Nutrition and Exercise Julia Socke RD, LDN, CDE Diabetes Educator and Outreach Coordinator Kovler Diabetes Center University of Chicago

What Affects Blood Sugar? Carbohydrates Quantity of carbohydrates at one time Protein, fat, and fiber content of the meal Overall volume of meal Timing of insulin dose or other medication Physical activity Stress levels Illness Site absorption Excitement

How Fast Foods Breakdown Carbohydrate: -2 hours Protein: -7-8 hours Fat: -20 hours

Percentage Of Nutrients Changed To Blood Glucose 100% Carbohydrates 50-60% Proteins Less than 10% Fats Glucose

Total Carbohydrates Count! The amount of carbohydrate at one time has the most significant impact on blood sugar

Starches 1 slice of bread ½ pita bread 1/3 c rice 1/3 c pasta 6” flour tortilla 4” corn tortilla ¾ c unsweetened cereal ½ c unsweetened hot cereal (made with water) 1 small potato ½ c mashed ½ c corn 1 c winter squash ½ c beans ½ english muffin 3 c popcorn 6 saltine crackers

Fruit ½ banana 1 small apple, pear, peach, orange, kiwi (5oz) 1 c whole strawberries 15 grapes 1c cubed watermelon 1/3 c cantaloupe 12 cherries ¾ c blueberries 3 prunes 2 tbsp raisins ½ c orange juice ¾ c fresh pineapple ½ small mango or papaya 2 figs

Milk and Yogurt 1c (8oz) milk 1c buttermilk 6-8oz yogurt (plain) 6-8oz yogurt using artificial sweetener 6-8oz yogurt without added sugar 1/3 c nonfat dry milk powder ½ c evaporated skim milk

Carbohydrate Counting and Coverage Do your best and utilize carb counting tools available Use past experiences to help guide you When at a gathering, bring a dish and/or dessert from home Look ahead at menus Can carbs in recipes be reduced? If possible, give insulin lead time to start working before eating Check 2 hours after meals

Consider Extended Bolus Meals high in fat, protein, and carbs may break down much slower The end result is an elevated BG 4-5 hours post meal even though the 2 hr pp sugar is normal Try giving 50% upfront and then the other 50% over 2-4 hour time span Check prior to meal + every 2 hours for 6 hours Goal to be within points at each interval

Food Labels

Carbohydrate and Recipe Resources American Diabetes Association Jewish Diabetes Association SELF Nutrition Data

Smart Phone Apps Carb counting with Lenny Fooducate Calorie King ChooseMyPlateSuperTracker EveryoneEat! GoMeals MyFitnessPal

Sugar Alcohols A type of reduced calorie sweetener Their effects on blood sugar can vary Rule: 5g or more per serving then subtract ½ from total carb Can have a laxative effect

Fiber Part of the plant that your body cannot digest Slows the digestion of carbohydrates If greater than 5g, 1/2 can be subtracted from total carb

Glycemic Index Determine how quickly a food will raise blood sugar Low glycemic foods can promote fullness for a longer period of time Remember basic healthy eating principles when interpreting low/high glycemic foods

2011 MyPlate

Balanced Meal Planning: The Plate Method

How Does Summer Vacation Impact Diabetes? Children may be out of their typical routine Different foods are often consumed Larger quantities of higher carbohydrate foods available Changes in physical activity level Travel

Summer Eating Tips Your child can still eat their favorites! Encourage your child to focus on carb foods that are most desired Limit snacking between meals or encourage non-carb foods Plan ahead!

Travel Tips Obtain letter from healthcare team Allow enough time for TSA to check bags Bring prescriptions and insurance cards Medical ID is a must Check BG often Consult with healthcare team if travelling across time zones Avoid exposing insulin to extreme temperatures If in foreign country, insulin strength is different than in the U.S.

Travel Supplies IN CARRY-ON BAG Glucometer and test strips Medication Batteries Glucose Tabs Glucagon Ketone strips Insulin and needles Snacks in case of delays Pack at least twice the amount of supplies you think will be needed!

Get Moving! Physical activity can help to control BG Exercise lowers insulin need Use caution if blood sugar is >250 Please contact your healthcare team if lows often occur as a result of exercise Avoid injecting insulin into an active site

Exercise and Blood Sugar Sulfonylurea and insulin both work to lower sugar Consider a decrease in medication prior to exercise or eat a snack before Take note of differences in sugar with different activities Sometimes there is a delayed effect on blood sugar hours later

Thank you!