HANA- Dietary Education DM-Final 1

Dietary Education for People with

DiabetesBsc. Nutrition & Food ProcessingBsc. Nutrition & Food Processing

Colonel Hana Khasrouf Mudabber Colonel Hana Khasrouf Mudabber

Outline Aims of Nutritional AdviceThe goals of dietary adviceRole of the dieticianDietary Education Tools:

Stage1Healthy EatingThe food pyramidThe signal systemThe hand jiveThe plate model

Stage 2 Food Exchanges Carbohydrate Counting

1. Portion Estimation2. Food Package Labels3. Carb factors

Advanced carb counting carb: insulin ratio Methods: #1 #2 & #3

Glycemic Index

Aims of Nutritional Advice The aim is to provide those who need advice

with the information requirement to make appropriate choices on the type and quantity of food which they eat.

It must take into account the individuals: - Specific needs- Personal and cultural preferences- Beliefs and lifestyle- Wishes and willingness to change

The Goals of Dietary AdviceAre:To maintain or improve health through

the use of appropriate and healthy food choices

To achieve and maintain optimal metabolic and physiological outcome

Role of the dieticianThe role of the dietitian is to translate

nutritional objectives into practice in a way which is realistic and practical for the diabetic.

Focussing on modifying the patient’s existing eating habits, food choice and timing of meals.

Role of the dieticianThe dietitian needs to assess diet for:

Food choicesMeal planNutritional adequacy and overall dietary balanceBeliefs or misconceptions held about diet and diabetesPhysical activity, occupation, literacy, economic

circumstances , etcBody weightOther medical conditions – Coeliacs, visual handicap,

nephropathy, etcAlcohol consumption

Avoid looking like a school teacher!Avoid looking like a school teacher!• Simple words

• Open-ended questions

• Encouragement

• Positive feedback

• Active listening

• Repetition

Role of the DieticianImplementing Good Communication Skills

Role of the dietician

Example:

Open-ended question At what time do you take your

meals?

Closed question Do you take your meals on

time?

Patients can be overwhelmed, the dietician must not cram all teaching points into one session

Adult learners have an attention span of about 20 minutes

Scheduling follow-up

Role of the dietician How to educate DM patient?

Role of the dietician Utilizing Interactive Tools and Educational Materials for Teaching

Diabetes dietary education color books or educational stories for kids.

Diabetes dietary education games for teens and adults (softwares or CDs)

الجيد الطعام أتناول أنالصحتي المفيد

وأرتاح أجلس أن الى أحتاج أحياناً. ً كثيرا لعبت إذا وخصوصاً قليالً

سكر كان إذا خفيفة وجبة وأتناول ً منخفضا الدم

الفطور أتناول أن قبلفي والدتي تساعدني

. األنسولين أخذمثلك سكري لدي أنا

تماماً.

بالدم السكر فحص على نعملتناول وبعد األنسولين أخذ قبل

الطعام.. بذلك أحياناً أبي يساعدني

سكر تفحص هل أيضاً وأنتالدم؟

Diabetes Dietary EducationBooks & Stories for Kids

Diabetes Software for Teens & Adults

Approach to meal planningA uniform approach to meal planning

does not work for everyone

A flexible plan or a variety of approaches is required to deal with differing needs

BackgroundHistorically advice given on carbohydrate

exchanges or portions In 1980s carbohydrate restriction found to

be unnecessary – advice changed to healthy eating : plate model

New DAFNE trial / Carbohydrate Counting

Dietary Education

Tools

Dietary educationStage 1 (simple education methods)

Awareness of the basics of healthy eating/ balance of good health

The food pyramidThe signal system (healthy food

choices)The hand jiveThe plate model

Dietary educationStage 2(advanced & require teaching skills)

