Constructing a Diabetes Plan...Water, plain, sparkling, infused Coffee, tea, herbal teas, unsweetened Master the basics of carb counting S AI N T LUKE’S H E A L T H S Y S T E M 11

Constructing a Diabetes PlanFood, exercise, blood sugar testing, meds

Suzanne Friesen, RD, LD, CDE

Cornerstones of a diabetes plan

• Food: What to eat, when to eat, how much to eat

• Exercise: a strategy for positive results

• Blood sugar testing: immediate feedback

• Medications: what, when, & how

S A I N T L U K E ’ S

H E A L T H S Y S T E M

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What do you want to achieve?

• Improve BG (blood glucose) control

• Weight loss

• Decrease meds/insulin doses

• Prevent low BG

• Start exercising

• Improve eating habits

• World peace



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Eat fresh, whole foods

SAINT LUKE’S HEALTH SYSTEM 4

Minimally Processed

SAIN T L U K E’S H EAL TH SYSTEM 5

Ultra-processed Fresh


Limit these:

Eat more:

Vegetables, especially green

& low carb veggies

Lean protein such as chicken, fish, tofu, eggs,

plain Greek yogurt, cottage

cheese

Nuts, seeds, nut butters

Avocados, olives & olive oil

Home-cooked foods

Feel OK about eating:

Whole fruits especially berries, apples, grapefruit, mandarins, plums, kiwi

(limit 1-2 servings/day)

Hard cheeses such as cheddar, swiss, mozzarella, parmesan

Dried beans such as pinto, black, kidney, garbanzo, lentils,

edamame (limit portion to 1 cup or less)

Drink:

Water, plain, sparkling, infused Coffee, tea, herbal teas, unsweetened

Master the basics of carb counting



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• Everything depends on accurate carb counting

Carbohydrate foods raise blood sugar

Starches & grains Fruits Milk & yogurtSweets,

candy, desserts, pastries, ice cream

Sugary drinks such as fruit juice, regular soda, lemonade, fruit

punch, sweet tea, Gatorade

How many grams carb per day? Per meal?

• 135g carbohydrate daily or less divided over 3 eating times

• 15-45g carb/meal is a good start

• ¼ plate carb = about 30-45g carbohydrate

• Include protein & fat with each meal

• Plenty of non-starchy vegetables

• Space eating times 4-6 hours apart

• Master the basics!



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What does 15g carbohydrate look like?

• 1 small apple

• 1 cup berries or melon

• ½ cup black beans or corn

• 3 cups popcorn

• ¾ cup Greek yogurt

• 1 slice bread or 2 corn tortillas



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https://www.google.com/url?sa=i&url=https://www.shutterstock.com/search/premade%2Btaco%2Bshells&psig=AOvVaw2_X1zpsRHjgUHarPkUY6do&ust=1606407798433000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCLD438ONnu0CFQAAAAAdAAAAABAL

What does 30-45g carb look like?

S A I N T L U K E’ S

H EA L TH S YS TEM 1 5

Use the plate method to guide you


How to find carb grams

• Food label

• Internet

• Apps• Carbs&cals

• carbmanager

• Books/pamphlets

How to read a food label

• What is the serving size?

• How many servings per package?

• Total carbohydrate grams?

• Dietary fiber, sugars & starches are included in the total carbohydrate grams

When to eat

• Space eating times 4-6 hours apart

• Overnight fast of at least 12 hours

• Snacking is not recommended unless

• BG trending too low between meals

• Know timing of diabetes meds/insulin



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What to eat:

• Low carbohydrate• 135g carb or less

• Moderate protein

• Natural fats

• Plenty of non-starchy vegetables

• Fresh & minimally processed foods

Exercise: why not?S A I N T

L U K E’ S H EA L TH

S YS TEM 2 1


Prolonged Leisure Time Spent Sitting in Relation to Cause-Specific Mortality in a Large US Cohort Alpa V Patel, Maret L Maliniak, Erika Rees-Punia, Charles E Matthews, Susan M GapsturAmerican Journal of Epidemiology, Volume 187, Issue 10, October 2018, Pages 2151–2158,

Sitting Time Linked to Higher Risk of Death from All CausesJune 29, 2018

Home » Harvard Health Blog » Too much sitting linked to an early death - Harvard Health Blog

Yes, sitting too long can kill you, even if you exercise

RESEARCH NEWSThere's More Evidence That Too Much Sitting Can Be Very Unhealthy

Study takes a stand against prolonged sitting

Science News

Sitting For Long Periods May Harm The Heart, New Study Finds

Sitting All Day May Increase Your Risk of Dying From Cancer

https://www.health.harvard.edu/https://www.health.harvard.edu/bloghttps://www.npr.org/sections/research-news/

The good news


Walking, Cycling, or Taking Train to Work Instead of Driving Associated With Lower Risk of Death and Illness

