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WHAT DO I EAT NOW? Nita Purcell, MS, RD, LD, CDE What is Diabetes Diabetes Mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both Types of Diabetes Type 1 Develops at any age, but most cases are diagnosed before the age of 30 Pancreas make little insulin or no insulin People with type 1 depend on insulin injection to sustain life. Type 2 diabetes Usually diagnosed after the age of 30, but it is can occur at any age Currently accounts for 30% to 50% of childhood onset diabetes Frequently asymptomatic at the time of diagnosis Pancreas make some insulin, but the amount is not adequate or the insulin is not effective (insulin resistance) Gestational Diabetes Develops in pregnant women or is first recognized during pregnancy Usually resolves after delivery Increases the risk of developing type diabetes after the age of 40 Factors Contributing to the Development of Diabetes Exact cause of diabetes is unknown Heredity is a factor in both types of diabetes, but is more often associated with type 2 Being overweight Injury to the pancreas Certain medications Ethnic background Long Term Complications Heart Diseases Cardiovascular disease is two to four times more common in people with diabetes Cardiovascular disease is present in 75% of diabetes related deaths Stroke - The risk of stroke is 25 times higher in people with diabetes Complications High Blood Pressure affects 60% to 65% of people with diabetes Blindness diabetes is the leading cause of new cases of blindness among adults and accounts for 12% of the legal blindness in the US. Diabetic retinopathy is often detectable within 5 years of diagnosis of diabetes Complications Kidney Disease – Diabetes is the most common cause of end stage renal disease (ESRD) Nerve Disease – 60%-70% of people with diabetes have mild to severe forms of diabetic nerve damage Manifestations are impaired sensation in the feet or hands, delayed stomach empting and/or carpal tunnel syndrome Complications Amputation – Diabetic neuropathy is the major contributing factor in lower extremity amputation Result of amputation is poor quality of life, possible second amputation and low survival rate. Study Findings DCCT Study for type 1 Diabetes UKPDS Study for type 2 Diabetes Both studies overwhelmingly resulted in reduced complication with tight control of blood glucose levels How Do We Control Diabetes What is eaten Physical Any Activity Medications Taken for Diabetes Medications Patient needs to understand that medications for diabetes are not a ‘stand alone’ solution Exercise is a part of the over all treatment plan and needs to be incorporated into a daily/weekly routine So, what do I eat now? At least 5 fruit and vegetables daily 6 or more serving daily of grain products including whole grains 6 to 8 ounces of lean meats/protein 2/3 serving daily of low fat dairy products Low saturated fat oils including salad dressing and spreads. People with Diabetes Are Given Many Messages Don’t eat sugar Cut back on fat Eat three meals, no snacks Lose Weight Eat high protein, low carbohydrate Keep food and blood glucose records Emphasis blood glucose, not weight Count carbs Eat high fiber foods Increase Physical activity Eat snacks Sweets are ok No white foods The Place of Carbohydrates The brain requires glucose easily made from carbohydrates Inexpensive food energy source High in fiber, vitamins and minerals Add variety of our meals Most people like foods that are carbohydrates Meal Planning choices There is no longer one ‘ADA Diet’ Several methods to teach meal planning Food Guide Pyramid Healthy Plate Method Portion Control Carbhydrate counting Why Carbohydrate Counting Carbohydrates or carbs affect the blood glucose level more than protein or fat. Counting the carbs help manage blood glucose levels. Counting carb offers more variety in the foods eaten Most people like carbs Carb counting About ½ daily calories come form carbohydrates 1600 calorie plan then 800 calories from carb 800 divided by 4 =200 gm. daily 200 divided by 15 = 13 choices daily Balance the carbs through the day Carb Counting With in the limits of total carbs per day individual may eat a variety of carbohydrate rich foods. Use carbohydrate counting books Food labels Food Labels All packaged foods have a Nutrition Facts label. The label lists a serving size and the number of grams of carbohydrate per serving. Using the knowledge of total number of carbs per meal or the number of choices per meal a person is guided to the correct amount of carbohydrate to eat Portion Control Similar to the Plate Method Non starchy vegetables are unlimited Serving size of Meat is about the size of a woman’s palm of the hand Fruit about the size of a tennis ball 1 cup serving is the size of a fist – Fats and spreads - a teaspoon or the tip of the index finger Plate Method The plate method is a concept that encourages the individual to have ¼ the plate meat or protein, ¼ of the plate starch and ½ the plate vegetable plus a fruit and milk or bread added to the meal. This is a very simple method of thinking about how much to eat and is very suitable for those with limited resources. Food Guide Pyramid Restates the information we have discussed in a picture form Wide variety of foods Everything fits in moderation How Do You know what to suggest? Judgment Know Watch Blood call your patient for clues Glucose control is the result. Thank You