Food Exchange SystemCarbohydrate CountingGlycemic Index

Healthy Eating

Australian Food Guide

Healthy Eating

Grain products

Vegetables and fruits

Milk products

Meat and alternatives

Canadian Food Guide

Balance of Good Health

Bread, cereals & potatoes

Milk & dairy

productsFoods rich in sugars and fat

Meat, fish & protein

alternatives

Fruits & vegetables

UK Food Guide

My Food Pyramid (USDA)

Utilizing Interactive

Activities for Teaching My

Pyramidfor

Kids

Diabetes Dietary Education Games for Teaching My Pyramid

Signal SystemThe signal system is based on a traffic lights concept: Red foods (to be taken in small amounts)

those rich in fat sugars (refined carbohydrate) high glycemic index foods low fiber content

Yellow foodsYellow foods (to be taken in moderation) Moderate glycemic index foods low fiber content

Green foods (healthy choice) low glycemic index high fiber content low in fat

Healthy versus unhealthy food choices?

Food groupsGreen zoneYellow zoneRed zoneRice Steamed or

boiled rice Fried rice/biryani

BreadWhole wheat bread

White breadCroissants and cakes

NoodlesSteamed or boiled noodles

Deep fried noodles

PotatoesBaked potatoFrench friesVegetablesSteamed

vegetableSauteed vegetable

Deep fried vegetable

SaladGreen saladSalad with mayonnaise

SauceTomato basedCream basedChicken, fish & red meat

GrilledPan friedDeep fried

Hand Jive (starch): choose an amount equivalent to the size of 2 Carbohydrates fists.

Fruit: choose an amount equivalent to the size of 1 fist . Protein: choose an amount equivalent to the size of the palm of

your hand and the thickness of your little finger. Vegetables: choose as much as you can hold in both hands.

These should be low carbohydrate vegetables – green or yellow beans, cabbage or lettuce.

Fat: limit fat to an amount the size of the tip of your thumb. Drink no more than 250 ml of low-fat milk with a meal

Plate Model

Protein

Starch/cereal

Vegetable

Vegetable

FruitFat Milk/yoghurt

Advanced Education Tools –Stage 2 Food Exchanges

Carbohydrate Counting

Glycemic Index

The “Exchange” SystemFoods with common nutrient values

are grouped together.

1 Fat

1 Meat

1 Vegetable

1 Milk

1 Fruit

1 Starch

0 5 10 15

Food exchangesWithin groups, a single food based on weight/

measure/ size has the same carbohydrate or Calorie value as another and can be interchanged

Cereal exchanges: 1 slice of bread can be exchanged for 1/3 cup rice

Foods from different groups cannot be interchanged – 1 slice of bread cannot be exchanged for 1½ tsp of butter

The Exchange Lists1Groups/ ListsCarb.ProteinFatCaloriesCarbohydrate GroupStarch1531 or less80

Fruit15______60

Milk Skim Low-fat Whole

121212

888

0-358

90120150

Other carbohydrates15variesvariesvaries

Vegetables52___25

Meat and Substitute Group Very lean Lean Medium-fat High-fat

____________

7777

0-1358

355575100

Fat Group______5451. Exchange Lists for Meal Planning, The American Diabetes Association, The American Dietetic Association, 1995

Counting Carbs Using the Exchange system

Breakfast Exchange/# Carb Grams1 pita bread (4 oz) starch (4) x 15 60g

1 tsp. olive oil fat (1)x0 0g

1 hard boiled egg protein (1)x0 0g

1/2 cup orange juice fruit (1) 15g

6 oz skim milk (3/4) x 12 9g

Total Carbs 84g

One oz.pita bread 15g carbExampl

e:

Carbohydrate Choices

One oz.slice bread

Small piece of fruit

One cup unsweetened

cereal

1 small ear of corn ½ cup of

juice

One small potato

1 cup of milk

1/3 cup riceOne oz.

