1. Diabetes and Nutrition Lesson 2 Expand Your Options, Improve Your Choices

2. Objectives • Meal Plans for Diabetes • Diabetes Pyramid/My Pyramid • Exchange list • Plate Method • Carbohydrate Counting • General Nutrition Recommendations • Reading the Food Label

3. Managing Diabetes Successfully Involves three things: • Food • Exercise • Medication

4. Did You Know?? • Food raises blood glucose • Exercise and medication lowers it • Balance these three to keep blood glucose level close to normal.

5. Diabetes Facts Food choices can make a difference in blood Glucose control. • You don’t need special foods • The foods that are good for you are good for everyone • Eat a variety of foods that contain the right amount of nutrients

6. The Diabetes Pyramid

7. Healthy Food Choices A healthy daily meal plan includes at least… • 2 to 3 servings of nonstarchy vegetables • 2 servings of fruit • 6 servings of grains, beans, and starchy vegetables • 2 servings of low-fat or fat-free milk • About 6 ounces of meat or meat substitutes • Small amounts of fat and sugar

8. The Plate Method

9. Which Plate is Better?? A 10 inch dinner plate-a typical dinner plate A 8 inch dinner plate-this is the recommended plate to use

10. The Plate Method

11. Fruit = Milk = Starch • Sometimes, if you want an extra starch during a meal, you just need to omit a fruit or milk from that meal.

12. Visualize Portion Sizes • 1 cup pasta/rice is about the size of a fist. • 1 oz of cheese is about the size of your thumb. • 1 or 2 oz of crackers, nuts, or snack crackers equals a handful. • 1 fruit is about the size of a tennis ball.

13. Exchange List for Meal Planning • Oldest method for meal planning. • Based on Dietary Guidelines and My Pyramid. • Includes a variety of foods. • Emphasizes label reading and most exchanges are listed under the food label.

14. Carbohydrate Counting • Newest method of meal planning. • Type 1 or Type 2 can use. • Requires reading the food label. • Requires constant blood sugar monitoring. • When reading the food label, look at total carbohydrate grams only. • Carbohydrates are found in milk, breads/starches, fruit and starchy vegetables only!

15. Know Your Carbohydrates

16. More on Total Carbs… • Helpful for carb counters. • Look at the total carbohydrates not the grams of sugar. • Total carbohydrates include: sugar, complex carbohydrates, and fiber content. • When a food has 5 g or more of fiber per serving: • subtract half the fiber grams from the total grams of carbohydrate for a more accurate estimate of the carbohydrate content.

17. Sample 1800 calorie Carbohydrate Counting Meal Plan • Breakfast:  2 servings of starch, 1 fruit serving, 1 milk serving, 1 meat serving, 1 fat serving. • Lunch:  2 starch servings, 1 fruit servings, ½ milk serving, 2 vegetable servings, 2 meat servings, 2 fats. • Dinner:  2 starch servings, 1 fruit serving, 2 vegetable servings, 3 meat servings, 2 fats. • Snack:  1 starch serving, 1 fruit serving, ½ milk serving. • This meal plan is approximately 60 g of carbohydrates per meal and 30 g of carbohydrates per snack.

18. 1 ounce granola bar 3 graham crackers with 1 tbsp. peanut butter 3 cups popped non-fat popcorn 6 animal crackers 1 small muffin A 3 inch cookie 1 medium apple, orange, pear 12-15 cherries or grapes ¼ cup dried fruit 1 cup soy milk ¾ to 1 cup yogurt ½ cup sugar free pudding Examples of One Carbohydrate Choice Snacks

19. Portion Control Is The Key To Managing Your Diabetes • Which will have the greater effect on your blood sugar, 1 tsp of sugar or ½ cup potatoes?? • Potatoes have 15 g of Carbohydrate, while 1 tsp. of sugar has only 4 g of carbohydrate. Therefore, potatoes have 3 times the effect on blood sugar than table sugar would.

