Fundamentals of Diabetes Care Module 3, Lesson 1

Transcription

1 Module 3, Lesson 1 Fundamentals of Diabetes Care Module 3: Healthy Eating Healthy Eating Being Active Monitoring Taking Medication Problem Solving Healthy Coping Reducing Risks Objectives Identify the benefits of healthy eating for the adult with diabetes List three practical food-related strategies people can use to keep blood sugar levels in control Identify at least three sources to find correct information about healthy eating for diabetes Give two reasons why patients with diabetes should talk with a diabetes educator or dietitian about healthy eating Describe three ways you can support the clinician s recommended meal plan Foundations For Control

2 Module 3, Lesson 1 Lesson One Benefits of Healthy Eating It s Not a Diet Healthy Eating A lifestyle choice A meal plan that is: Well-balanced Individualized Culturally appropriate Focused on the patient s clinical needs and personal goals What s in a Word? Medical Nutrition Therapy Dietitian Nutritionist Certified Diabetes Educator RD, CDE is best person to design personal meal plans for diabetes patients

3 Module 3, Lesson 1 Nutrition Goals Achieve and maintain: Normal or Near Normal blood sugar Cholesterol levels that reduce risk of vascular disease Normal blood pressure Prevent or slow development of chronic complications of diabetes through lifestyle changes Maintain the pleasure of eating Individual meal plan according to cultural preferences and willingness to change American Diabetes Association Nutrition recommendations and interventions for diabetes: A position statement. Diabetes Care. 31:S The Impact of MNT for Diabetes Blood Sugar Control A1C Plasma Glucose (fasting) Lipids LDL Cholesterol Total Cholesterol Triglycerides HDL cholesterol No exercise With exercise Blood Pressure Potential Effect from Diet 1%-2% decrease point decrease point decrease point decrease point decrease 3 point decrease No decrease 5 point decrease in systolic and 2 point decrease in diastolic Pastors J.G. et al How effective is medical nutrition therapy in diabetes care? J Am Diet Assoc. 103:

4 Module 3, Lesson 1 Measuring Weight Ideal body weight Desirable body weight Body mass index Waist circumference BMI in Adults Normal: Overweight : Obese: Over 30 Measuring Tape Position for Waist (Abdominal) Circumference High Risk Waist Circumference Men: Over 40 inches (102 cm) Women: Over 35 inches (88 cm) Culture Family Finances Lifestyle Work/Job Likes and Dislikes Locality Individualize

5 Module 3, Lesson 1 The Secret of Weight Loss Eat Less Move More Good Support System 1 pound of fat = 3,500 calories Eating 500 calories less each day = 1 pound weight loss per week FYI: Nutrition for Pre-diabetes 5 10% weight loss Lower overall calories Reduced fat intake Increased dietary fiber intake Increase in physical activity 150 minutes (2 ½ hours) every week Diabetes Prevention Program Research Group The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care. 25(12): FYI: Nutrition for Type 1 Diabetes Match insulin doses to eating and physical activity patterns Prevention of hypoglycemia Heart healthy meal plan Calorie intake is adjusted to maintain weight

6 Module 3, Lesson 1 Nutrition for Type 1 Diabetes Meal based insulin Flexible dosing pattern Insulin pump therapy Fixed dosing pattern Adjustments for exercise Planned exercise Adjust insulin dose Unplanned exercise Add carbohydrate FYI: Nutrition for Type 2 Diabetes Decrease insulin resistance Weight loss Physical activity Focus on the ABCs Reduce A1C Control blood pressure Control cholesterol FYI: Nutrition for Diabetes in Pregnancy Enough intake to provide normal growth and development of the baby Keep blood sugar in target ranges to protect baby from complications Portion control Healthy food choices and healthy cooking practices Blood sugar monitoring Metzger, B.E. et al Summary and recommendations of the Fifth International Workshop Conference on Gestational Diabetes Mellitus. Diabetes Care. 30: S