pita bread

Carbohydrate Counting

Carbohydrate Counting Defined A meal-planning approach based on the

following ideas Carbohydrate is the main nutrient affecting

postprandial glycemic response Total amount of carbohydrates consumed is

more important than the source of carbohydrates

Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs

Timed Effect on Blood Sugar Levels

* In absence of dietary carbs ** may cause insulin resistance in large qty

CarbohydrateCarbohydrate: rapid digestion, total absorption/conversion to glucose (100%)

Sugar AlcoholsSugar Alcohols: moderate digestion, partial absorption as glucose (50%)

Protein…………..Protein…………..slow digestion, partial conversion to glucose* (~40%)

Fat………………..Fat………………..slow digestion, little conversion to glucose** (<20%)

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Why Count Carbohydrate?Keeping carb intake consistent at meals from

day to dayBase for rapid-acting insulin dosing with

meals/snacks Allow more flexibility with eating for people with

type 1 diabetesResult in reduced post-prandial hyper- and

hypoglycemia

PrerequisitesThe ability & willingness of the diabetics to :

Perform basic carb countingDo simple mathUse nutrient analysis information, measuring

cups, spoons and scalesKeep accurate, detailed records:

Blood glucose results Carbohydrate eatenInsulin or other medsPhysical activity/exercise

Methods for Basic Carb Counting

1. Portion Estimation

2. Food Package Labels

3. Carb factors

Portion Estimation Using Food Models

1. Portion Estimation Method

Examples of 1-cup Carb Estimates:Potato: 40gPasta: 40gRice: 50gRolls: 25gCereal: 25gCereal: 25gFruit: 20gFruit: 20gCooked Vegetables: 10gSalad Vegetables: 5gMilk: 12g

Corn: 30gPeas: 30gBeans: 40gPretzels: 25gChips: 15gPopcorn: 5gPopcorn: 5gIce Cream: 35gCake: 45g

Portion Estimation MethodExample: 1

1cup fruit 20g carb

X 1 ¼ cups

25g carb

1cup popcorn 5g carb

X 4 cups

20g carb


Portion Estimation MethodLong Sandwiches8g carb per inch (2.5 cm)

Pizza30g carb per adult hand-sized piece (fingers together)

Cookies20g carb per adult-sized palm

Breaded meat/veg/cheese

4g carb per small (“thumb/nugget sized”)

10g carb large (“patty/palm-sized”)

1hand pizza 30g carb

X 1 1/3 hands

40g carb


2. Nutrition Facts Label Method

Labels are the best resource for carb counting but consideringServing SizeTotal CarbohydrateFiber & Sugar Alcohol (if any)

Sugar Alcohols and Carb CountingArtificial SweetenersFound in sugar free products e.g. chewing gum,

mints, jam, ice cream, cookies and candyDigest slowly and partially ( 50%)Requires little or no insulin to be metabolized. Can have laxative effect (bloating, gas, diarrhea) if

consumed in large amounts.

Comparison of Sweeteners

SweetenerCal per gramArtificial (Aspartame, Saccharin, Splenda)0Sugar Alcohols: Erythritol

MannitolIsomaltLactitolMaltitolXylitol

Sorbitol Hydrogenated starch hydrolysates

0.21.62.02.02.12.42.63.0

Glycerine, sucrose, fructose, lactose4.0

Example: 1 Nutrition FactsNutrition Facts

Serving size: 2 piecesServing size: 2 piecesAmount Per ServingAmount Per Serving

CaloriesCalories3.83.8

Calories from Fat0Total Fat0g (0%)

Cholesterol0g (0%)Sodium0g (0%)

Total Carbohydrate1.6g (1%)

Sugars0g

Sugar Alcohol (Xylitol)1.6g

Protein0g

If all carb is from sugar alcohols

< 10 grams: FREE food

Example: 2

Nutrition FactsNutrition FactsServing size: 5 pieces Serving size: 5 pieces

( about 16 grams)( about 16 grams)Amount Per ServingAmount Per Serving

CaloriesCalories4040Calories from

Fat10

Total Fat1g (2%)Saturated Fat0.5 g (3%)

