eating plan for type 2 diabetes - continuing medical
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EATING PLAN FOR TYPE 2 DIABETES
Thiseatingplanislowinrefinedgrainsandsugar,lowinsaturatedandtransfatandhighinfibre.Itfocusesoneatingregularlytimedmealsandselectinglowglycemicindexfoods.
Type 2 Diabetes affects how your body uses and stores glucose. Glucose comes from digestion of sugars and starches in the foods we eat. Our body produces a hormone called insulin that it uses to remove glucose from our blood. In Type 2 diabetes our body may not be making enough insulin or our body is not properly responding to the insulin it is making. Glucose levels in our blood rise and can cause both short term and long-term effects on our body.
• Symptoms include: unusual thirst, frequent need to urinate, weight change, lack of energy, blurred vision, frequent infections, cuts and bruises that are slow to heal, tingling in the hands and feet.
• Risk factors include: being overweight, a parent or sibling with diabetes, having diabetes while pregnant (gestational diabetes), impaired glucose tolerance or impaired fasting glucose, high blood pressure, high cholesterol, polycystic ovary syndrome, being of Aboriginal, Hispanic, Asian, South Asian or African descent.
Did You Know? Morethan3 million Canadians have diabetesandmorethan90% of these have Type 2 Diabetes.
Tips to Help Keep Your Blood Sugar levels in a Healthy Range1. Eatthreebalancedmealsperday,nomorethansixhoursapart.
Limitaddedsugarsandsweets.2. Eatacombinedtotalofatleast7servingsofvegetablesandfruit
eachday.3. Eatyourfruitratherthandrinkingitasjuice.4. Includesmallportionsofwhole-grainstarchyfoodsateachmeal.5. Eatlowerglycemicindexfoods.See ‘Go Low GI’.6. Drinkwaterinsteadofregularpopandfruitdrinks.Tea,coffeeandlow
caloriejuicesandbeveragesaregreattoo.7. Includeleanproteinchoicesateachofyourmeals.8. Makelowerfatchoices,avoidfryingyourfoodsandlimitaddonfats
suchasbutter,margarineandoil.9. Moveyourbodyforatleast30minuteseveryday–walkingisgreat!10. Ifyouareoverweight,trytolose5to10%ofyourpresentweight.
Blood Glucose Target Ranges Fasting: 4.0 -7.0 (empty stomach or no food for at least 3 hours)Postprandial: 5.0-10.0 (2 hours after a meal)
Type 2 Diabetes FACTS – Focus on Carboyhdrate, Fibre and Glycemic Index• Overtime,highbloodsugarcausesdamagetoyourbloodvesselsandcanresultinblindness,heartdisease,kidney
problems,circulationproblems,nervedamageanderectiledysfunction.• Bychoosingappropriateportionsofcarboydratecontainingfoodsandselectingonesthathavemorefibreandalower
glycemicindex,youhelpimproveyoubloodglucosecontrol.
Go Low GI – Foods and Their Glycemic IndexGlycemicindexisascale(0-100)rankinghowquicklyacarbohydratecontainingfoodwilldigestintoglucoseinourblood.HighGIfoodsbreakdownquicklywhereaslowGIfoodsbreakdownslowly.WithlowGIfoodsyoufeelfulllongerandyoubody’sinsulinhasmoretimetoperformitsjobandremoveglucosefromtheblood.
Hint: HintlowGIfoodsaregenerally‘closetothefarm.’
