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Similaire à DSMT Nutrition 2012- debi edited
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DSMT Nutrition 2012- debi edited
- 1. Life with Pre- diabetesLearn to eat with Pre-diabetes
- 2. Did You Know? Total prevalence of diabetes: Total: 29.1 million children and adults in the United States Diagnosed: 21.0 million people Undiagnosed: 8.1 million people Prediabetes: 86 million people
- 3. Objectives Participants will be able to: Stage 3 actions to prevent diabetes Describe treatment plan for pre-diabetes Describe one day’s menu for diet prescription
- 5. What is Prediabetes? o People with prediabetes have blood sugar levels that are higher than normal, but not high enough for a diagnosis of diabetes. o Without lifestyle changes to improve their health, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years.
- 6. How can Type 2 diabetes be prevented? Modest weight loss 5-7% of body weight (which is 10-14 lbs for a 200 lb person) Regular physical activity! 150 minutes each week of physical activity (ex: brisk walking) Both can help delay type 2 diabetes by 58% in people with prediabetes.
- 7. How the Body Gets Energy? Food is composed of protein, fat, carbohydrate, vitamins, minerals and water Digestive system breaks down food into more simple nutrients, one of which is glucose-needed by cells for energy Some of the glucose is stored in the liver but the majority enters the bloodstream. Glucose needs the help of insulin to enter most cells. Think of insulin as a
- 8. Role of Diet Food Raises blood glucose What, when and how much food is eaten affects how much the blood glucose goes
- 9. Reasons for Meal Planning Maintain blood glucose as close to target range as possible. Maintain cholesterol (blood fats) and blood pressure as close to target as possible. Prevent, delay, or treat diabetes-related complications. Improve health through food choices. Meet individual nutritional needs
- 11. 3 Things Directly Affecting Blood Glucose Timing of Food Intake -- Small amounts throughout the day help keep glucose levels more even. Portion Sizes -- Too much food at one time raises blood glucose Food Composition -- Some foods make your blood glucose go up higher and faster.
- 12. The Glycemic Index A ranking system that shows how a carbohydrate- containing food raises blood glucose. Foods are ranked based on how they compare to a reference food Glucose White bread
- 13. The Glycemic Index A high GI food raises blood glucose more than a medium or low GI. A low GI food will cause a small rise, while a high GI food will trigger a dramatic spike. A GI value tells you only how rapidly a particular carbohydrate turns into sugar. It doesn’t tell you how much of that carbohydrate is in a serving of a particular food.
- 17. Fiber Type of Carbohydrate Contributes no calories Food Label Insoluble vs. Soluble fiber Makes you feel full! 25 to 30 grams of fiber each day
- 18. Tips to get more fiber! Eat more whole fruit instead of fruit juice Read labels Look for the word “whole” Start your day with a bowl of high fiber cereal Snack on raw veggies Replace white bread, pasta, and rice with whole grain products
- 19. Grouping foods can make it easier to think about how different foods affect your blood glucose Currently foods are divided into 6 different groups: Starch Fruit Milk Vegetable Meat Fat
- 22. Sugar Alcohols Do not contain alcohol “Sugar free” or “No sugar added” Fewer calories than sugar Weight management Not always considered a free food!
- 23. • Products labeled as “sugar free” • Carbohydrates are still available for body to use, so they still need to be counted in your meal plan • ADA recommends half of these carbohydrates to be counted towards your meal total How many carbohydrates is in this 1 candy bar? Sugar Alcohols
- 24. Good Fats vs. Bad Fats An individual with diabetes is at a higher risk of heart disease Lower good cholesterol Increase bad cholesterol Insulin resistance
- 25. Meal Planning Approaches: Healthy Food Choices Preplanned Menus The Plate Method Basic Carbohydrate Counting The Exchange System
- 26. Healthy Food Choices 2 Main Parts: Healthy Food Choices Food Servings
- 27. Food Servings Starch Fruits Milk Nonstarchy Vegetables Meat and Meat Substitutes Fats
- 28. Preplanned Meals Month of Meals series (books available from the American Diabetes Association. Includes menus with 28 breakfasts, 28 lunches and 28 dinners.
