The Diabetes Champion
Your Role in Medical Nutrition Therapy
Do you know?
Based on statistics
from the Centers for
Disease Control
website, 17.0 million
people in the United
States, approximately
6.2% of the
population, have
diabetes. Of this 17
million people, 11.1
million are diagnosed
and 5.9 million are
undiagnosed.
Why are we concerned?
 Cost of care
 Complications of the disease
 Quality of life
Objectives:
 The RN will be able to
identify patients
nutrition learning
needs
 The RN will learn the
relationship between
foods, macronutrients,
and blood glucose
control
 The RN be able to
identify the foods that
are classified as
carbohydrates
 The RN will be able to
reinforce medical
nutrition therapy for
diabetes
Factors that affect Blood Glucose
 Insulin and medications
 Emotions
 Activity
 Sickness
 DIET
What Carbohydrate Counting is Not
 Based upon a system of food exchanges
 Inflexible
 Difficult to follow
 Without consideration for each person’s
individualized needs
The ADA Nutritional Guidelines Goals:
 Focus upon achieving optimal metabolic outcomes as
related to glycemia, lipid profiles, and blood pressure
 Promote consumption of a healthy diet consisting of
multiple servings of fruits, vegetables, whole grains, lowfat dairy products, fish, lean meats, and poultry
 Provides guidelines so that the patient can Maintain a
consistent day-to-day carbohydrate intake at meals and
snacks
 Enables the patient to Consume a calorie level to
promote achievement of ideal body weight
Glucose Targets
Before Meals
2 hours post
meals
A1C
RMC, AACE,
AADE
70 to 110
ADA
90-130
less than 140
less than 180
Less than
6.5%
less than 7%
Meal Planning
True/False
 All white foods are bad for you?
 People with diabetes can never eat sugar
 Karo Syrup will cause diabetes
 People with diabetes should not eat bread
 People with diabetes can eat from all
groups of foods
What nutrient drives serum glucose?
Classification of Foods
 Vitamins and mineral provide the nutrients we
need for metabolic functions, but no calories
(energy)
 The amount of carbohydrate, fat, and protein a
food contains determine it’s food class and
total calories (according to the portion size)
 Carbohydrate, fat, and protein provide calories
(energy) and also play significant roles in
achievement of good health
Food Classifications
CHO
grams
Protein
grams
Fat
grams
Carb
Group
12 to 15 g
3 to 8 g
1 to 8 g
Protein
Group
0g
7g
0 to 8g
Fat
Group
0g
0g
5g
Carbohydrate
 Another name for
starches and sugar
 Body uses for energy
 100% of most types of
CHO turns into glucose
within 1 to 2 hours of
eating
 Provides 4 calories per
gram
Protein
 Little impact on
glucose
 Builds and repairs
muscles, skin, all cells
 Includes both animal
and vegetable sources
 Can be too high in fat
 Provides 4 calories per
gram
Fat
 Small amounts needed
for healthy skin and
vitamin transport
 Heart Healthy vs. Not
Heart Healthy
 Provides
9 calories
per grams
Carbohydrates Include:
 Starches (whole grain
and refined) including
snacks
 Starchy vegetables
 Fruits and fruit juices
 Milk, yogurt, and “milk
like (soy)” foods
 Foods that contain
sugars
Simple vs. Complex
 What does the word sugar mean to
you?
 What type of sugars are used in food?
 What words come to your mind?
These words mean simple CHO or sugars
 High Fructose Corn
Syrup
 Sucrose
 Corn Syrup
 Manitol
 Sorbitol
 Dextrin
 Crystallized Cane
Sugar or Evaporated
Cane Sugar
 Invert Sugar
 Molasses and Honey
Simple carbohydrates are:
 Chemically very simple
 Easily digested and absorbed by your body
 Move quickly into your blood stream
 Limit to less than 10% of total CHO intake
Tip 1: It’s easier to say no once in the store than
50 times at home!
Complex Carbohydrate
 Starches and Fiber
 More complex chemically
 Spend longer time in digestion and
absorption
 Contribute to energy, slowly and healthfully
Complex Carbohydrate
 Provide rich sources of vitamins and
minerals, especially in the low
carbohydrate vegetables
 Excellent source of fiber, most people
need between 3 to 5 grams in a
serving
 Choose whole grain over refined CHO
Great Sources of Complex
Carbohydrate Include:
Tip 2
Portion Size Matters!
Why carbohydrate counting?
 Carbohydrate is the nutrient that affect serum glucose
 It’s a precise method to limit carbohydrate
 Carbohydrate counting controls portion size
 Portion size is how carbohydrates are controlled and
counted
 Portion estimation can be used once the patient learns
portion control as opposed to always weighing or
measuring foods
 Its portable, no measuring cups or scales
Portion size examples:
 One cup=
1 baseball or a fist
 ½ cup=
½ a baseball
 Piece of fruit
a tennis ball
 1 oz cheese
4 dice
 3 oz meat
a deck of cards
 1 tablespoon
a book of matches
Label Reading
Counting Carbohydrates
per serving- one
Serving= 15 grams
Label Reading Tip
Tip 3 Always look for total carbohydrate
If the item contains 5 grams of fiber of
more, subtract 5 grams of carbohydrate
from the total
So---- if a product has 20 grams of
carbohydrate per serving and 5 grams of
fiber, you will count the total carbohydrate
grams as_______.
Summary:
the key to carbohydrate control is
 Following the meal plan each day, limiting
the total carbohydrate to only the allowed
number of servings
 Eating at the same time each day
 Checking blood sugar level each day and
according to plan
 Planning ahead for any special event each
day
Or tip 4:
 Consistency
 Consistency
 Consistency
Which means the same amount of
CHO at each meal and snack
“My Doctor told me
to stop having
intimate dinners for
four….unless there
were three other
people”
Orson wells
Meal Planning
Meal
Carbohydrate
Counting
Method
1800 kcal
210 grams of
carbohydrate
B
CHO PR0
4
L
4
D
4
Snack
2
Fat
Free
Foods
of
choice
1
oz
3
oz
2
2
1&1/2
cups
3
oz
2
1&1/2
cups
As
desired
Tip 5
Use this phone number to remember
the basic meal plan:
444-133-2222
Or
4 carbohydrates with each meal (444)
1 ounce of protein at Breakfast3 and 3 at Lunch and Dinner (133)
And
2 fats with each meal (222) adding 2 Carbs for as snack (2222)
Meal Planning Basic Principles
 Keep all food portions moderate in size
 Make meal size similar from day to day
 Eat meals and snack at the same time
everyday
 Eat 3 meals everyday
 Choose foods in the “sweets” category less
often
Meal Planning Basic Principles