LOW GI FOODS (55 OR LESS) CHOOSEMOSTOFTEN
MEDIUM GI FOODS (56-69) HIGH GI FOODS (70+) CHOOSELESSOFTEN
Whole grain bread Couscous White bread
Pumpernickle bread Rye bread Instant mashed potatoes
Oatmeal Instant Oatmeal Corn Flakes, Rice Krispies
All-Bran cereal Shredded Wheat Refined, sweetened cereals
Converted rice Cream of Wheat Instant rice
Brown & Basmati rice Whole grain crackers Bagels
Bulgur, Barley, Quinoa Pita bread Waffles/pancakes – made with white flour
Firm cooked pasta Long grain white rice Soda crackers
Beans, peas, lentils Apricot, banana French fries
Apples, peaches, pears Cantaloupe Dried dates/figs
Grapefruit, oranges Pineapple, raisins Sweetened fruit juice
Berries, cherries, grapes Canned fruit in juice Parsnips, pumpkin
Kiwi, Mango, Plum Cranberry juice Rutabaga, turnip
Avocado New potatoes Broad beans
Sweet Potato Beets Refried beans
Carrots, broccoli Sweetened condensed milk Ice cream
Cauliflower, corn Soft drinks
Leafy vegetables Glucose
Low fat milk, soymilk, yogurt and cottage cheese
Tips for using the Glycemic Index• Thinklowandslow-choosefromthelowandmediumGIfoodsmostoften.• Balanceyourchoiceswithleanproteinchoicesandhealthyfats.Proteinandfatalsoslowthedigestion,keepyoufeeling
fullandslowthereleaseofglucoseintoyourblood.• Moredetailscanbefoundonlineatwww.gidiet.comorwww.diabetes.ca/files/glycemicindex_08.pdf
Did you know?TheGlycemicIndexdietwasdevelopedbyDavidJenkins,aprofessorofnutritionandreasearcherattheUniversityofToronto.
*Adaptedfrom“TheGIDiet”RickGallop
See it to Believe it!1 tsp = 5 grams sugar
Balancing Carbohydrates (‘Carbs’)Alongwiththeglycemicindexapproach,itisimportanttounderstandandcontroltheamountofcarbohydratesyoueatanddrinktobettermanageyourbloodglucose.
Herearesometips:1. Carbohydrateisthenutritiontermusedforstarch,sugarandfibre.2. Spacingyourcarbohydratesoverthedayhelpsyourbodytokeepastableglucoselevel.3. Starchchoicesthatarehigherinfibrecontributelesstoraisingyourbloodglucose.UsetheNutritionFactspaneltochoose
cereal,bread,crackers,riceandothergrainorstarchchoicesthathaveatleast2gramsoffibreperserving.4. Breakfastshouldbe1/3starchorgrain,1/3fruitand1/3protein.5. Lunchandsuppershouldbe1/2vegetables,1/4starchand1/4protein.6. Snackchoicescanhelppreventdipsinbloodglucosethatcanoccurifyourmealsaremorethan4hoursapartorifyouare
veryactive.7. Choosesnackswithabout20gramsofcarbohydrate.Fruit,vegetables,highfibregranolabars,wholegraincrackerswith
cheeseorpeanutbutterarejustafewoptions.
Sugar and Refined Starches • Tablesugar,brownsugar,honey,maplesyrupandmolasses
areallsimplesugarsandtheyallhave5gramsofcarbohydratesor“carbs”inateaspoon.
• Simplesugarssuchastheseand‘white’orrefinedstarchesbreakdownquicklyandcausebloodglucosetorisequickly.
• Aquickriseinbloodglucosecanoftenbefollowedbyanequallyquickdrop.• Thiscanleadtocravingsformoresugaryfoodsandfeelingsofhungerandfatigue.• Aimtochoosepackagedfoodswithlessthan10gramsofsugarperserving• Avoidaddingsugar,reducetheamountorsubstituteanon-sugarsweetenerforbakingsuchasSplenda(sucralose)
The Canadian Diabetes Association has an excellent summary sheet on sugars and sweetners. Finditonlineatwww.diabetes.ca/files/en_sweeteners_final.pdforcall1-800-BANTINGtorequestacopy.
Did you know?Astandardcanofregularpopcontainstheequivalentof10tspofsugaranda2Lbottleofpophas1½cupsofsugar!Wateristhebestbeverageforquenchingyourthirst.
