Transcript Diet and Health Guidelines to Lower Risk of Diabetes

Diet and Health Guidelines to Lower
Risk of Diabetes
Presented by
Janice Hermann, PhD, RD/LD
OCES Adult and Older Adult Nutrition Specialist
Carbohydrates
 Body breaks down carbohydrates (complex
and simple) into monosaccharides
 Maltose = glucose + glucose
 Surcrose = glucose + fructose
 Lactose = glucose + galactose
 Fructose and galactose converted in the body
to glucose
 Glucose is form body uses for energy
Blood Glucose Regulation
 Blood glucose level must be closely regulated
 Hormones control blood glucose levels:
 Insulin
 Glucagon
Blood Glucose Regulation
 When blood glucose levels are high
 Pancreatic beta cells release insulin which helps
glucose enter body cells so glucose can be:
 Used for energy
 Stored as glycogen in liver
 Converted into triglycerides for storage
When blood glucose levels low
 Pancreatic alpha cells release glucagon:
 Signals liver to release glucose from liver glycogen
Blood Glucose Regulation: Insulin
Figure 4.8a
Blood Glucose Regulation: Glucagon
Figure 4.8b
Blood Glucose
Regulation
What Is Diabetes
 Diabetes is a condition that results in high
blood glucose levels
 When someone has diabetes the body:
 Makes little or no insulin,
 Doesn’t use insulin properly, or
 Both
 As a result, body cells don’t get energy they
need, and blood glucose levels stay high
Diabetes Symptoms
 Symptoms are caused by high blood glucose,
may include:
 Frequent urination
 Increased hunger
 Increased thirst
 Blurred vision
 Feeling tired
 Irritability
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Types of Diabetes
 Pre diabetes
 Type 1 (5-10%)
 Body doesn’t make insulin
 Must take insulin
 Develops rapidly
 Type 2 (90-95%)
 Body doesn’t make enough insulin, or the body
doesn’t respond to insulin
 Weight control may help
 May still need medication
 Develops slowly
 Gestational
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Types of Diabetes
 Pre Diabetes
 Overweight increases risk of developing type 2
diabetes by decreasing body's ability to use insulin
 Insulin resistance
 Body produces insulin; however, body cells resist action of
insulin
 Blood glucose levels begin to increase
 Impaired glucose tolerance and/or impaired fasting glucose
Types of Diabetes
 Pre Diabetes
 At first, body responds to insulin resistance by
having beta cells produce more insulin to keep
blood glucose levels down
 Can lead to high blood insulin levels
 Body may be able to keep blood glucose levels down by
producing extra insulin for several years
 Eventually beta cells begin to wear out and
produce less insulin, which can potentially lead to
development of type 2 diabetes
Types of Diabetes
 Pre Diabetes
 Where extra weight is carried is a factor in
insulin resistance
 Upper body fat cells are more likely to be large insulin
resistant fat cells
 Lower body fat cells are more likely to be smaller and
respond normally to insulin
Types of Diabetes
 Type 1 (5-10%)
 Autoimmune disorder: defect in which immune
cells attack and destroy the insulin producing
pancreatic beta cells
 Symptoms
 High blood glucose
 Increased urination
 Increased thirst
 Weight loss
 Dehydration
 Feeling tired
 Irritability
Types of Diabetes
 Type 2 (90-95%)
 Usually develops after 40 years of age as the
pancreatic beta cells progressively lose function
with age
 Most people with type 2 diabetes are overweight
 However, type 2 diabetes is also being seen in
overweight children
 Closely related to overweight and inactivity
 Estimates are 30 to 50 percent of people with
type 2 diabetes are undiagnosed
Types of Diabetes
 Gestational Diabetes
 Glucose intolerance that develops during
pregnancy (usually 2-3 trimester)
 7% of all pregnancies
 Insulin antagonist hormone levels increase and
insulin resistance occurs
 Blood glucose control usually returns to normal
after delivery
Diabetic Complications
 High blood glucose can damage:
 Nerves, eyes, kidneys, heart, and blood vessels
 This damage can lead to:
 Blindness, high blood pressure, heart disease,
kidney disease, and amputations
 Keeping blood glucose in control can stop or
prevent development of diabetic
complications
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Screening Recommended
 People with impaired glucose tolerance and/or
impaired fasting glucose
 People over age 45
 People with a family history of diabetes
 People who are overweight
 People who do not exercise regularly
 People with low HDL cholesterol or high
triglycerides, high blood pressure
 Certain racial/ethnic groups (Non-Hispanic Blacks,
Hispanic/Latino Americans, Asian Americans, Pacific
Islanders, and American Indians and Alaska Natives)