Weekly Physical Activity May Help Prevent Mild Cognitive Impairment Conversion to Dementia

Hope, Happiness And Social Connection: Hidden Benefits Of Regular Exercise

Type 2 Diabetes and ExerciseExercise Makes It Easier to Control Your Diabetes

Regular exercise reduces large number of health risks including dementia and some cancers, study finds

Physical ActivityPrevents Chronic Disease

Regular exercise changes the brain to improve memory, thinking skills

https://www.goodnewsnetwork.org/walking-cycling-or-taking-train-to-work-reduces-risk-of-death/https://www.sciencedaily.com/releases/2020/11/201112103517.htm

Exercise: a strategy for many positive results

• Lowers blood sugar

• Decreases insulin resistance

• Improves cardio/respiratory fitness

• Improves mood and cuts stress

• Helps with weight loss/maintenance

• Maintain or increase muscle mass

• Improves cognitive function

• Reduces cancer risk

• 14-20 minutes of walking at moderate pace lowers BG 20%



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Exercise

*check with provider before starting exercise program


150 minutes per week, minimum

No more than 2 days in a row without activity

Muscle strengthening 2-3x/week

Free weights, resistance bands, yoga

Use BG results to adjust your exercise plan

Exercise

• Low-moderate intensity exercise (aerobic) lowers BG

• Walking, running, biking

• High intensity (anaerobic) tends to raise BG

• Weightlifting, short bursts of activity, soccer, baseball

• Combination activities may cause little variability

• Know thyself! Test BG frequently-before, during, after

• Exercise can lower BG several hours later (especially long duration exercise)

Use exercise to your advantage• Reliably lowers BG fairly quickly

• 20% lower with 20 minutes moderate activity

• BG testing before/after can be motivating

• Can combine with other activities: listen to podcast, talk with friends/family, clean the house

• If you take insulin to correct highs-try a walk instead

• Can you devote 30 minutes out of 24 hours to activity? • 23 ½ hours left…



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Study: Just 11 Minutes of Exercise a Day Is Enough to Help You Live Longer

• new research suggests that you may only need 11 minutes of exercise each day to live longer, according to a study published in the British Journal of Medicine.

• This new study found that people who sat for about eight to 10 hours daily, but managed to clock about 11 minutes of moderate-to-vigorous exercise a day, were less likely to die than those who only got about two minutes of exercise a day.

• sedentary activity, which is any low-energy activity that involves sitting, reclining or lying, is linked with disease and early death.


https://bjsm.bmj.com/content/54/24/1499https://www.healthline.com/nutrition/why-sitting-is-bad-for-you#early-death

Quick Bursts of Exercise Can Help Diabetics' Hearts

• In one test, participants sat for eight hours without taking any exercise breaks. In a second test, they took breaks from sitting by doing three minutes of exercises that included squats, leg lifts and calf raises every 30 minutes. In a third test, they took six-minute exercise breaks every hour.

• Compared with uninterrupted sitting, blood vessel function tended to improve with both exercise approaches, but it improved significantly more with exercise every 30 minutes, the study found.

• SOURCE: American Journal of Physiology-Heart and Circulatory Physiology, news release, Nov. 23, 2020


Exercise safely

• When is the best time?

• Always carry fast acting carbs if taking diabetes medication

• Know the symptoms of low blood sugar

• Know how to treat low blood sugar

• BG in safe range before starting activity

• 100-270 mg/dl (individualized)



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Symptoms of Low blood sugar (hypoglycemia)


Rule of 15• Symptoms? Check BG

• 70-80 or less?

• Treat with 15g fast acting carb

• 3-4 glucose tabs, 4 oz fruit juice or regular soda, 6 soda crackers, 3-4 hard candies, 2 Tbsp raisins

• Wait 15 minutes

• Re-check BG



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Blood sugar testingHow often and when?

• 4+ times per day if taking insulin

• 4 times/day, 2-3 days per week

• 2 times/day, before and 2 hours post any meal

• 2 times/day, fasting and bedtime

• Before meals or after meals?

• Targets: before meals < 130, 2 hours post meals < 180



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Daily Food, Exercise, BG Record

Date June 1 Date June 1

Blood Glucose Insulin Blood Glucose Insulin

125 8am 125 8am

How much food Carb gramsRaisin Bran 1 cup 45Milk 1 cup 12Orange juice 1 cup 30

Total 87229 12pm

Chick Fil A Deluxe 42Waffle fries 43Choc chunk cookie 50

Total 135236 6pm

Spaghetti & meat sauce 2 c 90Garlic bread 1 slice 15Ice cream 1 cup 36

Total 141349 10pm

How much food Carb grams2 eggs 01 English muffin 25½ avocado 6Exercise: Total 31

119 12pmGreen salad large 10Kidney beans ½ cup 15Apple medium 20Exercise: Total 45

107 6pmGrilled salmon 0Green beans 2 cups 10Mixed berries 1 cup 15Dark chocolate 2 squares 10

117 10pm Total 35

Diabetes medications: get informed



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• What is the name?