7 Module 3, Lesson 1 Check Your Knowledge Which of the following is the best person to design personal meal plans for patients with diabetes? a) Dietitian b) Nutritionist c) Certified diabetes educator d) A dietitian who is also a certified diabetes educator Check Your Knowledge Which of the following is NOT a secret to lose weight? a) Eating less b) Dieting c) Moving more d) Having a good support system Check Your Knowledge True or false? In patients with type 2 diabetes, personalized meal plans are designed to decrease insulin resistance, reduce A1C, control blood pressure, and control cholesterol. a) True b) False

8 Module 3, Lesson 2 Lesson Two The Main Nutrients Protein Fat Carbohydrate Glucose Amino Acids Not much glucose Fatty Acids & Glycerol Not glucose Blood Glucose = Blood Sugar = Energy Balancing Main Nutrients Carbohydrates Important for blood sugar control 4 Kcal/gram 15 grams of carbohydrate per serving Protein 4 Kcal/gram Fat 9 Kcal/gram Minimal carbohydrate per serving

9 Module 3, Lesson 2 Benefits of Carbohydrates Provides brain and body with glucose Glucose is body s main source of fuel Provides vitamins, minerals, and fiber The Food Pyramid Grains, beans, starchy vegetables contain a larger amount of carbohydrate, small amount of protein. Certain items may contain a small amount of fat. Nutrients in Food Grains Wheat Rice Oats Barley Rye Corn (cornmeal) Beans & Peas Kidney beans Pinto beans Black beans Red beans Navy beans Split peas Blackeyed Peas Chickpeas, Lentils, etc. Starchy Vegetables Potatoes White Sweet Red Corn Green Peas Vegetables contain small amount of carbohydrate and protein No Fat. Fruit contains carbohydrate No Protein, No Fat. Meat, fish, poultry, eggs, nuts and cheese contain protein and fat and very little to no carbohydrate Milk and yogurt contain protein and carbohydrate can also contain fat. Adapted from: MyPyramid.gov Fats are fats No carbohydrate

10 Module 3, Lesson 2 Where s the Sugar on the Food Pyramid? Included in Discretionary calories Sugar is carbohydrate Sweets that contain sweeteners Products with flour (carbohydrate) Products with milk (carbohydrate) MyPyramid.gov Meal Planning Options No such thing as a diabetic diet Food pyramid Exchange system Consistent carbohydrates Carbohydrate counting Fat gram counting Consistent Carbohydrate Most common in pre-diabetes, type 2, or patients on fixed-dose insulin Allows flexibility with food choices A carb... is a carb... is a carb Carbohydrate is the macronutrient that has the most profound effect on blood glucose Too much carb is a common problem American Dietetic Association Basic Carbohydrate Counting. Chicago: American Dietetic Association.

11 Module 3, Lesson 2 Benefits of Carb Counting Balance between the amount of carbohydrate eaten and the amount of insulin injected determines blood glucose level Allows flexibility in meal plan American Dietetic Association Basic Carbohydrate Counting. Chicago: American Dietetic Association. Measuring Carbohydrates One carbohydrate serving = 15 grams of carbohydrate Portion Size is Important

12 Module 3, Lesson 2 All Muffins are Not Created Equal Neither are

13 Module 3, Lesson 2 Portion Size 1 cup = baseball ¾ cup = tennis ball ½ cup = computer mouse ¼ cup = egg Portion Size 3 ounces = deck of cards or the palm of a woman s hand 2 tablespoons (30 ml) = ping pong ball 1 teaspoon (5 ml) = tip of the thumb Weights and Measures Measuring cups Measuring spoons Kitchen scale Consistent serving bowls

14 Module 3, Lesson 2 Recommended Amounts Women: 3-4 carbohydrate servings / meal = g carbohydrate / meal Men: 4-5 carbohydrate servings / meal = g carbohydrate / meal Snacks: 1-2 carbohydrate servings = g carbohydrate Other Nutrients Water 6-8 glasses (8 oz each) per day Fiber 14 g fiber per 1,000 calories Sodium (Salt) Under 2,300 mg per day Vitamins and minerals Nutritive Sweeteners Sweeteners Sucrose (table sugar) Use in limited amounts Can be substituted for other carbohydrate sources Fructose Not recommended Syrup Honey