 Women who had gestational diabetes, or who have
had a baby weighing 9 pounds or more at birth
Screening Recommended
 Children and Adolescents should be screen if
overweight or at-risk-for-overweight and if
have two of the following risk factors:
 Family history of diabetes
 Low HDL cholesterol or high triglycerides, high
blood pressure
 Certain racial and ethnic groups (e.g., NonHispanic Blacks, Hispanic/Latino Americans,
Asian Americans and Pacific Islanders, and
American Indians and Alaska Natives)
 Signs of insulin resistance (acanthosis nigricans –
gray/brown skin pigmentation)
Preventing Diabetes
 Type 1 Diabetes
 No nutritional recommendations can be made for
prevention of type 1 diabetes
 Research is investigating if breast feeding over
bottle feeding may be beneficial
Preventing Diabetes
 Type 2 Diabetes
 Weight management (diet and physical activity)
 Diabetes Prevention Program (oral medication vs
lifestyle intervention)
 31% decrease in progression to diabetes in medication
group
 58% decrease in progression to diabetes in lifestyle
group


Modest weight loss (5-10%)
Modest physical activity (30 minutes daily)
Diabetes Treatment
 Goals of diabetes treatment are to achieve:
 Control blood glucose
 Control blood lipids
 Control blood pressure
 Prevent or delay large and small blood vessel and
nerve damage
 Diabetes Control and Complications Trials have
shown controlling blood glucose is effective in
preventing or delaying diabetic complications
Diabetes Treatment
 The goal of diabetes treatment is to keep
blood glucose in control through:
Diabetic Meal
Plan
Physical Activity
Medication
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Diabetes Health Care Team
 People with diabetes should receive medical
care from a physician-coordinated team. Such
teams may include, but are not limited to:
Physician
Nurse
Dietitian
Pharmacist
Diabetes Educator
Exercise Physiologist
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Mental Health Professional
Ophthalmologist/Optometrist
Podiatrist
Dentist
Dermatologist
Diabetes Health Care Team
 Most important person on a diabetes health
care team is the person with diabetes
 A lot of diabetes care is self-care. The person
with diabetes is the one who knows:
 How feels
 If following meal plan
 If physically active
 If taking medication
 If testing blood glucose and
 If problems start to occur
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Standards of Care
 Taking care of diabetes will allow people with
diabetes to enjoy life with few complications
 The American Diabetes Association provides
standards of care for people with diabetes
 For detailed information on standards of
diabetes care contact local American Diabetes
Association at www.diabetes.org
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Standards of Care
 After being diagnosed with diabetes, people
with diabetes should work with their
physician and health-care team to make a
diabetes care plan
 A diabetes care plan needs to be
individualized to fit the person’s lifestyle
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Standards of Care
 A diabetes care plan should be individualized
and include information on:
Visiting your doctor
Management goals
Medications
Diabetic meal plan
Physical activity
Glucose testing
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Eye care
Foot care
Dental care
Other professionals
Sick day plan
Stress management
Standards of Care
 Visiting doctor
 Every 3- 6 months




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Review blood glucose records
A1c
Blood pressure
Weight
Foot check
Blood Glucose Goals
Normal
Fasting or before meals <100 mg/dl
2 Hr Post Meal
<140 mg/dl
HbA1c
<6%
*varies
Goal*
70-130 mg/dl
<180 mg/dl
<7%
Standards of Care
 Visiting doctor
 Every year
 Total cholesterol, LDL cholesterol, HDL cholesterol,
triglycerides
 Kidneys (urine analysis for protein in urine)
 Dilated eye exam
 Review meal plan
 Flu shot
 Update with diabetes educator
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Blood Lipid and Blood Pressure Goals
Lipids
Cholesterol
LDL Cholesterol
HDL Cholesterol
Triglycerides
< 200 mg/dl
< 100 mg/dl
> 40 mg/dl (men) > 50 mg/dl (women)
< 150 mg/dl
Blood Pressure
Systolic
<130 mm Hg
Diastolic
< 80 mm Hg
Standards of Care
 Diabetes management goals
 Both short and long-term goals
 Diabetes management goals are individualized
depending on diabetes control and other health
conditions
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Standards of Care
 If need medications, education needed to:
 Learn how to use them
 How they work with diet and physical activity
