Diet Teaching For the Diabetic Patient

1. Diet Teaching For the Diabetic Patient Elva McNurlin, RD, LD, CDE – SLMV Diabetes Educator Sarah Renaldi, MS, RD, LD – SLMV Clinical Dietitian Original Slides/Presentation By: Kate Waltz, RD, CDN, CDE; Clinical Nutrition Bassett Healthcare

2. Eating! • Can’t live with it, can’t live without it! • Constant opportunity for change • Major factor in health, wellness, & happiness. • Can be a major stressor! • Focus on the positive

3. Objectives • List diet and nutrition goals for patients with both Type 1 and Type 2 diabetes. • Explain role of carbohydrate, protein, and fat in meal planning and glucose control. • Explain basic concept of consistent carbohydrate diet and use of carbohydrate counting. • Identify additional diet modifications to address cardiac risk reduction.

4. Type 1 Diabetes • Use of daily insulin • Goals for diet education: • Coordinate meal plan with insulin treatment • Use of carbohydrate counting for intensive insulin therapy programs • Alter intake as needed for activity level • Identify/reduce risk of hypoglycemia

5. Type 2 Diabetes • May be diet and exercise controlled, using oral medications, or insulin treated. • Goals for diet education: • Weight control or weight loss • Use of carbohydrate counting for consistent carbohydrate diet or insulin program • Address co-morbid conditions and risk factors

6. The Basics • Carbohydrate • Digests quickly, from 15 minutes to 2 hours • Has direct effect on postprandial blood glucose levels, more carbs = higher glucose • Should provide about 50% of total calories • Sources: grains, beans, vegetables, milk, fruit, sweets and added sugars

8. The Basics • Protein • Digests more slowly, 3-5 hours • Can aid in prolonged post-meal satiety • May help prevent between meal and nocturnal hypoglycemia • Sources: meat, fish, poultry, eggs, cheese, nuts/peanut butter, soy products

9. The Basics • Fat • Digests the most slowly- several hours • Promotes prolonged satiety • Type of fat consumed affects cardiac risk • Should be less than 30% total calories • Sources: butter, margarine, oils, mayo, salad dressing, cream cheese, nuts, seeds, gravy

10. The Idaho Plate Method

11. Carbohydrate Counting • Identify carbohydrate sources • Estimate or measure portion size • Quantify carbohydrate intake for that meal or snack in either carbohydrate servings or grams of total carbohydrate • There are no “good carbs” or “bad carbs”

12. What is one serving of carbohydrate?(one serving = 15 grams carbohydrate) • 1 slice bread • 1/2 hamburger bun or English muffin • 1/2 cup potato, corn, peas, cooked cereal • 1/3 cup rice or pasta • 1 small fresh fruit, 1/2 cup canned fruit or juice • 1 cup milk or yogurt • 1 tablespoon sugar, honey, jam, maple syrup

13. Sample Meal Example • 1/2 cup oatmeal • 1 hard boiled egg • 1 slice whole wheat toast • 1 teaspoon margarine • 1/2 cup orange juice Which are the carbs? How many servings? How many grams total carbohydrate?

14. Sample Meal Example • 1/2 cup oatmeal = 1 serving (15 g) • 1 hard boiled egg = protein • 1 slice whole wheat toast = 1 serving (15 g) • 1 teaspoon margarine = fat • 1/2 cup orange juice = 1 serving (15 g) Total is 3 servings or 45 grams carbohydrate

15. Sample Meal Example 2 • 3 ounces roast chicken • 1 cup cooked rice • 1/2 cup green beans • 1 cup tossed salad • 1/2 cup applesauce • 1 cup 1% milk

16. Sample Meal Example 2 • 3 ounces roast chicken = protein • 2/3 cup cooked rice = 2 servings (30 g) • 1/2 cup green beans = 1/3 serving (5 g) • 1 cup tossed salad = 1/3 serving (5 g) • 1/2 cup applesauce = 1 serving (15 g) • 1 cup 1% milk = 1 serving (15 g) Total is 4 2/3 servings or 70 grams total carb

17. Using a label to Count Carbs 1. Serving size, # of servings 2. Total grams of carbohydrate

18. How much carbohydrate to eat? • 1200 kcal = 150 grams = 10 servings • 1500 kcal = 187 grams = 12-13 servings • 1800 kcal = 225 grams = 15 servings • 2000 kcal = 250 grams = 16-17 servings *Amounts and types of protein and fat can greatly affect total calorie intake.

19. Not only how much, but when... • Goal is to spread carbohydrate servings out consistently over the day • 3-5 servings per meal • 1-2 servings per snack • Patient has freedom to change food choices and amounts eaten while staying within recommended carbohydrate intake

20. Example of 1500 kcal diet(Total of 12-13 carb servings or 187 g per day) • Breakfast: 4 carb servings (60 g) • 1 cup oatmeal, 1 cup skim milk, 2 Tbs raisins • Lunch: 3 carb servings (45 g) • sandwich, small salad, 1 small fresh fruit • Dinner: 4 carb servings (60 g) • chicken, 1 cup pasta, broccoli, 1 cup skim milk • Snack: 1 carb serving (15 g) • 1 cup low fat yogurt

21. Weight Loss • Weight loss of just 7-10% of a patient’s current weight can help lower glucose • Slow and steady wins the race! • Helpful modifications are low fat intake and high fiber intake • Exercise: 5-7 days/week with goal of 150 minutes/week or 10,000 steps per day

22. High Fiber Intake • Can increase satiety, slow carbohydrate digestion and modify postprandial glucose • Intake of at least 25 grams/day, up to 35 grams/day to optimize cardiac benefits • Can subtract from total carbohydrate grams • Sources of fiber: whole grains, beans, nuts, seeds, fruits, vegetables

23. Low Fat Intake • All patients with diabetes are at increased cardiac risk- more aggressive with cholesterol and blood pressure control • Total fat <30% kcal, sat fat <10%, trans fat 0% • Decrease added fats- 100 kcal/tablespoon • Opt for unsaturated fat- oils, nuts, margarine

24. “Let nothing that can be treated by diet be treated by any other means.” Maimonides