hana- dietary education dm-final 1
TRANSCRIPT
Dietary Education for People with
DiabetesBsc. Nutrition & Food ProcessingBsc. Nutrition & Food Processing
Colonel Hana Khasrouf Mudabber Colonel Hana Khasrouf Mudabber
Outline Aims of Nutritional AdviceThe goals of dietary adviceRole of the dieticianDietary Education Tools:
Stage1Healthy EatingThe food pyramidThe signal systemThe hand jiveThe plate model
Stage 2 Food Exchanges Carbohydrate Counting
1. Portion Estimation2. Food Package Labels3. Carb factors
Advanced carb counting carb: insulin ratio Methods: #1 #2 & #3
Glycemic Index
Aims of Nutritional Advice The aim is to provide those who need advice
with the information requirement to make appropriate choices on the type and quantity of food which they eat.
It must take into account the individuals: - Specific needs- Personal and cultural preferences- Beliefs and lifestyle- Wishes and willingness to change
The Goals of Dietary AdviceAre:To maintain or improve health through
the use of appropriate and healthy food choices
To achieve and maintain optimal metabolic and physiological outcome
Role of the dieticianThe role of the dietitian is to translate
nutritional objectives into practice in a way which is realistic and practical for the diabetic.
Focussing on modifying the patient’s existing eating habits, food choice and timing of meals.
Role of the dieticianThe dietitian needs to assess diet for:
Food choicesMeal planNutritional adequacy and overall dietary balanceBeliefs or misconceptions held about diet and diabetesPhysical activity, occupation, literacy, economic
circumstances , etcBody weightOther medical conditions – Coeliacs, visual handicap,
nephropathy, etcAlcohol consumption
Avoid looking like a school teacher!Avoid looking like a school teacher!• Simple words
• Open-ended questions
• Encouragement
• Positive feedback
• Active listening
• Repetition
Role of the DieticianImplementing Good Communication Skills
Role of the dietician
Example:
Open-ended question At what time do you take your
meals?
Closed question Do you take your meals on
time?
Patients can be overwhelmed, the dietician must not cram all teaching points into one session
Adult learners have an attention span of about 20 minutes
Scheduling follow-up
Role of the dietician How to educate DM patient?
Role of the dietician Utilizing Interactive Tools and Educational Materials for Teaching
Diabetes dietary education color books or educational stories for kids.
Diabetes dietary education games for teens and adults (softwares or CDs)
الجيد الطعام أتناول أنالصحتي المفيد
وأرتاح أجلس أن الى أحتاج أحياناً. ً كثيرا لعبت إذا وخصوصاً قليالً
سكر كان إذا خفيفة وجبة وأتناول ً منخفضا الدم
الفطور أتناول أن قبلفي والدتي تساعدني
. األنسولين أخذمثلك سكري لدي أنا
تماماً.
بالدم السكر فحص على نعملتناول وبعد األنسولين أخذ قبل
الطعام.. بذلك أحياناً أبي يساعدني
سكر تفحص هل أيضاً وأنتالدم؟
Diabetes Dietary EducationBooks & Stories for Kids
Diabetes Software for Teens & Adults
Approach to meal planningA uniform approach to meal planning
does not work for everyone
A flexible plan or a variety of approaches is required to deal with differing needs
BackgroundHistorically advice given on carbohydrate
exchanges or portions In 1980s carbohydrate restriction found to
be unnecessary – advice changed to healthy eating : plate model
New DAFNE trial / Carbohydrate Counting
Dietary Education
Tools
Dietary educationStage 1 (simple education methods)
Awareness of the basics of healthy eating/ balance of good health
The food pyramidThe signal system (healthy food
choices)The hand jiveThe plate model
Dietary educationStage 2(advanced & require teaching skills)
Food Exchange SystemCarbohydrate CountingGlycemic Index
Healthy Eating
Australian Food Guide
Healthy Eating
Grain products
Vegetables and fruits
Milk products
Meat and alternatives
Canadian Food Guide
Balance of Good Health
Bread, cereals & potatoes
Milk & dairy
productsFoods rich in sugars and fat
Meat, fish & protein
alternatives
Fruits & vegetables
UK Food Guide
My Food Pyramid (USDA)
Utilizing Interactive
Activities for Teaching My
Pyramidfor
Kids
Diabetes Dietary Education Games for Teaching My Pyramid
Signal SystemThe signal system is based on a traffic lights concept: Red foods (to be taken in small amounts)
those rich in fat sugars (refined carbohydrate) high glycemic index foods low fiber content
Yellow foodsYellow foods (to be taken in moderation) Moderate glycemic index foods low fiber content
Green foods (healthy choice) low glycemic index high fiber content low in fat
Healthy versus unhealthy food choices?