- 29. The Plate Method Breakfast ½ plate is for starches ¼ for meat/meat substitute Can also add a piece of fruit and/or glass of milk
- 31. The Plate Method Lunch and Dinner ¼ of plate is for starches ¼ of plate for meat/meat substitute ½ for vegetables Then add a piece of fruit and/or glass of milk
- 33. Carbohydrate Counting Foods that contain carbohydrate are: starchy foods like bread, cereal, rice, and crackers fruit and juice milk and yogurt dried beans like pinto beans and soy products like veggie burgers starchy vegetables like potatoes and corn sweets and snack foods like sodas, juice drinks, cake, cookies, candy, and chips Non-starchy vegetables have a little bit of carbohydrate but in general are very low (Examples include green beans, carrots, tomato, broccoli, onions).
- 34. One carbohydrate serving has approximately 15 grams of carbohydrate = 15
- 36. How Much Carbohydrate??? The amount of carbohydrate that is desired at meals/each day is determined by factors such as calorie needs, food preferences, blood glucose readings and triglyceride levels. The average number of carbohydrate servings per meal is between 3-5
- 37. Examples of Carbohydrate Servings: Fruits Small piece of fruit 1/3-1/2 cup of juice 2 tbsp of dried fruits Milk 8 ounces of milk 6-8 ounces of yogurt Sweets, Desserts and Other Carbs 1 1/4” square brownie, unfrosted 3 tbsp BBQ sauce or sweet & sour sauce Starches 1/2 cup cooked cereal, grain, or starchy vegetable 1/3 cup rice or pasta 1 oz of bread ¾-1 oz of most snack foods
- 38. Non-starchy Vegetables Green beans Cabbage Broccoli Tomatoes 5 grams of carbohydrate per ½ cup cooked or 1 cup raw.
- 39. Meat and Fat Do not count as carbohydrate choices as they do not tend to be high in carbohydrate.
- 40. Exchange System Food/Exchange Groups: Starch Fruit Milk Vegetable Meat Fat
- 50. Let’s Practice!
Notes de l'éditeur
- Just 7% of people with prediabetes are aware of their condition 79 million Americans-35% of adults aged 20 years and older- have prediabetes Half of all Americans aged 65 years and older have prediabetes I would like to begin by showing you some interesting statistics. As you can see by the numbers, you are not alone by any means. Sometimes it is helpful to know that. Some of these statistics reflect the seriousness of this condition. I prefer to focus on the positive. That includes the fact that it can be managed. Diet is considered the cornerstone of treatment. Today I am going to be sharing information with you to help to better understand how you can control your diabetes. Lastly, I would just like to point out that diabetes does not define you. It is a condition that affects your life. It is one aspect of your life but not who you are as a person.
- Yet the vast majority of people with prediabetes do not know they have the condition Prediabetes is a serious health condition that increases the risk of developing type 2 diabetes, heart disease, and stroke. Adults with diabetes have heart disease rates 2-4 times higher than adults without diabetes The risk for stroke is 2 to 4 times higher among people with diabetes It is the leading cause of new cases of blindness and kidney failure
- Lifestyle programs offered through the National Diabetes Prevention Program, which is led by the CDC, can help participants adopt the healthy habits needed to prevent type 2 diabetes. Trained lifestyle coaches lead classes to help participants improve their food choices, increase physical activity, and learn coping skills to maintain weight loss and healthy lifestyle choices.
- If insulin is not available or effective, the glucose cannot enter the cells. If glucose cannot enter the cells, it builds up in the blood, causing hyperglycemia.
- The more you know about what is in food, the better you’ll understand how it affects your blood glucose. Each person’s response to foods varies. Blood glucose monitoring helps to learn about those individual responses. Learning to balance food intake, diabetes medications and activity help keep blood glucose levels in your target range. Some people with diabetes may be able to keep their blood glucose in the target range with meal planning alone. However, meal planning is the cornerstone of treatment for diabetes even when oral medicines, injectables or insulin are taken.
- The closer to normal blood glucose levels can be safely kept, the lower the risk for complications from diabetes. People with diabetes have a greater risk of developing heart and blood vessel diseases. Calories are needed for maintaining a reasonable weight, normal growth and development, pregnancy and lactation and energy to do all the things you need to do. Weight loss in an overweight person with diabetes may help reduce blood glucose, blood fats and blood pressure. Losing 10-20# or 5-10% of body weight can help significantly. A reasonable weight goal is one that you choose, you can achieve and maintain and you can stick with over time.
