Advice for people newly diagnosed with Type 2 Diabetes- what do I say? Catherine Washbrook Community Dietitian.

Advice for people newly diagnosed with Type 2 Diabetes-

what do I say?Catherine WashbrookCommunity 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

Department of Nutrition and DieteticsAdran Maetheg a Deietegyddiaeth Cymunedol

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).

What foods affect our blood glucose levels?

ALL carbohydrate containing foods.

Department of Nutrition and DieteticsAdran 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 cerealsCakesBiscuitsFizzy drinks

Natural Sugars (Fructose/Lactose):

Fruit

Fruit juice

Yoghurt

Milk

Department of Nutrition and DieteticsAdran 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?

5-14 portions5-9 portions

2-3 portions2-3 portions

0-4 portions

Department of Nutrition and DieteticsAdran Maetheg a Deietegyddiaeth Cymunedol

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?

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

80-90Baked 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

60-70Cream 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

40-50Minimally 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.

NegligibleSalad vegetables, non starchy vegetables such as asparagus, broccoli, cabbage, cauliflower and green

beans

Glycaemic IndexLow Medium HighMuesli Basmati rice Cornflakes

Dried apricots Pitta bread Rice krispies

Sultana bran Sweet potatoes White/ wholemeal bread

Milk Oatmeal biscuits Lucozade

Fruit & vegetables Popcorn Frozen chips

Pulses Shredded wheat Long grain rice

Rye bread New potatoes Old potatoes

Porridge Jam Fizzy drinks

Baked beans

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 CHO Content (g)

- 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

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?