The Great Sugar Shake Up
Nutrition Guidelines
For Managing Diabetes
Sugar Shake Up
Babs Carlson, PhD, RD, CDE
Coordinator, DSMEP
Lifestyle Center
Chesapeake Regional Medical Center
Retired
Diabetes
24 million Americans have Diabetes –
8% of the population (1 in 12)
 57 million Americans have pre-diabetes20% of the population
 By 2020, 20% of the population will have
Diabetes
 34% of babies born after the year 2000
will develop Diabetes in their lifetime

Diabetes

Diabetes cost the nation $174 billion in
2008

1 in every 8 dollars spent on healthcare
is attributed to Diabetes (12%)
Diabetes
50% of Black and Hispanic Americans
over age 50 have Diabetes or
Prediabetes
 40% of white/ Caucasian Americans
over age 50 have Diabetes or
Prediabetes

Obesity
66% Americans are Overweight
 34% Americans are Obese: BMI>30

50 years ago, 20% of Americans were
overweight. Some experts predict that
by the year 2099, 99% of Americans will
be overweight
Obesity
Why the Increase in Obesity?
 Why the increase in Visceral Obesity

ie Insulin Resistance
 ie Beta Cell Failure

Obesity

Consumption of calories as Fat has remained
steady since 1980s

Consumption of calories as Sugar has
increased from 129 pounds per person in 1980
to 148 pounds per person in 2005

Sugar consumption now as high fructose corn
syrup contributes to Diabetes and triglycerides
Sugar Shake Up
Why Sugar? Sugar does not cause
Diabetes.
 ADA: “substituting sucrose containing
foods for isocaloric amounts of other
carbohydrates will have similar blood
glucose effects”

Sugar Shake Up

Sugar does deliver excess calories with
no satiety value

ADA: “People with diabetes should avoid
intake of sugar-sweetened beverages to
reduce the risk for weight gain and
worsening cardiometabolic risk profile.”
Sugar Shake Up

Dietary Guidelines: Reduce added
sugars intake to 4 – 10 teaspoons per
day
Sedentary females: 4 teaspoons
 Active males:
10 teaspoons

1 teaspoon = 4 grams of sugars
Sugar Beverages – 12 ounces
Apple juice –
7 teaspoons
 Energy Drink
10.5 teaspoons
 Orange juice
7 teaspoons
 Pepsi
11 teaspoons
 Coke
9 teaspoons
 Gingerale
9 teaspoons
 Vitamin Water
5 teaspoons

Sugar Beverages








7-11 Slurpee
6 teaspoons (ice)
Big Gulp
12 teaspoons
Sweet tea
6 teaspoons
Latte
7 teaspoons
Tazo Chai Frappuccino 14 teaspoons
Tropical Smoothie
12 teaspoons
Gatorade
6 teaspoons
Powerade
8 teaspoons
Sugar Foods
Instant oatmeal
4 teaspoons
 Blueberry muffin
5 teaspoons
 Chocolate chip cookies
2 teaspoons
 Glazed donut
5.5 teaspoons
 Sherbet
5 teaspoons
 Fruit Yogurt
7 teaspoons
 Mars bar
7 teaspoons

Sugar Calorie Sources

Top calorie sources for Adults
Grain-based desserts
 Yeast breads
 Soda/ energy drinks
 Dairy desserts

Sugar Shake Up
If not Sugar, then WHAT?
 Follow the A, B, C’s

HbA1c = Average Blood Glucose: 6.5
 Blood Pressure: 130/80
 Cholesterol

Tchol
 Trig
 HDL
 LDL

<200mg/dl
< 150mg/dl
> 40 >50mg/dl
< 70mg/dl
Nutrition Guidelines
Eat Breakfast every day
 Breakfast should be eaten within 60
minutes after getting out of bed
 Breakfast should be eaten before
exercise
 Breakfast should include Protein
 Last meal should be eaten prior to 2
hours before going to bed

Nutrition Guidelines
Carbohydrates – greatest impact on post
prandial blood glucose
 Protein – building block for insulin,
provides satiety, necessary in each meal
 Fat – delays gastric emptying, plant
sources necessary daily


Salt as sodium – 1500 - 2300 mg daily
Nutrition Guidelines

Carbohydrates should provide 45-60% of
calories per meal, per day
1500 calories:
 1800 calories:
 2400 calories:


185 grams
225 grams
300 grams
Minimum daily recommendation is 135
grams distributed among 3 meals, snacks if
necessary
Nutrition Guidelines

Carbohydrate sources
Vegetables: 4-5 servings daily
 Fruits: 2-3 servings unless triglycerides
elevated. Fruit not juice
 Whole grains should provide 2-3 grams fiber
per serving
 Cereals should provide 3 grams fiber per
serving
 Fiber total: 25 grams daily

Nutrition Guidelines

Protein should provide 12-20% of
calories per meal, per day
1500 calories:
 1800 calories:
 2400 calories:


55 grams
70 grams
90 grams
Daily protein recommendation is 1 gram to
1.5 grams per kilo body weight
Nutrition Guidelines

Include low fat animal sources or plant
protein sources in each meal. Include at
least 10 grams protein in each meal

Portion size: 3 ounce portion, the “deck
of cards” is 21 grams protein
Nutrition Guidelines

Fats should provide 27-27% of calories
per meal, per day
1500 calories:
 1800 calories:
 2400 calories:

55 grams fat
63 grams fat
90 grams fat
Nutrition Guidelines

Monounsaturated fats improve lipid
profile, reduce cardiovascular risk.
Choose olive oil, canola oil, peanut oil

Fish oils, Omega-3 oils, reduce
cardiovascular risk, reduce inflammation.
Choose fatty fish: salmon, mackeral,
sardines; also walnuts.
Nutrition Guidelines

Pattern Management
Breakfast should provide ¼ daily calories
 Second meal: 4-5 hours after breakfast
 Third meal: 5-6 hours after second meal
 Snacks are optional, not required
 A “meal” must include carbohydrate,
protein, fat. Two “meals” should include
vegetables.

Nutrition Guidelines
Supplements. There is no scientific
evidence to support routine use of
nutrient supplements.
Long term use of Metformin destroys
Vitamin B12. Many persons with
Diabetes are deficient in Vitamin D
Dinner
Resources
www.DietaryGuidelines.gov
• Policy Document
• Advisory Committee Report
• Public Comments Database
www.NutritionEvidenceLibrary.gov