Food groupsGreen zoneYellow zoneRed zoneRice Steamed or
boiled rice Fried rice/biryani
BreadWhole wheat bread
White breadCroissants and cakes
NoodlesSteamed or boiled noodles
Deep fried noodles
PotatoesBaked potatoFrench friesVegetablesSteamed
vegetableSauteed vegetable
Deep fried vegetable
SaladGreen saladSalad with mayonnaise
SauceTomato basedCream basedChicken, fish & red meat
GrilledPan friedDeep fried
Hand Jive (starch): choose an amount equivalent to the size of 2 Carbohydrates fists.
Fruit: choose an amount equivalent to the size of 1 fist . Protein: choose an amount equivalent to the size of the palm of
your hand and the thickness of your little finger. Vegetables: choose as much as you can hold in both hands.
These should be low carbohydrate vegetables – green or yellow beans, cabbage or lettuce.
Fat: limit fat to an amount the size of the tip of your thumb. Drink no more than 250 ml of low-fat milk with a meal
Plate Model
Protein
Starch/cereal
Vegetable
Vegetable
FruitFat Milk/yoghurt
Advanced Education Tools –Stage 2 Food Exchanges
Carbohydrate Counting
Glycemic Index
The “Exchange” SystemFoods with common nutrient values
are grouped together.
1 Fat
1 Meat
1 Vegetable
1 Milk
1 Fruit
1 Starch
0 5 10 15
Food exchangesWithin groups, a single food based on weight/
measure/ size has the same carbohydrate or Calorie value as another and can be interchanged
Cereal exchanges: 1 slice of bread can be exchanged for 1/3 cup rice
Foods from different groups cannot be interchanged – 1 slice of bread cannot be exchanged for 1½ tsp of butter
The Exchange Lists1Groups/ ListsCarb.ProteinFatCaloriesCarbohydrate GroupStarch1531 or less80
Fruit15______60
Milk Skim Low-fat Whole
121212
888
0-358
90120150
Other carbohydrates15variesvariesvaries
Vegetables52___25
Meat and Substitute Group Very lean Lean Medium-fat High-fat
____________
7777
0-1358
355575100
Fat Group______5451. Exchange Lists for Meal Planning, The American Diabetes Association, The American Dietetic Association, 1995
Counting Carbs Using the Exchange system
Breakfast Exchange/# Carb Grams1 pita bread (4 oz) starch (4) x 15 60g
1 tsp. olive oil fat (1)x0 0g
1 hard boiled egg protein (1)x0 0g
1/2 cup orange juice fruit (1) 15g
6 oz skim milk (3/4) x 12 9g
Total Carbs 84g
One oz.pita bread 15g carbExampl
e:
Carbohydrate Choices
One oz.slice bread
Small piece of fruit
One cup unsweetened
cereal
1 small ear of corn ½ cup of
juice
One small potato
1 cup of milk
1/3 cup riceOne oz.
