DIABETES Nutrition Education for Diet Clerks October 2012 Presented by Kristen Estima, Sodexo Dietetic Intern Beth Chiodo,RD,LDN, and Nicole Michael,RD,LDN Lower Bucks Hospital

What is Diabetes? Is a metabolic disease characterized by Hyperglycemia (High Blood Sugars) Hyperglycemia results from: - Insufficient insulin secretion - Defect in the action of Insulin

Prevalence of Diabetes? Diagnosed people: 18.8 million Undiagnosed: 7 million Total: 25.8 million

Types of Diabetes Type 1 – Insulin deficiency (requires insulin every day) Type 2 – Resistance to insulin. Gestational Diabetes – Glucose intolerance.

Diagnostic Criteria Type 1 and Type 2 Glucose of 126 mg/dL- Fasting Glucose of 200 mg/dL- 2hours after meal 75g OGTT A1C of >6.5%

Recommended Diet Carbohydrates: 5 servings of fruits and vegetables 3 servings of whole grains 2 to 4 servings of milk or milk products Examples of 1 serving: 1 slice of bread; ½ cup of fruit; 1 cup of fat-free milk; ½ cup sherbet.

Recommended Diet Protein: 4-6 ounces of meat, or other protein foods. Protein does not affect blood glucose levels too much.

Recommended Diet Fat: Saturated fat should be limited (<7%) Cholesterol should be limited to <200mg/day - Healthy fats such as olive oil, canola oil, and nuts are encouraged.

Recommended Diet Sodium: Should be limited to <1500 - Type 2 diabetics are usually more sodium sensitive. Examples of High Sodium foods are canned foods, cheese, salt.

Carbohydrate Counting Estimating Needs: In a 1800 calorie diet 50% calories should come from Carbs. 1800 x .5 = 900 calories from Carbohydrates. 900calories/4grams= 225g per day 225g/15g= 15 exchanges per day. 15ex./4 meals= 3.75 exchanges per meal. Conclusion: On a 1800cal diet, pt should be eating 3-4 exchanges of carbs distributed in 4 meals.

Breakfast sample On a 1800 calorie CHO-controlled diet If patient picks 1 Bagel = 4 carbs -Having eggs, orange juice and a banana would total 6 carbohydrates. -Patient is only allowed 5 servings for breakfast so suggesting only ½ a bagel would leave room for more carbohydrate choices. - See attached form for carbohydrate exchanges.

Carbohydrate Counting Hand Guides: Fist = 1cup Handful = ½ cup Palm = 3 oz Thumb = 1 oz Thumb tip = 1 tsp.

Carbohydrate Counting Food labels: - Look at the total grams of carbohydrates. - Next, confirm the number of servings. Ex: If total carbohydrate grams is 30g but the serving size is 2. Multiple 30g by 2 which means that there are actually 60 g of carbohydrates in that food package. - Lastly, divide 60 by 15g which will yield 4 carbohydrates exchanges.

Conclusion Moderation and consistency is the key factor in controlling blood sugars.

References "Diabetes Basics." - American Diabetes Association. N.p., n.d. Web. 03 Oct. 2012. http://www.diabetes.org/diabetes-basics/?loc=GlobalNavDB. N.p., n.d. Web. 03 Oct. 2012. <http://nutritioncaremanual.org/topic.cfm?ncm_heading=Nutrition Care>.