serving, 1 serving or 2 or more servings? In this sample label, one serving equals one cup. If you ate the whole package, you would eat 2 cups since there are 2 servings in the package. That would double the calories and other nutrient numbers including the % Daily Values.

Calories Labels include the total calories as well as the calories from fat General Guide to Calories per serving: 40 calories is low 100 calories is moderate 400 calories or more is high Calories provide a measure of how much energy you get from a serving of the food and drinks. The calorie section of the label can help you manage your weight. Remember though that the number of servings you consume determines the number of calories you actually eat. If you eat and drink more calories than your body needs, you will gain extra weight. In this example, there are 250 calories in one serving of the food with 110 of those calories coming from fat. This means that almost half the calories in a single serving come from fat. There is a General Guide to Calories based on a 2,000 calorie diet that provides a general reference for calories when you look at a Nutrition Facts Label. It is as follows: 40 calories is low 100 calories is moderate and 400 calories or more is high.

Percent Daily Value (%DV)
Based on Daily Value recommendations Only for a 2,000 calorie diet The % Daily Values (or %DV) illustrate how a food’s nutrients fit into a 2,000 calorie diet and help consumers compare nutrient content among food products. A few nutrients, like trans fat, do not have a %DV, which will be discussed later. The %DV column doesn’t add up vertically to 100%. Instead each nutrient is based on 100% of the daily requirements for that nutrient based on a 2,000 calorie diet. This way you can tell if a product is high or low in certain nutrients. The 5 and 20 Rule is an easy way to determine if the content of a nutrient is high or low. 5%DV or less is low for all nutrients. 20%DV or more is high for all nutrients. The %DV makes it easy for you to make comparisons. You can compare one product or brand to a similar product. Just make sure the serving sizes are similar, especially the weight (gram, milligram or ounces) of each product. It is easy to see which foods are higher or lower in nutrients because the serving sizes are generally consistent for similar types of foods except in a few cases. There are many claims found on the packages of food products: sugar free, no added sugar, reduced sugar, calorie free, low calories, reduced calories, fat free, low fat, reduced fat and many more. You can also use the %DV to help you quickly distinguish one claim from another such as reduced fat vs. light or nonfat. All you have to do is compare the % DVs for Total Fat in each food product to see which one is higher or lower in that nutrient. This keeps you from having to memorize the definitions for all of the claims. Notice that some of nutrients have a %DV listed, but no weight shown. One example is calcium. In this label, the product contains 2%DV for calcium. This shows how much one serving contributes to the total amount you need per day. The %DV for calcium is based on 1,000 mg, so 10% would be 100 mg. You can use this as a reference if you are trying to consume 1,200 mg of calcium per day.

Nutrients Without a %DV
Trans Fats Sugars Protein Trans fat, sugars and protein do not list a %DV on the Nutrition Facts label. Experts could not provide a reference value for trans fat to establish a Daily Value or % Daily Value. Scientific reports link trans fat and saturated fat with raising blood LDL or “bad” cholesterol levels. This increases your risk of coronary heart disease. Health experts recommend that you keep your intake of saturated fat, trans fat and cholesterol as low as possible as part of a nutritionally balanced diet. It is recommended to consume no more than 2g daily of trans fats. Keep in mind that food manufacturers can put 0g trans fats on the food label when the product has .5g of trans fats per serving. A % Daily Value is required to be listed if a claim is made for protein, such as “high in protein.” Otherwise, unless the food is meant for use by infants and children under 4 years old, none is needed. According to current scientific evidence, protein intake is not a public health concern for adults and children over 4 years of age. No daily reference value has been established for sugars because no recommendations have been made for the total amount to eat in a day. The sugars listed on the Nutrition Facts label include naturally occurring sugars, like those in fruit and milk, as well as those added to a food or drink. When managing diabetes, you should limit the amount of sugars your eat and drink. Sugar doesn’t contain the nutrients (vitamins, minerals, and fiber) that are in other carbohydrate-rich foods like rice and potatoes. That’s the main reason to eat only small amounts of sugar. To limit nutrients that have no %DV, like trans fat and sugars, compare the labels of similar products and choose the food with the lowest amount.

Nutrients Limit these nutrients Get enough of these
The top of the nutrient section shows you some key nutrients that impact your health and separates them into two main groups: The Nutrients listed first are the ones Americans generally eat in adequate amounts or even too much. On this slide, they are identified in yellow, and we should limit these nutrients. Eating too much fat, saturated fat, trans fat, cholesterol or sodium may increase your risk of certain chronic diseases like heart disease, some cancers or high blood pressure. Health experts recommend that you keep your intake of saturated fat, trans fat and cholesterol as low as possible as part of a nutritionally balanced diet. Most Americans don’t get enough dietary fiber, vitamin A, vitamin C, calcium and iron in their diets. These nutrients are identified in blue on this slide, and we should strive to get enough of these nutrients. Eating enough of these important nutrients can improve your health and help reduce the risk of some diseases and conditions. For example, getting enough calcium may reduce the risk of osteoporosis which results in brittle bones. You can use the Nutrition Facts label to help limit those nutrients you want to cut back on and to increase the nutrients you need to consume in greater amounts.