Trans Fat0 (0)%Cholesterol0g (0%)

Sodium70mg (3%) Total

Carbohydrate

14g (5%)

Sugars 0gSugar Alcohol

(lactitol) 14gProtein0g (0%)

If all carb is from sugar alcohols >10 grams: count ½ of the total carb

If serving size = 5 pieces sugar alcohol: 14 g = 7g

2

Nutrition FactsNutrition FactsServing Size: 1 Tbsp (17g). Serving Size: 1 Tbsp (17g). Servings per Container: 20. Servings per Container: 20.

Calories per serv.: 10. Calories per serv.: 10.

AMOUNT PER SERVING

% DAILY VALUE*

Total Fat: 0g0%

Sodium: 20mg1%

Total Carbohydrate: 3g1%

Sugars: 0g

Sugar Alcohol: 3g

Sorbitol

Protein: 0g

If all carb is from number of sources, including sugar alcohols

Subtract ½ of the sugar alcohol grams from the total carb

If 2 servings used = 2Tbsp

6g Carb + 6g sorbitol = 9 g Carb 2

Example: 3

3. Carbohydrate Factor Method

Getting total carb count by:Weighing the portion of foodMultiplying the weight by its

carb factor*

A carb factor is the percentage of the food’s weight that is carbohydrate .

The rest is water, protein, fat and minerals.

Apple: 0.13

Apple Pie: 0.32

Carrot (raw): 0.06

Chocolate Cake: 0.51

mixed grain bread: 0.46

White bread: 0.50

Pancake: 0.28

Pizza (cheese): 0.32

Potato, baked: 0.22Potato Salad: 0 .09

Rice: 0.27

Spaghetti: 0.26

Vanilla Ice Cream: 0.23

Watermelon: 0.06

Carb Factor Examples:

Carbohydrate Factor Method

How much carb? is in a baked potato weighing exactly 300 grams?

300 x 0.22g = 66g carb

Example: Calculating grams of Carb content

Impact of Fiberin Carbohydrate CountingIncluded in total carbohydrateDoes not convert to glucoseSubtract fiber from the Total Carbohydrate

Impact of Fiber Example:

1 Serving size:

13 g Total Carb

- 3 g dietary fiber

Count as 10 g carb

How Much Carbohydrate is Needed1

Calorie level~ 1200~1400~1600~1800~2400~2800

Calorie range1200-15001300-1600

1400-1700

1600-1900

1800-2300

2200-2800

Carb grams180180195210240300

Carb choices121212-1313-1415-1618-20

Grains, beans, & starchy vegetables

6667911

Vegetables333445

Fruits333334

Milk222-32-32-32-3

Meats2 (4oz)2 (4oz)2 (5oz)2 (5oz)2 (6oz)3 (70z)

Fats g/servings40/447/554/660/774/993/121. Practical Carbohydrate Counting, American Diabetes Association, 2001.

Calculated as 60% CHO from total calories.

Determining Amount of Carbs per meal

PopulationCarb choices

per mealSmaller, older, inactive women2-4

Older, inactive men3-5

Smaller, older, inactive men

Large, active women trying to lose weight4-6

Most older men

Active women

Larger men desiring to lose weight

5-7

Active, younger men6-8

Advanced Carb CountingFor those on insulin (MDI/ Insulin Pump)Adjusts rapid-acting insulin based on carb

consumed and physical activityCarb: Insulin Ratio

Calculates insulin dose for a specific amount of carbohydrate

The Actions of Insulins1 InsulinOnsetPeakDuration Rapid acting

Lispro (Humalog)

Aspart (Novolog)

<15 min

<15 min

0.5-1.5 hrs

0.5-1.0 hr

2-4 hrs

1-3 hrs

Short acting

Regular0.5- 1 hr2-3 hrs3-6 hrs

Intermediate

NPH

lente

2-4 hrs

3-4 hrs

4-10 hrs

4-12 hrs

10-16 hrs

12-18 hrs

Long acting

Ultralente

Glargine (Lantus)

