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Beverly A Benes, PhD, RD Nutrition Services, NE Dept of Education bev.benes@nde.ne

Diabetes in the School and Carbohydrate Control. Beverly A Benes, PhD, RD Nutrition Services, NE Dept of Education bev.benes@nde.ne.gov. Some slides adapted from the the University of Georgia Cooperative Extension Service http://www.fcs.uga.edu/pubs/ppt/PPT-26.ppt. Objectives:.

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Beverly A Benes, PhD, RD Nutrition Services, NE Dept of Education bev.benes@nde.ne

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  1. Diabetes in the School and Carbohydrate Control Beverly A Benes, PhD, RDNutrition Services, NE Dept of Educationbev.benes@nde.ne.gov Some slides adapted from the the University of Georgia Cooperative Extension Servicehttp://www.fcs.uga.edu/pubs/ppt/PPT-26.ppt

  2. Objectives: • Describe the prevalence of diabetes • Describe the legal considerations for schools • Describe the responsibilities of school personnel • Discuss the role of carbohydrates in the diabetic diet • Q & A

  3. 1995 2001 Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1990 1990 Source: Mokdad et al., Diabetes Care 2000;23:1278-83; J Am Med Assoc 2001;286:10 retrieved fromhttp://www.cdc.gov/diabetes/statistics/maps/

  4. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1990 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  5. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1991 - 92 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  6. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1993 - 94 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  7. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1995 - 1996 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  8. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1995 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  9. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1997 - 1998 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  10. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 1999 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  11. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 2000 Source: Mokdad et al., Diabetes Care 2000;23:1278-83. Source: Mokdad et al., J Am Med Assoc 2001;286:10.

  12. No Data <4% 4-6% 6-8% 8-10% >10% Diabetes Trends Among Adults in the U.S. (incl. Gestational Diabetes)BRFSS 2001 Source: Mokdad et al., Diabetes Care 2000;23:1278-83. Source: Mokdad et al., J Am Med Assoc 2001;286:10.

  13. Hypo and Hyperglycemia Monitoring Blood Glucose Ketones Glucagon Admin Insulin Admin Exercise Nutrition All the pieces must fit…. Legal Rights Health & Learning http://www.diabetes.org/advocacy-and-legalresources/discrimination/school/schooltraining.jsp Retrieved 1-31-06 Diabetes Care Tasks At School: What Key Personnel Need To Know

  14. Hypo and Hyperglycemia Monitoring Blood Glucose Ketones Glucagon Admin Health & Learning Legal Rights Insulin Admin Exercise Nutrition All the pieces must fit…. http://www.diabetes.org/advocacy-and-legalresources/discrimination/school/schooltraining.jsp Retrieved 1-31-06 Diabetes Care Tasks At School: What Key Personnel Need To Know

  15. Legal Rights It’s the law….Legal Considerations • Federal laws that protect students with diabetes • Impact of state laws upon diabetes care in the school setting • Recommendations for 504 Plan or IEP

  16. Legal Rights Legal Considerations –Needs of children with diabetes in school setting . . . • Eliminate discrimination • Equal access to educational and school related opportunities • Secure care • A medically safe environment for students with diabetes

  17. Legal Rights Legal Considerations –Federal Laws: Equal Access • Section 504 - section 504 of the Rehabilitation Act of 1973 • ADA – Americans with Disabilities Act • IDEA – Individuals with Disabilities Education Act

  18. Prohibits discrimination against people with disabilities by public schools and most private schools that receive federal funds Students must be given equal opportunity Related aids and services are required to meet the individual needs of a student with disability Legal Rights Legal Considerations –Federal Protection

  19. Educational needs: 504 Plan IEP Health care needs: Diabetes Medical Management Plan (DMMP) Legal Rights Legal Considerations –Written Plans

