Diabetes in Your School - Encouraging Healthy

Nutrition

Donna Amundson, RN, CDEDonna Amundson, RN, CDE

Diabetes Care CenterDiabetes Care Center

Medcenter OneMedcenter One

Food (mainly carbohydrate) is one of the major

influences on blood sugar levels in people with

diabetes.

In 1994, the Position Statement of the ADA stated:

““Today, there is no one ‘diabetic’ Today, there is no one ‘diabetic’ or ‘ADA’ diet. Medical nutrition or ‘ADA’ diet. Medical nutrition

therapy for people with diabetes therapy for people with diabetes should be should be individualizedindividualized, with , with consideration given to usual consideration given to usual

eating habits and other lifestyle eating habits and other lifestyle changes.”changes.”

The ideal diet for someone with diabetes (type 1 or type 2) is really just a healthy diet from which the entire family would

benefit.

Objectives of the Nutrition Plan

To balance To balance insulininsulin and and carbohydratecarbohydrate intake to help keep blood sugars as intake to help keep blood sugars as close to normal as possibleclose to normal as possible

To keep To keep cholesterolcholesterol at desired levels at desired levels To improve overall health by To improve overall health by

maintaining the best possible nutritionmaintaining the best possible nutrition To help avoid long term complicationsTo help avoid long term complications

To help attain To help attain normal growth and normal growth and development for development for children and achieve children and achieve appropriate weight appropriate weight for everyonefor everyone

To help prevent To help prevent severe low blood severe low blood sugar reactionssugar reactions

The Six Major Nutrient Groups: Carbohydrate:Carbohydrate: One of the One of the

main energy nutrients. It supplies main energy nutrients. It supplies energy for the body and is further energy for the body and is further divided into divided into starchesstarches (breads, (breads, noodles, pasta, rice, cereals and noodles, pasta, rice, cereals and starchy vegetables such as corn, starchy vegetables such as corn, peas, potatoes and legumes) and peas, potatoes and legumes) and sugarssugars (sucrose or table sugar, (sucrose or table sugar, fructose, lactose or milk sugar fructose, lactose or milk sugar and syrups).and syrups).

Protein:Protein: One of the energy nutrients. It is found One of the energy nutrients. It is found in meat, eggs, fish ,milk, yogurt and, in lesser in meat, eggs, fish ,milk, yogurt and, in lesser amounts, in vegetables and other non-meat amounts, in vegetables and other non-meat products, such as nuts, seeds and beans.products, such as nuts, seeds and beans.

Fat:Fat: Another of the energy nutrients. Total fat Another of the energy nutrients. Total fat includes:includes: Polyunsaturated fatPolyunsaturated fat Monounsaturated fatMonounsaturated fat Saturated fat Saturated fat Trans-fatty acidsTrans-fatty acids

Vitamins and MineralsVitamins and Minerals:: Important for growth, formation of blood Important for growth, formation of blood cells, healthy skin, good vision and cells, healthy skin, good vision and strong teeth and bones.strong teeth and bones.

Water:Water: The most important nutrient for The most important nutrient for survival. It makes up much of the body’s survival. It makes up much of the body’s blood, the body fluids and the body’s blood, the body fluids and the body’s transport system. Serves as a coolant, transport system. Serves as a coolant, shock absorber and waste remover. Our shock absorber and waste remover. Our bodies are made up of about 2/3 water.bodies are made up of about 2/3 water.

Fiber:Fiber: Dietary fiber is the part of Dietary fiber is the part of the plants that is not digested and the plants that is not digested and not absorbed into the body. It not absorbed into the body. It supplies bulk to the diet without supplies bulk to the diet without adding calories and helps satisfy adding calories and helps satisfy appetite and keep the digestive appetite and keep the digestive system running smoothly.system running smoothly.

The six main nutritional factors important for good glucose control are:

Following some sort of meal planFollowing some sort of meal plan Avoiding extra snacksAvoiding extra snacks Avoiding over-treatment of low Avoiding over-treatment of low

blood sugarsblood sugars Promptly treating high blood sugarsPromptly treating high blood sugars Adjusting insulin dosages for mealsAdjusting insulin dosages for meals Consistent night snacksConsistent night snacks

The basic recommendation for the use of sugars for people with diabetes has changed

over the years.