 What to do if blood glucose goes too high or low
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Medication
 Insulin
 Oral mediations
 Taking medication does not replace healthful
habits, still need to follow diabetic meal plan
and participate in physical activity
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Standards of Care
 A diabetic meal plan individualized to fit
person’s lifestyle, diabetes, and other health
conditions - education is needed to:
 Know how the diet works with medication and
physical activity
 How to follow the diabetic meal plan at home,
at work, and when eating out
 Know whether alcohol fits into the meal plan
 What to eat when sick, on how being sick affects
blood glucose
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Diabetic Meal Plan
 A diabetic meal plan focuses on providing a
healthy diet that:
 Controls blood glucose and
 Prevents diabetic complications
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Diabetic Meal Plan
 There is no one specific diabetic meal plan, a
diabetic meal plan is developed to meet your
own special needs:
 Individual food likes
 Daily schedule
 Medications used
 Other health issues:
 Glucose control
 Weight
 Blood lipids
 Blood pressure
Diabetic Meal Plan
 A healthy diet includes a variety of foods from
all the food groups. In general, a diabetic
meal plan is:
 Low in fat
 Moderate in protein
 Highs in complex carbohydrates like beans,
vegetables and grains (such as breads, cereals,
noodles, and rice)
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Consistency
 A diabetic meal plan provides a consistent
amount of carbohydrate from day to day,
spaced evenly throughout the day to prevent
wide changes in blood glucose
 Some methods used to provide the
consistency of a diabetic meal plan are:
 Plate method
 Diabetic pyramid
 Diabetic exchange system
 Carbohydrate counting
Consistency
 Eating too much carbohydrate at one time
can raise blood glucose too high.
 Eating too little carbohydrate can lead to
hypoglycemia, especially for people taking
oral diabetic medication or insulin.
Consistency
 To be consistent, it's best to:
 Eat about the same number of calories each day
 Eat meals and snacks about the same time each day
 Spread meals and snacks throughout the day
 Never skip meals
 Watch portion sizes
Individual Considerations
 Weight loss
 Carbohydrate
 Alcohol
 Fat
 Sodium
 Protein
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Weight Loss
 For many people with type 2 diabetes losing
weight is a big part of diabetes treatment
 Losing weight can help body cells use insulin
better
 For people who are trying to lose weight their
diabetic meal plan will be moderately lower in
calories and fat to help with weight loss
 Losing weight and lowering fat intake can also
help lower blood cholesterol and blood
pressure
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Weight Loss
 The best way to lose weight is to:
 Follow a healthy eating plan, moderately lower
in calories (about 500 calories less per day) and
 Increase physical activity (60 minutes per day)
 Healthy weight loss is slow
 Maximum recommended weight loss is 1 to 2
pound per week
 Many times, just a 10% weight loss can
bring blood glucose into control for people
with type 2 diabetes
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Carbohydrate
 Dietary carbohydrates include:
 Simple Sugars
 Complex Carbohydrates
 Grains, Fruits, Milk and Vegetables
 Fiber
 During digestion all carbohydrates except
fiber break down into simple sugars
Carbohydrate
 In the past, people with diabetes were told to
avoid sugar
 Now known that complex carbohydrates and
sugars have a similar effect on blood glucose levels
 The total amount of carbohydrate is the issue,
not just sugar
 People with diabetes can have sugar, but the
carbohydrate from foods containing sugar
must be worked into the meal plan
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Carbohydrates
 There are some problems with foods high in
sugar
 Foods high in sugar often don't provide other
important nutrients needed every day
 Foods high in sugar are also often high in fat
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Glycemic Index
 Glycemic index is the blood glucose response
to a food, this varies based on:
 Amount of carbohydrate
 Nature of the starch
 Cooking and processing
 Food form and particle size
 Severity of glucose intolerance
 Fasting and pre-meal glucose concentration
Glycemic Index
 However, although different carbohydrates
have different glycemic responses (glycemic
index), there is limited long-term benefits of
low glycemic index diets on blood glucose
control (A1c).
