1. Carbohydrates & Sweeteners
The WVU Extension Educator welcomes the participants to the West Virginia University Extension Service program Dining with Diabetes.
The educator reminds participants to complete the pre-questionnaire on knowledge and behavior. Remind the participants that they are not expected to know all of the answers.

2. and the West Virginia Bureau for Public Health,
Partial funding for this program is provided through a comprehensive grant from the Centers for Disease Control and Prevention
and the West Virginia Bureau for Public Health,
Diabetes Prevention and Control Program
The WVU Extension Educator gives credit to all funding sources and sponsors of the program.
The educator also introduces the health care partner presenting the lesson.

3. Program Goals Increase knowledge about healthy foods
Present healthy versions of familiar foods
Demonstrate new cooking techniques
Provide taste testing of new recipes
Provide basic information about diabetes and nutrition
Provide opportunities for people with diabetes to share and learn from one another and from diabetes health professionals
The WVU Extension Educator reads the goals of the program to participants.
Be sure to state that this program is not intended to provide individual prescriptions for diabetic meal planning and it is not intended to replace diabetes education furnished by qualified health care professionals.
The health care partner responsible for presenting the lesson begins with slide 4.

4. Blood glucose, or blood sugar, is the fuel that our bodies run on
Blood glucose, or blood sugar, is the fuel that our bodies run on. Glucose, or blood sugar, is vital to life itself. We make glucose from the foods we eat. Our bodies can make glucose from all foods that we eat, but some foods are better sources of glucose than others are. Can you name some foods that raise blood glucose?
Repeat these suggestions to the class. If there is a whiteboard or newsprint, write down some of these suggestions. Incorrect suggestions should be treated lightly, as in “I don’t believe meat will raise blood sugar as much as potatoes.”

5. Food Guide Pyramid for People with Diabetes
This is a Food Guide Pyramid showing the sources of carbohydrates. You have a handout of the Food Guide Pyramid for People with Diabetes in your notebook. You can see that many of the foods you just named are pictured in the Starches, Fruits, and Milk groups. Others are found in the group at the top of the Pyramid, called Sweets & Fats.
All foods that are starchy and all foods that are sweet are rich in carbohydrate. Carbohydrate is changed into blood glucose by digestion. Many foods that are rich in carbohydrate are also very nutritious.
Many people ask, “How many carbohydrates should I have each day?” The answer depends on how much fuel your body needs for the work you do each day. You need to ask your doctor, a registered dietitian, or a certified diabetes educator for a meal plan designed just for you.

6. The Plate Method Meat Vegetables Starches Milk Fruit
Meal planning for people with diabetes is not easy. And there is no “one-size-fits-all” when it comes to a diabetic meal plan. The Plate Method was introduced by dietitians in Idaho.
Using the Plate Method, no more than one-fourth of the plate should be covered by starchy foods such as bread, grains, or potatoes. For Heart Healthy eating, no more than one quarter of the plate should be covered by something from the meat group. Vegetables should cover the rest of the plate. The small circles represent single servings of milk and fruit. Since milk, fruit, and starches raise blood sugar in the same way, they can be changed sometimes to match your taste and nutrition needs.
But what about serving size? What if my plate looks like the drawing, but the portions are heaped up on the plate? You may not lose weight this way, but studies show that eating about the same amount of food every day can lead to more evenly controlled blood sugar—even if we eat too much every day. So balancing your intake of food is a good way to start balancing your diabetes.

7. What is a serving size? 3 ounces 8 ounces 1 cup 1 tablespoon 1/2 cup
What does one serving mean? One serving of starchy food is one slice of bread or half of a bun or bagel. If the starchy food is cooked, like rice or potatoes or pasta, one serving is just about ½ cup. Sometimes we say this is the amount a person can hold in one hand, but we all have different size hands, so learning how big a ½ cup portion actually is can help.
A serving of fruit is a small fresh fruit or ½ cup of canned or frozen fruit or fruit juice. One 8 ounce cup of milk is one serving. If the milk is made into pudding or a frozen dessert, the serving size is about ½ cup. Each of these serving sizes of starch, fruit, and milk raise blood sugar about the same amount.
1 cup
1 tablespoon
1/2 cup

8. Food Labels Carbohydrate = Fiber + Sugar + Starch
Total Carbohydrate 13 g %
Dietary Fiber g %
Sugar 3 g
This a picture of the nutrition label found on almost all packaged foods sold in this country. Look at the portion of the label that tells how much Total Carbohydrate is in the food in order to decide how much it might raise your blood glucose.
For comparison, one slice of bread or ½ cup of mashed potato or one small fruit has about 15 grams of carbohydrate. Most of the carbohydrate in bread comes from the starch in flour, and very little from sugar. One teaspoon of table sugar, or sucrose, has 4 grams of carbohydrate. Our bodies change all the starch, as well as the sugar, into glucose, or blood sugar. Be sure to look at Total Carbohydrate and not just at Sugars to see if a food will raise your blood sugar.
Carbohydrate =
Fiber + Sugar + Starch

9. What about desserts?
What about eating sugar and sweets? Studies show us that sugar and sweets do not raise blood glucose more than other foods that are rich in carbohydrate. If people with diabetes had to avoid all sugars in order to be healthy, they would not be able to eat fruits or drink milk because fruits and milk are good sources of natural sugars.
People with diabetes, just like all other people, should avoid substituting sweets for healthy foods at every meal. When they do eat sweets, having a nutrition label helps them to know how much to eat and how to count sweets as part of the total carbohydrate allowance for the meal.