Space meals about 5 hours apart
Match meal times to your activity and medication action time.
Manage carbohydrate intake

Limit refined carbohydrate foods:
White bread, pasta, rice, crackers and cereal
Added sugars or corn syrup

Plan meals with high fiber foods:
Solid fruit rather than juice.
Cooked and raw vegetables.
Cooked dried beans, peas, or lentils.
Whole grains—“Make half your grains whole!”
Meal Planning Basic Principles
 Solid fruit rather than juice.
 Cooked and raw vegetables.
 Cooked dried beans, peas, or lentils.
 Whole grains—Make half your grains whole!
 Plan meals with high fiber foods
Many tips for portion control
 Don’t purchase foods that tempt you
 Use smaller plates, bowls, glasses
 Take ½ of restaurant food home
 Avoid all you can eat buffets
 Take only one portion, and
Considerations for Sick Days
 Illness raises glucose, continue meds
 Increase glucose monitoring to every
2 to 4 hours
 Increase fluid intake
 Follow meal plan if able
 If unable to tolerate solid food, swicth
to regular sugar liquid items at meals,
and sugar free items between meals
Considerations for Sick Days Cont’d
 If glucose > 250m usual carb is not needed
but get at least 140 grams carb daily
 For nausea and vomiting, sip small
amounts of fluids
 Check urine for ketones
 DM1 with urination & gluc > 250
 DM2 if vomiting or too sick to get out of
bed or if glucose is >250 & insulin is used
Carbohydrate adjustment for exercise
If at risk for
hypoglycemia:
intensity
duration
glucose
+carb
low to
moderate
30 min
or less
< 100
10 to 15
grams
CHO
low to
moderate
30 min
or less
> 100
0 CHO
moderate
30 to 60
minutes
< 100
25 to 50 g
CHO
before+
15g/hr
100-179
15 g/hour
180-249
0 g CHO
Planning Protein
When planning a
meal the protein is
always the
“center of the plate”
Fruit
Milk
Vegetables
Bread/
Starch
Meat/Protein
Think Heart Smart
 Choose lean cuts of meat
 Limit red meat to three times weekly
 Cook by baking, broiling, stewing, braising,
or grilling
 Save fatty meats such as ribs for
very special occasions
Tip 6 And don’t forget about vegetable
sources of protein such as peas, beans, soy
Heart Smart Fats Include:
Mono-unsaturated such as:
*Nuts and seeds
*Avocados
*Olive oil
*Canola oil
*Peanut oil
*Tube or squeeze margarine
Heart Smart Fats Include:
Omega-3 fatty acids such as :
* Fish (salmon, mackerel, tuna)
* Walnuts
* Flaxseed
*Fortified Foods
Fats not heart smart:








Butter
Margarine
Shortening
Lard
Full fat dairy products
Any fat that is a solid at room temp
Coconut, palm, palm kernel oil
Shelf stable food such as pastries,
chips, cake mixes, donuts, snacks
Type II Diabetes Mellitus is
improved by weight loss
 Multitude of studies support gradual weight
loss
 Even 10 to 15 pound weight loss has
proven to improve serum glucose levels
 The patient is best treated with a lifestyle
approach.
 Very low carbohydrate diets are
problematic.
Meal Planning and Learning Readiness:
 Patient interview
role play
 Let’s count carbs
In summary:
Make change one step
at a time
Set goals
Count those carbs
Practice Happy Heart
Habits
Never give up- if you
eat that piece of
candy, get back on the
wagon and move
forward!
Work towards ideal
body weight