1. How Diet Affects Blood Glucose Levels July 30, 2007 Liz Weinandy, MPH, RD The Ohio State University Medical Center Liz.Weinandy@osumc.edu

2. Objectives At the end of the presentation you will be able to: Describe how different food components affect your blood glucose (BG) levels and your energy level Read a food label Count grams of carbohydrate

3. Diabetes in the US 20.8 million children and adults -- 7.0% of the population -- have diabetes. Diagnosed: 14.6 million people Undiagnosed: 6.2 million people Pre-diabetes: 54 million people 1.5 million new cases of diabetes were diagnosed in people aged 20 years or older in 2005. Source: American Diabetes Association

4. Diabetes in the US People with diabetes have increased health risks Heart disease Stroke High cholesterol Kidney disease Eyesight problems Vascular disease

5. Food and Blood Glucose Levels Factors that impact BG levels Food Eating a healthy diet can help control BG levels Healthy weight Physical activity

6. Food and Blood Glucose Levels Food is made up of three basic components: Carbohydrates Protein Fat What component(s) affects the BG the most? Carbohydrates!

7. Food and Blood Glucose Levels Carbs affect BG the most Proteins affect BG very little Fats keep BG elevated if eaten with a large carb load, but do not raise BG

8. Food and Blood Glucose Levels American Diabetes Association recd’s Carbohydrates: 50- 60% Low carb diets are NOT recommended Protein: 15- 20% Most from low fat sources Fat: ~30% Most from mono- and poly- unsaturated fats

9. Food and Blood Glucose Levels What foods have carbohydrates in them? Starches Bread, cereal, tortillas, pasta, rice, corn, peas, potatoes, crackers, pretzels, popcorn, muffins Fruits Dairy Desserts & Sweets Non- Starchy Vegetables

10. Food and Blood Glucose Levels Different Types of Carbs Simple and processed Sugars, refined flour Complex High fiber, whole grains Fiber Not digested

11. Food and Blood Glucose Levels Goal is to eat moderate carbs at all meals and avoid large carb intake at any one meal Eat three meals daily Snacks optional but good idea Can help prevent getting too hungry Concentrate on eating better carbs Complex carbs, those high in fiber

12. Food and Blood Glucose Levels Source: http://www.urbanext.uiuc.edu/diabetes2/subsection.cfm?SubSectionID=26

13. How Much Carbohydrate? Individualized approach Generally, for weight loss: 45 grams per meal for women 60 grams per meal for men 15- 30 grams for 1-2 snacks a day 130 grams total minimum per day Amount of carb depends on many factors Gender, age, activity level, BG levels

14. How Much Carbohydrate Example 1800 calorie diet 250 grams of carb total (55% carb) 60 grams carb each meal 35 grams carb for 2 snacks 225 grams of carb total (50% carb) 60 grams carb each meal 20-25 grams carb for 2 snacks

15. How Much Carbohydrate? Remember, if you are trying to lose weight, it is NOT just about the carbs Total calories matter Low to moderate fat (<30% of total calories) Moderate fat diets result in same or more weight loss as very low fat diets By limiting (not eliminating!) carbs, most people lose weight

16. Label Reading Reading labels is important in managing BG levels and overall health Carbohydrate counting Look at Total Carbohydrate grams Can subtract Dietary Fiber grams if 5g or more Sugars are included in total carb grams Simple carbohydrates raise BG levels faster

17. Label Reading

19. Carbohydrate Content What if a food item doesn’t have a label? Produce Specialty cheeses Meats, Poultry, Seafood Aunt Martha’s potato casserole Restaurant Foods Alcohol

20. Carbohydrate Content Easiest to buy calorie/ carb counter book or look up online American Diabetes Assoc. www.diabetes.org American Dietetic Assoc. www.eatright.org Calorie King book ($8 Barnes & Noble) Calorieking.com Fitday.com

21. Carbohydrate Content Produce Fruit Serving is generally small piece fruit (4 oz), ½ cup fruit, ¼ cup dried fruit, or ½ cup (4 oz.) juice 15 g carb, 60 calories Vegetables Starchy- ½ cup of peas, corn, or potatoes 15 g carb, 80 calories Nonstarchy vegetables- 3 cups raw or 1 ½ cups cooked broccoli, carrots, cucumbers, peppers, etc. 15 g carb or less, 75 calories or less

22. Carbohydrate Content Meat and Meat Substitutes Chicken, fish, beef, eggs, cheese, peanut butter Generally contain little or no carb, mostly protein and variable amounts of fat Choose lower fat options except for fish and pb Moderate portions 3-4 oz or deck of cards Calorie difference is great! Ex: 4 oz of skinless chicken breast vs 4 oz pork spareribs Calorie difference is 260 (140 vs 400 calories) Extra calories all from fat!

23. Carbohydrate Content Combination Foods Casseroles, lasagna, spaghetti w/ meatballs, mac & cheese, chili w/ beans, etc. In GENERAL, 1 cup = 30 g carb Pizza, thin crust ¼ of 12 inch (about 5 oz) = 30 g carb Most of carb is in crust so avoid thick ones or limit portion size greatly

24. Carbohydrate Content Restaurant Food If a chain, look up info If not a chain, will have to estimate Caution with portions! Number one way to eat large amount of carbs Ask waiter to bring to go container with meal and eat half or split with someone else Be moderate with bread basket, corn chips, etc. Decide where you want to “spend” carb grams

25. Alcohol Moderate consumption ok if physician approves 1 drink for women a day, 2 for men Always with food Not on empty stomach Not with high Triglycerides May cause hypoglycemia, or low blood sugar Stimulates appetite

26. Summary Carbohydrates affect BG the most 50- 60% of calories from carb Carb counting is an effective way to monitor carb intake Label reading important Lose weight if needed or maintain current Physical activity important

27. Questions?