Download Self management Tools - Community Health Association of

HEART HEALTH, DIABETES, WEIGHT
MANAGEMENT, HYPERTENSION, STROKE AND
EXERCISE MATERIALS AVAILABLE FROM
Community Health Centers of Arkansas, Inc.
: http://chcasvr2.chc-ar.org/Services/Services.htm
Self-Management Materials
Focus areas: heart health, diabetes, weight management, hypertension, stroke and
exercise. These materials were developed to provide information in a low literacy
format. They have colorful, multi-ethnic pictures with clear script. 5 of the
handouts have a teachers guide to them
Carbohydrate counting placemats:
The basis for these came from the Idaho plate method. This is where a plate is
divided into sections with each section that represents a certain food group.
The sections have been filled in with an illustration of the appropriate food.
One sector of the plate has been dedicated to the carbohydrate containing
foods. This highlighted sector has also a simple list of the carbohydrate foods
with portion sizes indicated for one serving. Each carbohydrate serving on the
placemat is roughly equal to 15 grams of carbohydrates. This provides the
patient with choice between the fruit, milk and starch groups, interchangeably.
On the backside of the placemat is information on heart healthy eating and
exercise.
The intent is for the diabetic to be able to come to the table and not only have
an example to compare his/her plate to, but to have some basic information
needed to count carbohydrates which is the basic first level of diabetes diet
control.
Introduction to Carbohydrate counting
The recommended amount of carbohydrates is 55% of calories
Example: 1800 calories
x .55 % of calories as carbohydrates
= 990 calories from carbohydrates

Each gram of carbohydrate has 4 calories
990 calories from carbohydrates
4 calories in each gram of carbohydrate
=248 grams of carbohydrates

Each serving of carbohydrate is = 15 grams:
248 grams of carbohydrates
15
grams of carbohydrates per serving:
= 16.5 servings of carbohydrate per day
subtract 1 serving from the total amount. This accounts for the carbohydrates attributed to
all of the non starchy vegetables through the day.
We now have
16.5 – 1= 15.5 servings for one day