- Healthy Food Choices gives 8 guidelines: Eat a variety of foods, avoid skipping meals, eat healthy carbohydrates, watch serving sizes, eat less fat, be at a healthy weight, be physically active and choose a healthy lifestyle. One idea under eat healthy carbohydrates is to avoid regular soft drinks. One can has 9 teaspoons of sugar and 150-200 calories. Are there changes you can make to eat healthier carbohydrates? Some ideas include eating fewer sweets and using sugar free soft drinks/powdered drinks, sparkling water, club soda, sugar free iced tea a slice of lemon in plain water. Under eat less fat, strategies you might use include choosing lower fat and very lean meats. Use healthy cooking methods such as baking, broiling, stewing or braising. Under being physically active it is important to note that the recommendation for people with diabetes is 30 minutes of moderate aerobic exercise 5 times per week or 20 minutes of vigorous activity 3 times a week. One approach may be the 10,000 Steps Program (= to 5 miles)
- The more you eat at one time, the more insulin you need. Small meals throughout the day help keep glucose levels more even. Try to eat at least three meals a day. Skipping a meal after taking insulin or some diabetes medications greatly increases the risk of low blood sugars. It may also mean that you overeat later, which makes it harder to manage both blood glucose and weight. Also, important to note that most diabetes medications work better to lower blood glucose if you take them at about the same time each day. Too much food at one time raises blood glucose. Too much total food increases body weight. If your blood glucose is high after some meals or if your weight is going up, eating less may help. Some ways to eat less are: eating only one serving, using a small plate instead of a large plate and eating more slowly so you are the last one finished, put your fork down between each bite, serve plates in the kitchen instead of putting serving dishes on the table.
- You need to know both things to understand a food’s effect on blood sugar.
- A high GI food raises blood glucose more than a medium or low GI. 55 or below- low 70 or higher- high
- Your body needs many types of nutrients to be healthy. Knowing about the different nutrients in foods can help you predict what different foods will do to your blood glucose. Nutrients in food are carbohydrate, protein, fat, vitamins, minerals and water. Only carbohydrate directly affect blood glucose. As much as 100% of the carbohydrate you eat may be changed into glucose in your body. There are 3 main types of carbohydrates. Carbohydrates are sugars, starch and fiber. Sugar: You may also hear sugar referred to as simple or fast-acting carbohydrate. There are two main types of sugar: naturally occurring sugars such as those in milk or fruit and added sugars such as those added during processing such as fruit canned in heavy syrup or sugar added to make a cookie. Starch (also known as complex carbohydrates) Starch is a chain of sugar molecules Fiber is the indigestible part of plant foods, including fruits, vegetables, whole grains, nuts, and legumes. . Carbohydrate is the body’s preferred energy source. Protein builds and repairs muscles and every cell in the body. Fats are essential nutrients which supply us with calories. They help us to maintain healthy skin and help us to utilize the fat-soluble vitamins A, D, E and K. Fat helps with satiety. Healthy fats can actually help lower our cholesterol. Fat also slows down digestion and can slow down how fast carbohydrates raise the blood glucose. It is important to note that fat is high in calories. Eating too much of any kind of food can give your body more carbohydrate, protein, fat and calories than it needs.
- Fiber is the indigestible part of plant foods, including fruits, vegetables, whole grains, nuts and legumes. When you consume dietary fiber, most of it passes through the intestines and is not digested. Not broken down by human body it contributes no calories Insoluble fiber keeps your digestive tract working well. These typically do not dissolve in water and speed up digestion. They have a laxative effect and add bulk to your diet which helps prevent constipation. Whole wheat bran is an example of this type of fiber. whole wheat, whole grains, wheat bran, corn bran, seeds, nuts, barley, couscous, brown rice, bulgur, zucchini, celery, broccoli, cabbage, onions, tomatoes, carrots, cucumbers, green beans, dark leafy vegetables, raisins, grapes, fruit, and root vegetable skins. Soluble fiber can help lower your cholesterol level and improve blood glucose control if eaten in large amounts. These delay the digestion and help you feel full longer, which helps control weight. Oatmeal is an example of this type of fiber. oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, and carrots. Another benefit of fiber is that it adds bulk to help make you feel full. Most Americans do not consume nearly enough fiber in their diet, so while it is wise to aim for this goal, any increase in fiber in your diet can be beneficial. Most of us only get about half of what is recommended. In general, an excellent source of fiber contains five grams or more per serving, while a good source of fiber contains 2.5 - 4.9 grams per serving.
