a Healthy Diet for Diabetes exist? Does a Healthy Diet for Diabetes exist? Aly R Abdel-Moemin Manal K Abdel-Rahman

Aims Define Diabetes and Nutrition Identify the role of nutrition in diabetes Important role of nutrition to control blood glucose Plan for Healthy meals for diabetics Conclusion.

Role of Insulin Insulin Food Cell Bloodstream Helps move glucose from the bloodstream into the cells Food Cell Glucose Bloodstream Glucose Insulin Insulin is a hormone used to convert carbohydrates and other food into energy The pancreas makes insulin and this enables glucose (blood sugar) to enter the cells. Foods you eat often contain sugar called carbohydrates. Food (carbohydrate) is broken down in the stomach into a sugar called glucose. Glucose is carried by the blood to cells throughout the body for energy. In this drawing, glucose moves from the blood stream into the cells of the body. Insulin helps get the glucose out of the blood stream and into the cells of the body. This glucose can then be used for energy. Insulin Energy ©Colorado State University Extension, 2008. 3 3 © Colorado State University Extension 2008 3 3

Untreated Diabetes Insulin Food Cell Glucose Less Glucose Energy Glucose in the blood cannot get to the body cells Food Cell Glucose Less Glucose Energy Glucose Bloodstream Untreated Diabetes People develop type 2 diabetes because the cells in the muscles, liver and fat do not use insulin properly. The pancreas cannot make enough insulin for the body’s needs. As a result, the amount of glucose in the blood increases while the cells are starved of energy. If the pancreas doesn’t make enough insulin or if insulin is not being properly used, glucose can’t get out of the bloodstream and into your cells. Glucose builds up in the bloodstream, called “high blood glucose” or “high blood sugar”. Because your cells are not getting glucose to make energy, you will probably feel tired. This can be treated with: Added insulin Oral medications Physical activity Diet Car and Gasoline Analogy: Just as gasoline is fuel to a car, blood glucose is fuel to the body. If you tried to fuel a car with out removing the gas cap, fuel could not reach the engine and the car could not run. If you continued to pump gas with the cap on, gasoline would spill all over the car, damaging and corroding the paint and tires. Untreated diabetes is like fueling your body with the gas cap on. Without enough insulin to get the blood glucose to the cells, the cells don’t have the energy they need to function properly and the glucose that builds up in the blood is corrosive to the large and small blood vessels throughout the body, causing damage to organs and tissues. Insulin ©Colorado State University Extension, 2008. 4 4 © Colorado State University Extension 2008 4 4

Types of Diabetes There are several types of diabetes: Type I - body does not produce any insulin. Usually diagnosed in children and young adults. Must take daily insulin shots to stay alive.

Type II The most common form of the disease. Approximately 50% of men and 70% of women are obese at the time of diagnosis. Nearing epidemic proportions, due to increase # of older people, greater occurrence of obesity and sedentary lifestyles.

Slimness of ancient Egyptians

Healthy diets for Diabetes Nutrition is a critical part of diabetes care. Carbohydrates are the component of food that causes an increase in blood sugar. Patients are encouraged to keep track of the amount of CHO they eat.

Special Considerations Weight loss Weight loss has been shown to improve insulin resistance Encourage dietary changes, increased physical activity, and behaviour modification Weight loss medications may be considered and can help with an additional 5-10% weight loss with lifestyle modifications.

The Plate Method http://www.tops.org/images/plate.gif

Why healthy diet? Weight control Eating a healthy diet can: Prevent complications from high blood sugars like nerve problems, kidney problems, and vision problems Prevent other complications like heart disease and circulatory problems

More fruit and vegetables Vitamins Minerals Fibre Flavonoids

High fibre foods To help maintain blood glucose levels and cholesterol levels Fruit Vegetables Pulses Oats Helps to maintain a healthy gut Wholegrain cereals Wholemeal bread Wholewheat pasta Brown rice

Less fat in cooking!! Advise for low light milk products (milk, yoghurt, oil high in unsaturated fat, eg olive oil, Grilling Dry-roasting Microwaving Steaming Light stew

What Should I Eat? http://www.mypyramid.gov

Pictures of Low/High GI Meals & Snacks GI = 60 GL = 48 GI = 42 GL = 31

Pictures of Low/High GI Meals & Snacks GI = 85 GL = 48 GI = 39 GL = 22

Pictures of Low/High GI Meals & Snacks GI = 80 GL = 32 GI = 61 GL = 12

Pictures of Low/High GI Meals & Snacks GI = 57 GL = 31 GI = 32 GL = 16

Case Study – “Amy” Before 3 years later…

Case Study – “Amy” Weight: 205 lbs BMI: 32 (mild obesity) A1c: 5.2 BP: 120/60, RHR 47 Medications: none. After

©Colorado State University Extension, 2008. The Plate Method Fruit Vegetables Breads Grains Starchy Veggies Meats Proteins Dairy Presenters: Handout • The Plate Method Colorado State University. The Plate Method Eating healthy is a lifestyle change, but it doesn’t have to be difficult! The 9-inch Plate Method provides a convenient and easy way to make healthy eating part of your every day lifestyle. Simple changes to make include: Adding vegetables Decreasing meat portions and including heart-healthy choices Choosing fruit and milk/dairy as desserts Always pairing a carbohydrate food with a protein source to prevent fluctuations in blood glucose levels By using a visual of a plate and your place setting at a table, estimate how much of the different types of foods you can eat at a meal. Food is not weighed or measured. The depth of the foods placed on your plate should be ~ ½” high, or equal to the thickness of your little finger. No more than ¼ of the plate should be bread, grains, or potatoes. (1oz bread, ½ cup rice or pasta) No more than ¼ of the plate should be  heart healthy meat choices. (1 to 3 oz meat, 1 egg, ½ cup cooked dry beans) Non-starchy vegetables should cover other ½ of the plate. (1 cup cooked vegetables, 2 cups leafy raw salad greens) Small circles represent single servings of low-fat milk and fruit. (1 cup milk, 8 oz yogurt, ¾ cup fruit juice, 1 small apple) The milk and fruit servings can be used as snacks between meals to match hunger and help maintain good blood glucose levels. By following these guidelines, you will also control how much food goes on your plate. This will ultimately help you control portions. ©Colorado State University Extension, 2008. 22 22 © Colorado State University Extension 2008 22 22

Final Dietary Guidelines Encourage Eating: a diet rich in whole grains. a diet low in saturated and total fat. a diet moderate in sodium and sugar. 5 or more fruits and vegetables a day. Eating at the same time everyday. Nutrition along with exercise and medication is important for good diabetes control. Diabetes control means keeping the blood sugar level as close to normal as possible. This can be done by eating a diet low in saturated fat and total fat, moderate in sodium and sugar, eating 5 or more fruits a day, a diet rich in whole grains, and moderate use of alcohol. Alcohol moves quickly through the blood without being broken down. The alcohol content of blood can be measured within 5 minutes of a having a drink. If you have diabetes alcohol can cause hypoglycemia.

Final dietary guidelines Eating about the same amount of carbohydrate with each meal. More fruit and vegetables Cut down on sugar Obtain carbohydrates mainly from fruits, vegetables, whole grains, legumes, and low-fat or skim milk

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