6-10 hrs

2-4 hrs

10-16 hrs

peakless

18-20 hrs

24 hrs

1. Practical Carbohydrate Counting, American Diabetes Association, 2001

Basal insulinLantus

Or Levemir

Peak: 0.5-1.0 hour

Onset: 15 minOnset: 15 min Duration: 1-3 hrsDuration: 1-3 hrs

Peakless 24 hrs Glargine

)Novolog( )Novolog( )Novolog(

Example of Carb CountingDAFNE

Dose adjustment for normal eating5 day structured teaching programmeImprove diabetes control by matching insulin

to carbohydrate. Evidence shows improved HbA1c, reduced

severe hypo’s and less hospital admissions from DKA

DAFNE Timetable MondayTuesdayWednesdayThursdayFriday

09.15-09.45 INTRODUCTION

09.15-10.30 Group Discussion:Individual blood glucose levels`

09.15-10.30 Group Discussion:Individual blood glucose levels


09.15-10.30 Group Discussion:Individual blood glucose levels 09.45-10.45

WHAT IS DIABETES?

10.45-11.00 Coffee10.30-10.45 Coffee10.30-10.45 Coffee10.30-10.45 Coffee10.30-10.45 Coffee

11.00-12.30 NUTRITION 1Identify carbohydrates

10.45-12.30 NUTRITION 2Putting carbohydrate estimation into practice

10.45-12.30 NUTRITION 3Food PackagingRecipes

10.45-12.30 NUTRITION 4AlcoholEating outHealthy eating/ weight controlTHEORY OF GOAL SETTING

10.45-12.00 ANNUAL REVIEW AND SCREENING

12.00-13.00 QUESTIONS FOR THE DOCTORGOAL SETTING

12.30-13.30 Lunch12.30-13.30 Lunch12.30-13.30 Lunch12.30-13.30 Lunch13.00 – 14.30 Lunch

13.30-15.00 SELF MONITORING

13.30-15.00 DAFNE INSULIN ADJUSTMENT

13.30-15.00 HYPOGLYCAEMIA(Relatives/partners welcome)

13.30-15.00 PHYSICAL ACTIVITYWalk – weather depending.

14.30-15.00 QUIZ

15.00-15.15 Coffee15.00-15.15 Coffee15.00-15.15 Coffee15.00 – 15.15 Coffee

15.15-16.15 ALL ABOUT INSULIN

15.15-16.15 INSULIN INJECTION TECHNIQUE

15.15-16.15 SICK DAY RULES

15.15-16.15 SOCIAL ASPECTS(Contraception and pregnancy – optional)

15.00-15.30 EVALUATION AND FOLLOW UP





Insulin: Carbohydrate RatioMethod # 1: Food dairy, insulin dose,

and SMBG information

Method # 2:Insulin: Carbohydrate ratio

The rule of 500 or 450

Method # 3:Using the insulin sensitivity factor (ISF)

Carb to Insulin Ratio’sStarting point (if new to carb/insulin ratio’s)

1:15 ratio (1 unit rapid acting insulin for every 15 g carb eaten)

May need different ratio’s for different mealsExample:

If 65 g carb for lunch Would need 4 units fast acting insulin coverage at

lunch (65 ÷ 15 =4)

Method #1 Food dairy, insulin dose, and SMBG information1,2 Insulin: Carb ratio = Grams of carb at a given meal ÷

number of units of insulin taken at that meal

Example patient needs 4 units of insulin to cover 45g of carbs Insulin: Carb ratio = 45 ÷ 4 = 11

Ratio = 1:11

1. Carbohydrate Counting: Using Carbohydrate/Insulin Ratios, The American Diabetes Association, The American Dietetic Association, 1995


Method #2 (The 500/450 Rule)

The rule of 450 or 5001 keeps post meal readings normal The 500 rule estimates accurately grams of carb per unit of

rapid acting insulin (Humalog or Novolog) The 450 Rule is used with Regular insulin.