15 Module 3, Lesson 2 Other Sweeteners Sugar alcohols Commonly used Erythritol Isomalt Lactitol Maltitol Mannitol Sorbitol Tagatose Xylitol FDA-approved May cause GI discomfort and diarrhea Artificial sweeteners Currently available Acesulfame K Aspartame Neotame Saccharin Sucralose Stevia Non-nutritive FDA-approved Safe in acceptable amounts Alcohol Consume in moderation Women: no more than 1 drink per day Men: no more than 2 drinks per day Monitor blood glucose Consume with food 1 drink 12 oz beer 5 oz wine 1.5 oz distilled spirits Check Your Knowledge Which of the following has the quickest effect on blood glucose? a) Protein b) Fat c) Carbohydrate d) Artificial sweeteners

16 Module 3, Lesson 2 Check Your Knowledge True or false? As a general rule, women usually need about 3 or 4 carbohydrate servings per meal, whereas men need about 4 or 5 servings. a) True b) False Check Your Knowledge True or false? With consistent carbohydrate meal plans, the RD works with a patient to teach them how to adjust insulin doses according to how much carbohydrate is eaten. a) True b) False

17 Module 3, Lesson 3 Lesson Three Putting It All Together: Tips for Healthy Eating Before the Dietitian Visit Patterns of eating 3 meals a day 4 5 hours apart Portions Plate Method Use lunch or salad plates Don t put serving bowls on the table Eat at the table Slow down! Plate Method Adapted from the Idaho Plate Method:

18 Module 3, Lesson 3 The Plate Method in Practice Making healthy food choices does not have to be difficult. Used with permission from Idaho Plate Method, llc. Material may be viewed at Food and Blood Glucose Record Sheet Quick Tips Eat a variety of foods Whole grains Fresh fruits and vegetables Lean protein sources Low-fat dairy Use the Food Pyramid Portion control

19 Module 3, Lesson 3 Healthy Meal Planning Don't skip meals Pay attention to serving sizes Eat foods low in fat (especially saturated and trans fat) and cholesterol Eat a diet moderate in sugars Limit soda and juice drinks Take your lunch to work (or school) Try to eat a variety of foods every day Tips for Dining Out Get baked or broiled, not fried Use salsa or mustard instead of mayo Use sour cream OR butter for the baked potato, not both Ask for salad dressing, butter, and sauces on the side Order the regular burger instead of a Quarter Pounder, Whopper, or Big Mac Don t Super Size! Weight Loss Strategies Reduce caloric intake; increase physical activity Slow, steady weight loss through healthy behaviors Further considerations: Low carbohydrate diets Meal replacements Weight loss medication Bariatric surgery

20 Module 3, Lesson 3 FYI: Diabetes in the Hospital Consult with hospital RD/CDE Room Service Clear or full liquid diets Tube feedings May not be an appropriate setting for diabetes education American Diabetes Association Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care 31: S61-S78. FYI: Diabetes in Long-Term Care Recommended: Regular menu Consistent carbohydrate amounts Liquid supplements may be helpful Not recommended: No Concentrated Sweets diet No Sugar Added diet American Diabetes Association Nutrition recommendations and interventions for diabetes: A position statement of the American Diabetes Association. Diabetes Care 31: S61-S78. Check Your Knowledge True or false? Patients using the plate method divide their plates into thirds, with equal portions of vegetables, meat, and carbohydrate. a) True b) False

21 Module 3, Lesson 3 Check Your Knowledge True or false? Food and blood glucose records are no longer recommended. a) True b) False Check Your Knowledge Which of the following should you recommend to patients with diabetes? a) Eat a variety of foods b) Use the Food Pyramid c) Control their portions d) All of the above

22 Module 3, Final Thoughts Final Thoughts FROM THE PATIENT S PERSPECTIVE Never say NEVER

23 Module 3, Final Thoughts Objectives Identify the benefits of healthy eating for the adult with diabetes List three practical food-related strategies people can use to keep blood sugar levels in control Identify at least three sources to find correct information about healthy eating for diabetes Give two reasons why patients with diabetes should talk with a diabetes educator or dietitian about healthy eating Describe three ways you can support the clinician s recommended meal plan