1. Advice for people newly diagnosed with Type 2 Diabetes- what do I say? Catherine Washbrook Community Dietitian

2. Aims of Dietary Advice Achieve / maintain blood glucose levels within normal range Management of lipid levels Management of blood pressure Weight reduction towards BMI 25 ADA 2002

3. Aims of Nutritional Management Improve health through healthy food choices and physical activity Address individual needs including personal and cultural preferences, lifestyle and willingness to change ADA 2002

4. Department of Nutrition and Dietetics Adran Maetheg a Deietegyddiaeth Cymunedol What is Type 2 Diabetes? It is a condition where the body cannot use glucose properly for energy because either the body does not produce enough insulin (insulin insufficiency) or the insulin does not work properly (insulin resistance).

5. What foods affect our blood glucose levels? ALL carbohydrate containing foods. Department of Nutrition and Dietetics Adran Maetheg a Deietegyddiaeth Cymunedol

6. What foods affect our blood glucose levels? ALL carbohydrate containing foods.

7. Carbohydrates Explained Starchy: Bread, Rice, Pasta, Potatoes Both starch & added sugar (Sucrose) Breakfast cereals Cakes Biscuits Fizzy drinks Natural Sugars (Fructose/Lactose): Fruit Fruit juice Yoghurt Milk

8. Department of Nutrition and Dietetics Adran Maetheg a Deietegyddiaeth Cymunedol

9. Diabetic foods Not recommended Often high in fat and low in fibre Expensive Diet is healthy not “special”

10. Which food groups contain carbohydrate ? 5-14 portions 5-9 portions 2-3 portions 0-4 portions

11. Department of Nutrition and Dietetics Adran Maetheg a Deietegyddiaeth Cymunedol Carbohydrate distribution When is the majority of carbohydrate eaten? Are patients aware of the effect of different foods on blood glucose levels ? Are patients aware of which foods contain carbohydrate ? Do they have an understanding of the amounts of carbohydrate in different foods?

12. Glycaemic index (GI) There has been recent evidence that lower glycaemic index foods can further improve HbA1c levels by 0.43% A method used to classify foods according to their glycaemic response compared to a standard amount of white bread Low GI foods are digested and absorbed more slowly than high GI foods

13. The total amount of carbohydrate consumed is a strong predictor of glycaemic response, and thus, carbohydrate content of foods is a key strategy in achieving glycaemic control

14. Glycemic index (GI) Examples 100Glucose 80-90 Baked potatoes, instant potatoes, pretzels, rice cakes, jelly beans, cornflakes, processed snack foods and breakfast cereals 70-80White bread, waffles, plain bagel, corn chips, Melba toast, french fries, carrots 60-70 Cream of wheat, quick-cooking oats, whole-wheat bread, couscous, new potatoes, table sugar, soft drinks, angel food cake, raisins, pineapple, cantaloupe 50-60 Brown rice, wild rice, popcorn, sweet potatoes, dense/coarse whole grain breads, whole-grain pita and tortillas, mango, banana, kiwi, sweet corn 40-50 Minimally processed cereals like old-fashioned oatmeal, oat bran and All bran; Bulgar wheat, pasta, green peas, grapes, oranges, chocolate 30-40Legumes, apple, apricots, pears, yogurt, milk 20-30Barley, cherries, grapefruit, peaches, plums. soya beans. Negligible Salad vegetables, non starchy vegetables such as asparagus, broccoli, cabbage, cauliflower and green beans

15. Glycaemic Index LowMediumHigh MuesliBasmati riceCornflakes Dried apricotsPitta breadRice krispies Sultana branSweet potatoesWhite/ wholemeal bread MilkOatmeal biscuitsLucozade Fruit & vegetablesPopcornFrozen chips PulsesShredded wheatLong grain rice Rye breadNew potatoesOld potatoes PorridgeJamFizzy drinks Baked beans

16. Case Study Estimate how much carbohydrate Mr. Brown is having throughout the day using the estimated CHO content list. How can making different food choices help glycaemic control?

17. BreakfastCHO Content (g) - 2 weetabix with milk - 1 slice white toast with butter and jam - Large glass of orange juice (300ml) Mid-morning - Scone with butter Lunch -Tuna with mayo and sweetcorn sandwich (4 slices bread) - Large banana - Cereal bar Mid-afternoon - Packet of crisps Evening meal 90g spaghetti with bolognaise sauce - 3 slices of garlic bread TOTAL

18. BreakfastCHO Content (g) - 2 weetabix with milk30 + 10 - 1 toast with butter and jam15 + 5 - Large glass of orange juice (300ml)30 Mid-morning - Scone with butter30 Lunch -Tuna with mayo and sweetcorn sandwich (4 slices bread)60 - Large banana30 - Cereal bar30 Mid-afternoon - Packet of crisps15 Evening meal 90g spaghetti with bolognaise sauce45 - 3 slices of garlic bread30 TOTAL335

19. Daily Carbohydrate Recommendations Minimum: 130g per day Guideline Daily Amount: Women 230g Men 300g (This will vary depending on activity levels)

20. BreakfastCHO Content (g) - 2 weetabix with milk30 + 10 - Handful of blueberries5 - small glass of orange juice (150ml)15 Mid-morning - Scone with butter30 Lunch -Tuna with mayo and sweetcorn sandwich (3 slices bread) 45 - Large banana30 - Yoghurt15 Mid-afternoon - 30g dried fruit & nuts15 Evening meal 60g spaghetti with bolognaise sauce30 - 1 slices of garlic bread10 Large salad0 TOTAL235

22. What works ? Structured education programmes that emphasise ; –Education & empowerment –Regular patient contact/ support –Lifestyle changes –Goal setting

23. What service do Cardiff Community Dietetics service provide? X-PERT PROGRAMME Structured education programme 6 weeks Dietitian and Diabetes Specialist Nurse Diabetes Awareness Session (DAS) 2 ½ hr session Aimed at people unable to attend X-PERT

24. Thank You Contact details: catherine.washbrook@wales.nhs.uk Tel: 20668089 Any questions?