Decoding Food LabelsTheNutritionFactstablefoundonthesideofpackagedfoodcanhelpyoumakebetterfoodchoices.Alwayschecktheservingsizefirstandconsiderthisinrelationtohowmuchofthefoodyouusuallyeat.
Lookforchoiceswithlessfat,saturatedfat,cholesterolandsodium.Lookforchoicesthatgiveyoumorefibre.Learn more about using food labels to make healthy choices on the web:Health Canada –www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.phpHealthy Eating Is In Store for You –www.healthyeatingisinstore.ca
Did you know?Fibreisacarbohydratethatdoesnotraisebloodsugar.UsingtheNutritionFacts,youcansubtractthegramsofFibrefromthegramsofCarbohydrate.Onlycounttheremainingcarbohydratetowardyourmealplan.
How Many carbs are right for me?• Carbsareoneoftheenergynutrients.Weallhavediferentenergyneedsbasedonouractivities,age,gender,goals
tomaintainorloseweightjusttonameafew.• Ingeneral,mostadultsneed45to60gramsofcarbohydratespermeal.• Usingfoodlabelswillhelpyoutochoosefoodstoprovideaboutthisamountofcarbohydratepermeal.• Toplanyourmealyoushouldknowthatineachofthefollowingfoodsthereareabout15gramsofcarbs:
– 1sliceofbread(thesizeofaCDcase)– ½cupofcereal– 1pieceoffruit(thesizeofatennisball)– 1cupoflowfatmilk
• Vegetablesareverylowincarbsandareoftenconsidered‘free’–loadup!
Exchangelistsindicatingtheportionsoffoodtoprovide15gramsofcarbohydrateareavailable.Askaregistereddietitianformoredetails.
Ifyouareusinginsulintocontrolyourbloodsugars,youmaywanttolearnmoreaboutbalancingyourcarbohydrateswithanapproachcalledCarbohydrateCounting.Asktospeakwitharegistereddietitian.
Fibre• Whenreadingfoodlabelslookforfoodshigherinfibre.• Breadchoicesshouldhaveatleast2gramsperslice.Cerealchoicesshouldbe4gramsormoreperserving.• Granduallyincreaseyourfibreintakeandaimfor30gramseachday.• Fibreisacarbthatdoesnotdigest.WhenreadingtheNutritionFactstable,subtractthefibregramsfromthetotal
gramsofcarbstodeterminethecarbsthatcontributetoyourmeal.
To Reduce WeightIfyouareoverweightagradualreductionof5-10%ofyourinitialweightcaninprovebloodglucosecontrol.Suggestionsinclude:• Eatsmallerportionsoffoodsandrememberthebalanceoffoodsonyourplate:1/4protein,1/4starch(including
potatoes),1/2vegetablesforlunchandsupper• Eat3mealsperday,nomorethan6hoursapart.Don’tskipmeals.Snackwithfruitbetweenmeals.• Choosefoodslowerinfatandsugar.Eatingstrategiesincludinglowglycemicindexchoicescanbehelpful.Learn
morefromaregistereddietitian.• Aimforamaximumweightlossof1-2lbs(0.5-1kg)perweek.
“Waist loss” is as important as weight loss. For tips on how to trim your waist see our ‘Waisting Away – Healthy Weight Management’ nutrition fact sheet. Staying Healthy with DiabetesBeingoverweightorobesemakesyourbodymoreinsulinresistant.Thismakescontrollingbloodsugarsmorechallenging.Excessweightanddiabetesarebothrisksfactorsforheartdisease.
FormoredetailsonWeightManagement,CholesterolorHypertensionsee:Eating Plan for Hypertension,Eating Plan for High CholesterolandWaisting Away - Healthy Weight Management.AllareavailablefromtheOttawaCardiovascularCentrewebsite.Gotowww.ottawacvcentre.com.
