1. Diet Teaching For the Diabetic Patient
Elva McNurlin, RD, LD, CDE – SLMV Diabetes Educator
Sarah Renaldi, MS, RD, LD – SLMV Clinical Dietitian
Original Slides/Presentation By:
Kate Waltz, RD, CDN, CDE; Clinical Nutrition Bassett Healthcare

2. Eating! Can’t live with it, can’t live without it!
Constant opportunity for change
Major factor in health, wellness, & happiness.
Can be a major stressor!
Focus on the positive

3. Objectives
List diet and nutrition goals for patients with both Type 1 and Type 2 diabetes.
Explain role of carbohydrate, protein, and fat in meal planning and glucose control.
Explain basic concept of consistent carbohydrate diet and use of carbohydrate counting.
Identify additional diet modifications to address cardiac risk reduction.

4. Type 1 Diabetes Use of daily insulin Goals for diet education:
Coordinate meal plan with insulin treatment
Use of carbohydrate counting for intensive insulin therapy programs
Alter intake as needed for activity level
Identify/reduce risk of hypoglycemia

5. Type 2 Diabetes
May be diet and exercise controlled, using oral medications, or insulin treated.
Goals for diet education:
Weight control or weight loss
Use of carbohydrate counting for consistent carbohydrate diet or insulin program
Address co-morbid conditions and risk factors

6. The Basics Carbohydrate Digests quickly, from 15 minutes to 2 hours
Has direct effect on postprandial blood glucose levels, more carbs = higher glucose
Should provide about 50% of total calories
Sources: grains, beans, vegetables, milk, fruit, sweets and added sugars

8. The Basics Protein Digests more slowly, 3-5 hours
Can aid in prolonged post-meal satiety
May help prevent between meal and nocturnal hypoglycemia
Sources: meat, fish, poultry, eggs, cheese, nuts/peanut butter, soy products

9. The Basics Fat Digests the most slowly- several hours
Promotes prolonged satiety
Type of fat consumed affects cardiac risk
Should be less than 30% total calories
Sources: butter, margarine, oils, mayo, salad dressing, cream cheese, nuts, seeds, gravy

10. The Idaho Plate Method

11. Carbohydrate Counting
Identify carbohydrate sources
Estimate or measure portion size
Quantify carbohydrate intake for that meal or snack in either carbohydrate servings or grams of total carbohydrate
There are no “good carbs” or “bad carbs”

12. What is one serving of carbohydrate
What is one serving of carbohydrate? (one serving = 15 grams carbohydrate)
1 slice bread
1/2 hamburger bun or English muffin
1/2 cup potato, corn, peas, cooked cereal
1/3 cup rice or pasta
1 small fresh fruit, 1/2 cup canned fruit or juice
1 cup milk or yogurt
1 tablespoon sugar, honey, jam, maple syrup

13. Sample Meal Example 1/2 cup oatmeal 1 hard boiled egg
1 slice whole wheat toast
1 teaspoon margarine
1/2 cup orange juice
Which are the carbs? How many servings? How many grams total carbohydrate?

14. Sample Meal Example 1/2 cup oatmeal = 1 serving (15 g)
1 hard boiled egg = protein
1 slice whole wheat toast = 1 serving (15 g)
1 teaspoon margarine = fat
1/2 cup orange juice = 1 serving (15 g)
Total is 3 servings or 45 grams carbohydrate

15. Sample Meal Example 2 3 ounces roast chicken 1 cup cooked rice
1/2 cup green beans
1 cup tossed salad
1/2 cup applesauce
1 cup 1% milk

16. Sample Meal Example 2 3 ounces roast chicken = protein
2/3 cup cooked rice = 2 servings (30 g)
1/2 cup green beans = 1/3 serving (5 g)
1 cup tossed salad = 1/3 serving (5 g)
1/2 cup applesauce = 1 serving (15 g)
1 cup 1% milk = 1 serving (15 g)
Total is 4 2/3 servings or 70 grams total carb

17. Using a label to Count Carbs
1. Serving size, #
of servings
2. Total grams
of carbohydrate

18. How much carbohydrate to eat?
1200 kcal = grams = 10 servings
1500 kcal = grams = servings
1800 kcal = grams = 15 servings
2000 kcal = grams = servings
*Amounts and types of protein and fat can greatly affect total calorie intake.

19. Not only how much, but when...
Goal is to spread carbohydrate servings out consistently over the day
3-5 servings per meal
1-2 servings per snack
Patient has freedom to change food choices and amounts eaten while staying within recommended carbohydrate intake

20. Example of 1500 kcal diet (Total of 12-13 carb servings or 187 g per day)
Breakfast: 4 carb servings (60 g)
1 cup oatmeal, 1 cup skim milk, 2 Tbs raisins
Lunch: 3 carb servings (45 g)
sandwich, small salad, 1 small fresh fruit
Dinner: 4 carb servings (60 g)
chicken, 1 cup pasta, broccoli, 1 cup skim milk
Snack: 1 carb serving (15 g)
1 cup low fat yogurt

21. Weight Loss
Weight loss of just 7-10% of a patient’s current weight can help lower glucose
Slow and steady wins the race!
Helpful modifications are low fat intake and high fiber intake
Exercise: 5-7 days/week with goal of 150 minutes/week or 10,000 steps per day

22. High Fiber Intake
Can increase satiety, slow carbohydrate digestion and modify postprandial glucose
Intake of at least 25 grams/day, up to 35 grams/day to optimize cardiac benefits
Can subtract from total carbohydrate grams
Sources of fiber: whole grains, beans, nuts, seeds, fruits, vegetables

23. Low Fat Intake
All patients with diabetes are at increased cardiac risk- more aggressive with cholesterol and blood pressure control
Total fat <30% kcal, sat fat <10%, trans fat 0%
Decrease added fats- 100 kcal/tablespoon
Opt for unsaturated fat- oils, nuts, margarine

24. “Let nothing that can be treated by diet be treated by any other means
“Let nothing that can be treated by diet be treated by any other means.” Maimonides