A Peer-Reviewed Publication

2014 | Volume 35 | Number 2

CARbohydRAte, diAbetes NutRitioN theRAPy ANd RelAted issues: A New look At AN old toPiC

oN the

diabetes Care and educationCUTTING EDGE

Message from the Theme Editor: susan weiner, Ms,RdN, CdN, Cdesusan weiner Nutrition, llC susan@susanweinernutrition.comlong island, New york

the authors who contributed to this issue were chosen for their extensive knowledge of carbohydrate-related issues. we are extremely fortunate and grateful that they shared their expertise with us.

lyn wheeler, Ms, RdN, Cd, FAdA, FANd, describes the revisions to the Choose Your Foods (CYF) series of nutrition teaching materials. these publications, co-sponsored by the Academy of Nutrition and dietetics/dCe and the American diabetes Association, have enabled clinicians to help people with diabetes to better understand how a variety of foods may be included in a

4 Choose Your Foods (CYF) series update, 6th Revision (7th edition, 2014)

5 Finding an effective Match: Nutrition teaching Materials for the Patient with diabetes

7 Carbohydrate, insulin Pumps, and Continuous Glucose Monitoring (CGM): technology and special Features to Manage Glycemia

12 Real-time Continuous Glucose Monitoring: An exciting tool for Patients with type 1 and type 2 diabetes and Professionals

15 literacy and Numeracy: Considerations and Methods with Application to Carbohydrate Counting

20 Glycemic index and Glycemic load: A New look at an old topic

27 Celiac disease, type 1 diabetes and Considerations for Carbohydrate Counting

a dietetic practice group of the

Diabetes Care and Education

healthful eating plan and lifestyle.

sara weigel, Rd, ld, Cde, and kim bisanz, Rd, ld, Cde, follow by illustrating how to match education materials to a patient’s education and learning style. they address the practical challenges associated with patient education decisions.

Mamie lausch, Ms, RN, Rd, Cde, addresses the modern tools of insulin pumps and continuous glucose monitoring (CGM). she shares what research shows about using a CGM to characterize the effects of meals on blood glucose.

Counseling and educating people with diabetes about their meal planning options can be challenging for educators and confusing for patients. when planning this issue of On the Cutting Edge, our theme team considered the various ways that carbohydrates affect the lives and health of people with diabetes. Registered dietitians (Rds) and registered dietitian nutritionists (RdNs) may find it challenging to advise patients effectively on how to adjust their carbohydrate intake and regulate insulin dosage. Patients with diabetes mellitus should be aware of the importance of glycemic control in helping them to enjoy healthy and active lifestyles and prevent hypo- and hyperglycemic episodes. this issue of OTCE addresses many issues associated with carbohydrate consumption and diet as well as many of the concerns that Rds and RdNs face when counseling, educating, and coaching patients.

NewsFlAsh and On the Cutting Edge are bi-monthly publications of the diabetes Care and education (dCe) dietetic Practice Group of the Academy of Nutrition and dietetics (the Academy).

Print Communications Coordinator:lorena drago, Ms, Rd, CdN, Cde

Newsflash Editor:Anna henry, MPh, Rd, ld, Cde

On the Cutting Edge Editor:sue Mclaughlin, Mol, bs, Rd, Cde

On the Cutting Edge associate Editor:Janis Roszler, Ms, Rd,ld/N, Cde, FANd

Publication in this dCe newsletter does not imply a statement of policy or endorsement by the dCe. the opinions expressed represent those of the authors and do not reflect official policy of the Academy.

Mention of product names in this publication does not constitute endorsement by dCe or the Academy.

All material appearing in the NewsFlAsh and On the Cutting Edge is covered by copyright and may be photocopied or otherwise reproduced for noncommercial scientific or educational purposes only, provided the source is acknowledged. special arrangements for permission are required from the Print Communications Coordinator for any other purpose.

subscriptions are available for people who are ineligible for the Academy membership for $30 (domestic), $35 (international) by sending a check to:

linda flanagan Vahl DCE administrative Manageracademy of Nutrition and Dietetics120 south Riverside Plaza, suite 2000Chicago, Il 60606-6995

Payable to Academy of Nutrition and dietetics/dCe noting preferred mailing address.

©2014 diabetes Care and educationdietetic Practice Group/Academy of Nutrition and dietetics.All rights reserved.library of Congress National serials data Program issN #1070-5945, issued 7/93.

MIssIONempowering dCe members to be leaders in nutrition and diabetes education, management and prevention.

VIsIONoptimizing the quality of life for people with diabetes.

oN the

diabetes Care and educationCUTTING EDGE Monica Joyce, Ms, Rd, ldN, Cde, and

Jackie king, Ms, Rd, Cde, FAdA provide further testament to the value of real-time continuous glucose monitoring (Rt-CGM), as they describe implementation in clinical practice through a recent case study example.