pita bread
Carbohydrate Counting
Carbohydrate Counting Defined A meal-planning approach based on the
following ideas Carbohydrate is the main nutrient affecting
postprandial glycemic response Total amount of carbohydrates consumed is
more important than the source of carbohydrates
Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs
Timed Effect on Blood Sugar Levels
* In absence of dietary carbs ** may cause insulin resistance in large qty
CarbohydrateCarbohydrate: rapid digestion, total absorption/conversion to glucose (100%)
Sugar AlcoholsSugar Alcohols: moderate digestion, partial absorption as glucose (50%)
Protein…………..Protein…………..slow digestion, partial conversion to glucose* (~40%)
Fat………………..Fat………………..slow digestion, little conversion to glucose** (<20%)
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Why Count Carbohydrate?Keeping carb intake consistent at meals from
day to dayBase for rapid-acting insulin dosing with
meals/snacks Allow more flexibility with eating for people with
type 1 diabetesResult in reduced post-prandial hyper- and
hypoglycemia
PrerequisitesThe ability & willingness of the diabetics to :
Perform basic carb countingDo simple mathUse nutrient analysis information, measuring
cups, spoons and scalesKeep accurate, detailed records:
Blood glucose results Carbohydrate eatenInsulin or other medsPhysical activity/exercise
Methods for Basic Carb Counting
1. Portion Estimation
2. Food Package Labels
3. Carb factors
Portion Estimation Using Food Models
1. Portion Estimation Method
Examples of 1-cup Carb Estimates:Potato: 40gPasta: 40gRice: 50gRolls: 25gCereal: 25gCereal: 25gFruit: 20gFruit: 20gCooked Vegetables: 10gSalad Vegetables: 5gMilk: 12g
Corn: 30gPeas: 30gBeans: 40gPretzels: 25gChips: 15gPopcorn: 5gPopcorn: 5gIce Cream: 35gCake: 45g
Portion Estimation MethodExample: 1
1cup fruit 20g carb
X 1 ¼ cups
25g carb
1cup popcorn 5g carb
X 4 cups
20g carb
Portion Estimation MethodExample: 2
Portion Estimation MethodLong Sandwiches8g carb per inch (2.5 cm)
Pizza30g carb per adult hand-sized piece (fingers together)
Cookies20g carb per adult-sized palm
Breaded meat/veg/cheese
4g carb per small (“thumb/nugget sized”)
10g carb large (“patty/palm-sized”)
1hand pizza 30g carb
X 1 1/3 hands
40g carb
Portion Estimation MethodExample: 4
2. Nutrition Facts Label Method
Labels are the best resource for carb counting but consideringServing SizeTotal CarbohydrateFiber & Sugar Alcohol (if any)
Sugar Alcohols and Carb CountingArtificial SweetenersFound in sugar free products e.g. chewing gum,
mints, jam, ice cream, cookies and candyDigest slowly and partially ( 50%)Requires little or no insulin to be metabolized. Can have laxative effect (bloating, gas, diarrhea) if
consumed in large amounts.
Comparison of Sweeteners
SweetenerCal per gramArtificial (Aspartame, Saccharin, Splenda)0Sugar Alcohols: Erythritol
MannitolIsomaltLactitolMaltitolXylitol
Sorbitol Hydrogenated starch hydrolysates
0.21.62.02.02.12.42.63.0
Glycerine, sucrose, fructose, lactose4.0
Example: 1 Nutrition FactsNutrition Facts
Serving size: 2 piecesServing size: 2 piecesAmount Per ServingAmount Per Serving
CaloriesCalories3.83.8
Calories from Fat0Total Fat0g (0%)
Cholesterol0g (0%)Sodium0g (0%)
Total Carbohydrate1.6g (1%)
Sugars0g
Sugar Alcohol (Xylitol)1.6g
Protein0g
If all carb is from sugar alcohols
< 10 grams: FREE food
Example: 2
Nutrition FactsNutrition FactsServing size: 5 pieces Serving size: 5 pieces
( about 16 grams)( about 16 grams)Amount Per ServingAmount Per Serving
CaloriesCalories4040Calories from
Fat10
Total Fat1g (2%)Saturated Fat0.5 g (3%)
Trans Fat0 (0)%Cholesterol0g (0%)
Sodium70mg (3%) Total
Carbohydrate
14g (5%)
Sugars 0gSugar Alcohol
(lactitol) 14gProtein0g (0%)
If all carb is from sugar alcohols >10 grams: count ½ of the total carb
If serving size = 5 pieces sugar alcohol: 14 g = 7g
2
Nutrition FactsNutrition FactsServing Size: 1 Tbsp (17g). Serving Size: 1 Tbsp (17g). Servings per Container: 20. Servings per Container: 20.
