Diet and Health Guidelines to Lower Risk of Diabetes

Diet and Health Guidelines to Lower Risk of Diabetes
Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

Carbohydrates Body breaks down carbohydrates (complex and simple) into monosaccharides Maltose = glucose + glucose Surcrose = glucose + fructose Lactose = glucose + galactose Fructose and galactose converted in the body to glucose Glucose is form body uses for energy Carbohydrates The body breaks down carbohydrates, both complex and simple, into monosaccharides in the intestine for absorption. Maltose = glucose + glucose Surcrose = glucose + fructose Lactose = glucose + galactose Once absorbed fructose and galactose converted in the body to glucose. Glucose is the form the body uses for energy.

Blood Glucose Regulation
Blood glucose level must be closely regulated Hormones control blood glucose levels: Insulin Glucagon Blood Glucose Regulation Blood glucose level must be closely regulated. Hormones control blood glucose levels including: Insulin Glucagon

When blood glucose levels are high Pancreatic beta cells release insulin which helps glucose enter body cells so glucose can be: Used for energy Stored as glycogen in liver Converted into triglycerides for storage When blood glucose levels low Pancreatic alpha cells release glucagon: Signals liver to release glucose from liver glycogen Blood Glucose Regulation When blood glucose levels are high the pancreatic beta cells release insulin which helps glucose enter body cells so glucose can be: Used for energy Stored as glycogen in liver Converted into triglycerides for storage As a result blood glucose levels decrease. When blood glucose levels are low the pancreatic alpha cells release glucagon. Glucagon signals the liver to release glucose from liver glycogen to raise blood glucose levels.

Blood Glucose Regulation: Insulin
Figure 4.8a

Blood Glucose Regulation: Glucagon
Figure 4.8b

What Is Diabetes Diabetes is a condition that results in high blood glucose levels When someone has diabetes the body: Makes little or no insulin, Doesn’t use insulin properly, or Both As a result, body cells don’t get energy they need, and blood glucose levels stay high What Is Diabetes Diabetes is a condition that results in high blood glucose levels. When someone has diabetes the body: Makes little or no insulin, Doesn’t use insulin properly, or Both As a result, body cells don’t get energy they need, and blood glucose levels stay high.

Diabetes Symptoms Symptoms are caused by high blood glucose, may include: Frequent urination Increased hunger Increased thirst Blurred vision Feeling tired Irritability Diabetes Symptoms Symptoms of diabetes are caused by high blood glucose, may include: Frequent urination Increased hunger Increased thirst Blurred vision Feeling tired Irritability 4/19/2017

Types of Diabetes Pre diabetes Gestational Gestational Type 1 (5-10%)
Body doesn’t make insulin Must take insulin Develops rapidly Type 2 (90-95%) Body doesn’t make enough insulin, or the body doesn’t respond to insulin Weight control may help May still need medication Develops slowly Gestational Types of Diabetes There are different types of diabetes: Pre diabetes Type 1 (5-10%) Body doesn’t make insulin Must take insulin Develops rapidly Type 2 (90-95%) Body doesn’t make enough insulin, or the body doesn’t respond to insulin Weight control may help May still need medication Develops slowly Gestational 4/19/2017

Types of Diabetes Pre Diabetes
Overweight increases risk of developing type 2 diabetes by decreasing body's ability to use insulin Insulin resistance Body produces insulin; however, body cells resist action of insulin Blood glucose levels begin to increase Impaired glucose tolerance and/or impaired fasting glucose Pre Diabetes Overweight increases risk of developing type 2 diabetes by decreasing the body's ability to use insulin, called insulin resistance. With insulin resistance the body produces insulin; however, body cells resist action of insulin. Because the body resists the action of insulin blood glucose levels begin to increase resulting in impaired glucose tolerance and/or impaired fasting glucose.

At first, body responds to insulin resistance by having beta cells produce more insulin to keep blood glucose levels down Can lead to high blood insulin levels Body may be able to keep blood glucose levels down by producing extra insulin for several years Eventually beta cells begin to wear out and produce less insulin, which can potentially lead to development of type 2 diabetes Pre Diabetes At first, the body responds to insulin resistance by having the pancreatic beta cells produce more insulin to help keep blood glucose levels down. This can lead to high blood insulin levels. The body may be able to keep blood glucose levels down by producing extra insulin for several years. Eventually the beta cells begin to wear out and produce less insulin, which can potentially lead to development of type 2 diabetes.

Where extra weight is carried is a factor in insulin resistance Upper body fat cells are more likely to be large insulin resistant fat cells Lower body fat cells are more likely to be smaller and respond normally to insulin Pre Diabetes Where extra weight is carried is a factor in the development of insulin resistance. Upper body or abdominal fat cells are more likely to be large insulin resistant fat cells. Lower body fat cells are more likely to be smaller and respond normally to insulin.

Types of Diabetes Type 1 (5-10%)
Autoimmune disorder: defect in which immune cells attack and destroy the insulin producing pancreatic beta cells Symptoms High blood glucose Increased urination Increased thirst Weight loss Dehydration Feeling tired Irritability Type 1 Diabetes (5-10%) Type 1 diabetes is an autoimmune disorder, defect in which immune cells attack and destroy the insulin producing pancreatic beta cells. Symptoms of type 1 diabetes include: High blood glucose Increased urination Increased thirst Weight loss Dehydration Feeling tired Irritability

Types of Diabetes Type 2 (90-95%)
Usually develops after 40 years of age as the pancreatic beta cells progressively lose function with age Most people with type 2 diabetes are overweight However, type 2 diabetes is also being seen in overweight children Closely related to overweight and inactivity Estimates are 30 to 50 percent of people with type 2 diabetes are undiagnosed Type 2 Diabetes (90-95%) Type 2 Diabetes usually develops after 40 years of age as the pancreatic beta cells progressively lose function with age. Most people with type 2 diabetes are overweight. However, type 2 diabetes is also being seen in overweight children. The incidence of type 2 diabetes in children is is closely related to overweight and inactivity. Because type 2 diabetes develops slowly many people are unaware they have it. Some estimates are 30 to 50 percent of people with type 2 diabetes are undiagnosed.

Types of Diabetes Gestational Diabetes
Glucose intolerance that develops during pregnancy (usually 2-3 trimester) 7% of all pregnancies Insulin antagonist hormone levels increase and insulin resistance occurs Blood glucose control usually returns to normal after delivery Gestational Diabetes Gestation diabetes is glucose intolerance that develops during pregnancy, usually in the 2nd to 3rd trimester. Gestational diabetes occurs in approximately 7% of all pregnancies. During pregnancy insulin antagonist hormone levels increase which can increase the risk of insulin resistance. Blood glucose control usually returns to normal after delivery.

