1. Carbs Are the Key: Current Nutrition for Diabetes Provided Courtesy of RD411.com Where health care professionals go for information D-0556Contributed by Karen Auwaerter, RD Review Date 4/10

3. Remember when… No sugar or sugary foods More complex carbohydrates, because they are digested more slowly and will not increase blood sugar as rapidly

4. Remember when… (cont’d) American Diabetes Association (ADA): Nutrition Recommendations and Principles for People With Diabetes Mellitus, 1986:  People with diabetes can safely incorporate 1 teaspoon of sugar into a meal, as long as blood sugar is under good control

5. Remember when… (cont’d) Patients followed rigid meal plans and could not request any foods high in concentrated carbohydrates Calories were calculated to within 100 calories of the diet prescription (ie, 1800 ADA) Patients were told: “I am sorry, but that is not on your diet.”

6. Remember when… (cont’d) HS snack was automatic Snacks included protein, because it helped “regulate” blood sugar Patients typically were on NPH insulin or sulfonylureas (Diabinese ®, Glucotrol ®, Micronase ® )

7. Newer research… Abraira C, Derler J. Large variations of sucrose in constant carbohydrate diets in type II diabetes. Am J Med. 1988;84:193-200. Bantle JP, Swanson JE, Thomas W, Laine DC. Metabolic effects of dietary sucrose in type II diabetic subjects. Diabetes Care. 1993;16:1301- 1305. Malerbi DA, Paiva ES, Duarte AL, Wajchenberg BL. Metabolic effects of dietary sucrose and fructose in type II diabetic subjects. Diabetes Care. 1996;19: 1249-1256.

8. The research says… Postprandial glucose levels and insulin responses to a variety of starches and sucrose are similar if the amount of carbohydrate is constant Day-to-day variations in energy and protein or fat intake are not significantly related to HbA1c

9. ADA Guidelines change to reflect new science “Sugars” and concentrated sweets are allowed as part of a healthy eating pattern for all persons with diabetes Sweets can replace other forms of carbohydrates in a meal pattern Most carbohydrates should come from nutritious sources, such as fruits and vegetables, grains, and low-fat or fat-free dairy foods ADA=American Diabetes Association

10. The evidence says… Foods containing carbohydrates (CHO) from whole grains, fruits, vegetables, and low-fat milk are important components—include them in a healthy diet The total amount of CHO in meals or snacks is more important than the source or type

11. The evidence says… (cont’d) Because sucrose does not increase glycemia to a greater extent than isocaloric amounts of starch, it is not necessary to restrict sucrose and sucrose-containing foods However, you must substitute sucrose and sucrose-containing foods for other CHO sources or cover them with insulin or other glucose-lowering medication

13. Position Statement, ADA, 2009 Implementation of a “consistent carbohydrate” diabetes meal plan at health care facilities Elimination of the name ADA Diet and No Concentrated Sweets (NCS) Diet CHO content comparable from day to day at each breakfast, lunch, and dinner Diet approximately 50% CHO, 20% protein, 30% fat ADA=American Diabetes Association

14. Position Statement, ADA, 2008 Patients requiring clear or full liquids should receive approximately 200 grams (g) CHO daily Sugar-free liquids are not appropriate After surgery, initiate food intake as quickly as possible Source: American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care [serial online]. 2008;31(suppl 1):S61-S78. Available at: http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf. Accessed March 30, 2010.http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf ADA=American Diabetes Association

15. Consistent CHO diet Typically 60 g CHO at each meal Occasional sweets counted into the total CHO (coffee cake, Fig Newtons ® ) Increased amount of fresh vegetables, fresh fruit, and whole grains 60 g CHO in all liquid diets

16. Patient and staff education is key The “old” ADA Diet no longer exists Artificial sweeteners are allowed to help reduce total carbohydrate intake of a meal Foods with “added sugars” are acceptable, as long as they do not affect the overall carbohydrate balance of a meal

17. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care [serial online]. 2008;31 (suppl 1):S61-S78. Available at: http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf. Accessed March 30, 2010. http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf American Dietetic Association. Nutrition Care Manual ®. Available at:. Accessed March 30, 2010. American Dietetic Association. Nutrition Care Manual ®. Available at: http://www.nutritioncaremanual.org/auth.cfm?p=%2Findex.cfm%3F. Accessed March 30, 2010. http://www.nutritioncaremanual.org/auth.cfm?p=%2Findex.cfm%3F Executive summary: standards of medical care in diabetes—2010. Diabetes Care [serial online]. 2010;33:S4-S10. Available at:. Accessed March 30, 2010. Executive summary: standards of medical care in diabetes—2010. Diabetes Care [serial online]. 2010;33:S4-S10. Available at: http://care.diabetesjournals.org/content/33/Supplement_1/S4.full.pdf+html. Accessed March 30, 2010. http://care.diabetesjournals.org/content/33/Supplement_1/S4.full.pdf+html References

18. Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care. 2002;25:148-198. References (cont’d)