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Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648

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Presentation on theme: "Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648"— Presentation transcript:

1 Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648 Use of Glycemic Index In Diabetes Management


3 Carbohydrate……. rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols…. moderate digestion, partial absorption as glucose (50%) Protein…………….. slow digestion, partial conversion to glucose* (~40%) Fat…………………… slow digestion, little conversion to glucose** (0%) Timed Effect on Blood Sugar Levels * In absence of dietary carbs ** may cause insulin resistance in large qty

4 MEET THE CARBS! Fruit Fruit Juice Candy Regular Soda Punch Wine Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly

5 MEET THE CARBS! Potatoes Rice Noodles/Pasta Cereal Oatmeal Bread Tortillas Pancakes Waffles Crackers Bagels Pizza Beans Corn Pretzels Chips Popcorn Beer

6 The fate of dietary carbohydrates Simple Carbohydrates (sugars) Complex Carbohydrates (starches) Blood Glucose

7 Does the Type of Carbohydrate Matter? Glycemic Index All carbs (except fiber) convert to blood glucose eventuallyAll carbs (except fiber) convert to blood glucose eventually G.I. Reflects the magnitude of blood glucose rise in the first 2 hoursG.I. Reflects the magnitude of blood glucose rise in the first 2 hours G.I. Number is % of rise relative to pure glucose (in dextrose form)G.I. Number is % of rise relative to pure glucose (in dextrose form)

8 Glycemic Index (contd.) Example: Spaghetti GI = 37 37% of spaghettis carbs turn into blood glucose in the first 2 hours. The rest will convert to blood glucose over the next several hours.

9 Glycemic Index (contd)

10 Glycemic Index Values BREAD/CRACKERS Bagel72 Crispbread81 Croissant67 French baguette95 Graham Crackers74 Hamburger bun61 Kaiser roll73 Melba toast70 Pita bread57 Pumpernickel51 Rye, dark76 Saltines74 Sourdough52 Wheat Thins67 Wheat Bread,68 White Bread71 CAKES/COOKIES/MUFFINS Angel Food Cake67 Banana Bread47 Blueberry Muffin59 Chocolate Cake38 Corn Muffin102 Cupcake with icing73 Donut76 Oat Bran Muffin60 Oatmeal cookies55 Pound Cake54 Shortbread cookies64 Vanilla wafers77 CANDY Chocolate49 Jelly beans80 Lifesavers70 M & M, peanut33 Nestle Crunch42 Skittles69 Snickers Bar40 Twix Bar43 CEREALS/BREAKFAST All-Bran42 Bran Chex58 Cheerios74 Corn Flakes83 Cream of Wheat70 Crispix cereal87 Golden Grahams71 Grape Nuts67 Oatmeal49 Pancakes67 PopTarts 70 Puffed Wheat67 Raisin Bran73 Rice Krispies 82 Shredded Wheat69 Special K66 Total76 Waffles76 COMBINATION FOODS Chicken Nuggets46 Fish fingers38 Macaroni & Cheese64 Pizza (cheese)60 Sausages28 Stuffing74 Taco shells68 DAIRY Chocolate milk34 Custard43 Ice cream, vanilla62 Ice Cream, choc.68 Milk, skim32 Milk, whole27 Pudding43 Yogurt, low fat33 FRUITS & JUICES Apple38 Apple juice41 Banana55 Cantaloupe65 Cherries22 Cranberry Juice68 Fruit cocktail55 Grapefruit25 Grapes46 Kiwi53 Mango56 Orange44 Orange juice52 Peach42 Pear37 Plum39 Raisins64 Watermelon72 LEGUMES Baked beans48 Black beans30 Black-eyed Peas42 Butter beans30 Chick peas33 Lentils, red25 Lima Beans32 Pinto Beans45 Red kidney beans19 PASTA/RICE Brown Rice 55 Couscous65 Fettucini32 InstantRice87 Long grain Rice56 Macaroni45 Spaghetti, white41 Spaghetti, wheat37 Tortellini50 Risotto69 SNACK FOODS Corn Chips74 Granola Bars 61 NutriGrain bars66 Peanuts15 Popcorn55 Potato Chips54 Pretzels81 Rice Cakes77 SOUPS Black Bean64 Green Pea 66 Lentil 44 Minestrone39 Split Pea60 Tomato 38 SPORTS BARS/DRINKS Gatorade78 Power Bar58 SUGARS & SPREADS Glucose tablets102 Corn syrup 62 Honey58 Strawberry Jam51 Syrup66 Table Sugar 64 VEGETABLES French fries 75 Potato, baked85 Potato, instant83 Potato, mashed91 Potato, boiled88 Carrots, boiled49 Carrots raw47 Corn46 Sweet potato44 Tomato Juice38