Diabetic Complications
High blood glucose can damage: Nerves, eyes, kidneys, heart, and blood vessels This damage can lead to: Blindness, high blood pressure, heart disease, kidney disease, and amputations Keeping blood glucose in control can stop or prevent development of diabetic complications Diabetic Complications High blood glucose can damage nerves, eyes, kidneys, heart, and blood vessels. This damage can lead to blindness, high blood pressure, heart disease, kidney disease, and amputations. Keeping blood glucose in control can stop or prevent development of diabetic complications. 4/19/2017

Screening Recommended
People with impaired glucose tolerance and/or impaired fasting glucose People over age 45 People with a family history of diabetes People who are overweight People who do not exercise regularly People with low HDL cholesterol or high triglycerides, high blood pressure Certain racial/ethnic groups (Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans, Pacific Islanders, and American Indians and Alaska Natives) Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth Screening for Diabetes is Recommended People with impaired glucose tolerance and/or impaired fasting glucose People over age 45 People with a family history of diabetes People who are overweight People who do not exercise regularly People with low HDL cholesterol or high triglycerides, high blood pressure Certain racial/ethnic groups (Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans, Pacific Islanders, and American Indians and Alaska Natives) Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

Screening Recommended
Children and Adolescents should be screen if overweight or at-risk-for-overweight and if have two of the following risk factors: Family history of diabetes Low HDL cholesterol or high triglycerides, high blood pressure Certain racial and ethnic groups (e.g., Non- Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives) Signs of insulin resistance (acanthosis nigricans – gray/brown skin pigmentation) Screening for Diabetes is Recommended Children and Adolescents should be screen if overweight or at-risk-for-overweight and if have two of the following risk factors: Family history of diabetes Low HDL cholesterol or high triglycerides, high blood pressure Certain racial and ethnic groups (e.g., Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives) Signs of insulin resistance (acanthosis nigricans – gray/brown skin pigmentation)

Preventing Diabetes Type 1 Diabetes
No nutritional recommendations can be made for prevention of type 1 diabetes Research is investigating if breast feeding over bottle feeding may be beneficial Preventing Diabetes No nutritional recommendations can be made for prevention of type 1 diabetes. Research is investigating if breast feeding over bottle feeding may be of benefit.

Preventing Diabetes Type 2 Diabetes
Weight management (diet and physical activity) Diabetes Prevention Program (oral medication vs lifestyle intervention) 31% decrease in progression to diabetes in medication group 58% decrease in progression to diabetes in lifestyle group Modest weight loss (5-10%) Modest physical activity (30 minutes daily) Preventing Diabetes Preventing type 2 diabetes focuses on weight management through healthy eating and physical activity. The Diabetes Prevention Program compared the effects of oral medication vs lifestyle intervention in preventing progression to diabetes. There was a 31% decrease in progression to diabetes in medication group. There was a 58% decrease in progression to diabetes in lifestyle group. The lifestyle intervention program focused on a modest weight loss (5-10%) and modest physical activity (30 minutes daily).

Diabetes Treatment Goals of diabetes treatment are to achieve:
Control blood glucose Control blood lipids Control blood pressure Prevent or delay large and small blood vessel and nerve damage Diabetes Control and Complications Trials have shown controlling blood glucose is effective in preventing or delaying diabetic complications Diabetes Treatment Goals of diabetes treatment are to achieve: Control blood glucose Control blood lipids Control blood pressure Prevent or delay large and small blood vessel and nerve damage Diabetes Control and Complications Trials have shown controlling blood glucose is effective in preventing or delaying diabetic complications

Diabetes Treatment The goal of diabetes treatment is to keep blood glucose in control through: Diabetic Meal Physical Activity Plan Medication Diabetes Treatment The goal of diabetes treatment is to keep blood glucose in control through diabetic meal plan, physical activity and medication (if needed). 4/19/2017

Diabetes Health Care Team
People with diabetes should receive medical care from a physician-coordinated team. Such teams may include, but are not limited to: Physician Mental Health Professional Nurse Ophthalmologist/Optometrist Dietitian Podiatrist Pharmacist Dentist Diabetes Educator Dermatologist Exercise Physiologist Diabetes Health Care Team People with diabetes should receive medical care from a physician-coordinated team. Such teams may include, but are not limited to: Physician Nurse Dietitian Pharmacist Diabetes Educator Exercise Physiologist Mental Health Professional Ophthalmologist/Optometrist Podiatrist Dentist Dermatologist 4/19/2017

Diabetes Health Care Team
Most important person on a diabetes health care team is the person with diabetes A lot of diabetes care is self-care. The person with diabetes is the one who knows: How feels If following meal plan If physically active If taking medication If testing blood glucose and If problems start to occur Diabetes Health Care Team Most important person on a diabetes health care team is the person with diabetes. A lot of diabetes care is self-care. The person with diabetes is the one who knows: How feels If following meal plan If physically active If taking medication If testing blood glucose and If problems start to occur 4/19/2017

Standards of Care Taking care of diabetes will allow people with diabetes to enjoy life with few complications The American Diabetes Association provides standards of care for people with diabetes For detailed information on standards of diabetes care contact local American Diabetes Association at Standards of Care Taking care of diabetes will allow people with diabetes to enjoy life with few complications. The American Diabetes Association provides standards of care for people with diabetes. For detailed information on standards of diabetes care contact local American Diabetes Association at 4/19/2017

Standards of Care After being diagnosed with diabetes, people with diabetes should work with their physician and health-care team to make a diabetes care plan A diabetes care plan needs to be individualized to fit the person’s lifestyle Standards of Care After being diagnosed with diabetes, people with diabetes should work with their physician and health-care team to make a diabetes care plan. A diabetes care plan needs to be individualized to fit the person’s lifestyle. 4/19/2017

Standards of Care A diabetes care plan should be individualized and include information on: Visiting your doctor Eye care Management goals Foot care Medications Dental care Diabetic meal plan Other professionals Physical activity Sick day plan Glucose testing Stress management Standards of Care A diabetes care plan should be individualized and include information on: Visiting your doctor Management goals Medications Diabetic meal plan Physical activity Glucose testing Eye care Foot care Dental care Other professionals Sick day plan Stress management 4/19/2017

Standards of Care Visiting doctor Every 3- 6 months
Review blood glucose records A1c Blood pressure Weight Foot check Standards of Care Visiting doctor every 3- 6 months should include: Review blood glucose records A1c Blood pressure Weight Foot check 4/19/2017

Blood Glucose Goals Normal Goal*
Fasting or before meals <100 mg/dl mg/dl 2 Hr Post Meal <140 mg/dl <180 mg/dl HbA1c <6% <7% *varies

Standards of Care Visiting doctor Every year
Total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides Kidneys (urine analysis for protein in urine) Dilated eye exam Review meal plan Flu shot Update with diabetes educator Standards of Care Yearly doctor visits should include: Total cholesterol, LDL cholesterol, HDL cholesterol, triglyceridesKidneys (urine analysis for protein in urine) Dilated eye exam Review meal plan Flu shot Update with diabetes educator 4/19/2017

Blood Lipid and Blood Pressure Goals
Lipids Cholesterol < 200 mg/dl LDL Cholesterol < 100 mg/dl HDL Cholesterol > 40 mg/dl (men) > 50 mg/dl (women) Triglycerides < 150 mg/dl Blood Pressure Systolic <130 mm Hg Diastolic < 80 mm Hg

Standards of Care Diabetes management goals
Both short and long-term goals Diabetes management goals are individualized depending on diabetes control and other health conditions Standards of Care Diabetes management goals should include both short and long-term goals. Diabetes management goals are individualized depending on diabetes control and other health conditions. 4/19/2017

Standards of Care If need medications, education needed to:
Learn how to use them How they work with diet and physical activity What to do if blood glucose goes too high or low Standards of Care If need medications, education is needed to: Learn how to use them How they work with diet and physical activity What to do if blood glucose goes too high or low 4/19/2017

