1. Nutrition at School for Kids with Diabetes Lisa Emmert, MS, RD, LD, CDE Arkansas Children’s Hospital

2. Nutrition Education Inpatients: –3 day inpatient education –Involves nutrition education, social work, diabetes educator, 4 Adolescent nursing staff, and child life

3. Nutrition Education Day 1: –Which foods are carbohydrates? –Why count carbohydrates? –Insulin to carbohydrate ratio –Reading labels –Resources for carb amounts www.calorieking.com www.dlife.com/nutrition www.nutritiondata.com (recipe evaluation)www.nutritiondata.com –Emphasize measuring portions

4. Nutrition Education Day 2 –Starchy/non-starchy vegetables –Protein and fats –Free foods –Sweets Day 3: –School lunch/breakfast –Snacking –Resources

5. Education Materials Our own departmental handbook Calorie King books “Pink Panther Book” from the Barbara Davis Center (in Denver, CO)

6. Carbohydrate Counting Can be counted using exchanges, carb choices, or grams of carbohydrate. We most often use grams of carbohydrate.

7. Food Labels Focus on 2 things: total carbohydrate and serving size.

8. Carb Counting Resources Websites: –www.calorieking.comwww.calorieking.com –www.dlife.com/nutritionwww.dlife.com/nutrition –www.nutritiondata.comwww.nutritiondata.com –www.allrecipes.comwww.allrecipes.com –www.cookinglight.comwww.cookinglight.com Cell Phone Apps –GoMeals –Carb Counting with Lenny –SparkPeople –Calorie King

9. Carb Counting Resources Check with your food service director or dietitian Network with other school nurses Google search

10. Insulin to Carb Ratio If ratio is: 1 unit of insulin (novolog) per 15gms carbohydrate And patient eats: Ham & cheese sandwich 30gms Medium orange15gms 8 oz. Whole milk 12gms 57 gms 57 ÷ 15 = 3.8 Round to 4 units

11. What About Protein? Meat, cheese, eggs, cottage cheese Do not have to count, unless breaded Meals should contain a source of protein to help stabilize blood sugars

12. What About Fat? Do not need to count carbs for fats However, some fat-free items (such as salad dressing) DO have carbohydrate.

13. Condiments Do count the following: –Ketchup –Barbecue sauce –Honey mustard –Sweet and sour sauce

14. Free Foods Free foods have less than 5 gm CHO and 20 calories per serving. Examples are sugar free jello, dill pickles, and sugar free popsicles.

15. Snacking Not usually required with pumps or MDI If snack is desired give insulin only for snacks that go over the insulin to carb ratio For example, if ratio is 1:15, snacks of 15 gm or more require insulin, those less than 15, do not require insulin

16. Meal Patterns Some kids with type 1 may have a specific meal pattern. This is usually related to their insulin regimen Important to be consistent with carbohydrate intake and meal timing May need snacks to prevent hypoglycemia.

17. Meal Plan for Type 1 Diabetes BksSnackLunchSnackDinnerSnack Grams of carbo- hydrate 601560306030

18. Meal Plan for Type 2 Diabetes BkstLunchSnackDinner Grams of Carbohydrate 45 1545 Ounces of protein 13XX3 Fat Servings 11XX1

19. Thank You!