advice for people newly diagnosed with type 2 diabetes- what do i say? catherine washbrook community...
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Advice for people newly diagnosed with Type 2 Diabetes-
what do I say?Catherine WashbrookCommunity Dietitian
Aims of Dietary Advice
• Achieve / maintain blood glucose levels within normal range
• Management of lipid levels• Management of blood pressure• Weight reduction towards BMI 25
ADA 2002
Aims of Nutritional Management
• Improve health through healthy food choices and physical activity
• Address individual needs including personal and cultural preferences, lifestyle and willingness to change
ADA 2002
Department of Nutrition and DieteticsAdran Maetheg a Deietegyddiaeth Cymunedol
What is Type 2 Diabetes?
It is a condition where the body cannot use glucose properly for energy because either the body does not produce enough insulin (insulin insufficiency) or the insulin does not work properly (insulin resistance).
What foods affect our blood glucose levels?
ALL carbohydrate containing foods.
Department of Nutrition and DieteticsAdran Maetheg a Deietegyddiaeth Cymunedol
What foods affect our blood glucose levels?
ALL carbohydrate
containing foods.
Carbohydrates Explained
Starchy:Bread, Rice, Pasta, Potatoes
Both starch & added sugar (Sucrose)
Breakfast cerealsCakesBiscuitsFizzy drinks
Natural Sugars (Fructose/Lactose):
Fruit
Fruit juice
Yoghurt
Milk
Department of Nutrition and DieteticsAdran Maetheg a Deietegyddiaeth Cymunedol
Diabetic foods
• Not recommended• Often high in fat and low in fibre• Expensive• Diet is healthy not “special”
Which food groups contain carbohydrate?
5-14 portions5-9 portions
2-3 portions2-3 portions
0-4 portions
Department of Nutrition and DieteticsAdran Maetheg a Deietegyddiaeth Cymunedol
Carbohydrate distribution
• When is the majority of carbohydrate eaten?
• Are patients aware of the effect of different foods on blood glucose levels ?
• Are patients aware of which foods contain carbohydrate ?
• Do they have an understanding of the amounts of carbohydrate in different foods?
Glycaemic index (GI)
• There has been recent evidence that lower glycaemic index foods can further improve HbA1c levels by 0.43%
• A method used to classify foods according to their glycaemic response compared to a standard amount of white bread
• Low GI foods are digested and absorbed more slowly than high GI foods
The total amount of carbohydrate consumed is a strong predictor of glycaemic response, and thus, carbohydrate content of foods is a key strategy in achieving glycaemic control
Glycemic index (GI)
Examples
100 Glucose
80-90Baked potatoes, instant potatoes, pretzels, rice cakes, jelly beans, cornflakes, processed snack foods
and breakfast cereals
70-80 White bread, waffles, plain bagel, corn chips, Melba toast, french fries, carrots
60-70Cream of wheat, quick-cooking oats, whole-wheat bread, couscous, new potatoes, table sugar, soft
drinks, angel food cake, raisins, pineapple, cantaloupe
50-60 Brown rice, wild rice, popcorn, sweet potatoes, dense/coarse whole grain breads, whole-grain pita and
tortillas, mango, banana, kiwi, sweet corn
40-50Minimally processed cereals like old-fashioned oatmeal, oat bran and All bran; Bulgar wheat, pasta,
green peas, grapes, oranges, chocolate
30-40 Legumes, apple, apricots, pears, yogurt, milk
20-30 Barley, cherries, grapefruit, peaches, plums. soya beans.
NegligibleSalad vegetables, non starchy vegetables such as asparagus, broccoli, cabbage, cauliflower and green
beans
Glycaemic IndexLow Medium HighMuesli Basmati rice Cornflakes
Dried apricots Pitta bread Rice krispies
Sultana bran Sweet potatoes White/ wholemeal bread
Milk Oatmeal biscuits Lucozade
Fruit & vegetables Popcorn Frozen chips
Pulses Shredded wheat Long grain rice
Rye bread New potatoes Old potatoes
Porridge Jam Fizzy drinks
Baked beans
Case Study
• Estimate how much carbohydrate Mr. Brown is having throughout the day using the estimated CHO content list .
• How can making different food choices help glycaemic control?
Breakfast CHO Content (g)
- 2 weetabix with milk
- 1 slice white toast with butter and jam
- Large glass of orange juice (300ml)
Mid-morning
- Scone with butter
Lunch
-Tuna with mayo and sweetcorn sandwich (4 slices bread)
- Large banana
- Cereal bar
Mid-afternoon
- Packet of crisps
Evening meal
90g spaghetti with bolognaise sauce
- 3 slices of garlic bread
TOTAL
Breakfast CHO Content (g)
- 2 weetabix with milk 30 + 10
- 1 toast with butter and jam 15 + 5
- Large glass of orange juice (300ml) 30
Mid-morning
- Scone with butter 30
Lunch
-Tuna with mayo and sweetcorn sandwich (4 slices bread) 60
- Large banana 30
- Cereal bar 30
Mid-afternoon
- Packet of crisps 15
Evening meal
90g spaghetti with bolognaise sauce 45
- 3 slices of garlic bread 30
TOTAL 335
Daily Carbohydrate Recommendations
• Minimum: 130g per day
• Guideline Daily Amount:
Women 230g
Men 300g
(This will vary depending on activity levels)
Breakfast CHO Content (g)
- 2 weetabix with milk 30 + 10
- Handful of blueberries 5
- small glass of orange juice (150ml) 15
Mid-morning
- Scone with butter 30
Lunch
-Tuna with mayo and sweetcorn sandwich (3 slices bread)
45
- Large banana 30
- Yoghurt 15
Mid-afternoon
- 30g dried fruit & nuts 15
Evening meal
60g spaghetti with bolognaise sauce 30
- 1 slices of garlic bread 10
Large salad 0
TOTAL 235
What works ?
• Structured education programmes that emphasise ;– Education & empowerment– Regular patient contact/ support– Lifestyle changes– Goal setting
What service do Cardiff Community Dietetics service provide?
X-PERT PROGRAMME• Structured education programme 6 weeks• Dietitian and Diabetes Specialist Nurse
Diabetes Awareness Session (DAS)• 2 ½ hr session• Aimed at people unable to attend X-PERT
