Transcript dietetics Diabetes for PNs Mar 14x

Advice for people newly
diagnosed with Type 2 Diabeteswhat do I say?
Catherine Washbrook
Community Dietitian
Aims of Dietary Advice
• Achieve / maintain blood glucose levels
within normal range
• Management of lipid levels
• Management of blood pressure
• Weight reduction towards BMI 25
ADA 2002
Aims of Nutritional Management
• Improve health through healthy food
choices and physical activity
• Address individual needs including
personal and cultural preferences,
lifestyle and willingness to change
ADA 2002
What is Type 2 Diabetes?
It is a condition where the body cannot use
glucose properly for energy because either
the body does not produce enough insulin
(insulin insufficiency) or the insulin does
not work properly (insulin resistance).
Department of Nutrition and Dietetics
Adran Maetheg a Deietegyddiaeth Cymunedol
What foods affect our blood
glucose levels?
ALL carbohydrate containing foods.
Department of Nutrition and Dietetics
Adran Maetheg a Deietegyddiaeth Cymunedol
What foods affect our blood
glucose levels?
ALL carbohydrate
containing foods.
Carbohydrates Explained
Starchy:
Bread,
Rice,
Pasta,
Potatoes
Both starch & added sugar
(Sucrose)
Breakfast cereals
Cakes
Biscuits
Fizzy drinks
Natural Sugars
(Fructose/Lactose):
Fruit
Fruit juice
Yoghurt
Milk
Department of Nutrition and Dietetics
Adran Maetheg a Deietegyddiaeth Cymunedol
Diabetic foods
•
•
•
•
Not recommended
Often high in fat and low in fibre
Expensive
Diet is healthy not “special”
Which food groups contain carbohydrate?
5-9 portions
5-14 portions
2-3 portions
2-3 portions
0-4 portions
Carbohydrate distribution
• When is the majority of carbohydrate
eaten?
• Are patients aware of the effect of different
foods on blood glucose levels ?
• Are patients aware of which foods contain
carbohydrate ?
• Do they have an understanding of the
amounts of carbohydrate in different
foods?
Department of Nutrition and Dietetics
Adran Maetheg a Deietegyddiaeth Cymunedol
Glycaemic index (GI)
• There has been recent evidence that lower
glycaemic index foods can further improve
HbA1c levels by 0.43%
• A method used to classify foods according to
their glycaemic response compared to a
standard amount of white bread
• Low GI foods are digested and absorbed more
slowly than high GI foods
The total amount of carbohydrate
consumed is a strong predictor of
glycaemic response, and thus,
carbohydrate content of foods is a key
strategy in achieving glycaemic control
Glycemic
index (GI)
Examples
100
Glucose
80-90
Baked potatoes, instant potatoes, pretzels, rice cakes, jelly beans, cornflakes, processed snack foods
and breakfast cereals
70-80
White bread, waffles, plain bagel, corn chips, Melba toast, french fries, carrots
60-70
Cream of wheat, quick-cooking oats, whole-wheat bread, couscous, new potatoes, table sugar, soft
drinks, angel food cake, raisins, pineapple, cantaloupe
50-60
Brown rice, wild rice, popcorn, sweet potatoes, dense/coarse whole grain breads, whole-grain pita and
tortillas, mango, banana, kiwi, sweet corn
40-50
Minimally processed cereals like old-fashioned oatmeal, oat bran and All bran; Bulgar wheat, pasta,
green peas, grapes, oranges, chocolate
30-40
Legumes, apple, apricots, pears, yogurt, milk
20-30
Barley, cherries, grapefruit, peaches, plums. soya beans.
Negligible
Salad vegetables, non starchy vegetables such as asparagus, broccoli, cabbage, cauliflower and green
beans
Glycaemic Index
Low
Medium
High
Muesli
Dried apricots
Sultana bran
Basmati rice
Pitta bread
Sweet potatoes
Cornflakes
Rice krispies
White/ wholemeal
bread
Lucozade
Frozen chips
Milk
Oatmeal biscuits
Fruit & vegetables Popcorn
Pulses
Rye bread
Porridge
Baked beans
Shredded wheat
New potatoes
Jam
Long grain rice
Old potatoes
Fizzy drinks
Case Study
• Estimate how much carbohydrate Mr.
Brown is having throughout the day using
the estimated CHO content list .
• How can making different food choices
help glycaemic control?
Breakfast
- 2 weetabix with milk
- 1 slice white toast with butter and jam
- Large glass of orange juice (300ml)
Mid-morning
- Scone with butter
Lunch
-Tuna with mayo and sweetcorn sandwich (4 slices bread)
- Large banana
- Cereal bar
Mid-afternoon
- Packet of crisps
Evening meal
90g spaghetti with bolognaise sauce
- 3 slices of garlic bread
TOTAL
CHO Content (g)
Breakfast
CHO Content (g)
- 2 weetabix with milk
30 + 10
- 1 toast with butter and jam
15 + 5
- Large glass of orange juice (300ml)
30
Mid-morning
- Scone with butter
30
Lunch
-Tuna with mayo and sweetcorn sandwich (4 slices bread)
60
- Large banana
30
- Cereal bar
30
Mid-afternoon
- Packet of crisps
15
Evening meal
90g spaghetti with bolognaise sauce
45
- 3 slices of garlic bread
30
TOTAL
335
Daily Carbohydrate Recommendations
• Minimum: 130g per day
• Guideline Daily Amount:
Women 230g
Men 300g
(This will vary depending on activity levels)
Breakfast
CHO Content (g)
- 2 weetabix with milk
30 + 10
- Handful of blueberries
5
- small glass of orange juice (150ml)
15
Mid-morning
- Scone with butter
30
Lunch
-Tuna with mayo and sweetcorn sandwich (3 slices
bread)
45
- Large banana
30
- Yoghurt
15
Mid-afternoon
- 30g dried fruit & nuts
15
Evening meal
60g spaghetti with bolognaise sauce
30
- 1 slices of garlic bread
10
Large salad
0
TOTAL
235
What works ?
• Structured education programmes that
emphasise ;
– Education & empowerment
– Regular patient contact/ support
– Lifestyle changes
– Goal setting
What service do Cardiff Community
Dietetics service provide?
X-PERT PROGRAMME
• Structured education programme 6 weeks
• Dietitian and Diabetes Specialist Nurse
Diabetes Awareness Session (DAS)
• 2 ½ hr session
• Aimed at people unable to attend X-PERT
Thank You
Contact details:
[email protected]
Tel: 20668089
Any questions?