Medication Insulin Oral mediations
Taking medication does not replace healthful habits, still need to follow diabetic meal plan and participate in physical activity Medication There are different medications: Insulin Oral mediations Taking medication does not replace healthful habits, still need to follow diabetic meal plan and participate in physical activity. 4/19/2017

Standards of Care A diabetic meal plan individualized to fit person’s lifestyle, diabetes, and other health conditions - education is needed to: Know how the diet works with medication and physical activity How to follow the diabetic meal plan at home, at work, and when eating out Know whether alcohol fits into the meal plan What to eat when sick, on how being sick affects blood glucose Standards of Care A diabetic meal plan individualized to fit person’s lifestyle, diabetes, and other health conditions - education is needed to: Know how the diet works with medication and physical activity How to follow the diabetic meal plan at home, at work, and when eating out Know whether alcohol fits into the meal plan What to eat when sick, on how being sick affects blood glucose 4/19/2017

Diabetic Meal Plan A diabetic meal plan focuses on providing a healthy diet that: Controls blood glucose and Prevents diabetic complications Diabetic Meal Plan A diabetic meal plan focuses on providing a healthy diet that controls blood glucose and prevents diabetic complications. 4/19/2017

Diabetic Meal Plan There is no one specific diabetic meal plan, a diabetic meal plan is developed to meet your own special needs: Individual food likes Daily schedule Medications used Other health issues: Glucose control Weight Blood lipids Blood pressure Diabetic Meal Plan There is no one specific diabetic meal plan, a diabetic meal plan is developed to meet your own special needs: Individual food likes Daily schedule Medications used Other health issues: Glucose control Weight Blood lipids Blood pressure

Diabetic Meal Plan A healthy diet includes a variety of foods from all the food groups. In general, a diabetic meal plan is: Low in fat Moderate in protein Highs in complex carbohydrates like beans, vegetables and grains (such as breads, cereals, noodles, and rice) Diabetic Meal Plan A healthy diet includes a variety of foods from all the food groups. In general, a diabetic meal plan is: Low in fat Moderate in protein Highs in complex carbohydrates like beans, vegetables and grains (such as breads, cereals, noodles, and rice) 4/19/2017

Consistency A diabetic meal plan provides a consistent amount of carbohydrate from day to day, spaced evenly throughout the day to prevent wide changes in blood glucose Some methods used to provide the consistency of a diabetic meal plan are: Plate method Diabetic pyramid Diabetic exchange system Carbohydrate counting Consistency A diabetic meal plan provides a consistent amount of carbohydrate from day to day, spaced evenly throughout the day to prevent wide changes in blood glucose Two methods used to provide the consistency of a diabetic meal plan are: Plate method Diabetic pyramid Diabetic exchange system Carbohydrate counting

Consistency Eating too much carbohydrate at one time can raise blood glucose too high. Eating too little carbohydrate can lead to hypoglycemia, especially for people taking oral diabetic medication or insulin. Consistency Eating too much carbohydrate at one time can raise blood glucose too high. Eating too little carbohydrate can lead to hypoglycemia, especially for people taking oral diabetic medication or insulin.

Consistency To be consistent, it's best to:
Eat about the same number of calories each day Eat meals and snacks about the same time each day Spread meals and snacks throughout the day Never skip meals Watch portion sizes Consistency To be consistent, it's best to: Eat about the same number of calories each day Eat meals and snacks about the same time each day Spread meals and snacks throughout the day Never skip meals Watch portion sizes

Individual Considerations
Weight loss Carbohydrate Alcohol Fat Sodium Protein Individual Considerations Individual dietary considerations may be needed for: Weight loss Carbohydrate Alcohol Fat Sodium Protein 4/19/2017

Weight Loss For many people with type 2 diabetes losing weight is a big part of diabetes treatment Losing weight can help body cells use insulin better For people who are trying to lose weight their diabetic meal plan will be moderately lower in calories and fat to help with weight loss Losing weight and lowering fat intake can also help lower blood cholesterol and blood pressure Weight Loss For many people with type 2 diabetes losing weight is a big part of diabetes treatment. Losing weight can help body cells use insulin better. For people who are trying to lose weight their diabetic meal plan will be moderately lower in calories and fat to help with weight loss. Losing weight and lowering fat intake can also help lower blood cholesterol and blood pressure. 4/19/2017

Weight Loss The best way to lose weight is to:
Follow a healthy eating plan, moderately lower in calories (about 500 calories less per day) and Increase physical activity (60 minutes per day) Healthy weight loss is slow Maximum recommended weight loss is 1 to 2 pound per week Many times, just a 10% weight loss can bring blood glucose into control for people with type 2 diabetes Weight Loss The best way to lose weight is to: Follow a healthy eating plan, moderately lower in calories (about 500 calories less per day) and Increase physical activity Healthy weight loss is slow Maximum recommended weight loss is 1 to 2 pound per week Many times, just a 5-10% weight loss can bring blood glucose into control for people with type 2 diabetes 4/19/2017

Carbohydrate Dietary carbohydrates include:
Simple Sugars Complex Carbohydrates Grains, Fruits, Milk and Vegetables Fiber During digestion all carbohydrates except fiber break down into simple sugars Carbohydrate Dietary carbohydrates include: Simple Sugars Complex Carbohydrates including Grains, Fruits, Milk and Vegetables Fiber During digestion all carbohydrates except fiber break down into simple sugars

Carbohydrate In the past, people with diabetes were told to avoid sugar Now known that complex carbohydrates and sugars have a similar effect on blood glucose levels The total amount of carbohydrate is the issue, not just sugar People with diabetes can have sugar, but the carbohydrate from foods containing sugar must be worked into the meal plan Carbohydrate In the past, people with diabetes were told to avoid sugar. It is now known that complex carbohydrates and sugars have a similar effect on blood glucose levels. The total amount of carbohydrate is the issue, not just sugar People with diabetes can have sugar, but the carbohydrate from foods containing sugar must be worked into the meal plan. 4/19/2017

Carbohydrates There are some problems with foods high in sugar
Foods high in sugar often don't provide other important nutrients needed every day Foods high in sugar are also often high in fat Carbohydrates There are some problems with foods high in sugar. Foods high in sugar often don't provide other important nutrients needed every day. Foods high in sugar are also often high in fat. 4/19/2017

Glycemic Index Glycemic index is the blood glucose response to a food, this varies based on: Amount of carbohydrate Nature of the starch Cooking and processing Food form and particle size Severity of glucose intolerance Fasting and pre-meal glucose concentration Glycemic Index Glycemic index is the blood glucose response to a food, this varies based on: Amount of carbohydrate Nature of the starch Cooking and processing Food form and particle size Severity of glucose intolerance Fasting and pre-meal glucose concentration

Glycemic Index However, although different carbohydrates have different glycemic responses (glycemic index), there is limited long-term benefits of low glycemic index diets on blood glucose control (A1c). Therefore there is insufficient evidence to recommend low glycemic index diets as a strategy in diabetes meal planning. Glycemic Index However, although different carbohydrates have different glycemic responses (glycemic index), there is limited long-term benefits of low glycemic index diets on blood glucose control (A1c). Therefore there is insufficient evidence to recommend low glycemic index diets as a strategy in diabetes meal planning.

