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

Eating!Can’t live with it, can’t live without it!

Constant opportunity for change

Major factor in health, wellness, & happiness.

Can be a major stressor!

Focus on the positive

ObjectivesList 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.

Type 1 DiabetesUse of daily insulin

Goals for diet education:Coordinate meal plan with insulin treatmentUse of carbohydrate counting for intensive

insulin therapy programsAlter intake as needed for activity levelIdentify/reduce risk of hypoglycemia

Type 2 DiabetesMay be diet and exercise controlled, using

oral medications, or insulin treated.

Goals for diet education:Weight control or weight lossUse of carbohydrate counting for consistent

carbohydrate diet or insulin programAddress co-morbid conditions and risk factors

The BasicsCarbohydrate

Digests quickly, from 15 minutes to 2 hoursHas direct effect on postprandial blood glucose

levels, more carbs = higher glucoseShould provide about 50% of total caloriesSources: grains, beans, vegetables, milk,

fruit, sweets and added sugars

The BasicsProtein

Digests more slowly, 3-5 hoursCan aid in prolonged post-meal satietyMay help prevent between meal and nocturnal

hypoglycemiaSources: meat, fish, poultry, eggs, cheese,

nuts/peanut butter, soy products

The BasicsFat

Digests the most slowly- several hoursPromotes prolonged satietyType of fat consumed affects cardiac riskShould be less than 30% total caloriesSources: butter, margarine, oils, mayo,

salad dressing, cream cheese, nuts, seeds, gravy

The Idaho Plate Method

Carbohydrate CountingIdentify 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”

What is one serving of carbohydrate?(one serving = 15 grams carbohydrate)

1 slice bread1/2 hamburger bun or English muffin1/2 cup potato, corn, peas, cooked cereal1/3 cup rice or pasta1 small fresh fruit, 1/2 cup canned fruit or

juice1 cup milk or yogurt1 tablespoon sugar, honey, jam, maple syrup

Sample Meal Example1/2 cup oatmeal1 hard boiled egg1 slice whole wheat toast1 teaspoon margarine1/2 cup orange juice Which are the carbs? How many servings? How

many grams total carbohydrate?

Sample Meal Example1/2 cup oatmeal = 1 serving (15 g)1 hard boiled egg = protein1 slice whole wheat toast = 1 serving (15 g)1 teaspoon margarine = fat1/2 cup orange juice = 1 serving (15 g)

Total is 3 servings or 45 grams carbohydrate

Sample Meal Example 23 ounces roast chicken1 cup cooked rice1/2 cup green beans1 cup tossed salad1/2 cup applesauce1 cup 1% milk

Sample Meal Example 23 ounces roast chicken = protein2/3 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

Using a label to Count Carbs

1. Serving size, # of servings

2. Total grams of carbohydrate

How much carbohydrate to eat?

1200 kcal = 150 grams = 10 servings1500 kcal = 187 grams = 12-13 servings1800 kcal = 225 grams = 15 servings2000 kcal = 250 grams = 16-17 servings

*Amounts and types of protein and fat can greatly affect total calorie intake.

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

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

Weight LossWeight loss of just 7-10% of a patient’s

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

High Fiber IntakeCan 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

Low Fat IntakeAll patients with diabetes are at increased

cardiac risk- more aggressive with cholesterol and blood pressure control

Total fat <30% kcal, sat fat <10%, trans fat 0%

Decrease added fats- 100 kcal/tablespoon

Opt for unsaturated fat- oils, nuts, margarine

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