The Footnote Based on 2,000 and 2,500 calorie diets
Only found on larger packages An asterisk appears on the Nutrition Facts label after the heading % Daily Value. This refers to the footnote in the lower part of the label, which tells you that % Daily Values are based on a 2,000 calorie diet. This statement must be on all food labels. However, the remaining information in the full footnote as shown above may not be on the package if the size of the label is too small. When the full footnote does appear, it will always be the same. It doesn’t change from product to product since it shows recommended dietary advice for all Americans and is not about a specific food. (Show examples of Nutrition Facts labels from products with the footnote included and those without the footnote.) The amounts circled in red in the footnote are the Daily Values (not % Daily Values) for each nutrient listed and are based on public health experts’ advice. Daily Values are recommended levels of intake based on a 2,000 or 2,500 calorie diet. If you follow this dietary advice, you will stay within public health experts’ recommended intake for the nutrients listed based on a 2,000 or 2,500 calorie diet. Remember that the food label and DV is based on 2,000 or 2,500 calorie diet so, of course, the amounts would adjust if you ate fewer or more calories.

DVs Compared to %DVs Nutrient *DV %DV Goal Total Fat 65g 100% DV
Less Than **Sat. Fat 20g Cholesterol 300mg Sodium 2400mg Total ***CHO 300g At Least Dietary Fiber 25g This information is based on a 2,000 calorie diet. (NOTE: DV = Daily Value; Sat. Fat = Saturated Fat; CHO = Carbohydrate) Let’s look at this chart to see how the Daily Values relate to the % Daily Values and dietary guidance. For each nutrient listed, there is a DV, the %DV and dietary advice or the goal. The nutrients that we need to consume in moderation are listed first on the footnote found on larger food packages. It is recommended that you eat less than the Daily Value nutrient amounts listed per day. For example, the DV for saturated fat is 20g. This amount reflects 100% of the Daily Value for this nutrient. The goal is to eat less than 20 g or less than 100%DV for the day. The DV for dietary fiber is 25g, which is 100%DV. This means you should eat at least this amount of dietary fiber per day. *DV = Daily Value; **Sat. Fat = Saturated Fat; ***CHO (carbohydrate)

Ingredient Statement List of ingredients found in the food product
Listed in descending order by weight, from the most to the least The ingredient list helps consumers identify foods that have substances they are allergic to or want to avoid for other reasons. For example, sugar for those who are watching their sugar intake or partially hydrogenated oils for those wanting to limit trans fats. It can also help consumers select foods with ingredients they want, such as whole grains. An ingredient list is required on all packaged foods composed of 2 or more ingredients. Ingredients must be listed in descending order of predominance by weight. Therefore, the first ingredient listed would be the one contained in the product in the greatest amount. This gives consumers an idea of the proportion of an ingredient in a food. If sugar was listed as the first ingredient, you would know that the product contained a great deal of sugar.

Eat Smart – Read the Label
Be informed. Determine the best choices. Eat a variety of foods. Consumers need to be informed. The Nutrition Facts label is a great tool to help you stay informed about the food products you purchase and consume. You can read food labels to determine the best choices for your family. Read the label and select a variety of healthy foods so that you are receiving all the nutrients needed for a healthy you!

Points To Remember About Diabetes Meal Planning
Actual amounts of each depend on the number of calories you need. Calorie needs depend on your gender, size, age, and activity level. Meal planning with diabetes is very individualized. Get a personalized meal plan from a Registered Dietitian or Certified Diabetes Educator.

References American Diabetes Association, www.diabetes.org
American Dietetic Association, Mahan,L.K. and Escott-Stump, S. Krause’s Food, Nutrition, and Diet Therapy. 10thed Diabetes Medical Nutrition Therapy. American Dietetic and Diabetes Association LSU AgCenter’s Diabetes Education and Awareness Program. University of Illinois Extension Service. American Dietetic Association & American Diabetes Association Guide to Diabetes Medical Nutrition Therapy, CD-ROM 2008. Amercian Diabetes and Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes.” University of Idaho Extension Service. “The Idaho Plate Method.”

References University of Georgia Extension Service. U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition - Keeping Up with the Changing Food Label: International Food Information Council (IFIC) – Understanding Food Labels, American Dietetic Association Food Label Presentation Developed By: Cathy Agan, Extension Agent (FNP), Ouachita Parish and Adapated by Bertina McGhee, MPH, RD, LDN; Extension Agent, Orleans Parish.

Diabetes and Nutrition
Prepared By: Mandy G. Armentor, MS, RD, LDN Assoc. Extension Agent-FCS (Nutrition) Vermilion Parish

Diabetes and Nutrition

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