10. Artificial Sweeteners
Sweet Taste
Sugar
Sweet Taste
Color
Tenderness
Moisture
Volume
In today’s demonstrations, you will see some ways to reduce the extra carbohydrates in desserts. Familiar home recipes for desserts may contain large portions of sugar. Sugar does more than just make a recipe sweet. Sugar helps a recipe to be tender and moist. It also helps make the familiar golden brown color of baked desserts and breads. Sometimes sugar makes up a lot of the volume of a recipe as it does in cakes and cookies. When it does, replacing sugar entirely with artificial sweeteners may produce a cake that is tough, flat, and dry, as well as gray in color. Remember that artificial sweeteners only make a recipe sweet.
Recipes which usually do well with sugar substitutes include beverages, frozen desserts, pie fillings, sauces, gelatins, and puddings. Cakes, cookies, and meringues depend on large amounts of sugar for more of their finished properties. You should not replace more than ½ cup of the total amount of sugar with an artificial sweetener in these recipes.

11. Fat-free products may be HIGH in carbohydrate. READ LABELS CAREFULLY!
Applesauce
Fruit Juices
Fruit Puree
Many people use fruit purees and fruit juices to replace sugar in recipes. These products may not be any lower in carbohydrate than the sugar they replace. However, they do help with moisture and volume. Be sure to read the label on fruit purees and on fat-free baking products to see how much carbohydrate they add to the recipe.
Fat-free products may be HIGH in carbohydrate.
READ LABELS CAREFULLY!

12. Artificial Sweeteners
Aspartame
Sucralose
Acesulfame Potassium
Guidelines vary for using artificial sweeteners. Each sweetener acts differently when heated and some leave an aftertaste when used in large amounts. A handout in your notebook provides a chart showing user guidelines based on manufacturers’ directions for common sweeteners. The best way to begin using artificial sweeteners in home cooking is to read label directions carefully. Sending for recipe booklets from manufacturers or looking for recipes that manufacturers place on internet websites or in magazines are good ways to begin.
Aspartame, also known as NutraSweet™ or Equal™ has very little aftertaste but it tends to denature or lose its sweet taste, when it is heated.
Saccharin, sold as Sweet n’ Low™ and as a brown sugar substitute, is very stable for baking, but it has a noticeable aftertaste when used in large quantities.
Acesulfame potassium, sold as Sweet One™ has less aftertaste than saccharin and it is more stable when heated than aspartame.
Sucralose. Also known as Splenda™ , is the newest artificial sweetener. It is made from sugar with certain chemical changes. It has the same volume and taste as sugar and it is stable when heated.
Most artificial sweeteners are 100 or more times sweeter than sugar. They need to be used in small amounts at first and increased only gradually to avoid an overly sweet taste or unpleasant aftertaste.
Saccharin

13. It is possible to use less to get more
It is possible to use less to get more. When two different classes of artificial sweeteners are combined (such as saccharin with aspartame or acesulfame potassium with aspartame), the result is a much sweeter taste than it is when one kind is used alone in cooking. If a recipe calls for 6 packages of saccharin sweetener, for instance, try using a total of only 3 packages of sweetener, but use two different kinds, such as one package of saccharin and two packages of aspartame.
We know that aspartame loses its sweet taste when exposed to high heat in baking. If aspartame is combined with another class of sweetener (such as saccharin or acesulfame potassium) or if the recipe includes a very acidic ingredient (such as lemon juice), aspartame becomes more stabile and does not lose its sweet taste. Aspartame can also be added just after baking by sprinkling it on top of pies or cakes. It then is slowly absorbed into the cooling product and the sweet taste is retained.
Since 1 teaspoon of sugar has only 4 grams of carbohydrate, using a small amount of sugar in a recipe can help reduce the need for artificial sweeteners while increasing tenderness and browning. Usually 1 teaspoon of sugar per serving is acceptable for most people with diabetes. This is news to many people with diabetes, but studies show that this amount of added sugar does not seem to raise blood sugar significantly.
Use LESS
Get MORE

14. Are
They
Safe??
Are they safe? Saccharin, aspartame, acesulfame potassium, and Sucralose underwent years of testing before manufacturers were permitted to add them to foods. They have each been determined by the Food and Drug Administration to be safe for use by all people. The exception is for those very rare people who are born with a condition called phenylketonuria (PKU). These people cannot metabolize foods that contain large amounts of phenylalanine, one of the ingredients in aspartame. They must avoid aspartame and many other high-protein foods.
There have been some scary reports on the internet about artificial sweeteners. While the internet can be a wonderful source of information, it is also a place where incorrect information can be distributed quickly and widely. Look for information about the safety of food items from reliable sources, such as the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators, all of whom maintain web sites.