gary scheiner ms, cde owner & clinical director integrated diabetes services llc (877) 735-3648 ...
TRANSCRIPT
Gary Scheiner MS, CDEGary Scheiner MS, CDEOwner & Clinical DirectorOwner & Clinical Director
Integrated Diabetes Services LLCIntegrated Diabetes Services LLC(877) 735-3648(877) 735-3648
www.integrateddiabetes.comwww.integrateddiabetes.comgary@[email protected]
Use of Glycemic Index In Diabetes Management
Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs
Carbohydrate…….rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols….moderate digestion, partial absorption as glucose (50%) Protein……………..slow digestion, partial conversion to glucose* (~40%) Fat……………………slow digestion, little conversion to glucose** (0%)
Timed Effect on Blood Sugar Levels
* In absence of dietary carbs ** may cause insulin resistance in large qty
MEET THE CARBS!
Fruit Fruit Juice Candy Regular Soda Punch Wine
Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar
Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly
MEET THE CARBS!
• Potatoes• Rice• Noodles/Pasta• Cereal• Oatmeal• Bread
• Tortillas• Pancakes• Waffles• Crackers• Bagels• Pizza
• Beans• Corn• Pretzels• Chips• Popcorn• Beer
The “fate” of dietary carbohydrates
Simple Carbohydrates (sugars)
Complex Carbohydrates (starches)
BloodGlucose
Does the Type of Carbohydrate Matter?
Glycemic IndexGlycemic Index
• All carbs (except fiber) convert to All carbs (except fiber) convert to blood glucose eventuallyblood glucose eventually
• G.I. Reflects the magnitude of blood G.I. Reflects the magnitude of blood glucose rise in the first glucose rise in the first 2 hours2 hours
• G.I. Number is % of rise relative to G.I. Number is % of rise relative to pure glucose (in dextrose form) pure glucose (in dextrose form)
Glycemic Index (contd.)Glycemic Index (contd.)
Example:
SpaghettiGI = 37• 37% of spaghetti’s
carbs turn into blood glucose in the first 2 hours.
• The rest will convert to blood glucose over the next several hours.
Glycemic Index (contd)Glycemic Index (contd)
0 hrs 1 hr 2 hrs 3 hrs 4 hrs 5 hrs 6 hrs
High GI
Med GI
Low GI
Glycemic Index ValuesBREAD/CRACKERSBagel 72Crispbread 81Croissant 67French baguette 95Graham Crackers 74Hamburger bun 61Kaiser roll 73Melba toast 70Pita bread 57Pumpernickel 51Rye, dark 76Saltines 74Sourdough 52Wheat Thins 67Wheat Bread, 68White Bread 71 CAKES/COOKIES/MUFFINSAngel Food Cake 67Banana Bread 47Blueberry Muffin 59Chocolate Cake 38Corn Muffin 102Cupcake with icing 73Donut 76Oat Bran Muffin 60Oatmeal cookies 55Pound Cake 54Shortbread cookies 64Vanilla wafers 77 CANDYChocolate 49Jelly beans 80Lifesavers 70M & M, peanut 33Nestle Crunch 42Skittles 69Snickers Bar 40Twix Bar 43
CEREALS/BREAKFASTAll-Bran 42Bran Chex 58Cheerios 74Corn Flakes 83Cream of Wheat 70Crispix cereal 87Golden Grahams 71Grape Nuts 67Oatmeal 49Pancakes 67PopTarts 70Puffed Wheat 67Raisin Bran 73Rice Krispies 82Shredded Wheat 69Special K 66Total 76Waffles 76 COMBINATION FOODSChicken Nuggets 46Fish fingers 38Macaroni & Cheese 64Pizza (cheese) 60Sausages 28Stuffing 74Taco shells 68 DAIRYChocolate milk 34Custard 43Ice cream, vanilla 62Ice Cream, choc. 68Milk, skim 32Milk, whole 27Pudding 43Yogurt, low fat 33
FRUITS & JUICESApple 38Apple juice 41Banana 55Cantaloupe 65Cherries 22Cranberry Juice 68Fruit cocktail 55Grapefruit 25Grapes 46Kiwi 53Mango 56Orange 44Orange juice 52 Peach 42Pear 37Plum 39Raisins 64Watermelon 72 LEGUMESBaked beans 48Black beans 30Black-eyed Peas 42Butter beans 30Chick peas 33Lentils, red 25Lima Beans 32Pinto Beans 45Red kidney beans 19 PASTA/RICEBrown Rice 55Couscous 65Fettucini 32InstantRice 87Long grain Rice 56Macaroni 45Spaghetti, white 41Spaghetti, wheat 37Tortellini 50Risotto 69
SNACK FOODSCorn Chips 74Granola Bars 61NutriGrain bars 66Peanuts 15Popcorn 55Potato Chips 54Pretzels 81Rice Cakes 77 SOUPSBlack Bean 64Green Pea 66Lentil 44Minestrone 39Split Pea 60Tomato 38 SPORTS BARS/DRINKSGatorade 78Power Bar 58 SUGARS & SPREADSGlucose tablets 102Corn syrup 62Honey 58Strawberry Jam 51Syrup 66Table Sugar 64
VEGETABLESFrench fries 75Potato, baked 85Potato, instant 83Potato, mashed 91Potato, boiled 88Carrots, boiled 49Carrots raw 47Corn 46Sweet potato 44Tomato Juice 38
What About MIXED Meals?