Artificial Sweeteners
The American Diabetes Association considers FDA approved artificial sweeteners safe in moderation Although artificial sweeteners do not provide significant calories, foods containing them may not always be lower in calories than similar products that contain sugars. Artificial Sweeteners The American Diabetes Association considers FDA approved artificial sweeteners safe in moderation Although artificial sweeteners do not provide significant calories, foods containing them may not always be lower in calories than similar products that contain sugars. 4/19/2017

Sugar Alcohol Sugar alcohols, are a group of low calorie, carbohydrate based sweeteners. They provide the taste and texture of sugar with about half the calories Since sugar alcohols are only partially absorbed by the body they provide fewer calories than sugar In large amounts sugar alcohols can cause gastrointestinal problems, such as diarrhea. Sugar Alcohols Sugar alcohols, are a group of low calorie, carbohydrate based sweeteners. They provide the taste and texture of sugar with about half the calories. Since sugar alcohols are only partially absorbed by the body they provide fewer calories than sugar. In large amounts sugar alcohols can cause gastrointestinal problems, such as diarrhea.

Sugar Alcohols Some common sugar alcohols include: Erythritol
Hydrogenated Starch Hydrolysates (Polyglycitol and Polyglucitol) Isomalt Lactitol Maltitol Mannitol Sorbitol Xylitol Sugar Alcohols Some common sugar alcohols include: Erythritol Hydrogenated Starch Hydrolysates (Polyglycitol and Polyglucitol) Isomalt Lactitol Maltitol Mannitol Sorbitol Xylitol

Fiber Dietary fiber has many important health benefits
Soluble fiber delays glucose absorption and has been promoted to help with blood glucose control Fiber Dietary fiber has many important health benefits. Soluble fiber delays glucose absorption and has been promoted to help with blood glucose control

Fiber Early short-term studies using > 30 g fiber/day suggested a positive effect of fiber on glucose control However, later studies have shown larger amounts of fiber, approximately 50 g/day, are necessary to have beneficial effects on blood glucose and cholesterol It is unlikely people could maintain a fiber intake of 50 g/day Fiber Early short-term studies using > 30 g fiber/day suggested a positive effect of fiber on glucose control. However, later studies have shown larger amounts of fiber, approximately 50 g/day, are necessary to have beneficial effects on blood glucose and cholesterol. It is unlikely people could maintain a fiber intake of 50 g/day.

Fiber Therefore, there is no reason to recommend people with diabetes consume greater amounts of fiber than the general public The Adequate Intake for dietary fiber is 14 grams dietary fiber per 1,000 calories Equal to 28 grams fiber for a typical 2,000 calorie diet Guidelines for increasing dietary fiber are: Go gradually Drink plenty of water Fiber Therefore, there is no reason to recommend people with diabetes consume greater amounts of fiber than the general public. The Adequate Intake for dietary fiber is 14 grams dietary fiber per 1,000 calories. This is equal to 28 grams fiber for a typical 2,000 calorie diet. Guidelines for increasing dietary fiber are: Go gradually Drink plenty of water

Alcohol Most people in good diabetes control can safely have a drink with a meal every so often Alcohol can cause low blood glucose, especially for people using medication It is important to test blood glucose level, before, during and after drinking Never drink an alcohol beverage on an empty stomach Alcohol Most people in good diabetes control can safely have a drink with a meal every so often. It is important to test blood glucose level, before, during and after drinking. Never drink an alcohol beverage on an empty stomach, Alcohol can cause low blood glucose, especially for people using medication. 4/19/2017

Alcohol and Hypoglycemia
Diabetic medications increase the risk of alcohol related hypoglycemia because these work to remove glucose from the blood Normally when blood glucose start to fall, the liver releases glucose into the blood to keep the blood glucose from going too low When alcohol is consumed, the liver works to clear the alcohol and doesn’t release glucose into the blood As a result, if blood glucose is falling one can quickly go into hypoglycemia Alcohol and Hypoglycemia Diabetic medications increase the risk of alcohol related hypoglycemia because these work to remove glucose from the blood. Normally when blood glucose start to fall, the liver releases glucose into the blood to keep the blood glucose from going too low . When alcohol is consumed, the liver works to clear the alcohol and doesn’t release glucose into the blood. As a result, if blood glucose is falling one can quickly go into hypoglycemia.

Alcohol after hard physical activity increases the risk of hypoglycemia: Physical activity helps to lower blood glucose After physical activity the body replaces muscle glucose with glucose from the blood This can cause blood glucose levels to start falling. If the liver doesn’t release glucose hypoglycemia can occur Alcohol and Hypoglycemia Alcohol after hard physical activity increases the risk of hypoglycemia. This is because physical activity helps to lower blood glucose. In addition, after physical activity the body replaces muscle glucose with glucose from the blood. This can cause blood glucose levels to start falling. If the liver doesn’t release glucose hypoglycemia can occur.

Glucagon shots are used to treat sever hypoglycemia caused by too much insulin, they will not help sever hypoglycemia caused by alcohol. Glucagon works by causing the liver to release more glucose into the blood. But the liver will not release more glucose into the blood while clearing alcohol. Alcohol and Hypoglycemia Glucagon shots are used to treat sever hypoglycemia caused by too much insulin, they will not help sever hypoglycemia caused by alcohol. Glucagon works by causing the liver to release more glucose into the blood. But the liver will not release more glucose into the blood while clearing alcohol.

Alcohol Not Recommended
Alcohol is not recommended: If blood glucose is not in control. If trying to lose weight. If have diabetic nerve damage. Alcohol can increase symptoms of nerve damage. If have high blood pressure Alcohol can raise blood pressure. If have high triglycerides Alcohol promotes the liver to make more triglycerides. Alcohol Not Recommended Alcohol is not recommended: If blood glucose is not in control. If trying to lose weight. If have diabetic nerve damage. Alcohol can increase symptoms of nerve damage. If have high blood pressure. Alcohol can raise blood pressure. If have high triglycerides. Alcohol promotes the liver to make more triglycerides.

Guidelines for Alcohol
Never drink on an empty stomach Limit to 1 drink/day for women and 2 drinks/day for men Test blood glucose before having a drink and following to watch for falling blood glucose Test blood glucose before going to sleep to see if a snack is needed to avoid going into hypoglycemia while sleeping Guidelines for Alcohol Never drink on an empty stomach. Limit to 1 drink/day for women and 2 drinks/day for men. Test blood glucose before having a drink and following to watch for falling blood glucose. Test blood glucose before going to sleep to see if a snack is needed to avoid going into hypoglycemia while sleeping.

Guidelines for Alcohol
Wear a medical diabetes identification bracelet Symptoms of hypoglycemia include slurred speech and confusion These symptoms are similar to symptoms of too much alcohol Guidelines for Alcohol Wear a medical diabetes identification bracelet. Symptoms of hypoglycemia include slurred speech and confusion. These symptoms are similar to symptoms of too much alcohol.