  20. Location and timing of blood glucose monitoring Identity of trained diabetes personnel Location of diabetes supplies Free access to water and restroom Nutritional needs, meals and snacks Full participation in all school-sponsored activities Alternative times for academic exams if student is experiencing hypoglycemia or hyperglycemia Absences without penalty for doctors’ appointments and diabetes-related illness Maintenance of confidentiality and student’s right to privacy Legal Rights Legal Considerations –Needs addressed by 504 Plan/IEP Plan

  21. State and local laws and regulations vary regarding who may perform various aspects of diabetes care Become familiar with state and local laws that impact school diabetes care Regardless of state and local law, the requirements of federal laws must be met Legal Rights Legal Considerations –State Laws and Regulations

  22. http://www.ndep.nih.gov/diabetes/pubs/Youth_SchoolGuide.pdf

  23. Monitoring Blood Glucose Blood Glucose Goals for Children From ADA, 2005

  24. Nutrition Carbohydrate CountingAdvantages • Easier - only count carbohydrate • Allows more flexibility in food choices • Virtually any food can be worked into a meal plan

  25. Nutrition What is Carbohydrate Counting? • Keeping track of the amount of carbohydrate eaten at meals and snacks • Keeping carbohydrate intake consistent at meals from day to day • Matching insulin injections to carbohydrate intake (for some)

  26. Monitoring Blood Glucose Why Count Carbohydrate? • Amount of carbohydrate eaten determines how high blood glucose will rise after a meal • Carbohydrate begins to raise blood glucose within 15 minutes of eating

  27. Nutrition Nutrients in Foods • Carbohydrate • Protein • Fat (Vitamins, minerals, water)

  28. Nutrition Why Count Carbohydrate? Carbohydrate is the nutrient in food that raises blood glucose the most

  29. Nutrition Carbohydrate is Healthy • Most foods containing carbohydrate are among the healthiest foods to eat: • grains, fruits, vegetables, low-fat milk and yogurt • Carbohydrates are the foundation of a healthy eating plan • contain many essential vitamins, minerals, and fiber

  30. Nutrition Other Factors to Consider • Fat • Slows down time your stomach takes to empty • Delays rise in blood glucose • High in calories

  31. Nutrition Other Factors to Consider • Protein • Very little effect on blood glucose • Usually combined with fat

  32. Nutrition What are Carbohydrates? fruit, milk, regular sodas, candy, juices bread, rice, cereal, potatoes, pasta, corn, peas, butter beans oats, barley, fruits and vegetables Sugars Starches Fiber

  33. Macaroni & Cheese Soups Casseroles Lasagna Subs/sandwiches Beef Stew Spaghetti and Meatballs Nutrition Mixed Foods Containing Carbohydrate

  34. Brunswick stew Brussels sprouts Sugar-free jello Skim milk Fat-free frozen yogurt Baked chicken Rice Orange juice Diet soda Oreos Nutrition Which Contain Significant Carbohydrate?

  35. Brunswick stew Brussels sprouts Sugar-free jello Skim milk Fat-free frozen yogurt Baked chicken Rice Orange juice Diet soda Oreos Nutrition Which Contain Significant Carbohydrate?

  36. Nutrition Does the Type of Carbohydrate Matter? Glycemic Index Various carbohydrates have slightly different effects on blood glucose • Processing • Cooking • Fiber • Mixed meals with with fat or protein

  37. The amount of Carbohydrate is more important than the type 1 frosted brownie = 2 slices bread 1 cup ice-cream = 1 cup cereal (30 grams carbohydrate) Nutrition

  38. Nutrition 2 Ways to Count Carbohydrate • Carbohydrate Choices Food Exchanges or Servings • Carbohydrate Grams Specific number of grams of carbohydrate per meal or snack

  39. Carbs in food - an eg from the grains and veges: 15 15 5

  40. Nutrition Carbohydrate Choices(servings) • Each food in fruit or starch group contains about15 grams carbohydrate • White milk contains 12-15 grams carbohydrate • A vegetable has about 5 grams carbohydrate • One carbohydrate choice = 15 grams carbohydrate

  41. Meal Plan carbohydrate gram counting Basic Carbohydrate Counting 2003 American Diabetes Association

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