1. Part 2: Nutrition Therapy for Diabetes Management

2. How Do You Control Blood Sugar With Food? Meal Planning Consistent meal times Consistent carbohydrates Combine protein foods with carbohydrates

3. CARBOHYDRATE PROTEIN FAT How Nutrients Affect Blood Sugar

4. Total Carbohydrates Count Carbohydrates give energy But too much carbohydrate can raise blood sugar above your target range ENERGY

5. Total Carbohydrates Count Men 45-60 grams per meal 15-30 grams per snack Women 30-45 grams per meal 15-30 grams per snack

6. Carbohydrates (CHO) in Each Food Group

7. Breads, Cereals, Grains & Starchy Vegetables Have CHO Each serving has about 15 grams carbohydrates One serving is: 1 slice of bread ¼ bagel 1/3 cup cooked rice, pasta or oatmeal ½ cup starchy vegetables – potatoes, beans, peas, corn

8. Fruits Have CHO Each serving has about 15 grams carbohydrates One serving is: 1 small fruit (size of tennis ball) ½ cup fruit ½ large banana 17 small grapes 2 Tbsp raisins or dried fruit

9. Non-starchy Vegetables Have Very Few CHO Each serving has about 5 grams carbohydrates One serving is: 1 cup raw vegetables ½ cup cooked vegetables

10. Dairy Products Have CHO Each serving has about 15 grams carbohydrates One serving is: 8 oz cow’s milk 6 – 8 oz plain yogurt – Flavored yogurt = 18 – 45 g! Check the label!

11. Meats & Protein Alternatives Have No CHO Meats, eggs and cheeses have very little CHO but can be high in fat and cholesterol Beware of breading and sugary sauces Protein alternatives have very little CHO: – Nuts, nut butters, seeds, soy & tofu – Veggie burgers DO have CHO – check the label!

12. Sweets & Sugars Have CHO Count towards total carbohydrates ‘Sweets’ have little nutritional value but can be high in fat and calories, which can cause an increase in weight and triglycerides Sugar free products still have CHO Limit ‘sweets’ to 1-2 servings each week

13. Portion Sizes 3 oz of meat = size of deck of cards 1 cup = size of baseball ½ cup = ice cream scoop 1 serving of fruit = size of baseball 1 Tbsp of fat = thumb tip 1 serving of bread = size of CD

14. Use the Plate Method ½ Plate Veggies ¼ Plate Protein ¼ Plate Starches, Grains, Fruit or Milk

15. Reduce Saturated Fat Roasting Baking Broiling Grilling Remove skin from poultry & choose white meat Choose lean proteins – chicken, turkey, fish, tofu or pork tenderloin Eat fewer high-fat foods – cold cuts, hot dogs, sausage, bacon & fried food Use less fat in cooking or use cooking sprays

16. Meal Planning: Timing Eat every 3-5 hours Do NOT skip meals Try to eat at the same time every day Eat a snack if meal is delayed

17. Nutrition Facts Serving Size 1 cup (236 g) Servings Per Container 2 Amount Per Serving Calories 230 Calories from fat 120 % Daily Value* Total Fat 14g 22% Saturated Fat 7g 35% Trans Fat 1g Cholesterol 40mg 13% Sodium 950mg 40% Total Carbohydrate 16g 5% Dietary Fiber 2g 8% Sugars 3g Protein 11 g Vitamin A 20% Vitamin C 0% Calcium 2% Iron 6% Reading a Label Always check the serving size! Look for total CALORIES Check the FAT *Check the first 3 items on the ingredients list for hidden fats and sugars Check for CARBS

18. Water & Non-Calorie Liquids = 8 cups per day Sugar-free drinks do count, but water is best! SF Tang Diet Soda Herbal Tea Crystal Light Flavored Water Coffee or Tea

19. Your Meal Plan: Deciding What to Eat Lunch Sample 2 slices whole wheat bread 2 oz of turkey 1 slice of 2% cheese 1 Tbsp lite mayo Lettuce/tomato 1 small piece of fruit Noncalorie beverage Total Carbohydrates 30 grams 0 grams 0-2 grams 15 grams 0 grams = 45 grams

20. Exercise Therapy for Diabetes Management

21. Total Carbohydrates Count Lose weight Lower risk of heart disease Possibly reduce the need for some medications Gain energy Increase well-being Improve overall health Good News About Physical Activity

22. Keep It Fun! Choose Enjoyable Activities Enjoy Activities with Friends Add Variety to Your Daily Routine

23. Blood Sugar & Exercise Blood Glucose LevelGuidelines Lower than 100 mg/dL (5.6 mmol/L) Your blood sugar may be too low to safely exercise. Eat a carbohydrate containing snack. 100 to 250 mg/dL (5.6 to 13.9 mmol/L) You're good to go! This is a safe pre-exercise zone. > 250 mg/dL (13.9 mmol/L) or higher Your blood sugar may be too high to exercise safely. Postpone your workout until your blood sugar drops to a safe pre-exercise range.

24. Diabetes & Exercise Exercise only when feeling well Become familiar with blood glucose patterns Know the symptoms of highs and lows

25. Diabetes & Exercise 30 – 45 minutes of exercise is safe when diabetes is under good control Eat a meal 1 – 3 hours before exercise Insulin – Administer insulin more than 1 hour before exercise – Administer insulin in abdomen – Avoid extremity injection

26. Diabetes & Exercise During exercise, drink plenty of fluids Remember: sports drinks contain sugar After exercise, monitor your blood glucose Wear shoes and socks at all times Always wear properly fitted footwear Check your feet after every session Consult your physician if any symptoms develop during or after exercise

27. Pharmacies Podiatrists – Wilmington Foot & Ankle Omega Sports (Oleander Dr) Diabetic socks can be purchased at the EFC, most pharmacies and large retail stores – Dr. Scholl’s brand Where Can You Find Shoes & Socks for Exercise?

28. Exercise is anything you want it to be – walking the dog, cleaning, taking the stairs, working out at the Employee Fitness Center Focus on duration over intensity – three 10 min sessions or one 30 min session; every minute counts!! Adding to your normal, daily activity is important – if you walk all day at work, you still need planned exercise or additional physical activity in your routine What is Exercise?

30. Want to get started now? Your safety is very important to us. Follow the guidelines we have provided, and remember that you can always contact a trainer at the EFC for more specific advice on physical activity and exercise. Always seek help with each new exercise. Can’t start the 12toLife just yet? Try a group exercise class offered at the EFC, take a walk with some friends or coworkers during lunch, take the stairs, or even contact a trainer for an appointment. Not sure if you can participate in any of the NHRMC EFC programs? Remember our guidelines, and seek help when needed. Your team is here to help you. For more information on outdoor resources for exercise and physical activity in your area, contact a member of the Diabetes Health Plan Team or an EFC staff member! Even if you live farther away, always remember that you are not alone. Time to Get Started