Fat Increased risk of high blood cholesterol, triglycerides and heart disease is a diabetes complication If a person is at risk for high blood cholesterol their diabetic meal plan may be modified to be low in fat, saturated fat and trans fat Weight loss also helps lower blood cholesterol and triglycerides for people who are over weight Fat Increased risk of high blood cholesterol, triglycerides and heart disease is a diabetes complication. If a person is at risk for high blood cholesterol their diabetic meal plan may be modified to be low in fat, saturated fat and trans fat. Weight loss also helps lower blood cholesterol and triglycerides for people who are over weight. 4/19/2017

Fat For all persons; recommended total fat, saturated fat, and cholesterol intakes are: Total fat – Between 20 to 35 percent of calories Saturated fat - Less than 10 percent of calories Cholesterol - Less than 300 milligrams per day Trans fatty acid intake should be as low as possible Fat For all persons; recommended total fat, saturated fat, and cholesterol intakes are: Total fat – Between 20 to 35 percent of calories Saturated fat - Less than 10 percent of calories Cholesterol - Less than 300 milligrams per day Trans fatty acid intake should be as low as possible

Fat If LDL cholesterol is > 100 mg/dl, some people may benefit from lower intakes: Saturated fat - Less than 7 percent of calories Cholesterol - Less than 200 milligrams per day Trans-fatty acid intake should be as low as possible Fat If LDL cholesterol is > 100 mg/dl, some people may benefit from lower intakes: Saturated fat - Less than 7 percent of calories Cholesterol - Less than 200 milligrams per day Trans-fatty acid intake should be as low as possible

Sodium High blood pressure is a diabetes complication
As a result, if a person is at risk for high blood pressure their diabetic meal plan may be modified to be low in sodium Sodium High blood pressure is a diabetes complication. As a result, if a person is at risk for high blood pressure their diabetic meal plan may be modified to be low in sodium. Weight loss will also help lower blood pressure for people who are over weight. 4/19/2017

Sodium High sodium intake may contribute to high blood pressure in “salt sensitive” people People who have diabetes tend to be more “sodium sensitive” Sodium High sodium intake may contribute to high blood pressure in “salt sensitive” people. People who have diabetes tend to be more “sodium sensitive.”

Sodium Dietary Guidelines recommend
People reduce daily sodium intake to less than 2,300 mg (approximately 1 teaspoon of salt) and Further reduce sodium intake to less than 1,500 mg sodium among those: 51 years of age or older of any age who are African American or have hypertension, diabetes or chronic kidney disease Weight loss will also help lower blood pressure for people who are over weight Sodium As a result, the Dietary Guidelines for Americans recommends people reduce daily sodium intake to less than 2,300 mg ( approximately 1 teaspoon) and further reduce intake to 1,500 mg (approximately ¾ teaspoon) among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population. Weight loss will also help lower blood pressure for people who are over weight

Protein Kidney disease is also a complication of diabetes
If a person has kidney disease the protein content of their diabetic meal plan may be modified Protein Kidney disease is also a complication of diabetes. If a person has kidney disease the protein content of their diabetic meal plan may be modified. 4/19/2017

Protein No evidence typical protein intake (15-20% of calories) must be modified if kidney function is normal A higher incidence of protein in the urine has been observed with protein intakes greater than 20% of calories May be an indication to keep protein intake below 20% of calories Protein There is no evidence that the typical protein intake (15-20% of calories) must be modified if kidney function is normal. A higher incidence of proteinuria (protein in the urine) has been observed with protein intakes greater than 20% of calories. This may be an indication to keep protein intake below 20% of calories.

High Protein Diets High protein diets are promoted for weight loss
Long term effects of high protein weight-loss diets on kidney function is a concern Effect of high protein diets, high in saturated fat, on LDL cholesterol is a concern. Although initially weight may be lost, unknown whether weight loss is maintained better than with other low calorie diets High Protein Diets High protein diets are often promoted for weight loss. However, the long term effects of high protein weight-loss diets on kidney function among people with diabetes is a concern. Effect of high protein diets, high in saturated fat, on LDL cholesterol and heart disease risk among people with diabetes is also a concern. Although initially weight may be lost, unknown whether weight loss is maintained better than with other low calorie diets. A lot of the initial weight loss with high protein diets is due to water loss not fat loss.

Standards of Care Recommendations for physical activity and education on: Effect of physical activity on blood glucose How physical activity works with diet and medication What to do if change the level of physical activity Standards of Care Recommendations for physical activity and education on: Effect of physical activity on blood glucose How physical activity works with diet and medication What to do if change the level of physical activity 4/19/2017

Physical Activity Physically active has many benefits:
Helps body cells take in glucose Lowers blood glucose levels May lower the amount of medication needed Helps with weight loss Lowers blood cholesterol Lowers blood pressure Lower stress Physical Activity Physically active has many benefits: Helps body cells take in glucose Lowers blood glucose levels May lower the amount of medication needed Helps with weight loss Lowers blood cholesterol Lowers blood pressure Lower stress 4/19/2017

Standards of Care Education on:
Self-testing blood glucose and urine ketones Keeping blood glucose records How to treat high and low blood glucose reactions Standards of Care Education on: Self-testing blood glucose and urine ketones Keeping blood glucose records How to treat high and low blood glucose reactions 4/19/2017

Glucose Testing It is important to check blood glucose to see how the treatment plan is working Testing blood glucose helps people will learn how the food they eat and physical activity affects their blood glucose level If blood glucose is not in control it may mean a person needs to change their meal plan, physical activity, or medication. Glucose Testing A diabetes treatment plan is a balance of medication, meal plan, and physical activity to help keep blood glucose levels normal. It is important to check blood glucose to see how the treatment plan is working. Testing blood glucose levels at home helps people will learn how the food they eat and physical activity affects their blood glucose level. Self-testing your blood glucose helps you be in control of your diabetes. If blood glucose is not in control it may mean a person needs to change their meal plan, physical activity, or medication.

Glucose Testing Various glucose testing times Before meals
2 hours after meals Bedtime During the night Glucose Testing Various glucose testing times Before meals 2 hours after meals Bedtime During the night

Glucose Monitoring Fasting glucose normal/HbA1C high Dawn phenomenon
Able to bring blood glucose down overnight, but blood glucose high at other times, possibly after meals Dawn phenomenon Increased hepatic glucose output overnight (dawn phenomenon)-common with type 2 diabetes Evening snack Oral medication that affect liver glucose output Glucose Monitoring Monitoring blood glucose can help detect problems in glucose control such as: Fasting glucose normal but HbA1C high. A normal fasting blood glucose indicates able to bring blood glucose down overnight, but high HbA1c indicates blood glucose is high at other times, possibly staying elevated after meals. Dawn phenomenon. If blood glucose goes too low overnight this can result in increased hepatic glucose output overnight and elevated blood glucose in the morning (dawn phenomenon). This is common with type 2 diabetes. People may misinterpret this as a need to further reduce carbohydrate intake, whereas in reality they may need an evening snack to help keep blood glucose from going to low overnight. In addition there are specific oral medications that can affect liver glucose output.

