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Diet Teaching For the Diabetic Patient
Elva McNurlin, RD, LD, CDE – SLMV Diabetes Educator
Sarah Renaldi, MS, RD, LD – SLMV Clinical Dietitian
Original Slides/Presentation By: Kate Waltz, RD, CDN, CDE; Clinical Nutrition Bassett Healthcare
Eating!Can’t live with it, can’t live without it!
Constant opportunity for change
Major factor in health, wellness, & happiness.
Can be a major stressor!
Focus on the positive
ObjectivesList diet and nutrition goals for patients with both
Type 1 and Type 2 diabetes.
Explain role of carbohydrate, protein, and fat in meal planning and glucose control.
Explain basic concept of consistent carbohydrate diet and use of carbohydrate counting.
Identify additional diet modifications to address cardiac risk reduction.
Type 1 DiabetesUse of daily insulin
Goals for diet education:Coordinate meal plan with insulin treatmentUse of carbohydrate counting for intensive
insulin therapy programsAlter intake as needed for activity levelIdentify/reduce risk of hypoglycemia
Type 2 DiabetesMay be diet and exercise controlled, using
oral medications, or insulin treated.
Goals for diet education:Weight control or weight lossUse of carbohydrate counting for consistent
carbohydrate diet or insulin programAddress co-morbid conditions and risk factors
The BasicsCarbohydrate
Digests quickly, from 15 minutes to 2 hoursHas direct effect on postprandial blood glucose
levels, more carbs = higher glucoseShould provide about 50% of total caloriesSources: grains, beans, vegetables, milk,
fruit, sweets and added sugars
The BasicsProtein
Digests more slowly, 3-5 hoursCan aid in prolonged post-meal satietyMay help prevent between meal and nocturnal
hypoglycemiaSources: meat, fish, poultry, eggs, cheese,
nuts/peanut butter, soy products
The BasicsFat
Digests the most slowly- several hoursPromotes prolonged satietyType of fat consumed affects cardiac riskShould be less than 30% total caloriesSources: butter, margarine, oils, mayo,
salad dressing, cream cheese, nuts, seeds, gravy
The Idaho Plate Method
Carbohydrate CountingIdentify carbohydrate sources
Estimate or measure portion size
Quantify carbohydrate intake for that meal or snack in either carbohydrate servings or grams of total carbohydrate
There are no “good carbs” or “bad carbs”
What is one serving of carbohydrate?(one serving = 15 grams carbohydrate)
1 slice bread1/2 hamburger bun or English muffin1/2 cup potato, corn, peas, cooked cereal1/3 cup rice or pasta1 small fresh fruit, 1/2 cup canned fruit or
juice1 cup milk or yogurt1 tablespoon sugar, honey, jam, maple syrup
Sample Meal Example1/2 cup oatmeal1 hard boiled egg1 slice whole wheat toast1 teaspoon margarine1/2 cup orange juice Which are the carbs? How many servings? How
many grams total carbohydrate?
Sample Meal Example1/2 cup oatmeal = 1 serving (15 g)1 hard boiled egg = protein1 slice whole wheat toast = 1 serving (15 g)1 teaspoon margarine = fat1/2 cup orange juice = 1 serving (15 g)
Total is 3 servings or 45 grams carbohydrate
Sample Meal Example 23 ounces roast chicken1 cup cooked rice1/2 cup green beans1 cup tossed salad1/2 cup applesauce1 cup 1% milk
Sample Meal Example 23 ounces roast chicken = protein2/3 cup cooked rice = 2 servings (30 g)1/2 cup green beans = 1/3 serving (5 g)1 cup tossed salad = 1/3 serving (5 g)1/2 cup applesauce = 1 serving (15 g)1 cup 1% milk = 1 serving (15 g)
Total is 4 2/3 servings or 70 grams total carb
Using a label to Count Carbs
1. Serving size, # of servings
2. Total grams of carbohydrate
How much carbohydrate to eat?
1200 kcal = 150 grams = 10 servings1500 kcal = 187 grams = 12-13 servings1800 kcal = 225 grams = 15 servings2000 kcal = 250 grams = 16-17 servings
*Amounts and types of protein and fat can greatly affect total calorie intake.
Not only how much, but when...Goal is to spread carbohydrate servings out
consistently over the day
3-5 servings per meal
1-2 servings per snack
Patient has freedom to change food choices and amounts eaten while staying within recommended carbohydrate intake
Example of 1500 kcal diet(Total of 12-13 carb servings or 187 g per day)
Breakfast: 4 carb servings (60 g)1 cup oatmeal, 1 cup skim milk, 2 Tbs raisins
Lunch: 3 carb servings (45 g)sandwich, small salad, 1 small fresh fruit
Dinner: 4 carb servings (60 g)chicken, 1 cup pasta, broccoli, 1 cup skim milk
Snack: 1 carb serving (15 g)1 cup low fat yogurt
Weight LossWeight loss of just 7-10% of a patient’s
current weight can help lower glucose
Slow and steady wins the race!
Helpful modifications are low fat intake and high fiber intake
Exercise: 5-7 days/week with goal of 150 minutes/week or 10,000 steps per day
High Fiber IntakeCan increase satiety, slow carbohydrate
digestion and modify postprandial glucose
Intake of at least 25 grams/day, up to 35 grams/day to optimize cardiac benefits
Can subtract from total carbohydrate grams
Sources of fiber: whole grains, beans, nuts, seeds, fruits, vegetables
Low Fat IntakeAll patients with diabetes are at increased
cardiac risk- more aggressive with cholesterol and blood pressure control
Total fat <30% kcal, sat fat <10%, trans fat 0%
Decrease added fats- 100 kcal/tablespoon
Opt for unsaturated fat- oils, nuts, margarine
“Let nothing that can be treated by diet be treated by any other means.” Maimonides