Diet Teaching For the Diabetic Patient

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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

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Eating!

• Cant live with it, cant live without it!
• Constant opportunity for change
• Major factor in health, wellness, happiness.
• Can be a major stressor!
• Focus on the positive

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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.

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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

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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

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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

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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

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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

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The Idaho Plate Method
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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

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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

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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?

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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

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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

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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

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Using a label to Count Carbs

• 1. Serving size,
• of servings
• 2. Total grams
• of carbohydrate

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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.

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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

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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

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Weight Loss

• Weight loss of just 7-10 of a patients 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

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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

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Low Fat Intake

• All patients with diabetes are at increased
  cardiac risk- more aggressive with cholesterol
  and blood pressure control
• Total fat lt30 kcal, sat fat lt10, trans fat 0
• Decrease added fats- 100 kcal/tablespoon
• Opt for unsaturated fat- oils, nuts, margarine

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• Let nothing that can be treated by diet be
  treated by any other means. Maimonides