• What is the dosage?

• How does it work?

• When should you take it?

• How should you take it?

• How should you store it?

• Does it expire?

• Can you adjust it?

In summary:

• Eat real food, in the right amount, at the right time

• Low carb, moderate protein, natural fats, lots of non-starchy veggies

• Exercise at least 150 minutes per week

• Take diabetes medication at the right time, in the right amount, and know how it works

• Test your blood sugar for instant feedback

• Master the basics!



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Resources

Diatribe.orgRecipes

Up to date information on research & advocacy

Diabetes.orgDiabetes Forecast magazine

Resources:

Saint Luke’s Diabetes Centers

Individualized Diabetes Education on site or virtual visit

Call 816-932-2707 to make an appointment (requires provider referral)

Centers available at Saint Luke's Plaza, North, South and East Clinics

Resources:

Saint Luke’s Primary Care

Barry Road

816-880-6100

Blue Springs

816-347-4600

Blue Valley

913-323-8830

Cushing

913-651-6565

East

816-347-5600

Independence 816-251-5200

Lee’s Summit

816-347-5100

Mission Farms

913-317-7990

Parkville

816-569-1506

Platte City

816-858-7050

Plaza

816-932-3100

Shoal Creek

816-437-8161

Smithville

816-532-3999

Southridge

913-317-3200

Resources:

Saint Luke’s Community Resource Hub

https://saintlukesresources.org/

https://saintlukesresources.org/

Q&A

• Q: eating that much carbs per day, doesn't that keep your sugar running high all day and not allow it to drop?

A: The maximum is 135g/day. Ok to eat less. Let your BGs guide you

• Q: I have a new Glucose meter (Livongo) and is is 20-40 mg/dl higher than my "old" OneTouch Ultra 2 meter. I have tested at the exact same time. Why such a difference and which is accurate?

A: Ideally compare your meter result to a BG result from a lab draw. Not recommended to compare meter to meter. I have had other patients tell me their Livongo runs too low or too high. You might want to contact the company and let them know your concerns. I know the Livongostrips are free so that’s a nice benefit. A good meter that is cheap & reliable and strips are cheap is the Reli-On Prime from Wal-Mart.

• Q: Which is worse, high BS from working out or high BS from eating?

• A: Although best to prevent all high BGs, I would say from eating is worse. BG spikes after exercise are due to glucose release from the liver not from calories/carbs so no risk of weight gain. High BG after exercise tends to come down fairly quickly. Test your BGs to see how it affects you


Q&A

• Q: BS increases from exercising? Could you explain, please?

A: Intense or anaerobic exercise can cause a release of stress hormones which cause a release of sugar from the liver (the fight or flight response). This sugar is needed to fuel the “fight or flight” or just the weight lifting or the sprint! Low-moderate intensity exercise will lower the BG (walking, jogging)

• Q: how many of grams of sugar should you for on a label , I am reversing my BS , lost 30 pounds

A: Look for very little “added sugars” on labels as foods with high added sugars are typically ultra-processed. Keep Total Carbs 135g/day or less. Great job on the weight loss!

• Q: Are these one-on-one education with counselor covered by insurance?

A: Medicare covers. Private insurance coverage depends on the plan. After you schedule a visit, our insurance verification department will verify your coverage and let you know if there is a fee for your visit. It also depends on if you have a deductible and if you have met it yet.

• Q: Does the diabetes educator work with exercise as well?

A: Yes. We can help you set up an exercise program.


Q&A

• Q: Do counting your steps each day help with the exercise requirements?

A: Yes! All activity is good. To improve cardio/respiratory fitness and endurance, try for 10+ minutes at a time of continuous exercise (walking)

• Q: Is there ANY WAY at all that I can ever have fruit or fruit Juice. That is the thing that tears me up. A: You absolutely can eat fresh fruit. I suggest no more than 2 servings per day,

be sure to count the carb grams, and choose the lower sugar fruits such as berries, apples, kiwi, pear, cuties. Avoid ALL fruit juice except to treat a low blood sugar reaction. You might want to try sugar free cranberry juice cocktail.

• Q: can I get a carb book sent to me?A: You can get FREE information on carbs & diabetes from diatribe.org, and

diabetes.org. Our carb counting books are reserved for our patients as we have to purchase them. If you attend an in-person or virtual visit with us, you will receive written resources from our program.


Documents

Constructing a Diabetes Plan...Water, plain, sparkling, infused Coffee, tea, herbal teas, unsweetened Master the basics of carb counting S AI N T LUKE’S H E A L T H S Y S T E M 11