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

2. 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

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

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

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

6. 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

7. 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

8. 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

9. 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

10. 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 30-50 points at each interval

11. Food Labels

12. Carbohydrate and Recipe Resources American Diabetes Association www.diabetes.org Jewish Diabetes Association www.jewishdiabetes.org SELF Nutrition Data http://nutritiondata.self.com/

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

14. 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

15. 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

16. 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

17. 2011 MyPlate

18. Balanced Meal Planning: The Plate Method

19. 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

20. 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!

21. 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.

22. 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!

23. 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

24. 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

25. Thank you! jsocke@uchicago.edu