Standards of Care Education on eye complications and a plan for seeing an eye doctor annually Standards of Care Education on eye complications and a plan for seeing an eye doctor annually. 4/19/2017

Standards of Care Education on foot complications and a plan for seeing a foot doctor Education is also needed on what to do if a person has a sore on your foot Standards of Care Education on foot complications and a plan for seeing a foot doctor. Education is also needed on what to do if a person has a sore on your foot. 4/19/2017

Standards of Care Education on caring for teeth, gums, and mouth and a plan for seeing a dentist Standards of Care Education on caring for teeth, gums, and mouth and a plan for seeing a dentist. 4/19/2017

Standards of Care Education on how stress affects blood glucose and a plan for seeing a mental health professional Information on other health professionals a person may need to see Standards of Care Education on how stress affects blood glucose and a plan for seeing a mental health professional. Information on other health professionals a person may need to see. 4/19/2017

Living With Diabetes A diabetes meal plan, medication and physical activity program work together to keep blood glucose in control Monitor blood glucose frequently to see how diabetes treatment plan is working Keeping blood glucose in control will help individuals with diabetes feel better now and stay healthy in the future Living with Diabetes A diabetes meal plan, medication and physical activity program work together to keep blood glucose in control. Monitor blood glucose frequently to see how diabetes treatment plan is working. Keeping blood glucose in control will help individuals with diabetes feel better now and stay healthy in the future. 4/19/2017

Diabetic Meal Plan Methods
Some methods used to provide the consistency of a diabetic meal plan are: Plate method USDA Daily Food Plan and MyPlate Diabetic exchange system Carbohydrate counting Diabetic Meal Plan Methods Some methods used to provide the consistency of a diabetic meal plan are: Plate method Diabetic pyramid Diabetic exchange system Carbohydrate counting

Plate Method ¼ plate: grains or starchy foods such as rice, pasta, potatoes, corn, or peas ¼ plate: protein foods such as meat, fish, poultry, or tofu ½ plate: non-starchy vegetables such as broccoli, carrots, cauliflower, salad and tomatoes Add a glass of non-fat milk and a small roll or piece of fruit Plate Method One-fourth of the plate should be filled with grains or starchy foods such as rice, pasta, potatoes, corn, or peas. One-fourth of the plate should be filled with protein foods such as meat, fish, poultry, or tofu. One-half of the plate should be filled with non-starchy vegetables such as broccoli, carrots, cauliflower, salad and tomatoes. Add a glass of non-fat milk and a small roll or piece of fruit.

USDA Daily Food Plan Guide for planning a healthful diet
Based on 2010 Dietary Guidelines Types and amounts of food for a healthful diet Limits for fats, sugars and sodium USDA Daily Food Plan The USDA Daily Food Plan is a guide to help you plan a healthful diet. The USDA Daily Food Plan is based on the Dietary Guidelines The USDA Daily Food Plan provides the types and amounts of foods you can eat each day to provide a healthful diet. The USDA Daily Food Plan also provides limits for fats, sugars and sodium.

USDA Daily Food Plan: Food Groups
Grains Vegetables Fruits Dairy Protein foods USDA Daily Food Plan: Food Groups Each USDA Daily Food Plan food group is represented by a different color, as illustrated in the MyPlate. Grains – orange Vegetables – green Fruits – red Dairy – blue Protein foods – purple

MyPlate MyPlate The MyPlate illustrates the USDA Daily Food Plan food groups using a familiar mealtime place setting. The MyPlate also supports the Dietary Guidelines 2010 consumer messages to build a healthy plate.

USDA Daily Food Plan Recommended Amounts
USDA Daily Food Plan recommended amounts is based on your estimated calorie needs Your estimated calorie needs is based on your: Gender Age Physical Activity Web site: USDA Daily Food Plan Recommended Amounts The USDA Daily Food Plan provides the amount you need to eat each day based on your estimated calorie needs. Your estimated calorie needs are based on your gender, age, and level of physical activity. You can get a personalized plan of the amount of food you should eat from each USDA Daily Food Plan food group at

Estimated Calorie Needs
Gender Age (years) Sedentary Moderately Active Active Child 2-3 1,000-1,200 1,000-1,400 Female 4-8 1,200-1,400 1,400-1,600 1,400-1,800 9-13 1,600-2,000 1,800-2,200 14-18 1,800 2,000 2,400 19-30 1,800-2,000 2,000-2,200 31-50 2,200 51+ 1,600 Male 2,000-2,600 2,000-2,400 2,400-2,800 2,800-3,200 2,400-2,600 2,600-2,800 3,000 2,200-2,400 2,800-3,000 Estimated Calorie Needs Your estimated calorie needs are based on your gender, age, and level of physical activity.

Daily Food Plan For Different Calorie Levels
Calories 1,400 1,600 1,800 2,000 2,200 2,400 2,600 2,800 3,000 Grains (oz) 5 6 7 8 9 10 Vegetables (cups) 1 ½ 2 2 ½ 3 3 ½ 4 Fruits (cups) Dairy (cups) Protein foods (oz) 5 ½ 6 ½ Oils (tsp) Solid Fats and Added Sugars (calories) 120 160 260 270 330 360 400 460 Sodium (mg) 2,300 Sodium if 51+, African American or have chronic disease 1,500 Daily Food Plan for Different Calorie Levels The amount of food you need to eat from each USDA Daily Food Plan food group is based on your estimated calorie needs.

Grain Group In general 1 ounce from the grains group is:
1 slice of bread 1 cup of ready-to-eat cereal ½ cup of cooked rice, cooked pasta, or cooked cereal Consumer message Make half your grains whole Grain Group Any food made from wheat, rice, oats, cornmeal, barley or another cereal grain is part of this group. Grains are divided into whole grains and refined grains. In general 1 ounce from the grains group is: 1 slice of bread 1 cup of ready-to-eat cereal ½ cup of cooked rice, cooked pasta, or cooked cereal Consumer message: Make Half Your Grains Whole

Vegetable Group In general 1 cup from the vegetable group is:
1 cup of raw or cooked vegetables or vegetable juice 2 cups of raw leafy greens is considered as 1 cup from the vegetable group Consumer message Make half your plate fruits and vegetables Vegetable Group Any vegetable or 100% vegetable juice is part of this group. Vegetables are divided into five subgroups including dark green vegetables, red and orange vegetables, beans and peas, starchy vegetables and other vegetables. Over a week’s time eat vegetables from as many of the five subgroups as you can. In general 1 cup from the vegetable group is: 1 cup of raw or cooked vegetables or vegetable juice 2 cups of raw leafy greens is considered as 1 cup from the vegetable group Consumer message: Make half your plate fruits and vegetables.

Fruit Group In general 1 cup from the fruit group is: Consumer message
1 cup of fruit or 100% fruit juice ½ cup of dried fruit Consumer message Make half your plate fruits and vegetables Fruit Group Any fruit or 100% fruit juice is part of this group. In general 1 cup from the fruit group is: 1 cup of fruit or 100% fruit juice ½ cup of dried fruit Consumer message: Make half your plate fruits and vegetables.

Diary Group In general 1 cup from the dairy group is: Consumer message
1 cup of milk, yogurt or soymilk 1 ½ ounces of natural cheese 2 ounces of processed cheese Consumer message Switch to fat-free or low-fat (1%) milk Dairy Group: Get Your Calcium-Rich Foods All fluid milk products and many foods made from milk are part of this food group. Foods made from milk that keep their calcium content are part of this group. Foods make from milk with little or no calcium, such as cream cheese, cream and butter, are not part of this group. Calcium-fortified soymilk is also part of this food group. In general 1 cup from the dairy group is: 1 cup of milk, yogurt or soymilk 1 ½ ounces of natural cheese 2 ounces of processed cheese Consumer message: Switch to fat-free or low-fat (1%) milk.