Protein
Fruit
Protein
Vegetables
StarchStarch
Breakfast Lunch & SupperPortions to Live By • Oneservingofwholegrainsis1/2cupcooked,notthe
3ormorecupsservedinmostrestaurants!Toomuchofagoodthingisnotagoodthing.
• FormoredetailsonhealthyportionsseeEating Well with Canada’s Food Guideonlineatwww.healthcanada.gc.ca/foodguide.
FOODS TO CHOOSE FOODS TO LIMIT OR AVOID
Whole Grains• Wholeandmultigrainbreads,wholewheatpasta,
brownrice• Low-fatandmultigraincrackers• Low-sugar,whole-graincereals• Oatmeal,bran,bulgur,buckwheat• Low-fat,wholegrainbakedgoodswithaddedbran
oroatbran
• Whitebreads,croissants,sweetrolls,high-fatwhitecrackers,waffles
• Short-grainandminuterice– whiterice• Sweetenedrefinedcereals• Commercialmuffins,cakes,doughnuts,Danish
pastries,high-fatcookies• Avoid“white”foods(whiteflour,whitesugar)
Milk and Alternatives• Dairyproductswithlessthan1%fat• Cheeseshouldbe10-20%MF
• Milkproductshigherthan1%fat• Cheesehigherthan21%MFandcreams
Type 2 Diabetes Eating PlanChoose Low Glycemic Index Foods Whenever Possible!
Vegetables and Fruit – with lots of colour• Darkgreenleafyvegetables• Eatanabundancefresh/frozenvegetables• Unsweetened,fresh,frozenorcannedfruits
• Parsnip,pumpkin,whitepotatoes(highGI)• Driedfruitsandfruitsinheavysyrup• Sweetenedfruitjuices
Meat and Alternatives• Fish(cannedinwater,fresh,frozen),seafood• Skinlesschickenandturkey• Leanmeatswithfattrimmed,wildgame• Leancoldcuts(butwatchthesaltcontent)• Legumes,tofu• Eggs(uptoeightperweek)
• Fishwithbutterorbreading• Friedchicken,poultrywithskin,wings• Fattymarbledmeats,ribs,regulargroundmeats,
organmeats• Highfatprocessedandcannedmeats:bacon,
sausages,patés,bologna,salami,wieners
Meat and Alternatives• Olive,canola,soybean,sesame,sunfloweroils(3tsp• orlessperday)• Non-hydrogenatedsoftmargarinesLow-calorie
dressingsandmayonnaise• Lightpeanutbutter,nuts(watchsaltandcalories)• Unsaltedseeds:flax,pumpkin,sunflower• Defattedgravyandlow-sugarcondiments• Cocoapowderorasmallpieceofdarkchocolate
• Hydrogenatedoils,coconutandpalmoils• Shortening,butter,lard,hardmargarines• Peanutbutterwithpalmorhydrogenatedfat• Nomorethan1/4cupnutsperday(highcalories)• Heavygravy,creamsauces,high-sugarcondiments• Chocolateandcarob
Sweets (in very small amounts)• Sugarsubstitutesandartificialsweeteners,lowsugar
jams/jellies/syrups• Sugar-freecandies,gelatins,gum• Low-sugarandhighfiberbakedgoods• Low-fatandlow-sugarfrozendessert
• Sugarandregularjams,jellies,syrups,candies,gelatins,gum,honey
• Regularcakes,pies,cookies• No“white”foods(whiteflour,whitesugar)• Regularfrozendesserts
Snack Foods• Popcornwithoutsalt,butter,orhydrogenatedoils• Chooselowfat,lowsugarsnackfoods
• Regularpopcorn,chips,pretzels,cheesies,cornchips
Eating Plan for Type 2 Diabetes, December 2010DanielleAldous,BSc,RD(FromOriginal2006HeleneCharlebois,BsC,RD&JasnaRobinson,DI)©ContinuingMedicalImplementation®Inc.