Calories per serv.: 10. Calories per serv.: 10.
AMOUNT PER SERVING
% DAILY VALUE*
Total Fat: 0g0%
Sodium: 20mg1%
Total Carbohydrate: 3g1%
Sugars: 0g
Sugar Alcohol: 3g
Sorbitol
Protein: 0g
If all carb is from number of sources, including sugar alcohols
Subtract ½ of the sugar alcohol grams from the total carb
If 2 servings used = 2Tbsp
6g Carb + 6g sorbitol = 9 g Carb 2
Example: 3
3. Carbohydrate Factor Method
Getting total carb count by:Weighing the portion of foodMultiplying the weight by its
carb factor*
A carb factor is the percentage of the food’s weight that is carbohydrate .
The rest is water, protein, fat and minerals.
Apple: 0.13
Apple Pie: 0.32
Carrot (raw): 0.06
Chocolate Cake: 0.51
mixed grain bread: 0.46
White bread: 0.50
Pancake: 0.28
Pizza (cheese): 0.32
Potato, baked: 0.22Potato Salad: 0 .09
Rice: 0.27
Spaghetti: 0.26
Vanilla Ice Cream: 0.23
Watermelon: 0.06
Carb Factor Examples:
Carbohydrate Factor Method
How much carb? is in a baked potato weighing exactly 300 grams?
300 x 0.22g = 66g carb
Example: Calculating grams of Carb content
Impact of Fiberin Carbohydrate CountingIncluded in total carbohydrateDoes not convert to glucoseSubtract fiber from the Total Carbohydrate
Impact of Fiber Example:
1 Serving size:
13 g Total Carb
- 3 g dietary fiber
Count as 10 g carb
How Much Carbohydrate is Needed1
Calorie level~ 1200~1400~1600~1800~2400~2800
Calorie range1200-15001300-1600
1400-1700
1600-1900
1800-2300
2200-2800
Carb grams180180195210240300
Carb choices121212-1313-1415-1618-20
Grains, beans, & starchy vegetables
6667911
Vegetables333445
Fruits333334
Milk222-32-32-32-3
Meats2 (4oz)2 (4oz)2 (5oz)2 (5oz)2 (6oz)3 (70z)
Fats g/servings40/447/554/660/774/993/121. Practical Carbohydrate Counting, American Diabetes Association, 2001.
Calculated as 60% CHO from total calories.
Determining Amount of Carbs per meal
PopulationCarb choices
per mealSmaller, older, inactive women2-4
Older, inactive men3-5
Smaller, older, inactive men
Large, active women trying to lose weight4-6
Most older men
Active women
Larger men desiring to lose weight
5-7
Active, younger men6-8
Advanced Carb CountingFor those on insulin (MDI/ Insulin Pump)Adjusts rapid-acting insulin based on carb
consumed and physical activityCarb: Insulin Ratio
Calculates insulin dose for a specific amount of carbohydrate
The Actions of Insulins1 InsulinOnsetPeakDuration Rapid acting
Lispro (Humalog)
Aspart (Novolog)
<15 min
<15 min
0.5-1.5 hrs
0.5-1.0 hr
2-4 hrs
1-3 hrs
Short acting
Regular0.5- 1 hr2-3 hrs3-6 hrs
Intermediate
NPH
lente
2-4 hrs
3-4 hrs
4-10 hrs
4-12 hrs
10-16 hrs
12-18 hrs
Long acting
Ultralente
Glargine (Lantus)
6-10 hrs
2-4 hrs
10-16 hrs
peakless
18-20 hrs
24 hrs
1. Practical Carbohydrate Counting, American Diabetes Association, 2001
Basal insulinLantus
Or Levemir
Peak: 0.5-1.0 hour
Onset: 15 minOnset: 15 min Duration: 1-3 hrsDuration: 1-3 hrs
Peakless 24 hrs Glargine
)Novolog( )Novolog( )Novolog(
Example of Carb CountingDAFNE
Dose adjustment for normal eating5 day structured teaching programmeImprove diabetes control by matching insulin
to carbohydrate. Evidence shows improved HbA1c, reduced
severe hypo’s and less hospital admissions from DKA
DAFNE Timetable MondayTuesdayWednesdayThursdayFriday
09.15-09.45 INTRODUCTION
09.15-10.30 Group Discussion:Individual blood glucose levels`
09.15-10.30 Group Discussion:Individual blood glucose levels
09.15-10.30 Group Discussion:Individual blood glucose levels
09.15-10.30 Group Discussion:Individual blood glucose levels 09.45-10.45
WHAT IS DIABETES?
