1. Diabetes and Nutrition Julie Thilges, RD, LD Mercy Medical Center- North Iowa

2. Many thanks to our friends at Camp Hertko Hollow for providing this presentation. Camp Hertko Hollow 101 Locust St. Des Moines, IA 50309 Ann Wolf, Executive Director 515-471-8523 a.wolf@camphertkohollow.com a.wolf@camphertkohollow.com Vivian Murray, Camp Director 352-750-6759 or 888-437-8652 (Toll free) v.murray@camphertkohollow.com v.murray@camphertkohollow.com

3. This presentation is intended to be a general guide that will help you create a thorough staff training tool for your camp. It is not intended to be a comprehensive resource or to fully cover the topic. We hope you will take this presentation and adapt it so that it fits your camp’s specific needs and meets the guidelines established for the safe and effective operation of your program. Each diabetes camp operates under detailed policies and procedures that follow Board of Health and national accreditation standards that ensure the health and safety of children with diabetes. It is essential that camp staff be trained according to your camp’s policies and procedures. Staff should be encouraged to carefully review materials before arriving at camp, participate fully in pre-camp training, ask questions and use good judgment as they provide diabetes management supervision and educate youth with diabetes at camp. While doing so, it is equally important that camp staff not lose focus – camp is a place for youth to have fun with peers – to feel supported and understood, and to feel part of a passionate community. Good luck!

4. Nutrition Food greatly impacts blood sugars Diabetes diet is a healthy diet, all people benefit from following this Different nutrients impact your child and family’s growth and health

5. Nutrients Carbohydrates Proteins Fats Vitamins and Minerals Water Fiber

6. Carbohydrates Main energy source for the body Sugar and starch is a type of carbohydrate It is not believed certain types of carbs are any worse than another HOW MUCH, WHEN, and WITH WHAT the carbohydrate is eaten with will impact blood sugars

7. Carbohydrates Breads Crackers Fruits Beans (baked, refried, black, kidney) Starchy vegetables (corn, peas, potatoes, squash) Milk and Yogurt Most desserts

8. Proteins Important for muscle and bone growth Eating extra will not mean increased muscle growth Complete proteins come from animal products- may be higher in fat Proteins may help keep blood sugars from going too low when consumed with carbs

9. Proteins Beef Pork Eggs Peanut butter Cheese Chicken Fish

10. Fats Fat is essential, however it provided more energy/ gram than other macronutrients High fat diets may lead to heart disease Fat consumption in large amounts tend to impede blood sugars coming down to a normal level

11. Vitamins and Minerals Essential for healthy growth Not significant for calories Most people with a balanced diet get adequate amounts A multivitamin may be beneficial for someone not getting a balanced diet (not liking milk or vegetables)

12. Water Water makes up two thirds of the body Recommend 6 cups/ day Especially important with increased activity and hot days (when your body is more likely to lose fluids)

13. Fiber Dietary fiber is a type of carbohydrate that is not digested May be subtracted from total carbs on food labels Is thought to help control blood sugars Aids in digestion Helps body feel satisfied longer

14. Sweetners (Non-nutritive) Provide no calorie or carbohydrate (Nutritive) sucrose and fructose –High fructose corn syrup is a combo of both and raises blood sugars more quickly than both Sugar alcohols –They provide a smaller amount of carbs (2 grams./ Tsp) and are absorbed more slowly –Found in sugar free candy

15. Non-Nutritive Sweetners Saccharin- found in some soft drinks Aspartame-contains phenylalanine, found in many products –It has been suggested the breakdown product (formaldehyde) could be bad for health- THIS HAS NEVER BEEN SCIENTIFICALLY SUPPORTED IN HUMANS Acesulfame- K- used in chewing gums, desserts, and soft drinks Sucralose- Splenda, most heat stable Stevia- natural alternative from a herb, –Not approved by the FDA

16. Reading Labels Serving size shown on top Total fat- may impact blood sugars and its importance r/t heart disease Total carbs (15g = 1 carb choice) Dietary Fiber

17. Objectives of Food Management Balance insulin and carb intake to keep blood sugars close to normal To keep blood fats and lipoproteins at desired levels Improve overall health by maintaining nutrition Attain normal growth and development Prevent severe hypoglycemia

18. Three Common Meal Plan Approaches Constant Carbohydrate Meal Planning –Carbs may vary from meals, but stay the same from day to day –Food eaten my vary d/t exercise, insulin taken, BS Carbohydrate Counting Meal Plan –Involves counting grams to match insulin –Assumes variation (provides more flexibility and safety from hypoglycemia) Exchange Meal Plan –Protein and fat exchanges used

19. Glycemic Index Ranks carbohydrates based on how quickly these foods will raise blood sugars Not suggesting any foods are good or bad Important to be aware of Not recommended to solely control food intake May see more of this in the future

20. Glycemic Index- continued Low GI diets help people lose and control weight Low GI diets increase the body's sensitivity to insulin Low GI carbs improve diabetes control Low GI carbs reduce the risk of heart disease Low GI carbs reduce blood cholesterol levels Low GI carbs can help you manage the symptoms of PCOS Low GI carbs reduce hunger and keep you fuller for longer Low GI carbs prolong physical endurance High GI carbs help re-fuel carbohydrate stores after exercise

21. Glycemic Index Examples High glycemic index foods include many carbohydrates such as these: –Pasta –Rice –Cereal –Baked goods Low glycemic index foods include these: –Fruits and vegetables –Whole grains –Legumes www.webmed.com

22. Ketoacididosis and Nutrition Nutrition mostly used as a tool for prevention Stay hydrated- will replace lost fluid from urine Orange juice and bananas are good for replacing potassium

23. Sick days It is important to keep track of consumption and fluid intake Drink out of a 1 L water bottle to keep track May need to consume foods normally avoided to meet carb needs (Regular pop or gelatin) May need extra snacks Check BS often If vomiting avoid solid foods, gradually start liquids (if vomiting is frequent may need med such as Phenergan)

24. Discussion