Transcript WHAT DO I EAT NOW?

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