 Therefore there is insufficient evidence to
recommend low glycemic index diets as a
strategy in diabetes meal planning.
Artificial Sweeteners
 The American Diabetes Association considers
FDA approved artificial sweeteners safe in
moderation
 Although artificial sweeteners do not provide
significant calories, foods containing them
may not always be lower in calories than
similar products that contain sugars.
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Sugar Alcohol
 Sugar alcohols, are a group of low calorie,
carbohydrate based sweeteners. They provide
the taste and texture of sugar with about half
the calories
 Since sugar alcohols are only partially
absorbed by the body they provide fewer
calories than sugar
 In large amounts sugar alcohols can cause
gastrointestinal problems, such as diarrhea.
Sugar Alcohols
 Some common sugar alcohols include:
 Erythritol
 Hydrogenated Starch Hydrolysates (Polyglycitol
and Polyglucitol)
 Isomalt
 Lactitol
 Maltitol
 Mannitol
 Sorbitol
 Xylitol
Fiber
 Dietary fiber has many important health
benefits
 Soluble fiber delays glucose absorption and
has been promoted to help with blood
glucose control
Fiber
 Early short-term studies using > 30 g
fiber/day suggested a positive effect of fiber
on glucose control
 However, later studies have shown larger
amounts of fiber, approximately 50 g/day, are
necessary to have beneficial effects on blood
glucose and cholesterol
 It is unlikely people could maintain a fiber
intake of 50 g/day
Fiber
 Therefore, there is no reason to recommend
people with diabetes consume greater
amounts of fiber than the general public
 The Adequate Intake for dietary fiber is 14
grams dietary fiber per 1,000 calories
 Equal to 28 grams fiber for a typical 2,000 calorie
diet
 Guidelines for increasing dietary fiber are:
 Go gradually
 Drink plenty of water
Alcohol
 Most people in good diabetes control can
safely have a drink with a meal every so often
 Alcohol can cause low blood glucose,
especially for people using medication
 It is important to test blood glucose level,
before, during and after drinking
 Never drink an alcohol beverage on an empty
stomach
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Alcohol and Hypoglycemia
 Diabetic medications increase the risk of
alcohol related hypoglycemia because these
work to remove glucose from the blood
 Normally when blood glucose start to fall,
the liver releases glucose into the blood to
keep the blood glucose from going too low
 When alcohol is consumed, the liver works
to clear the alcohol and doesn’t release
glucose into the blood
 As a result, if blood glucose is falling one can
quickly go into hypoglycemia
Alcohol and Hypoglycemia
 Alcohol after hard physical activity increases
the risk of hypoglycemia:
 Physical activity helps to lower blood glucose
 After physical activity the body replaces muscle
glucose with glucose from the blood
 This can cause blood glucose levels to start
falling. If the liver doesn’t release glucose
hypoglycemia can occur
Alcohol and Hypoglycemia
 Glucagon shots are used to treat sever
hypoglycemia caused by too much insulin,
they will not help sever hypoglycemia caused
by alcohol.
 Glucagon works by causing the liver to
release more glucose into the blood. But the
liver will not release more glucose into the
blood while clearing alcohol.
Alcohol Not Recommended
 Alcohol is not recommended:
 If blood glucose is not in control.
 If trying to lose weight.
 If have diabetic nerve damage.
 Alcohol can increase symptoms of nerve damage.
 If have high blood pressure
 Alcohol can raise blood pressure.
 If have high triglycerides
 Alcohol promotes the liver to make more triglycerides.
