Diet & Diabetes

Grace Neal (RD)

Diabetes Dietitian

Nutritional Intervention

• Help patient to make appropriate food choices to:

- reduce risk - Improve glycaemic control - quality of life.

• Advice needs to be based on scientific evidence and then tailored specifically for the individual, taking into account their personal and cultural preferences, beliefs, lifestyle and the change that the individual is willing and able to make.

No magic wand

Guidance Used

• Evidence-based nutrition guidelines for the prevention and management of diabetes – May 2011, Diabetes UK

• Hertfordshire Diabetes Clinical Guidelines – July 2010

• NICE Guidance GC66 – Type 2 Diabetes

• NICE Guidance GC15 – Type 1 Diabetes

• Diabetes UK

Management & Models

• Everyone with diabetes should receive individual, ongoing nutritional advice from a registered dietitian (A)

• All people with diabetes should be offered structured education at the time of diagnosis with an annual follow-up (A)

• Education should involve a person-centred approach & a variety of learning styles (A)

TYPE 1 • Foods that have a direct impact on BGL’s and

how to identify them (carbohydrate is the main nutritional consideration for glycaemic control)

• Carbohydrate awareness and/or counting• Count the carbs to either match the insulin (fixed

dose) OR adjust the insulin to match the carbs (basal bolus/MDI)

• Awareness of: Exercise, Sickness, Alcohol and snacking etc.

• General healthy eating advice in line with the population

• DAFNE course (Dose Adjusting For Normal Eating)

Type 2 – Glycaemic control

• Weight management should be the primary nutritional strategy in managing blood glucose (BG) in people who are overweight or obese

• Focus should be on total energy intake rather than the source of the energy in the diet

• The total amount of carbohydrate consumed is a strong predictor of glycaemic response & monitoring total carb intake is a key strategy in achieving glycaemic control

• Physical activity!! & ?Lower GI food choices

Type 2 – CVD (blood lipids & blood pressure)

• Saturated Fats & Trans fats• Plant sterols & stanols• Reduce sodium• Mediterranean style diet• Oily fish• Weight loss • Exercise (aerobic)

Type 2 – Practical 2 Pronged Approach

Educate about food/ food groups that have a direct impact on blood glucose levels

• Identifying carbs & understanding their relationship to glucose

- Menus, diet history - Food & carb diary - Food pictures & models - Games

Educate about foods/ diet types that will have a long term impact on BGL’s (abdominal obesity)

• Identifying high calorie & high fat foods/drinks

- Diet history - Calorie counting - Food portion pictures - Games

Carbohydrate Awareness

Menu 1Breakfast

2 x slices of thick wholemeal toast

2 heaped tsp jamLunch

250 gram jacket potato½ can of baked beans

125ml of low fat yogurtSnack

1 digestive biscuitLarge green apple

Dinner150 gram chips

2 scoops of vanilla ice cream

Menu 2Breakfast

Bowl of muesliSemi skimmed milk

150mls fresh orange juiceLunch

BaguettePacket of baked crisps

SnackHot buttered scone

Dinner225g cooked spagetti

2 cream crackersSmall pots of raisins

Example of a patients ‘Food, Carb & BG’ diary

Example of a patients ‘Food, Carb & BG’ diary

Day One: Thursday 12.1.2012 Day Two : Friday 13.1.201 Day Three : Saturday 14.1.2012

Time 6.45 am 6.45 am 8.30 am

BG levels 8.0 6.6 7.3

Breakfast 1 slice toast (16,) 1 Weetabix(13), bran flakes (20), O.juice (20)Total Carbohydrate: 69 grams

1 slice toast (16), 1 Weetabix (13), bran flakes (20), milk (10)

Total Carbohydrate: 59 grams

1 wholemeal bagel (40). 1 Weetabix(13), bran flakes (20), milk (10)Total Carbohydrate: 83 grams

Time 12.30 pm 12.15 pm 12.15 pm

BG Levels 9.0 6.9 11.6

Lunch Ham sandwich (wholemealbread) (32) Satsuma (10)Total Carbohydrate: 42 grams

Cheese sandwich (wholemeal bread) (32) Apple (16)At about 5 pm 2 ginger biscuits (14)Total Carbohydrate: 48 +14 grams

Ham sandwich (wholemeal bread) (32)Satsuma (10)At about 5 pm 2 ginger biscuits (14)Total Carbohydrate: 42+14 grams

Time 6 pm 6.30 pm 6.15 pm

BG Levels 7.0 7.4 8.0

Evening Meal

Faggots (24), rice (45), Apple (16)

Total Carbohydrate: 85 grams

Pasta bake (40), sauce (9), Satsuma (10)

Total Carbohydrate: 59 grams

Chicken & mushroom pie (30), potato(40), Satsuma (10)

Total Carbohydrate: 70 grams

B4 bedBG Levels

10 pm 11.0

10.15 pm7.3

10.15 pm9.0

Bedtime 2 digestive biscuitsTotal Carbohydrate 20 grams

2 digestive biscuitsTotal Carbohydrate 20 grams

2 digestive biscuitsTotal Carbohydrate 20 grams

• It’s a way of finding out more about type 2 diabetes - Understanding the nature of their diabetes

- The possible risks associated with having diabetes - What they can do to manage their diabetes and minimise any risks - Answers to most of the questions about their diabetes with which they may have

• It’s a resource to help people manage the changes diabetes will bring to their life

• It’s an opportunity to meet & share experiences with others• Different approach to education the patients are expected to

be very much involved e.g. - They are asked lots of questions, they are encouraged to explore the answers

themselves, often their questions will not be answered directly instead they are guided to work out the answer themselves OR to know how to find the answer

• 2 x ½ day sessions• Newly diagnosed Type 2 diabetes (6/12)• 10 people in the group• 2 local DESMOND educators• Evidence based information about the

causes, effects and options for managing diabetes

Summary• Type 1 - Carbohydrate & Insulin education (1-1 or DAFNE) - Food in relation to: hypo’s (tx), exercise etc

• Type 2 - Weight Loss (if overweight or abdo obese) - Carbohydrate awareness (food & BGLs) - Healthy eating i.e. ↑vegetables, ↓ fat, moderate

carb portions & opt for starchy carbs. - CVD: ↑oily fish, ↓ fat & opt for mono fats, ↑ lentils

pulses, ↑ grains - ↑ Activity

What can you do?

• Don’t try to be too specific!! Why?

• Be careful of ‘rigid’ blanket advice!! Why?

• ? Eating to prevent hypoglycaemia? Valid??

• Diabetes UK – “10 Steps to Healthy Eating”

• ↑Activity e.g. GP referral scheme, local walk

• ↓Sat Fat, ↓Sugary foods ↑Vegetables

• Eat Well Plate OR Weight Loss Plate

What can you do?

• Eat Well Plate

• Weight Loss Plate

Contacts & Referrals• Ask GP to refer OR refer directly to service by:

www.hertschs.nhs.uk

- Type “SPOC Form” into search box (top left of page)

Contact & Referrals• Diabetes Service:

Potters Bar Community Hospital Barnet Road Potters Bar Hertfordshire EN6 2RY Tel: 01707 621152 Fax: 01707 621178  Email: Hertscommunitydiabetes@nhs.net

• Dietitians direct: 01727 866600