Marjorie Cypress, Phd, C-NP, Cde, and Geri spollett, MsN, ANP-Cs, Cde, tackle the topic of literacy and numeracy for carbohydrate counting. diabetes educators should assess a patient’s ability to understand the numbers associated with all aspects of diabetes care, including food labels, portion sizes, and insulin calculations. the authors have made a detailed literature review and provide useful, practical, and essential information to help improve patient outcomes. sharon schatz, Ms, Rd, CsR, Cde, contributes an instructive article examining research pertaining to the glycemic index (Gi) and glycemic load (Gl). she examines the effect of carbohydrates on glycemic response and explains carbohydrate

composition and chemistry. this detailed article includes an in-depth review of the functionality of carbohydrates, which should be useful for educators at all levels of expertise. in addition, she reviews the rationale behind the research and how the structure and digestibility of carbohydrates may explain glycemic response and impact. this article is especially useful in describing how the literature about Gi and Gl may be translated into education efforts on diabetes meal planning. one editorial note: many professionals are choosing to write out the word “carbohydrate” rather than use “Cho,” its historical abbreviation. because “carbohydrate” is used so extensively in this piece, our team chose to employ the term “Cho” as a space-saving device.

Meghan Mclarney, Rd, lMNt, Cde, combines scientific evidence and practical applications in her outstanding article on celiac disease, type 1 diabetes, and carb counting. Rds and RdNs frequently must evaluate current research and apply results to individuals who have

GOal 1: sustain and enhance participation and retention among members. •Useelectronictechnologytoengagenewandexistingmembers •Promoteandsupportmemberprofessionaldevelopment •Maintainahighvalueofmembership

GOal 2: Advance dCe’s member relationships among industry, media, professional and public education. •CollaboratewithorganizationstopromoteRDsindiabetescare,educationand

prevention

Goal 3: support and promote public policy and research efforts in nutrition and diabetes •Addressandsupportpublicpolicyeffortsinvolvingnutritionanddiabetesandpre-

diabetes •Increaseresearchefforts

sTRaTEGIC PRIORITY aREas

3

OTCE Acknowledgments

ThaNK YOU!Many thanks to the following people for assisting with the development of this issue of On the Cutting Edge:

ThEME TEaMsusan weiner, Ms, RdN, CdN,Cde

sue Mclaughlin, Mol, bs, Rd, CdeJanis Roszler, Ms, Rd, ld/N, FANd, Cde

lorena drago, Ms, Rd, CdN, Cdediane Reader, Rd, ld, Cde

REVIEwERsCarol brunzell, Rd, Cde

Johanna burani, Ms, Rd, CdeFeon Cheng, MPh, Rd, Chts-CP

de Anna dahlem, Ms, Rd, Cde, bC-AdMbarbara eichorst, Ms, Rd, Cde

Alison evert, Ms, Rd, CdeJordyn Forsyth, Ms, Rd

lisa Gatti-Arnold, MsN, RN, CdeCarolyn harrington, Rd,ldN, Cde

haesun hwang, Ms, Rd, CdeNikarika Jaiswal, Ms, Rd, CdN

Monica Joyce, Ms, Rd, ldN, Cdesarah keegan, Ms, Rd, Cde

Jacqueline king, Ms, Rd,FAdA, Cdeheidi klasna, Rd, lMNt

Paula leibovitz, Ms, Rd,Cd-N, Cdelynn Maarouf, Ms, Rd, Cde

Angie Major, Rd, ldemily Mitchell-kreutner, Ms, Rd, Cssd, Cde, Ryt

kathy Mount, Ms, RdMelissa ocasio, bs, Rd

sarah Picklo, bs, bA, Rdlauren hardy sams, Ms, Rd

kate schindler, Rd, ldN, CdePatti urbanski, Med, Rd, ld, Cde

Meg wilson, Ms, Rd, Cd/N, CNsC, Cde

OThER CONTRIbUTORs TO PRODUCTIONJackie boucher, Ms, Rd, ld, Cde

sarah brokaw, MPh, Rdlisa brown, Rd, ld, Cde

therese hrncirik, Rd, ldN, Cde lisa Ranes, Rd, Cdelinda Flanagan Vahl

diabetes and celiac disease. this article is particularly useful for practitioners who would like to improve the clinical management of patients with celiac disease who have difficulty controlling blood glucose levels.

this issue of OTCE would not of have been possible without the support of several amazing and talented people. i’d especially like to express my gratitude to sue Mclaughlin, Mol, bs, Rd, Cde, and Janis Roszler, Ms, Rd, ld/N, Cde, FANd, who were abundantly helpful and offered invaluable assistance, support, and guidance. i’d also like to express my deep gratitude to each of the expert authors for constructing immensely informative articles with the sole purpose of educating our readership. in addition, the content and CPe reviewers, test item writers and others noted in the Acknowledgments section deserve our recognition and thanks. we are very grateful for your expertise and deeply appreciate the time and effort that you put into this worthwhile endeavor.