Power of the Plate: Nutrition and
Diabetes
Diabetes Symposium 2015
http://www.vinafengshui.com/wp-content/uploads/2014
Presentation Purpose
 To increase knowledge about identifying carbohydrates,
carbohydrate counting, and portion sizes of carbohydrates
 To understand the important role of the diet in diabetes
There are no conflicts of interest to disclose.
Presentation Objectives
 Identify major food groups with carbohydrates
 Understand the importance of portion sizes, and identify
portion sizes of carbohydrates
 Recognize the benefits and impact of good nutrition on
diabetes
What is Diabetes?
 Diabetes mellitus is a disorder in which the body either does
not produce enough insulin, or is unable to use the insulin it
makes
 Type 2 diabetes does not produce enough insulin
 Type 1 diabetes is unable to use the insulin it makes
Diabetes is all about Balance
 Controlling diabetes is a balance of what you eat, how much
you move, and what medicine you take
 Some people with type 2 diabetes can control their blood
sugar with diet only. Some people take medicine by mouth
and watch their diet. Others may take insulin, medicine, and
watch their diet
 It is most important to keep your blood sugar levels under
control
Diabetes and Diet
 The food we eat is fuel for our bodies
 The body breaks down food into glucose, or sugar
 The body uses insulin to move the glucose into our cells to
give us energy
 If glucose cannot enter our cells, it builds up, causing high
blood sugar (hyperglycemia)
Diabetes and Diet (cont.)
 Food raises blood glucose
 When you eat, how much you eat, and what you eat affects
how much your blood sugar increases.
 All foods are made up of protein, fat, carbohydrates,
vitamins, and minerals
 Carbohydrates impact and increase blood sugar levels the
most
What are Carbohydrates?
 Carbohydrates are foods that break down into sugar, or
glucose, in the body
 There are several groups of foods that contain carbohydrates,
including sweets, fruit, starches, and milk/yogurt
https://www.google.com/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1229&bih
Sweets
Cakes, cookies, candy,
chocolate, regular pop
http://www.kusi.com/story/28995262/soda-tax-legislation
http://andreakihlstedt.com/wpsys/wp-content/cropped-chocolate-chip-cookies-stacked.jpg
Fruit
All fruit has a naturally-occurring sugar called fructose.
http://www.teluguone.com/vanitha/content/health-benefits-of-fruits-75-24004.html
Starches
Includes bread, cereals,
grains, pasta, rice, beans,
and starchy vegetables
(potatoes, corn, peas)
http://jj-tropicalfood.com/product/corn/
http://www.ronchalker.co.uk/products/potatoes/
https://thedentalessentials.wordpress.com/2010/11/28/
Milk and Yogurt
Milk and yogurt products have naturally occurring sugar called
lactose.
http://smariorganics.com/our-yogurt/
Foods Without Carbohydrates
 Protein and fat groups contain ZERO carbohydrates
 Protein: meat, poultry, fish, cheese, eggs, peanut butter,
cottage cheese
 Fat: butter, oils, margarine, mayonnaise, cream cheese, sour
cream, nuts, seeds, avocado, salad dressing
https://thathealthygirlau.wordpress.com/2014/02/15
http://www.practitionerselect.com/You-Need-Nutrients-s/1885.htm
A Word on Artificial Sweeteners
 The scientific community, along with the US FDA, has
conducted hundreds of studies on the safety of approved lowcalorie sweeteners: “Consumption of these sweeteners
is well within designated ‘acceptable daily intake’
(ADI) levels, or levels that can be consumed safely
every day over a lifetime”.
 FDA Approved Low-Calorie Sweeteners:
 Splenda (sucralose), Equal(aspartame), Sweet ’N Low
(saccharin), Truvia (stevia), and others
Artificial Sweeteners (cont.)
 Scientific Positions:
 Academy of Nutrition and Dietetics: “Non-nutritive sweeteners,
when substituted for nutritive sweeteners, may help limit
carbohydrate and energy intake as a strategy to manage blood glucose
or weight.”