It has gone from avoidance to

allowing sugar in the context of a healthy

meal plan.

Types of Meal Planning Approaches

Constant Carbohydrate Meal Constant Carbohydrate Meal PlanPlan

Carbohydrate Counting Meal Carbohydrate Counting Meal PlanPlan

A third approach, the Exchange A third approach, the Exchange Meal Plan, is sometimes used Meal Plan, is sometimes used for type 2 diabetesfor type 2 diabetes

The purpose of all meal plans is to achieve better control of

blood sugar levels. The method that works best for one person may not be the

best for another.

It’s important for the family to meet with a registered dietitian to develop a meal plan that meets the needs of the child.

Constant Carbohydrate Meal Plan

The The amountamount of carbs (types of carbs (types can vary) is kept about the can vary) is kept about the same for each meal and snack same for each meal and snack from day to day to match a from day to day to match a relatively consistent dose if relatively consistent dose if insulin.insulin.

Consistency is the key!Consistency is the key!

Carbohydrate Counting Meal Plan

Involves counting the grams of Involves counting the grams of carbohydrate that are to be eaten and carbohydrate that are to be eaten and then giving a matching dose of insulin.then giving a matching dose of insulin.

Allows for greater freedom and Allows for greater freedom and flexibility in food choices.flexibility in food choices.

Often used with intensified diabetes Often used with intensified diabetes management with multiple daily insulin management with multiple daily insulin injections or insulin pump therapy.injections or insulin pump therapy.

Examples of Carb Counts

1 hard shell taco…15 gms1 hard shell taco…15 gms 1/8 12” thin pizza…15 gms1/8 12” thin pizza…15 gms Small order fries…30 gmsSmall order fries…30 gms One 3” cookie……15 gmsOne 3” cookie……15 gms Frosted cupcake…30 gmsFrosted cupcake…30 gms 3 cups popcorn….. 15 gms3 cups popcorn….. 15 gms ½ cup ice cream….15 gms½ cup ice cream….15 gms 1 cup bean, noodle or 1 cup bean, noodle or

vegetable soup…15 gms vegetable soup…15 gms

Medium apple…15 gmsMedium apple…15 gms Medium banana… 30 gmsMedium banana… 30 gms 1 cup milk………15 gms1 cup milk………15 gms 1 cup chocolate milk…30 1 cup chocolate milk…30

gmsgms 1 slice bread……15 gms1 slice bread……15 gms ⅓⅓ cup pasta…… 15 gmscup pasta…… 15 gms ½ cup corn………15 gms½ cup corn………15 gms Hamburger bun…30 gmsHamburger bun…30 gms 1 cup hotdish……30 gms1 cup hotdish……30 gms

Sample breakfast… 1 ½ cups unsweetened cereal1 ½ cups unsweetened cereal

30 gms30 gms 1 medium banana1 medium banana

30 gms30 gms 1 cup milk1 cup milk

15 gms15 gms

Total Carbs: Total Carbs: 75 gms75 gms

Sample Lunch… Peanut Butter and Jelly SandwichPeanut Butter and Jelly Sandwich

30 gms30 gms for 2 slices of bread for 2 slices of bread 15 gms15 gms for 1Tbsp jelly for 1Tbsp jelly

1 cup milk1 cup milk 15 gms15 gms

15 taco chips15 taco chips 15 gms15 gms

Total Carbs: Total Carbs: 75gms75gms

Another example… 1 cup hamburger hotdish1 cup hamburger hotdish

30 gms30 gms 1 medium apple1 medium apple

15 gms15 gms 2 sugar cookies (3 inches across)2 sugar cookies (3 inches across)

30 gms30 gms 1 cup sugar free koolaid1 cup sugar free koolaid

0 gms0 gms

Total Carbs:Total Carbs: 75 gms75 gms

One more… 1 hamburger with bun1 hamburger with bun

30 gms30 gms 1 small order french fries1 small order french fries

30 gms30 gms 1 medium apple1 medium apple

15 gms15 gms 1 can diet pop1 can diet pop

0 gms0 gms

Total Carbs:Total Carbs: 75 gms75 gms

Insulin to Carb Ratio Refers to the amount of rapid acting Refers to the amount of rapid acting

insulin given for the amount of insulin given for the amount of carbohydrate eaten at a meal or snackcarbohydrate eaten at a meal or snack

For example, for a carb ratio of For example, for a carb ratio of 1:151:15, 1 , 1 unit of rapid acting insulin would be unit of rapid acting insulin would be given for each 15 grams of carb eaten. given for each 15 grams of carb eaten. If the meal consisted of If the meal consisted of 4545 grams, grams, 33

units of insulin would be given.units of insulin would be given.