Ottawa Cardiovascular Centre502-1355BankStreetOttawa,ONK1H8K7Phone: (613)738-1584Email: [email protected]
Other Nutrition Fact Sheets Available: EatingPlanforHypertensionEatingPlanforHighCholesterolEatingPlanforHeartFailureHealthyWeightManagementPotassiumModifiedEatingPlanPlease visit www.cvtoolbox.com for more information
Alcohol• Limitalcoholtolessthan2drinksperday(1drink=12ozbeeror1.5ozliquoror4ozwine)• Alcoholisnotrecommendedifyou:
– havehightriglycerides(typeofbloodfat)– haveliverproblems– arepregnantorbreastfeeding
• Ifyouchoosetodrinkalcohol,remember:– Todrinkwithyourmealorsnack(notonanemptystomach)– Todrinkslowlyordilutewithwaterordietsoda– Thatliqueurs,sweetwinesanddessertwineshavemoresugar– TowearyourMedicAlertindicatingthatyouhavediabetes–alcoholcancausealowbloodsugarreactionwhich,ifleftuntreated,mayrequiremedicalattention
SupplementsCheck with your Doctor, Dietitian or Pharmacist before starting a supplement. • Heart Healthy Mixture =1/3groundflax,1/3oatbranand1/3psyllium.Use2Tablespoonsperdayaddedtofoods
orbeverages.Thefibreinthisblendisgoodforbothyourheartandbloodglucosecontrol.• For high triglycerides (atypeoffatinthebloodmorecommonlyhighwithdiabetes):
Omega 3 supplements –adding2000to4000mgofEPA+DHAfromfishoil.Thisshouldbedoneunderthesupervisionofyourdoctor.
Move your body, burn the glucose• Aimtobeactivefor30minutesatleast5daysperweek(150minutes/wk).Startwithbriskwalkingfor10minutes
afewtimesperdayandincreasegraduallyfromthere.Besuretohaveyourdoctorsapprovalbeforeengaginginanexerciseprogram.
• Strengthexercisescanbeincluded2-4timesperweektokeepthebonesstrongandbuildleanmuscle.• Aleanerbodyisbetterabletousetheinsulinitproducestomanagebloodglucose.• Measureyourbloodsugarbeforeandafterexercise.Typicallyyourreadingsafterexercisewillbelower.• Bepreparedincaseyourbloodsugardropstoolowduringorafterexercise.Treatmentsarelistedbelow.• Ifyoutakemedicationsthathaveariskofcausinglowbloodsugaritisbesttoexercisewithsomeoneandtakeacellphone
withyouforemergencies.Letsomeoneknowwhereyouwillbeandapproximatelywhenyouwillreturn.TakeemergencyglucosewithyouandwearyourMedicAlert.
Keeping active can lower your blood sugar, lower your blood pressure, help you lose weight, help you feel better reduce the amount of medication you need, relieve tension or stress, improve your heart and lung function and improve your muscle tone! Look at all those benefits!
Recognize and be ready to treat low blood glucoseUsuallyweareconcernedaboutbloodglucosebeingtoohighbutcertainmedications*,exercise,amissedmealoranillnesscancauseyoutoexperiencealowbloodsugar.• Whatislow?Abloodglucosebelow4.0• Symptoms:shakiness,fatigue,excessivehunger,headache,blurredvisionordizziness,coldclammyorsweatyskin,pale
colourinface,weakness.• Treatment:
– Take15gramsoffastactingcarbohydratesuchasglucosetabs,3packetsofsugardissolvedinwater,¾cfruitjuiceorregularpop,6LifeSavercandiesor1tablespoonofhoney.Wait15minutes.Ifsymptomsdonotresolvetreatagain.
– Ifsymptomsresolvebutthenextmealismorethananhouraway,haveasnackwith15to20gramsofcarbohydrateandsomeproteinsuchas½asandwichorcheeseandcrackers.
* Medications more likely to cause a low blood sugar include Amaryl, Diabeta, Diamicron, Gluconorm and Insulin.