 “Non nutritive sweeteners added to the diet have been shown to
promote modest loss of weight and, within a multidisciplinary
weight-control program, may facilitate long-term maintenance of
reduction in body weight.”
imgarcade.com550 × 273
Artificial Sweeteners (cont.)
 American Heart Association and American Diabetes
Association: “Substituting non-nutritive sweeteners for sugars
added to foods and beverages may help people reach and
maintain a healthy body weight, as long as the substitution
does not lead to eating additional calories later as a
‘compensation’.”
Eatdrinkbetter.com
http://www.walmart.com/ip/Monk-Fruit-In-The-Raw
Carbohydrate Counting: A Meal
Planning Approach for Diabetes
 Based on the following ideas:
 Carbohydrates are the main nutrients affecting blood sugar
levels after meals
 Total amount of carbohydrates consumed is more important
than the source of carbohydrates
How to Count Carbohydrates
 One serving of carbohydrates is about 15 grams
 There is about 1 serving of carbohydrate (15 grams) in 1
slice of bread, ½ cup fruit juice, ½ cup of ice cream, and 8
ounces of milk
 The number of carbohydrates you should have at a meal
depends on your weight, blood sugars, and lifestyle
 A good rule of thumb is to have about 45-60 grams of
carbohydrates per meal, per day
Timing of Carbohydrates with Meals
 If you eat a lot of carbohydrates at one time, it increases the
need for insulin
 It takes more insulin to bring down a high blood sugar level
than to keep your blood sugar level in a normal range
 To help keep your blood sugar in a normal range, eating 3
meals/day and a snack, or 6 small meals/day, can help do
this, depending on your lifestyle and medicine
 You can work with a diabetes nurse or dietitian to help you
Timing of Carbohydrates with Meals
 To help keep your blood sugars in a normal range, it is
important to:
 Eat the same amount of carbohydrates for each meal or snack
 Do not skip meals
 Eat breakfast every day
http://blog.prepscholar.com/how-to-get-36-on-act-english-9-strategies-from
Benefits of Carbohydrate Counting
 It is more flexible than other meal planning methods
 Sugar is not forbidden
 Focuses attention on the foods most likely to make blood
sugar levels go up
Tools to Count Carbohydrates
 Nutrition Labels
 Measuring tools
 Portion Guides
Nutrition Labels
 Total Carbohydrate:
includes grams of sugar, sugar
alcohol, starch, and dietary
fiber
 Total Grams of
Carbohydrate: to
determine amount of
carbohydrates eaten, multiply
grams of total carbohydrates
on the label by the number of
servings eaten
Measuring Tools
 Measuring Cups
 Measuring Spoons
 Food Scale
Ebay.com.au
http://pixhder.com/dry+measuring+cups+clipart
Overstock.com
Carbohydrate Counting Hand Guide
http://www.diabeticlivingonline.com/food-to-eat/count-carbs/easy-practical-tips-counting-carbs-accurately
Carbohydrate Counting in Action!
Please refer to handout on carbohydrate foods, so we can
practice carbohydrate counting.
Carbohydrate Counting in Action
 Pour your breakfast cereal into a bowl!
 It should equal ¾ cup, which equals about 15 grams
 With milk, cereal and milk typically equal about 30 grams of
carbohydrates for breakfast
http://www.consumerreports.org/content/dam/cro/news_articles/health/CRO_Health.jpng
Carbohydrate Counting in Action
 Portion Distortion: Beware!
 Larger sizes of plates and bowls can make us add more food
to the plate or bowl
 This is why it is so important to measure carbohydrates, and
consider eating from smaller plates or bowls
http://thedietitianspantry.com/2014/02/28/portion-perfection-or-portion-distortion/
Carbohydrate Counting in Action
 Pour 1 serving of 100% fruit juice!
 It should equal ½ cup, which is about 15 grams.
http://www.mairlynsmith.com/?p=2332
The glass on the right is the correct serving size, or ½ cup juice.
Carbohydrate Counting in Action
 Measure 1 serving of pasta!
 It should equal 1/3 cup, which is about 15 grams.
http://img2.timeinc.net/health/images/gallery/eating/carbs-wheat-pasta-400x400.jpg
Carbohydrate Counting in Action
 Measure one serving of a baked potato!