Guidelines for Alcohol
 Never drink on an empty stomach
 Limit to 1 drink/day for women and 2
drinks/day for men
 Test blood glucose before having a drink
and following to watch for falling blood
glucose
 Test blood glucose before going to sleep to
see if a snack is needed to avoid going into
hypoglycemia while sleeping
Guidelines for Alcohol
 Wear a medical diabetes identification
bracelet
 Symptoms of hypoglycemia include slurred speech
and confusion
 These symptoms are similar to symptoms of too
much alcohol
Fat
 Increased risk of high blood cholesterol,
triglycerides and heart disease is a diabetes
complication
 If a person is at risk for high blood cholesterol
their diabetic meal plan may be modified to
be low in fat, saturated fat and trans fat
 Weight loss also helps lower blood cholesterol
and triglycerides for people who are over
weight
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Fat
 For all persons; recommended total fat,
saturated fat, and cholesterol intakes are:
 Total fat – Between 20 to 35 percent of calories
 Saturated fat - Less than 10 percent of calories
 Cholesterol - Less than 300 milligrams per day
 Trans fatty acid intake should be as low as
possible
Fat
 If LDL cholesterol is > 100 mg/dl, some
people may benefit from lower intakes:
 Saturated fat - Less than 7 percent of calories
 Cholesterol - Less than 200 milligrams per day
 Trans-fatty acid intake should be as low as
possible
Sodium
 High blood pressure is a diabetes
complication
 As a result, if a person is at risk for high blood
pressure their diabetic meal plan may be
modified to be low in sodium
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Sodium
 High sodium intake may contribute to high
blood pressure in “salt sensitive” people
 People who have diabetes tend to be more
“sodium sensitive”
Sodium
 Dietary Guidelines recommend
 People reduce daily sodium intake to less than
2,300 mg (approximately 1 teaspoon of salt) and
 Further reduce sodium intake to less than 1,500
mg sodium among those:
 51 years of age or older
 of any age who are African American or have
hypertension, diabetes or chronic kidney disease
 Weight loss will also help lower blood
pressure for people who are over weight
Protein
 Kidney disease is also a complication of
diabetes
 If a person has kidney disease the protein
content of their diabetic meal plan may be
modified
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Protein
 No evidence typical protein intake (15-20%
of calories) must be modified if kidney
function is normal
 A higher incidence of protein in the urine
has been observed with protein intakes
greater than 20% of calories
 May be an indication to keep protein intake
below 20% of calories
High Protein Diets
 High protein diets are promoted for weight
loss
 Long term effects of high protein weight-loss
diets on kidney function is a concern
 Effect of high protein diets, high in saturated
fat, on LDL cholesterol is a concern.
 Although initially weight may be lost,
unknown whether weight loss is maintained
better than with other low calorie diets
Standards of Care
 Recommendations for physical activity and
education on:
 Effect of physical activity on blood glucose
 How physical activity works with diet and
medication
 What to do if change the level of physical activity
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Physical Activity
 Physically active has many benefits:
 Helps body cells take in glucose
 Lowers blood glucose levels
 May lower the amount of medication needed
 Helps with weight loss
 Lowers blood cholesterol
 Lowers blood pressure
 Lower stress
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Standards of Care
 Education on:
 Self-testing blood glucose and urine ketones
 Keeping blood glucose records
 How to treat high and low blood glucose reactions
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Glucose Testing
 It is important to check blood glucose to see
how the treatment plan is working
 Testing blood glucose helps people will learn
how the food they eat and physical activity
affects their blood glucose level
 If blood glucose is not in control it may mean
a person needs to change their meal plan,
physical activity, or medication.