Protein Foods Group In general 1 ounce from the protein foods group is: 1 ounce of meat, poultry or fish ¼ cup cooked dry beans 1 egg 1 tablespoon of peanut butter ½ ounce of nuts or seeds Consumer message Vary your protein Protein Foods All foods made from meat, poultry, seafood, beans or peas, eggs, processed soy products, nuts and seeds are part of this group. Beans and peas are also part of the vegetable group. In general 1 ounce from the protein foods group is: 1 ounce of meat, poultry or fish ¼ cup cooked dry beans 1 egg 1 tablespoon of peanut butter ½ ounce of nuts or seeds Consumer message: Vary your protein. The Dietary Guidelines recommends to vary your protein to improve health benefits, including at least 8 ounces of seafood per week.

Fats, Sugars and Sodium Although not food groups the USDA Daily Food Plan provides limits for fats, sugars and sodium. Fats, Sugars and Sodium Although not foods groups the USDA Daily Food Plan provides limits for fats (oils and solid fats), sugars and sodium. Most of the fat you eat should be oils. Oils are high in monounsaturated or polyunsaturated fats and low in saturated fats. Oils are fats that are liquid at room temperature. Oils come from many plants and fish. Some salad dressings and soft margarine with no trans fats are counted as oils. Solid fats tend to be high in saturated fat which can increase risk of certain chronic diseases. Solid fats are fats that tend to be solid at room temperature. Butter, shortening and animal fats are counted as solid fats. A few plant oils, such as coconut oil and palm kernel oil are high in saturated fats. Although these are liquid at room temperature they are counted as solid fats not oils. The Dietary Guidelines 2010 consumer sub-message for fat is: Eat fewer foods that are high in solid fats. The Dietary Guidelines 2010 recommend: Consuming less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. Consuming less than 300 mg per day of dietary cholesterol. Keeping trans fatty acid consumption as low as possible by limiting foods that contain synthetic sources of trans fats, such as partially hydrogenated oils, and by limiting other solid fats. The Dietary Guidelines consumer sub-message for sugar is: Choose foods and drinks with little or no added sugar. The Dietary Guidelines 2010 consumer sub-message for sodium is: Look out for sodium in foods you buy. The Dietary Guidelines recommend sodium intake be reduced to less than 2,300 mg or 1,500 mg if 51 years of age or older, African American or have high blood pressure, diabetes or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

Diabetic Exchanges Carbohydrates Meat and Meat Substitutes Fats Starch
Milk Fruit Other Carbohydrates Vegetables Meat and Meat Substitutes Fats Diabetic Exchanges Carbohydrates Starch Milk Fruit Other Carbohydrates Vegetables Meat and Meat Substitutes Fats

Nutrient Content of Exchanges
Carbohydrate Protein Fat Carbohydrates Starch g g g Fruit g g g Milk g g g Other Carbohydrates g varies varies Non-starchy Vegetables g g g Meat and Substitutes g g g Fats g g g

Diabetic Exchanges and Carbohydrate Counting
Exchange Groups Grams Carbohydrate Carbohydrate Choices Starch Fruit Milk Other Carbohydrate Vegetable

Starch Exchange: 1 carbohydrate choice
Contains breads, cereals, grains, pasta, starchy vegetables (potatoes, corn, green peas, sweet potatoes), crackers, and snacks Dried beans and lentils count as a starch and a very lean meat exchange Some starchy foods prepared with added fat count as a starch and a fat exchange Starch Exchange: 1 carbohydrate choice Contains breads, cereals, grains, pasta, starchy vegetables (potatoes, corn, green peas, sweet potatoes), crackers, and snacks. Dried beans and lentils count as a starch and a very lean meat exchange. Some starchy foods prepared with added fat count as a starch and a fat exchange.

1 Starch Exchange Contains
15 g carbohydrate 3 g protein 0-1 g fat 80 calories 1 Starch Exchange Contains 15 g carbohydrate 3 g protein 0-1 g fat 80 calories

In General 1 Starch Exchange Is:
1/2 cup of cooked cereal, grain, or starchy vegetable 1/3 cup of cooked rice or pasta 1 ounce of a bread product 1/2 cup cooked dried beans or lentils Counts as 1 starch and 1 very lean meat exchange 3/4 to 1 ounce of most snack foods Some snack foods count as 1 starch and 1 fat In General 1 Starch Exchange Is: 1/2 cup of cooked cereal, grain, or starchy vegetable 1/3 cup of cooked rice or pasta 1 ounce of a bread product 1/2 cup cooked dried beans or lentils counts as 1 starch and 1 very lean meat exchange 3/4 to 1 ounce of most snack foods some snack foods count as 1 starch and 1 fat)

Fruit Exchange The fruit exchange list contains fruits and unsweetened fruit juices 1 Fruit Exchange Contains 15 g carbohydrate 0 g protein 0 g fat 60 calories Fruit Exchange The fruit exchange list contains fruits and unsweetened fruit juices. 1 Fruit Exchange Contains: 15 g carbohydrate 0 g protein 0 g fat 60 calories

In General 1 Fruit Exchange Is:
1 small to medium fresh fruit 1/2 cup canned fruit 1/2 cup fruit juice 1/4 cup dried fruit In General 1 Fruit Exchange Is: 1 small to medium fresh fruit 1/2 cup canned fruit 1/2 cup fruit juice 1/4 cup dried fruit

Milk Exchange Contains milk and yogurt
Cheese is not included in the milk exchange Cheese is in the meat and meat substitute exchange Three milk exchange categories: Fat-free/Low-fat (1/2% or 1%) Reduced-fat (2%) Whole Milk Milk Exchange Contains milk and yogurt. Cheese is not included in the milk exchange Cheese is in the meat and meat substitute exchange. There are three milk exchange categories: Fat-free/Low-fat (1/2% or 1%) Reduced-fat (2%) Whole Milk

1 Milk Exchange Contains
Fat-free Reduced-fat Whole Carbohydrate g g g Protein g g g Fat g g g Calories

In General 1 Milk Exchange Is:
1 cup milk 2/3 cup of fat-free or low-fat flavored yogurt with a non-nutrative sweetener In General 1 Milk Exchange Is: 1 cup milk 2/3 cup of fat-free or low-fat flavored yogurt with a non-nutrative sweetener

Other Carbohydrates Exchange
Contains many foods that contain sugar (such as sweets, candy, and desserts) which used to be restricted in a diabetic diet Now known that carbohydrates (bread, rice, pasta, fruits and vegetables) and sugars have a similar effect on blood glucose levels Other Carbohydrates Exchange Contains many foods that contain sugar (such as sweets, candy, and desserts) which used to be restricted in a diabetic diet. Now know that carbohydrates (bread, rice, pasta, fruits and vegetables) and sugars have a similar effect on blood glucose levels

The total amount of carbohydrate is the issue, not just sugar But the carbohydrate from foods containing sugar must be worked into the meal plan However, foods high in sugar often don’t provide other important nutrients and may be high in fat Other Carbohydrates Exchange The total amount of carbohydrate is the issue, not just sugar. But the carbohydrate from foods containing sugar must be worked into the meal plan. However, foods high in sugar often don’t provide other important nutrients and may be high in fat.