20. 2008 ADA Recommendations for General Meal Planning for Persons with Diabetes • Meal plan should include fruits, vegetables, legumes, low-fat dairy products, lean meats, and whole grains. • You can eat sugar containing foods, but your meal plan will be adjusted. • Monitor carbohydrate intake. • Consume 25-35 grams of fiber. • Avoid Skipping meals.

21. More Recommendations • Sugar alcohols and artificial sweeteners are safe. • Limit saturated fat intake. • Limit trans fat intake. • Eat fish at least 2x’s per week. • Moderate alcohol intake. • Consume a meal plan that if low in fat, cholesterol, sodium, and calories • Increase physical activity or exercise. • Continuously monitor blood sugar levels. • Check with physician for vitamins. • Lose weight if you are told to.

22. Alcohol • Limit/control your intake of alcohol. • Ask yourself the three questions to determine if you can drink. • Is my diabetes under control? • Does my doctor agree that I do not have any other problems that alcohol can affect? • Do I know how alcohol can affect my diabetes and me?

23. A Drink Is Defined As:

24. Avoid Low Blood Sugar When Drinking • Never drink on an empty stomach. • Limit yourself to 1 or 2 drinks. • Test your blood sugar before you drink and once while drinking. • Make sure to test before going to bed and eat a snack!

25. Reading Food Labels to Manage Diabetes

26. What’s on a Label? • Serving Size • Servings Per Container • Calories and Calories from Fat • Nutrients with % Daily Value • Footnote (Only found on larger packages)

27. Serving Size • Stated in Household and Metric Measures

28. Servings Per Container • Servings Per Container tells you how many servings are in a package. • There are 2 servings in this package. • The label shows that 1 cup is a serving. • If you consume 2 cups you are having two servings.

29. Calories • Labels include the total calories as well as the calories from fat • General Guide to Calories per serving: • 40 calories is low • 100 calories is moderate • 400 calories or more is high

30. Percent Daily Value (%DV) • Based on Daily Value recommendations • Only for a 2,000 calorie diet

31. Nutrients Without a %DV • Trans Fats • Sugars • Protein

32. Nutrients • Limit these nutrients • Get enough of these

33. The Footnote • Based on 2,000 and 2,500 calorie diets • Only found on larger packages

34. DVs Compared to %DVs *DV = Daily Value; **Sat. Fat = Saturated Fat; ***CHO (carbohydrate)

35. Ingredient Statement • List of ingredients found in the food product • Listed in descending order by weight, from the most to the least

36. Eat Smart – Read the Label • Be informed. • Determine the best choices. • Eat a variety of foods.

37. Points To Remember About Diabetes Meal Planning • Actual amounts of each depend on the number of calories you need. • Calorie needs depend on your gender, size, age, and activity level. • Meal planning with diabetes is very individualized. • Get a personalized meal plan from a Registered Dietitian or Certified Diabetes Educator.

38. References • American Diabetes Association, www.diabetes.org • American Dietetic Association, www.eatright.org • Mahan,L.K. and Escott-Stump, S. Krause’s Food, Nutrition, and DietTherapy. 10thed. 2000. • Diabetes Medical Nutrition Therapy. American Dietetic and Diabetes Association. 2002. • LSU AgCenter’s Diabetes Education and Awareness Program. • University of Illinois Extension Service. • American Dietetic Association & American Diabetes Association Guide to Diabetes Medical Nutrition Therapy, CD-ROM 2008. • Amercian Diabetes and Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes.” 2008. • University of Idaho Extension Service. “The Idaho Plate Method.”

39. References • University of Georgia Extension Service. http://www.fcs.uga.edu/ext/food/diabetes.php • U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition - www.cfsan.fda.gov • Keeping Up with the Changing Food Label: International Food Information Council (IFIC) – www.ific.org • Understanding Food Labels, American Dietetic Association • Food Label Presentation Developed By: Cathy Agan, Extension Agent (FNP), Ouachita Parish and Adapated by Bertina McGhee, MPH, RD, LDN; Extension Agent, Orleans Parish.

40. Diabetes and Nutrition Prepared By: Mandy G. Armentor, MS, RD, LDN Assoc. Extension Agent-FCS (Nutrition) Vermilion Parish