• Tends toward G.I. of primary food in meal (i.e. bread in sandwich)
• Eating low-g.i. food first lowers G.I. of entire meal
G.I. Is NOT An Exact Science!
Vaai@bL$
• Food combinations• Quantity being consumed• Time since last meal• Recent & planned physical activity• Individual food sensitivities• The winner in the 3rd race at Belmont
G.I. Gereralization
Slow Stuff Average Stuff
Fast Stuff
PastaLegumes
Salad VeggiesDairy
Chocolate
FruitJuicePizzaSoupCake
Breads/CrackersSalty Snacks
PotatoesRice
CerealsSugary Candies
If All Carbs Turn Into Glucose Eventually, Why Is Glyemic
Index Important?
1. Satiety• Low G.I. =
Slower Gastric Emptying
• Leads to Less Consumption, Smaller Portions
• Less Tendency to “Graze”
Low Glylcemic-Index Foods Are More Satisfying!
Jackie Scheiner
Age 1
2. Mealtime Insulin Timing
• Goal is to match insulin action to food’s effects, prevent high & low BG
– High G.I.: 15-30 min prior
– Moderate G.I.: 0-15 min prior
– Low G.I.: 0-15min after
Normal Pump Bolus with Low-G.I. Meal:
• Insulin peaks too early (hypoglycemia)• Insulin dissipates too soon (hyperglycemia)
Square/Extended/Long Bolus• Entire bolus is delivered gradually over 30min – 8 hrs• 1 -2 hours is common
Insulin Pump Options
Dual/Combo/Combination Bolus• Part of bolus delivered up-front, remainder over time• 30% Up-Front is common, remainder over 2 hrs
Insulin Pump Options
3. Reducing Post-Meal Spikes
• Glucose variability is associated with increased complication risk, emotional distress, and diminished physical & intellectural performance
• Injected/infused “rapid” insulin is much slower than insulin produced by the pancreas
• The amylin hormone is lacking or deficient
3. Reducing Post-Meal Spikes
LOW G.I. FOODS PRODUCE FLATTER BGs!
Diabetes Self-Management, August, 2006
Factors that lower G.I.Factors that lower G.I.
Fiber Fat Temperature• Solid (vs. liquid)• Acidity• Non-Processed• Type of carb
Fastest Glucose
Dextrose
Starch (branched-chain)
Sucrose/Corn Syrup
Fructose
Starch (straight-chain)
Lactose
Galactose
Slowest Sugar Alcohols
Starch Structure Affects G.I.
“branched chain” G – G – G – G – G - G G – G / \ /G – G G G – G – G G – G – G \ / \ / G – G – G – G – G – G G – G – G – G – G – G \ \ G – G – G G – G – G – G – G
“straight chain”G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G
Examples: Use of GIExamples: Use of GI
Meal High-GI Options Lower-GI Options
Breakfast Cereal
Bagel/Toast
Waffle
Pancakes
Muffins
Oatmeal
Milk
Whole Fruit
Nuts
Yogurt
Examples: Use of GIExamples: Use of GI
Meal High-GI Options Lower-GI Options
Lunch White Bread Fries
Tortillas
Fast Food
Sourdough Bread
Pumpernickel
Carrots & Peas
Bean Salad
Soup
Examples: Use of GIExamples: Use of GI
Meal High-GI Options Lower-GI Options
Dinner (sides) Rice
Mashed Potato
Baked Potato
Rolls
Pasta
Beans
Sweet Potato
Tomato
Examples: Use of GIExamples: Use of GI
Meal High-GI Options Lower-GI Options
Snacks Pretzels
Chips
Crackers Doughnuts
Popcorn
Nuts
Ice Cream
Chocolate
4. Treating Hypoglyemia
• High-GI foods convert to glucose rapidly (faster recovery)
• Lower-GI foods take longer to work, may lead to over-treatment and significant post-treatment hyperglycemia
Hypoglycemia Treatment
High-GI Foods• Dry Cereal• Pretzels• Graham Crackers• Vanilla Wafers• Jelly Beans• Gatorade• Regular (non-diet) Soda
Hypoglycemia TreatmentDEXTROSE Rules! (GI=100)
Dex Products•Glucose Tablets•Glucose Gel•Liquid Blasts
Dextrose-Sweetened Candies•Sweet Tarts•Smarties•Spree•Air Heads•Nerds•Runts
Glycemic Index References
Dr. Jennie Brand-Miller
The “New Glucose Revolution”Series