10.45-11.00 Coffee10.30-10.45 Coffee10.30-10.45 Coffee10.30-10.45 Coffee10.30-10.45 Coffee
11.00-12.30 NUTRITION 1Identify carbohydrates
10.45-12.30 NUTRITION 2Putting carbohydrate estimation into practice
10.45-12.30 NUTRITION 3Food PackagingRecipes
10.45-12.30 NUTRITION 4AlcoholEating outHealthy eating/ weight controlTHEORY OF GOAL SETTING
10.45-12.00 ANNUAL REVIEW AND SCREENING
12.00-13.00 QUESTIONS FOR THE DOCTORGOAL SETTING
12.30-13.30 Lunch12.30-13.30 Lunch12.30-13.30 Lunch12.30-13.30 Lunch13.00 – 14.30 Lunch
13.30-15.00 SELF MONITORING
13.30-15.00 DAFNE INSULIN ADJUSTMENT
13.30-15.00 HYPOGLYCAEMIA(Relatives/partners welcome)
13.30-15.00 PHYSICAL ACTIVITYWalk – weather depending.
14.30-15.00 QUIZ
15.00-15.15 Coffee15.00-15.15 Coffee15.00-15.15 Coffee15.00 – 15.15 Coffee
15.15-16.15 ALL ABOUT INSULIN
15.15-16.15 INSULIN INJECTION TECHNIQUE
15.15-16.15 SICK DAY RULES
15.15-16.15 SOCIAL ASPECTS(Contraception and pregnancy – optional)
15.00-15.30 EVALUATION AND FOLLOW UP
16.15-17.00 Group Discussion:Individual blood glucose levels
16.15-17.00 Group Discussion:Individual blood glucose levels
16.15-17.00 Group Discussion:Individual blood glucose levels
16.15-17.00 Group Discussion:Individual blood glucose levels
Insulin: Carbohydrate RatioMethod # 1: Food dairy, insulin dose,
and SMBG information
Method # 2:Insulin: Carbohydrate ratio
The rule of 500 or 450
Method # 3:Using the insulin sensitivity factor (ISF)
Carb to Insulin Ratio’sStarting point (if new to carb/insulin ratio’s)
1:15 ratio (1 unit rapid acting insulin for every 15 g carb eaten)
May need different ratio’s for different mealsExample:
If 65 g carb for lunch Would need 4 units fast acting insulin coverage at
lunch (65 ÷ 15 =4)
Method #1 Food dairy, insulin dose, and SMBG information1,2 Insulin: Carb ratio = Grams of carb at a given meal ÷
number of units of insulin taken at that meal
Example patient needs 4 units of insulin to cover 45g of carbs Insulin: Carb ratio = 45 ÷ 4 = 11
Ratio = 1:11
1. Carbohydrate Counting: Using Carbohydrate/Insulin Ratios, The American Diabetes Association, The American Dietetic Association, 1995
2. Practical Carbohydrate Counting, American Diabetes Association, 2001
Method #2 (The 500/450 Rule)
The rule of 450 or 5001 keeps post meal readings normal The 500 rule estimates accurately grams of carb per unit of
rapid acting insulin (Humalog or Novolog) The 450 Rule is used with Regular insulin.