Insulin: Carb ratio = 450 or 500 ÷ total daily insulin dose (TDD)

Example TDD = 36 units (Bolus + Basal)

Glucose levels are within target range Insulin: Carb ratio = 500 ÷ 36 = 14

Ratio = 1:141. Practical Carbohydrate Counting, American Diabetes Association, 2001

Method #3 (The 1800 OR 1600 Rule)Method # 3: Using the insulin sensitivity factor (ISF)1

can be used to bring down high blood sugars ISF = 1800 or 1600 ÷ TDD Insulin: Carb ratio = ISF× 0.33

Example TDD = 25 units (Bolus + Basal) ISF = 1800 ÷ 25 = 72 (meaning that 1 unit of rapid-acting insulin

Hum. or Novolog would drop BG approx. 72 mg/dL) Insulin: Carb ratio = 72 × 0.33= 24 Ratio = 1:24


Example TDD= 34 units Target BG = 100 mg/dl Pre-meal BG = 226 mg/dl 60g of carb are to be consumedAnswer ISF = 1800 34 = 53 Difference between target and actual BG = 226 – 100 =126 mg/dl Units of insulin to decrease high pre-prandial BGUnits of insulin to decrease high pre-prandial BG =126 ÷ 53 = 2.3 units Insulin: carb ratio

• 500 ÷ 34 TDD = 15• Ratio= 1:15

Units of insulin to cover carb consumed = 60 ÷ 15 = 4 units Premeal insulin = 2.3 units + 4 units = 6.3 units (rounded to 6)


Correcting Pre-meal Hyperglycemia1

Correcting Pre-meal Hypoglycemia1

Example Insulin: carb ratio = 1:13 ISF = 35 Carbs to be consumed: 40g Actual BG level = 57 mg/dl Target BG level = 110 mg/dl

Answer # 1: Increase amount of carbohydrate

13g of carbs will raise BG by 35 mg/dlAnswer # 2: Decrease pre-meal insulin dose

Amount of insulin to cover carbs= 40 ÷ 13 = 3 units of insulin Amount of insulin to be subtracted= Difference between target

and actual BG levels(110-57) ÷ ISF = 53 mg/dl ÷ 35 = 1.5 units insulin

Pre-meal insulin = 3 units – 1.5 units = 1.5 unitsAnswer # 3: Delay pre-meal insulin


Treating Hypoglycemia1 Amount of

Carbs

BGBG

Apple or Orange Juice

Grape juice

MilkCola/ Sprite

15 g

51-70 mg/dl51-70 mg/dl

120 ml90 ml300 ml125 ml

20 g

41-50 mg/dl41-50 mg/dl

180 ml120 ml420 ml190 ml

30 g

<40 mg/dl<40 mg/dl

240 ml180 ml600 ml250 ml

1. Exchanges For All Occasions, Marion Franz, RD, MS, 1987

Exercise Guidelines

Type of ExerciseIf BG Is: Carb. Intake

by:Suggested Food

Short Duration 80-100 mg/dl10-15 g. 1 fruit Or 1 bread

≥ 100 mg/dlNot necessary -------

Moderate intensity

80-100 mg/dl

25-50 g before exercise

then 10-15 g/hr, if necessary

½ meat sandwich + milk Or fruit

80-170 mg/dl10-15 grams 1 fruit Or 1 bread

180-300 mg/dlNot necessary---------

≥ 300 mg/dlDon’t exercise--------

Strenuous activity or exercise

80-100 mg/dl50 g1 meat sandwich + milk

Or fruit

180-300 mg/dl10-15 g/hr 1 fruit Or 1 bread

≥ 300 mg/dlDon’t exercise-----------

Carbohydrate Counting Disadvantages Takes time and practice Increase in BG testing and need to keep

detailed records of blood sugars/foods consumed

Possible weight gain if high calorie foods are eaten

Diet may become unbalanced

Glycemic Index and Load

Gylcemic Index – GIGI value is a ranking (on a 100 point scale)

of how quickly 50g of CHO from foods elevates blood sugar levelsThe higher the number the quicker the CHO

enters the bloodstream.