 It should equal 3 ounces, which can be measured with a food
scale
http://abcnews.go.com/Health/10-filling-foods-weight-loss/story?id=21153507
So what about the rest of my plate?
The MyPlate Method
https://www.eatsmart.org/client_assets/Images/myplate_white.jpg
The MyPlate Method and Diabetes
 The MyPlate method has 3 choices of carbohydrates per
“plate” (45 grams), and fits in with carbohydrate counting
 This method can also make eating healthier and keeping track
of carbohydrates more approachable
http://www.choosemyplate.gov/about
Keep Your Plate Balanced
 Your plates should include:
 1 cup of nonstarchy vegetables
 1 cup or 1 medium piece of fruit
 3 ounces of lean meat/protein
 ½ cup of carbohydrate
 8 oz. or 1 cup low fat dairy
http://www.melaniealbertfitness.com/styled-5/MEALPLANS.html
Remember…
 All of the carbohydrates in your meal include all of the
starches, fruit, and dairy you eat
 This total should equal around 45-60 grams per meal
Wholeheartedmen.com
Why Balance My Plate?
 Good nutrition can greatly benefit diabetics:
 Help keep blood sugar ranges as normal as possible
 Help maintain cholesterol ranges as normal as possible
 Provide appropriate calories that can help with weight
management
 Prevent or delay long term diabetes complications, including
neuropathy, kidney failure, retinopathy, etc.
 Improve your overall health!
Exercise
 Exercise works like a medicine
 It helps with insulin resistance: physical activity burns more
calories (and glucose), and helps the insulin you make work
better
 Always check with your doctor before starting an exercise
regimen to see what will work best for you
 Start slowly when beginning a new exercise routine
http://vivesse.net/blog/study-shows-exercise-can-keep-skin-healthy/
Summary
 Controlling diabetes is a balance of food, exercise, and
medicine
 Make small changes in your eating habits to positively affect
your weight, blood sugar, and the overall management of
diabetes
Diabetes Resources
 The Calorie King: “Calorie, Fat, and Carbohydrate Counter”
www.calorieking.com
Available at Walmart
 Diabetic Living
www.diabeticlivingonline.com
Available at Walmart or Kroger
 Diabetes Self Management: magazine published bimonthly
$18.00 per year
www.diabetesselfmanagement.com
Diabetes Resources (cont.)
 Diabetes Forecast: healthy living magazine of American
Diabetes Association
www.diabetes.org/diabetesforecast
 Diabetes Health: monthly magazine
www.diabeteshealth.com
References










Caso EK. Calculation of diabetic diets. J Am Diet Assoc. 1950; 26:575-583.
Evert AB, Boucher JL, Cypress M et al. Nutrition Therapy Recommendations for the Management
of Adults with Diabetes (a position statement of the American Diabetes Association). Diabetes Care.
2013; 36: 3821-3842.
Wheeler ML, Dunbar SA, Jaacks LM, et al. Macronutrients, food groups, and eating patterns in the
management of diabetes: a systematic review of literature, 2010. Diabetes Care. 2012; 35: 434-445.
Thomas E. Surgery reveals shortfall in pediatric nurses’ knowledge of diabetes. J Diabetes Nurs.
2004; 8:217-231.
American Dietetic Association, American Diabetes Association. Exchange lists for Meal Planning. 2nd
ed. Alexandria, VA. American Diabetes Association, 2003.
American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2007; 30:54541.
Warshaw H, Bolderman K. Practical Carbohydrate Counting, A How to Teach Guide for Health
Professionals. Alexandria, VA: American Diabetes Association, 2001.
Position of the Academy of Nutrition and Dietetics: Use of Nutritive and Nonnutritive Sweetener.
Journal of the Academy of Nutrition and Dietetics May 2012 Volume 11 Number 5.
Gardner, C et al. Nonnutritive Sweeteners: Current Use and Health Perspectives: A Scientific
Statement from the AHA and the ADA. Circulation, 2012; 126:509-519.
IFIC Foundation. Facts About Low-Calorie Sweeteners, 9/2014. www.foodinsight.org.
Questions?