Insulin: Carb ratio = 450 or 500 ÷ total daily insulin dose (TDD)
Example TDD = 36 units (Bolus + Basal)
Glucose levels are within target range Insulin: Carb ratio = 500 ÷ 36 = 14
Ratio = 1:141. Practical Carbohydrate Counting, American Diabetes Association, 2001
Method #3 (The 1800 OR 1600 Rule)Method # 3: Using the insulin sensitivity factor (ISF)1
can be used to bring down high blood sugars ISF = 1800 or 1600 ÷ TDD Insulin: Carb ratio = ISF× 0.33
Example TDD = 25 units (Bolus + Basal) ISF = 1800 ÷ 25 = 72 (meaning that 1 unit of rapid-acting insulin
Hum. or Novolog would drop BG approx. 72 mg/dL) Insulin: Carb ratio = 72 × 0.33= 24 Ratio = 1:24
1. Practical Carbohydrate Counting, American Diabetes Association, 2001
Example TDD= 34 units Target BG = 100 mg/dl Pre-meal BG = 226 mg/dl 60g of carb are to be consumedAnswer ISF = 1800 34 = 53 Difference between target and actual BG = 226 – 100 =126 mg/dl Units of insulin to decrease high pre-prandial BGUnits of insulin to decrease high pre-prandial BG =126 ÷ 53 = 2.3 units Insulin: carb ratio
• 500 ÷ 34 TDD = 15• Ratio= 1:15
Units of insulin to cover carb consumed = 60 ÷ 15 = 4 units Premeal insulin = 2.3 units + 4 units = 6.3 units (rounded to 6)
1. Practical Carbohydrate Counting, American Diabetes Association, 2001
Correcting Pre-meal Hyperglycemia1
Correcting Pre-meal Hypoglycemia1
Example Insulin: carb ratio = 1:13 ISF = 35 Carbs to be consumed: 40g Actual BG level = 57 mg/dl Target BG level = 110 mg/dl
Answer # 1: Increase amount of carbohydrate
13g of carbs will raise BG by 35 mg/dlAnswer # 2: Decrease pre-meal insulin dose
Amount of insulin to cover carbs= 40 ÷ 13 = 3 units of insulin Amount of insulin to be subtracted= Difference between target
and actual BG levels(110-57) ÷ ISF = 53 mg/dl ÷ 35 = 1.5 units insulin
Pre-meal insulin = 3 units – 1.5 units = 1.5 unitsAnswer # 3: Delay pre-meal insulin
1. Practical Carbohydrate Counting, American Diabetes Association, 2001
Treating Hypoglycemia1 Amount of
Carbs
BGBG
Apple or Orange Juice
Grape juice
MilkCola/ Sprite
15 g
51-70 mg/dl51-70 mg/dl
120 ml90 ml300 ml125 ml
20 g
41-50 mg/dl41-50 mg/dl
180 ml120 ml420 ml190 ml
30 g
<40 mg/dl<40 mg/dl
240 ml180 ml600 ml250 ml
1. Exchanges For All Occasions, Marion Franz, RD, MS, 1987
Exercise Guidelines
Type of ExerciseIf BG Is: Carb. Intake
by:Suggested Food
Short Duration 80-100 mg/dl10-15 g. 1 fruit Or 1 bread
≥ 100 mg/dlNot necessary -------
Moderate intensity
80-100 mg/dl
25-50 g before exercise
then 10-15 g/hr, if necessary
½ meat sandwich + milk Or fruit
80-170 mg/dl10-15 grams 1 fruit Or 1 bread
180-300 mg/dlNot necessary---------
≥ 300 mg/dlDon’t exercise--------
Strenuous activity or exercise
80-100 mg/dl50 g1 meat sandwich + milk
Or fruit
180-300 mg/dl10-15 g/hr 1 fruit Or 1 bread
≥ 300 mg/dlDon’t exercise-----------
Carbohydrate Counting Disadvantages Takes time and practice Increase in BG testing and need to keep
detailed records of blood sugars/foods consumed
Possible weight gain if high calorie foods are eaten
Diet may become unbalanced
Glycemic Index and Load
Gylcemic Index – GIGI value is a ranking (on a 100 point scale)
of how quickly 50g of CHO from foods elevates blood sugar levelsThe higher the number the quicker the CHO
enters the bloodstream.