- Eat more whole fruit instead of fruit juice. Read labels. Look for the word "whole” before any grains on the ingredient list and check the number of grams of dietary fiber on the nutrition facts panel of packages to select high-fiber foods. Start your day with a bowl of bran or other high-fiber cereal that contains at least five grams of fiber per serving. Snack on raw vegetables. Add legumes, seeds, and nuts into soups, salads, and stews. Replace refined white bread, pasta, and rice with whole-grain products.
- cookies, puddings, candies and chewing gum that is labeled as "sugar-free" or "no sugar added." Sugar alcohols provide fewer calories than sugar Many of the food products containing these types of sweeteners still have a significant amount of carbohydrate, calories and fat, so never consider them a "free food" without checking the label. GI problems Some people prefer to use the regular version of a food and cut back on the serving size instead of buying the sugar-free version.
- If you are carbohydrate counting, the food label can provide you with the information you need for meal planning. Look at the grams of total carbohydrate, rather than the grams of sugar. Total carbohydrate on the label includes sugar, complex carbohydrate, and fiber. If you look only at the sugar number, you may end up excluding nutritious foods such as fruits and milks thinking they are too high in sugar. You might also overeat foods such as cereals and grains that have no natural or added sugar, but do contain a lot of carbohydrate. Fiber is part of plant foods that is not digested – or for some types, only partially digested. Dried beans such as kidney or pinto beans, fruits, vegetables and grains are all good sources of fiber. The recommendation is to eat 25-30 grams of fiber per day. People with diabetes need the same amount of fiber as everyone else for good health. If a food has 5 grams or more fiber in a serving, subtract the fiber grams from the total grams of carbohydrate for a more accurate estimate of the carbohydrate content.
- Lower risk of Heart disease- To eat less saturated and trans fat Eat more mono and poly This lipoprotein pattern is associated with insulin rsistance and is present eve Diabetes tends to lower "good" cholesterol levels and raise triglyceride and "bad" cholesterol levels, which increases the risk for heart disease and stroke. n before the onset of diabetes.
- There are different ways to plan meals for diabetes. Different plans work for different people. You may use different approaches over time or in different situations. I am presenting 5 different approaches. Think about which approach might work for you. There is no one diet or meal plan that works for everyone with diabetes. The important thing is to follow a meal plan that is tailored to personal preferences and lifestyle and helps achieve goals for blood glucose, cholesterol and triglycerides levels, blood pressure, and weight management.
- Healthy Food Choices is a guide for simplifying meal planning. It has 2 main parts: “Healthy Food Choices” and “Food Servings”.
- The Food Servings section helps you to plan meals using foods from 6 different food groups and 2 specialy groups. The 6 food groups are starch, fruits, milk, non-starchy vegetables, meat and meat substitutes and fats. The specialty sections are “other foods” and “free foods”. The “other” foods section shows how to count combination foods which include more than one food group in a single serving. The “free foods” lists foods which have less than 20 calories per serving. Remember that even low calorie foods can add up to weight gain if you eat too much of them.
- Using preplanned menus is another way to plan your meals. An example is the Month of Meals series. It includes menus with 28 breakfasts, 28 lunches and 28 dinner menus each. The pages are divided so that each breakfast can go with any lunch and dinner. The three meals plus a planned snack provide 1,500 calories. It also includes information on how to increase or decrease the calorie level to match your needs. Simple recipes are printed with the menus. Most recipes make one to four servings.
- The plate method is yet another way in which to plan your meals and manage carbohydrates with no measuring. The plate is divided into fourths. At breakfast ½ is for starches and ¼ for meat/meat substitute. No vegetables are eaten and protein is optional so the entire plate is not used.
- At lunch and dinner, ¼ of the plate is used for starches, ¼ for meat or meat substitute, and ½ of the plate should be non-starchy vegetables. Keep in mind that this method does not account for fat. You can also add a piece of fruit and/or glass of milk. Keep in mind that this method does not account for fat. You can also add a piece of fruit and/or glass of milk.