Glucose Testing
 Various glucose testing times
 Before meals
 2 hours after meals
 Bedtime
 During the night
Glucose Monitoring
 Fasting glucose normal/HbA1C high
 Able to bring blood glucose down overnight, but
blood glucose high at other times, possibly after
meals
 Dawn phenomenon
 Increased hepatic glucose output overnight (dawn
phenomenon)-common with type 2 diabetes
 Evening snack
 Oral medication that affect liver glucose output
Standards of Care
 Education on eye complications and a plan for
seeing an eye doctor annually
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Standards of Care
 Education on foot complications and a plan
for seeing a foot doctor
 Education is also needed on what to do if a
person has a sore on your foot
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Standards of Care
 Education on caring for teeth, gums, and
mouth and a plan for seeing a dentist
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Standards of Care
 Education on how stress affects blood glucose
and a plan for seeing a mental health
professional
 Information on other health professionals a
person may need to see
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Living With Diabetes
 A diabetes meal plan, medication and
physical activity program work together to
keep blood glucose in control
 Monitor blood glucose frequently to see
how diabetes treatment plan is working
 Keeping blood glucose in control will help
individuals with diabetes feel better now
and stay healthy in the future
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Diabetic Meal Plan Methods
 Some methods used to provide the
consistency of a diabetic meal plan are:
 Plate method
 USDA Daily Food Plan and MyPlate
 Diabetic exchange system
 Carbohydrate counting
Plate Method
 ¼ plate: grains or starchy foods such as rice,
pasta, potatoes, corn, or peas
 ¼ plate: protein foods such as meat, fish,
poultry, or tofu
 ½ plate: non-starchy vegetables
such as broccoli, carrots,
cauliflower, salad and tomatoes
 Add a glass of non-fat milk and
a small roll or piece of fruit
USDA Daily Food Plan
 Guide for planning a healthful diet
 Based on 2010 Dietary Guidelines
 Types and amounts of food for a healthful diet
 Limits for fats, sugars and sodium
USDA Daily Food Plan: Food Groups
 Grains
 Vegetables
 Fruits
 Dairy
 Protein foods
MyPlate
USDA Daily Food Plan Recommended Amounts
 USDA Daily Food Plan recommended amounts is
based on your estimated calorie needs
 Your estimated calorie needs is based on your:
 Gender
 Age
 Physical Activity
 Web site: www.choosemyplate.gov
Estimated Calorie Needs
Gender
Age (years)
Sedentary
Moderately Active
Active
Child
2-3
1,000-1,200
1,000-1,400
1,000-1,400
Female
4-8
1,200-1,400
1,400-1,600
1,400-1,800
9-13
1,400-1,600
1,600-2,000
1,800-2,200
14-18
1,800
2,000
2,400
19-30
1,800-2,000
2,000-2,200
2,400
31-50
1,800
2,000
2,200
51+
1,600
1,800
2,000-2,200
4-8
1,200-1,400
1,400-1,600
1,600-2,000
9-13
1,600-2,000
1,800-2,200
2,000-2,600
14-18
2,000-2,400
2,400-2,800
2,800-3,200
19-30
2,400-2,600
2,600-2,800
3,000
31-50
2,200-2,400
2,400-2,600
2,800-3,000
51+
2,000-2,200
2,200-2,400
2,400-2,800
Male
Daily Food Plan For Different Calorie Levels
Calories
1,400
1,600
1,800
2,000
2,200
2,400
2,600
2,800
3,000
5
5
6
6
7
8
9
10
10
Vegetables (cups)
1½
2
2½
2½
3
3
3½
3½
4
Fruits (cups)
1½
1½
1½
2
2
2
2
2½
2½
Dairy (cups)
2½
3
3
3
3
3
3
3
3
Protein foods (oz)
4
5
5
5½
6
6½
6½
7
7
Oils (tsp)
4
5
5
6
6
7
8
8
10
120
120
160
260
270
330
360
400
460
Sodium (mg)
2,300
2,300
2,300
2,300
2,300
2,300
2,300
2,300
2,300
Sodium if 51+,
African American
or have chronic
disease
1,500
1,500
1,500
1,500
1,500
1,500
1,500
1,500
1,500
Grains (oz)
Solid Fats and
Added Sugars
(calories)
Grain Group
 In general 1 ounce from the grains group is:
 1 slice of bread
 1 cup of ready-to-eat cereal
 ½ cup of cooked rice, cooked pasta, or cooked
cereal
 Consumer message
 Make half your grains whole
Vegetable Group
 In general 1 cup from the vegetable group is:
 1 cup of raw or cooked vegetables or vegetable
juice
 2 cups of raw leafy greens is considered as 1 cup
from the vegetable group
 Consumer message
 Make half your plate
fruits and vegetables
Fruit Group
 In general 1 cup from the fruit group is:
 1 cup of fruit or 100% fruit juice
 ½ cup of dried fruit
 Consumer message
 Make half your plate
fruits and vegetables
Diary Group
 In general 1 cup from the dairy group is:
 1 cup of milk, yogurt or soymilk
 1 ½ ounces of natural cheese
 2 ounces of processed cheese
 Consumer message
 Switch to fat-free or
low-fat (1%) milk
Protein Foods Group
 In general 1 ounce from the protein foods
group is:
 1 ounce of meat, poultry or fish
 ¼ cup cooked dry beans
 1 egg
 1 tablespoon of peanut butter
 ½ ounce of nuts or seeds
 Consumer message
 Vary your protein
Fats, Sugars and Sodium
 Although not food groups the USDA Daily Food
Plan provides limits for fats, sugars and
sodium.