High GI eg: White bread
Low GI eg: legumes
Time
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Glycemic Index ClassificationClassificationGI RangeExamples
Low GI55 or less
Most fruits and vegetables (except potatoes, melons & pineapple), grainy bread, brown rice, freekeh, fish, egg,
fructose.
Medium GI 56-69Pita bread, Whole wheat products, maftool, quick oats, basmati rice, sweet potato, honey & table sugar
High GI70 or more
Flakes, rice krispies, instant oats, popcorn, baked potatoes, short grain white rice, rice noodles, white bread,
straight glucose (100)
)healthy choice(
(to be taken in moderation)
(to be taken in small amounts)
GI ExampleExample : :SpaghettiSpaghettiGI = 37GI = 37Only 37% of spaghetti’s carbs turn into BG
in the first 2 hrs. The rest will convert to BG over the next
several hrs.
Glycemic ResponseA measure of the increase in blood sugar
after a combination of foods is eaten
Glycemic LoadRepresent the glycemic impact of more
typical portions of foods
High GI foods can be appropriate to treat hypos and for exercise
It allows for knowing the proper timing for injecting rapid insulin for quick or slow meals
It allows for occasional sweet food after a low GI meal
How to use the GI in Practical advice
Quick & Slow Acting Carbs
Game for Kids
Which Way to Go Treating
Hypoglycemia
educational game for
kids
Timing of Rapid Insulin for Quick or Slow Meals
1. Quick acting carb e.g. White roll bread, mashed potato inject insulin before meal
2. Slow acting carb High fat &/or high protein slows up rise in BG so for meals such as pizza, pasta, (Freekeh), curry, fish & chips, Large Steak inject after eating
3. Combined foods (Slow+ Quick) carb inject during meal
How to increase consumption of low GI foods
Eat high-fiber breakfast cereals (oats, bran, barley)
Add berries, nuts, flaxseed and cinnamon to high GI cereals.
OR
GI = 60 GI = 42
How to increase consumption of low GI foods
GI = 85 GI = 39
Replace white bread with whole grain breads,Watermelons & pineapples with pears & cherries
OR Include 5-9 servings of
fruits and vegetables every day.
Replace white potatoes with yams or sweet potatoes. OR
Just eat smaller portion of high GI potatoes.
How to increase consumption of low GI foods
GI = 80 GI = 61
How to increase consumption of low GI snacks
GI = 83 GI = 14
Replace crackers, Pretzels, Chips, Doughnuts with Fruit, Nuts, Ice Cream & Chocolates
Add nuts to high GI breads and crackers.OR
Eat less refined sugars and convenience foods (soda, sweets, desserts, etc.)
Combine nuts, fruit, yogurt, dark chocolates, ice cream with commercial sweets – just watch portion sizes.
OR
GI = 57 GI = 32
How to increase consumption of low GI snacks
Promotes healthy eating Increases fiber intakeHelps control appetiteHelps control BG levelsHelps lower blood lipid levelsAssists weight lossOffers a more comprehensive approach for type 2 DMReduces risk of type 2 DM and heart disease
Low glycemic Index Diet – Advantages
Standards of Medical Care in Diabetes 2010Monitoring carbohydrate intake, whether by
carbohydrate counting, exchanges, or experienced-based estimation, remains a key strategy in achieving glycemic control.
For individuals with diabetes, use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone.
Summery
“Helping others is good, teaching them to help themselves is better.”
Thank You
George Orwell