Every person is different in his or her need for rapid acting

insulin, so carbohydrate ratios differ as well. The same person may even have different carb ratios for

different times of the day.

How are insulin adjustments made for food and blood

sugar levels?

Correction Factor

When giving a dose of rapid acting When giving a dose of rapid acting insulin, thinking about the blood sugar insulin, thinking about the blood sugar level and the food to be eaten is always level and the food to be eaten is always important.important.

A A correction (or sensitivity) factorcorrection (or sensitivity) factor can be can be used to determine how much extra used to determine how much extra insulin should be insulin should be addedadded to the insulin to the insulin dose which will be given to cover the dose which will be given to cover the carb eaten.carb eaten.

The correction (or sensitivity) The correction (or sensitivity) factor refers to the amount of factor refers to the amount of insulin needed to correct a insulin needed to correct a blood sugar levelblood sugar level

The goal is to return the blood The goal is to return the blood sugar level into the desired sugar level into the desired rangerange

The most common correction dose is one unit of rapid acting insulin per 50mg/dl of

blood sugar above 100mg/dl.

So, if the child’s blood sugar was 180mg/dl, and 1 unit of rapid acting

insulin was given, you could expect the blood sugar to drop to 130mg/dl.

Every child is different, however, so the correction

factor must be individualized by the child’s family and

diabetes healthcare team working together.

Roles and Responsibilities

A key part of ensuring good A key part of ensuring good diabetes care for children at diabetes care for children at school is a clear understanding of school is a clear understanding of who will be responsible for each who will be responsible for each task.task.

In general, the parents are In general, the parents are responsible for providing all responsible for providing all diabetes equipment and snacks.diabetes equipment and snacks.

The parents should also help the school staff The parents should also help the school staff learn what they need to know about their learn what they need to know about their child’s individual diabetes care.child’s individual diabetes care. A health care plan should outline the A health care plan should outline the

child’s treatment, his target blood glucose child’s treatment, his target blood glucose range, insulin schedule, eating plan and range, insulin schedule, eating plan and usual blood glucose testing times.usual blood glucose testing times.

It should also include instructions on what It should also include instructions on what to do in various situations, such as to do in various situations, such as treatment of hypoglycemia.treatment of hypoglycemia.

An adult and a back up adult An adult and a back up adult should know how to test blood should know how to test blood

glucoseglucoseknow what to do if the blood know what to do if the blood

glucose is out of rangeglucose is out of rangeknow how to give (or supervise) know how to give (or supervise)

an insulin injection if that’s part an insulin injection if that’s part of the child’s heath care planof the child’s heath care plan

know how to recognize and know how to recognize and treat hypoglycemiatreat hypoglycemia

know when and how to give a know when and how to give a glucagon injectionglucagon injection

know the child’s meal plan and know the child’s meal plan and work with the parents to work with the parents to coordinate it with the schedule coordinate it with the schedule of the other children in the class of the other children in the class

Diabetes well managed not only helps Diabetes well managed not only helps young people avoid long term young people avoid long term

complications, it also allows them to feel complications, it also allows them to feel better and to be happier and more better and to be happier and more productive at school and at play.productive at school and at play.

Resources Children’s Diabetes FoundationChildren’s Diabetes Foundation

(800)695-2873(800)695-2873www.childrensdiabetesfdn.orgwww.childrensdiabetesfdn.org

Juvenile Diabetes Foundation International Juvenile Diabetes Foundation International (212)785-9500(212)785-9500www.jdfcure.orgwww.jdfcure.org

American Diabetes AssociationAmerican Diabetes Association(800)232-3472(800)232-3472www.diabetes.org