Diabetic Exchanges
 Carbohydrates
 Starch
 Milk
 Fruit
 Other Carbohydrates
 Vegetables
 Meat and Meat Substitutes
 Fats
Nutrient Content of Exchanges
Carbohydrate Protein
Carbohydrates
 Starch
 Fruit
 Milk
 Other Carbohydrates
 Non-starchy Vegetables
Meat and Substitutes
Fats
15 g
15 g
12 g
15 g
5g
0g
0g
3g
0g
8g
varies
2g
7g
0g
Fat
0-1 g
0g
0-8 g
varies
0g
0-8 g
5g
Diabetic Exchanges and
Carbohydrate Counting
Exchange Groups Grams Carbohydrate
Starch
15
Fruit
15
Milk
12
Other Carbohydrate
15
Vegetable
5
Carbohydrate Choices
1
1
1
1
Starch Exchange: 1 carbohydrate choice
 Contains breads, cereals, grains, pasta,
starchy vegetables (potatoes, corn, green
peas, sweet potatoes), crackers, and snacks
 Dried beans and lentils count as a starch and
a very lean meat exchange
 Some starchy foods prepared with added fat
count as a starch and a fat exchange
1 Starch Exchange Contains
 15 g carbohydrate
 3 g protein
 0-1 g fat
 80 calories
In General 1 Starch Exchange Is:
 1/2 cup of cooked cereal, grain, or starchy
vegetable
 1/3 cup of cooked rice or pasta
 1 ounce of a bread product
 1/2 cup cooked dried beans or lentils
 Counts as 1 starch and 1 very lean meat exchange
 3/4 to 1 ounce of most snack foods
 Some snack foods count as 1 starch and 1 fat
Fruit Exchange
 The fruit exchange list contains fruits and
unsweetened fruit juices
 1 Fruit Exchange Contains
 15 g carbohydrate
 0 g protein
 0 g fat
 60 calories
In General 1 Fruit Exchange Is:
 1 small to medium fresh fruit
 1/2 cup canned fruit
 1/2 cup fruit juice
 1/4 cup dried fruit
Milk Exchange
 Contains milk and yogurt
 Cheese is not included in the milk exchange
Cheese is in the meat and meat substitute
exchange
 Three milk exchange categories:
 Fat-free/Low-fat (1/2% or 1%)
 Reduced-fat (2%)
 Whole Milk
1 Milk Exchange Contains
Carbohydrate
Protein
Fat
Calories
Fat-free
12 g
8g
0-3 g
90
Reduced-fat
12 g
8g
5g
120
Whole
12 g
8g
8g
150
In General 1 Milk Exchange Is:
 1 cup milk
 2/3 cup of fat-free or low-fat flavored yogurt
with a non-nutrative sweetener
Other Carbohydrates Exchange
 Contains many foods that contain sugar
(such as sweets, candy, and desserts) which
used to be restricted in a diabetic diet
 Now known that carbohydrates (bread, rice,
pasta, fruits and vegetables) and sugars have
a similar effect on blood glucose levels
Other Carbohydrates Exchange
 The total amount of carbohydrate is the
issue, not just sugar
 But the carbohydrate from foods containing
sugar must be worked into the meal plan
 However, foods high in sugar often don’t
provide other important nutrients and may
be high in fat
Other Carbohydrates Exchange
 One other carbohydrate exchange contains:
 15 g carbohydrate
 Protein varies
 Fat varies
 Calories varies
 Portion size varies depending on the food
Non-starchy Vegetable Exchange
 Contains non-starchy vegetables and
vegetable juices
 Starchy vegetables including potatoes, green
peas, corn and sweet potatoes are not in the
non-starchy vegetable exchange but are in the
starch exchange
1 Non-starchy Vegetable Exchange
Contains:
 5 g carbohydrate
 2 g protein
 0 g fat
 25 calories
In General 1 Non-starchy
Vegetable Exchange Is:
 1/2 cup cooked or canned vegetables
 1/2 cup vegetable juice
 1 cup raw vegetables
Meat and Meat
Substitute Exchange
 Has four categories based on fat content:
 Very Lean
 Lean
 Medium-Fat
 High-Fat