Spread these servings into 3 meals and some snacks:
Women: approx 3-4 servings at a meal and 1-2 at a snack,
Men:
approx 5-6 servings at a meal and 1-2 for a snack
What you end up with for 1800 calories and 240 grams of carbohydrate is
something like this:
Breakfast
Total
Carbohydrate
servings:
Starch
Fruit
Milk
(4)
2
1
1
Snack Lunch Snack
(4)
3
1
(1)
1
Dinner Snack
Totals
(4)
3
1
(15)
10
3
2
(2)
1
1
The patient as long as he stays within the total carbohydrate amount, can use the
designated serving sizes interchangeably. For example, one day he wants to have
pancakes. He can choose to have 3 small pancakes and 1 glass of milk, as long as
all of his servings add up to the total carbohydrate number of servings for that
meal.
The other groups of meat, vegetables and fats are used with the following
guidelines to make up the balance of the calories:
MEATS:
Meat portions are recommended to be no more than the size of a deck of cards, or
the palm of your hand, trying to limit them to 2-3 times a day.
Cottage cheese or tuna is 1/2 – ¾ cup for a serving
Peanut butter is 2 tablespoons
VEGETABLES:
NON-STARCHY vegetables are recommended at the minimum to make up the
balance of the recommended 5 servings for fruits or vegetables a day. In the table
above, there are 3 fruit servings, therefore a minimum of 2 additional non starchy
vegetables is recommended. Encouragement to use these more freely, especially
salads: raw leafy greens, sprouts, radishes, mushrooms, cucumbers, etc., is very
beneficial and should not be limited unless there is an effect on blood sugar.
FATS:
Fats are recommended in the liquid form or one that is very soft at room
temperature Solid fats are discouraged.
A serving of fat is 5 grams. This is approximately a teaspoon of oil or margarine,
a tablespoon of diet margarine, or one tablespoon of salad dressing.
1-2 servings of fat per meal is recommended (including oil or fat used in
cooking.)
Fat free items are deceptive because in place of the fat, most of the time, starchy
fillers and additional sugars are used. Check the label for total carbohydrates, not
grams of fat.
Fats also have a beneficial effect when combined with carbohydrates, in keeping
the blood sugar lower.
LABEL READING:
Use labels to figure portion sizes based on 15 grams of carbohydrates per
serving.
If a food has 25 grams of total carbohydrate, for a serving of ½ cup, then ½ cup of
this food is nearly 2 servings of carbohydrate.
Do not direct your patients to look at “sugar” on the label, this is only a
part of the Total carbohydrates, always calculate from the total carbohydrates
amount.
Having a snack or lunch during diabetes education class can be very
instructive. Each person using their carbohydrate numbers can figure out how
much they need to serve themselves of each food. Bring the food labels of any
prepared foods you use.
Use the placemat in class, and have them look up their portions on the
mat. If you don’t have actual food, plan a sample lunch using the placemat to fill
in appropriate foods they like.
As much as you can, let them apply their knowledge in real life situations
with the labels, serving food, or handling food models to estimate portion sizes.
Because the table is abstract, practical experiences help to make it more real
before they get home and try to make sense of it.
This is diabetes diet information that nurses, pharmacists, and other health
professionals working on getting their Diabetes Educator certification (CDE)
would learn. It falls under first level management of diabetics.
ANY patients with multiple medical problems including: renal or
pulmonary insufficiency, large fluid shifts, or those whose blood sugars,
weight, hypertension, or other labs specifically related to intake are
continually abnormal, should be sent to a dietitian for further counseling.
For non-dietitians counseling on diet related matters, charting should state
that general principles of carbohydrate counting were covered.
The following is a sample of one of the teacher’s guides for the weight loss handout.
The handout is a page with 6 sections on it. See web site for actual handout.
Each sector has an illustration and the following captions:
1. How can I lose weight?
2. Eat only when you are hungry
3. Stop before you are too full
4. Eat slowly, take a minimum of 20 minutes to eat a meal
5. Always eat at the table, not in the car and not in front of the T.V.
6. Write down all you eat and drink for 3 days.
Teacher’s guide for You CAN Lose Weight (This is not a patient hand out).
Weight loss is a very difficult thing to do, especially if you are going
about it in an “unnatural” way. Eating a very limited diet, restricting or skipping
meals and ignoring hunger is counterproductive. Restrictive diets lead to
overeating. The information in this hand out is based on the idea called intuitive
eating. It emphasizes the whole concept of eating appropriately, eliminating
overeating and avoiding a “restrictive” mentality to weight management. Along
with these ideas is the fundamentally healthy eating approach, but the ideas of
“good” and “bad” foods are not stressed. Becoming aware of when you are
hungry and not overeating is a part of respecting your body and taking care of
yourself. It is the ultimate self-management. The patient needs to become aware
of his/her life practices that affect his/her weight. Much of the eating people do is
NOT related to hunger. Non-hunger related eating can be a result of stressful life
situations, boredom, anger, depression, feeling out of control, feeling isolated,
eating to reward oneself, or just plain habits of eating in certain situations like in
front of the television, or eating by the clock, instead of by your hunger cues.
1. Eating only when hungry requires a certain amount of attentiveness
and reducing distractions. Also skipping meals habitually or NOT eating when
hungry can contribute to overeating later. Having a FOOD LOG is a very
important tool to assess when and where eating is taking place.
2. Stopping before you are too full. There are 4 stages of hunger
satiation:
1. hungry
2. not hungry
3. satisfied
4. full (overly)
The patient should practice” tuning in” to these stages. Eating past satisfied can be
a habit.
3. Eat slowly. Each meal should take at least 20 minutes. Only in eating
slowly can the message of being satisfied make it from the stomach to the brain
before overeating takes place. Eating slowly also gives more time to enjoy the
food.
4. Eat while at the table, not in the car or in front of the television. Eating
at the table promotes normal weight in children as well as supports all of the
above mentioned ideas about “tuning in” to the cues for hunger and satiety. It
makes eating a more conscious act
5. Write down everything you eat or drink for 3 days. The FOOD LOG
fulfills several functions:
1. It makes the patient more aware of what he/she is eating
2. It records the times and patterns of eating
3. It gives a record of what the patient eats for further counseling aimed at
improving quality of diet.
4. It helps the patient to identify if emotions are involved in the decision to
eat.
These 5 steps of intuitive eating can be worked on one at a time. The
patient may already be doing some of them. It is important to ask the patient,” Are
there any of these steps you feel could help you in eating? What do you think you
would like to work on first?
Page 2 of the handout is important because it conveys that losing weight is
not just what you eat or when or why, but it is part of a bigger health picture.
Eating nutritiously is part of being healthy. Exercising is vital to everyone’s
health and dieting without exercising is not healthy because living without
exercising is not healthy! Exercise promotes increased metabolism and supports
muscle development which maintains the high basal metabolic rate. Trying to
lose weight is really not the goal--- learning to be healthy IS the permanent goal.
The habits we are working on are life long changes for the better. Weight loss can
be discouraging when the body is viewed as “the enemy”. Help your patient to see
their body as a tool, a friend, and a gift that he/she is in charge of. Our patients are
just like us—whole persons! So remember that weight loss is not a product, it’s a
process of learning to care for self and balance life. The goal is not pounds off,
that is the side effect of the true goal: healthy living and better self-management
in all areas of life.
OTHER MATERIALS AVAILABLE:
Eat Heart Healthy
You can lower your blood pressure
You can lose weight
Don’t gain while you are quitting
Exercise- what you need to know (1 page)
6 common signs of a stroke
All of these are in English and Spanish except 6 signs of a stroke and don’t gain
while you quit. To view all these materials see our website: http://chcasvr2.chcar.org/Services/Services.htm