One other carbohydrate exchange contains: 15 g carbohydrate Protein varies Fat varies Calories varies Portion size varies depending on the food Other Carbohydrates Exchange One other carbohydrate exchange contains: 15 g carbohydrate Protein varies Fat varies Calories varies Portion size varies depending on the food

Non-starchy Vegetable Exchange
Contains non-starchy vegetables and vegetable juices Starchy vegetables including potatoes, green peas, corn and sweet potatoes are not in the non-starchy vegetable exchange but are in the starch exchange Non-starchy Vegetable Exchange Contains non-starchy vegetables and vegetable juices. Starchy vegetables including potatoes, green peas, corn and sweet potatoes are not in the non-starchy vegetable exchange but are in the starch exchange.

1 Non-starchy Vegetable Exchange Contains:
5 g carbohydrate 2 g protein 0 g fat 25 calories 1 Non-starchy Vegetable Exchange Contains: 5 g carbohydrate 2 g protein 0 g fat 25 calories

In General 1 Non-starchy Vegetable Exchange Is:
1/2 cup cooked or canned vegetables 1/2 cup vegetable juice 1 cup raw vegetables In General 1 Non-starchy Vegetable Exchange Is: 1/2 cup cooked or canned vegetables 1/2 cup vegetable juice 1 cup raw vegetables

Meat and Meat Substitute Exchange
Has four categories based on fat content: Very Lean Lean Medium-Fat High-Fat Some foods, such as hot dogs, count as a high-fat meat exchange and a fat exchange Meat and Meat Substitute Exchange The meat and meat substitute exchange has four categories based on fat content: Very Lean Lean Medium-Fat High-Fat Some foods, such as hot dogs, count as a high-fat meat exchange and a fat exchange.

1 Meat and Meat Substitute Exchange Contains
Very Lean Lean Medium High Carbohydrate g g g g Protein g g g g Fat g g g g Calories

In General 1 Meat and Meat Substitute Exchange Is:
1 ounce of meat, fish, poultry, or cheese 1/2 cup dried beans, cooked (counts as a very lean meat and a starch exchange) In General 1 Meat and Meat Substitute Exchange Is: 1 ounce of meat, fish, poultry, or cheese 1/2 cup dried beans, cooked (counts as a very lean meat and a starch exchange)

Fat Exchange Contains margarine, butter, oils, and salad dressings
Contains monounsaturated fat, polyunsaturated fat and saturated fat lists Diabetic meal plans low in fat or reduced in calories will have the number of fat exchanges modified Fat Exchange Contains margarine, butter, oils, and salad dressings. Contains monounsaturated fat, polyunsaturated fat and saturated fat lists. Diabetic meal plans low in fat or reduced in calories will have the number of fat exchanges modified.

1 Fat Exchange Contains:
0 g carbohydrate 0 g protein 5 g fat 45 calories 1 Fat Exchange Contains: 0 g carbohydrate 0 g protein 5 g fat 45 calories

In General 1 Fat Exchange Is:
1 teaspoon regular butter, margarine, or vegetable oil 1 tablespoon regular salad dressing In General 1 Fat Exchange Is: 1 teaspoon regular butter, margarine, or vegetable oil 1 tablespoon regular salad dressing

Free Foods A food is considered free if it contains fewer than 5 grams carbohydrate or 20 calories per serving Free Foods A food is considered free if it contains fewer than 5 grams carbohydrate or 20 calories per serving

Example Meal Meal Number of Exchanges Breakfast 2 Starch Meat
Vegetable 1 Fruit 1 Milk 1 Fat

Example Meal Meal Number of Exchanges Dinner 3 Starch 3 Meat
1 Vegetable 1 Fruit 1 Milk 2 Fat

Carbohydrate Counting
Two ways to count carbohydrates Carbohydrate grams Carbohydrate choices One carbohydrate choice is 15 grams carbohydrate Carbohydrate Counting There are two ways to count carbohydrates; counting carbohydrate grams or carbohydrate choices. One carbohydrate choice is 15 grams carbohydrate.

Carbohydrate Counting
Exchange Carbohydrate Carbohydrate Groups Grams Choices Starch Fruit Milk Vegetable Other Carbohydrates

Carbohydrate Grams or Choices For Calorie Levels
Calories % Carbohydrate % % Grams Carbohydrate Carbohydrate Choices

Example Meal Plan Meal 225 g 15 Carbohydrate Carbohydrate Choices
Breakfast g Lunch g Snack g Dinner g Evening Snack 30 g

Recipes Pink Cow Smoothie Exchanges Carbohydrate Choices
1 C Raspberry Yogurt 1 milk choice 1 C Skim Milk milk choice 1 Peach fruit choice 1 Pkg Sweetener Total milk and choices or 1 fruit exchange 45 g carbohydrate

Food Labels 1 Cup Frosted Cereal 48 g carbohydrate
3 carbohydrate choices 45 g carbohydrate or 2 starch exchanges 30 g carbohydrate 1 other carbohydrate ex 15 g carbohydrate Total g carbohydrate

Food Labels Sugar Free Eskimo Pie 26 g carbohydrate
2 carbohydrate choices g carbohydrate or 1 starch exchange g carbohydrate 1 milk exchange g carbohydrate Total g carbohydrate

Food Labels: Fiber Fiber is a type of carbohydrate that is not digested and absorbed like complex carbohydrates or simple sugars If there is more than 5 grams fiber per serving subtract that from the total grams of carbohydrate to determine the amount of carbohydrate available Food Labels: Fiber Fiber is a type of carbohydrate that is not digested and absorbed like complex carbohydrates or simple sugars. If there is more than 5 grams fiber per serving subtract that from the total grams of carbohydrate to determine the amount of carbohydrate available

Food Labels: Sugar Alcohols
To calculate the grams of available carbohydrate in foods with more than 10 grams of sugar alcohol, subtract half the grams of sugar alcohol from the total carbohydrate grams If all the carbohydrate in a food is from sugar alcohols and the total carbohydrate is less than 10 grams, it is considered a “free food” Food Labels: Sugar Alcohols To calculate the grams of available carbohydrate in foods with more than 10 grams of sugar alcohol, subtract half the grams of sugar alcohol from the total carbohydrate grams. If all the carbohydrate in a food is from sugar alcohols and the total carbohydrate is less than 10 grams, it is considered a “free food.”

Other Lifestyle Factors
Eye Care Foot Care Skin Care Mouth Care Illness Stress Travel Motivation Other Lifestyle Factors Other lifestyle factors that may be affected by diabetes include: Eye Care Foot Care Skin Care Mouth Care Illness Stress Travel Motivation

Living With Diabetes Your diabetes meal plan, medication and physical activity program work together to keep your blood glucose in control. Monitor your blood glucose frequently to see how you are doing. Keeping your blood glucose in control will help you feel better now and stay healthy in the future. Living with Diabetes Your diabetes meal plan, medication and physical activity program work together to keep your blood glucose in control. Monitor your blood glucose frequently to see how you are doing. Keeping your blood glucose in control will help you feel better now and stay healthy in the future.

Diet and Health Guidelines to Lower Risk of Diabetes

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Diet and Health Guidelines to Lower Risk of Diabetes

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