 Some foods, such as hot dogs, count as a
high-fat meat exchange and a fat exchange
1 Meat and Meat Substitute
Exchange Contains
Carbohydrate
Protein
Fat
Calories
Very Lean
0g
7g
0-1 g
35
Lean
0g
7g
3g
55
Medium
0g
7g
5g
75
High
0g
7g
8g
100
In General 1 Meat and Meat
Substitute Exchange Is:
 1 ounce of meat, fish, poultry, or cheese
 1/2 cup dried beans, cooked (counts as a very
lean meat and a starch exchange)
Fat Exchange
 Contains margarine, butter, oils, and salad
dressings
 Contains monounsaturated fat,
polyunsaturated fat and saturated fat lists
 Diabetic meal plans low in fat or reduced in
calories will have the number of fat
exchanges modified
1 Fat Exchange Contains:
 0 g carbohydrate
 0 g protein
 5 g fat
 45 calories
In General 1 Fat Exchange Is:
 1 teaspoon regular butter, margarine, or
vegetable oil
 1 tablespoon regular salad dressing
Free Foods
 A food is considered free if it contains fewer
than 5 grams carbohydrate or 20 calories per
serving
Example Meal
Meal
Breakfast
Number of Exchanges
2
Starch
Meat
Vegetable
1
Fruit
1
Milk
1
Fat
Example Meal
Meal
Dinner
Number of Exchanges
3
Starch
3
Meat
1
Vegetable
1
Fruit
1
Milk
2
Fat
Carbohydrate Counting
 Two ways to count carbohydrates
 Carbohydrate grams
 Carbohydrate choices
 One carbohydrate choice is 15 grams carbohydrate
Carbohydrate Counting
Exchange
Groups
Carbohydrate
Grams
Starch
Fruit
Milk
Vegetable
Other Carbohydrates
15
15
12
5
15
Carbohydrate
Choices
1
1
1
1
Carbohydrate Grams or
Choices For Calorie Levels
Calories
% Carbohydrate
Grams Carbohydrate
Carbohydrate Choices
1800
50%
225
15
1800
60%
270
18
Example Meal Plan
Meal
225 g
Carbohydrate
Breakfast
45 g
Lunch
60 g
Snack
15 g
Dinner
75 g
Evening Snack 30 g
15
Carbohydrate Choices
3
4
1
5
2
Recipes
Pink Cow Smoothie
1 C Raspberry Yogurt
1 C Skim Milk
1 Peach
1 Pkg Sweetener
Total
Exchanges
1 milk
1 milk
1 fruit
-
Carbohydrate Choices
1 choice
1 choice
1 choice
-
2 milk and
3 choices or
1 fruit exchange 45 g carbohydrate
Food Labels
1 Cup Frosted Cereal
3 carbohydrate choices
or
2 starch exchanges
1 other carbohydrate ex
Total
48 g carbohydrate
45 g carbohydrate
30 g carbohydrate
15 g carbohydrate
45 g carbohydrate
Food Labels
Sugar Free Eskimo Pie
2 carbohydrate choices
or
1 starch exchange
1 milk exchange
Total
26 g carbohydrate
30 g carbohydrate
15 g carbohydrate
12 g carbohydrate
27 g carbohydrate
Food Labels: Fiber
 Fiber is a type of carbohydrate that is not
digested and absorbed like complex
carbohydrates or simple sugars
 If there is more than 5 grams fiber per serving
subtract that from the total grams of
carbohydrate to determine the amount of
carbohydrate available
Food Labels: Sugar Alcohols
 To calculate the grams of available
carbohydrate in foods with more than 10
grams of sugar alcohol, subtract half the
grams of sugar alcohol from the total
carbohydrate grams
 If all the carbohydrate in a food is from sugar
alcohols and the total carbohydrate is less
than 10 grams, it is considered a “free food”
Other Lifestyle Factors
 Eye Care
 Foot Care
 Skin Care
 Mouth Care
 Illness
 Stress
 Travel
 Motivation
Living With Diabetes
 Your diabetes meal plan, medication and
physical activity program work together to
keep your blood glucose in control.
 Monitor your blood glucose frequently to see
how you are doing.
 Keeping your blood glucose in control will
help you feel better now and stay healthy in
the future.