11 What About MIXED Meals? Tends toward G.I. of primary food in meal (i.e. bread in sandwich) Eating low-g.i. food first lowers G.I. of entire meal

12 a G.I. Is NOT An Exact Science! V a i @ b L $ Food combinations Quantity being consumed Time since last meal Recent & planned physical activity Individual food sensitivities The winner in the 3 rd race at Belmont

13 G.I. Gereralization Slow StuffAverage StuffFast Stuff Pasta Legumes Salad Veggies Dairy Chocolate Fruit Juice Pizza Soup Cake Breads/Crackers Salty Snacks Potatoes Rice Cereals Sugary Candies

14 If All Carbs Turn Into Glucose Eventually, Why Is Glyemic Index Important?

15 1. Satiety Low G.I. = Slower Gastric Emptying Leads to Less Consumption, Smaller Portions Less Tendency to Graze

16 Low Glylcemic-Index Foods Are More Satisfying! Jackie Scheiner Age 1

17 2. Mealtime Insulin Timing Goal is to match insulin action to foods effects, prevent high & low BG –High G.I.: 15-30 min prior –Moderate G.I.: 0-15 min prior –Low G.I.: 0-15min after

18 Normal Pump Bolus with Low-G.I. Meal: Insulin peaks too early (hypoglycemia) Insulin dissipates too soon (hyperglycemia)

19 Square/Extended/Long Bolus Entire bolus is delivered gradually over 30min – 8 hrs 1 -2 hours is common Insulin Pump Options

20 Dual/Combo/Combination Bolus Part of bolus delivered up-front, remainder over time 30% Up-Front is common, remainder over 2 hrs Insulin Pump Options

21 3. Reducing Post-Meal Spikes Glucose variability is associated with increased complication risk, emotional distress, and diminished physical & intellectural performance Injected/infused rapid insulin is much slower than insulin produced by the pancreas The amylin hormone is lacking or deficient

22 3. Reducing Post-Meal Spikes LOW G.I. FOODS PRODUCE FLATTER BGs! Diabetes Self-Management, August, 2006

23 Factors that lower G.I. Fiber Fat Temperature Solid (vs. liquid) Acidity Non-Processed Type of carb

24 Starch Structure Affects G.I. branched chain G – G – G – G – G - G G – G / \ / G – G G G – G – G G – G – G \ / \ / G – G – G – G – G – G G – G – G – G – G – G \ \ G – G – G G – G – G – G – G straight chain G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G

25 Examples: Use of GI MealHigh-GI OptionsLower-GI Options BreakfastCereal Bagel/Toast Waffle Pancakes Muffins Oatmeal Milk Whole Fruit Nuts Yogurt

26 Examples: Use of GI MealHigh-GI OptionsLower-GI Options LunchWhite Bread Fries Tortillas Fast Food Sourdough Bread Pumpernickel Carrots & Peas Bean Salad Soup

27 Examples: Use of GI MealHigh-GI OptionsLower-GI Options Dinner (sides)Rice Mashed Potato Baked Potato Rolls Pasta Beans Sweet Potato Tomato

28 Examples: Use of GI MealHigh-GI OptionsLower-GI Options SnacksPretzels Chips Crackers Doughnuts Popcorn Nuts Ice Cream Chocolate

29 4. Treating Hypoglyemia High-GI foods convert to glucose rapidly (faster recovery) Lower-GI foods take longer to work, may lead to over-treatment and significant post- treatment hyperglycemia

30 Hypoglycemia Treatment High-GI Foods Dry Cereal Pretzels Graham Crackers Vanilla Wafers Jelly Beans Gatorade Regular (non-diet) Soda

31 Hypoglycemia Treatment DEXTROSE Rules! (GI=100) Dex Products Glucose Tablets Glucose Gel Liquid Blasts Dextrose-Sweetened Candies Sweet Tarts Smarties Spree Air Heads Nerds Runts

32 Glycemic Index References Dr. Jennie Brand-Miller The New Glucose Revolution Series

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