High GI eg: White bread

Low GI eg: legumes

Time

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Glycemic Index ClassificationClassificationGI RangeExamples

Low GI55 or less

Most fruits and vegetables (except potatoes, melons & pineapple), grainy bread, brown rice, freekeh, fish, egg,

fructose.

Medium GI 56-69Pita bread, Whole wheat products, maftool, quick oats, basmati rice, sweet potato, honey & table sugar

High GI70 or more

Flakes, rice krispies, instant oats, popcorn, baked potatoes, short grain white rice, rice noodles, white bread,

straight glucose (100)

)healthy choice(

(to be taken in moderation)

(to be taken in small amounts)

GI ExampleExample : :SpaghettiSpaghettiGI = 37GI = 37Only 37% of spaghetti’s carbs turn into BG

in the first 2 hrs. The rest will convert to BG over the next

several hrs.

Glycemic ResponseA measure of the increase in blood sugar

after a combination of foods is eaten

Glycemic LoadRepresent the glycemic impact of more

typical portions of foods

High GI foods can be appropriate to treat hypos and for exercise

It allows for knowing the proper timing for injecting rapid insulin for quick or slow meals

It allows for occasional sweet food after a low GI meal

How to use the GI in Practical advice

Quick & Slow Acting Carbs

Game for Kids

Which Way to Go Treating

Hypoglycemia

educational game for

kids

Timing of Rapid Insulin for Quick or Slow Meals

1. Quick acting carb e.g. White roll bread, mashed potato inject insulin before meal

2. Slow acting carb High fat &/or high protein slows up rise in BG so for meals such as pizza, pasta, (Freekeh), curry, fish & chips, Large Steak inject after eating

3. Combined foods (Slow+ Quick) carb inject during meal

How to increase consumption of low GI foods

Eat high-fiber breakfast cereals (oats, bran, barley)

Add berries, nuts, flaxseed and cinnamon to high GI cereals.

OR

GI = 60 GI = 42


GI = 85 GI = 39

Replace white bread with whole grain breads,Watermelons & pineapples with pears & cherries

OR Include 5-9 servings of

fruits and vegetables every day.

Replace white potatoes with yams or sweet potatoes. OR

Just eat smaller portion of high GI potatoes.


GI = 80 GI = 61

How to increase consumption of low GI snacks

GI = 83 GI = 14

Replace crackers, Pretzels, Chips, Doughnuts with Fruit, Nuts, Ice Cream & Chocolates

Add nuts to high GI breads and crackers.OR

Eat less refined sugars and convenience foods (soda, sweets, desserts, etc.)

Combine nuts, fruit, yogurt, dark chocolates, ice cream with commercial sweets – just watch portion sizes.

OR

GI = 57 GI = 32

How to increase consumption of low GI snacks

Promotes healthy eating Increases fiber intakeHelps control appetiteHelps control BG levelsHelps lower blood lipid levelsAssists weight lossOffers a more comprehensive approach for type 2 DMReduces risk of type 2 DM and heart disease

Low glycemic Index Diet – Advantages

Standards of Medical Care in Diabetes 2010Monitoring carbohydrate intake, whether by

carbohydrate counting, exchanges, or experienced-based estimation, remains a key strategy in achieving glycemic control.

For individuals with diabetes, use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone.

Summery

“Helping others is good, teaching them to help themselves is better.”

Thank You

George Orwell

HANA- Dietary Education DM-Final 1

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