- Carbohydrate counting is another approach to meal planning. As you remember, carbohydrate affects blood glucose more than any other nutrient.
- If you are carbohydrate counting, the food label can provide you with the information you need for meal planning. Look at the grams of total carbohydrate, rather than the grams of sugar. Total carbohydrate on the label includes sugar, complex carbohydrate, and fiber. If you look only at the sugar number, you may end up excluding nutritious foods such as fruits and milks thinking they are too high in sugar. You might also overeat foods such as cereals and grains that have no natural or added sugar, but do contain a lot of carbohydrate. Fiber is part of plant foods that is not digested – or for some types, only partially digested. Dried beans such as kidney or pinto beans, fruits, vegetables and grains are all good sources of fiber. The recommendation is to eat 25-30 grams of fiber per day. People with diabetes need the same amount of fiber as everyone else for good health. If a food has 5 grams or more fiber in a serving, subtract half the fiber grams from the total grams of carbohydrate for a more accurate estimate of the carbohydrate content.
- I have come up with a meal plan for each person which has the total carbohydrate recommended at meals and snacks, if desired. (Pass out meal plans). For example, if you have listed 3 servings from carbohydrate foods at meals that would be 45 grams as a goal for carbohydrates at meals.
- Non-starchy vegetables do not generally have a big effect on a patient’s blood sugar level. A generous amount of these non-starchy vegetables may help the patient to feel more satisfied. Low in carbohydrate & rich in nutrients – therefore we do not restrict these foods. Non-starchy vegetables include the following: green beans, cabbage, broccoli and tomatoes. They only have 5 grams of carbohydrate per serving: 1/2 cup cooked or 1 cup raw vegetable. They do not count as a carbohydrate choices. A patient may request an extra serving of a non-starchy vegetable, such as a side salad, since non-starch vegetables do not have a big effect on a patient’s blood sugar. They are low in carbohydrate and calories but rich in other nutrients.
- No carbohydrate content unless coated in flour or cornmeal – recommend low fat selections (this includes cheeses and eggs) Meats are not a source of carbohydrate unless carbohydrate is added such as flour or cracker crumbs on chicken or cornmeal on fish, etc. some meat choices can be high in fat (specifically the bad kind) and we should try to stick to healthy portions of lean meats. They do contain calories and are a source of energy for the body: 4 calories per gram of protein and 9 calories per gram of fat. Sources of Meat: beef, chicken, pork, fish, eggs, cheese Sources of Fat: margarine, mayonnaise, salad dressing, bacon Fat also does not contain carbohydrate, but high fat foods might get in the way of other goals like weight loss or cholesterol control. Meats are not a source of carbohydrate unless carbohydrate is added such as flour or cracker crumbs on chicken or cornmeal on fish, etc. some meat choices can be high in fat (specifically the bad kind) and we should try to stick to healthy portions of lean meats for our patients who have diabetes. They do contain calories and are a source of energy for the body: 4 calories per gram of protein and 9 calories per gram of fat. Sources of Meat: beef, chicken, pork, fish, eggs, cheese Sources of Fat: margarine, mayonnaise, salad dressing, bacon Fat also does not contain carbohydrate, but high fat foods might get in the way of other goals like weight loss or cholesterol control. Help your patients to choose wisely from fat selections (e.g. salad dressings, margarine, mayonnaise) but also to try to select low fat carbohydrate choices like – what? Low fat milk, whole wheat toast versus biscuits, a baked potato versus french fries or chips. A patient can not swap them for carbohydrate choices: 1) The patient may want to have bacon at breakfast, so they ask you to leave off the toast. 2) The patient may ask for an extra piece of meat in place of the rice at dinner. Are these acceptable swaps? These are not equal trades and do not allow for consistency in carbohydrate intake per meal.
- The Exchange system is another meal planning method. Using this method can help provide a balanced diet with a variety of foods needed for health and calories for weight management. It can also help lower cholesterol. You can think of this meal plan as a food budget and you have a certain number of food choices to “spend” at meals. The food groups are listed so that all of the carbohydrate-containing groups are together. “Exchange” means that any food in one group can be exchanged for any other food in the same group. The meal plan includes the number of choices or exchanges from each food group and the meal or snack for which they are planned.