nutrition and exercise julia socke rd, ldn, cde diabetes educator and outreach coordinator kovler...
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Nutrition and Exercise
Julia Socke RD, LDN, CDEDiabetes Educator and Outreach Coordinator
Kovler Diabetes CenterUniversity of Chicago
What Affects Blood Sugar?
CarbohydratesQuantity of
carbohydrates at one time
Protein, fat, and fiber content of the meal
Overall volume of meal
Timing of insulin dose or other medication
Physical activityStress levels IllnessSite absorptionExcitement
How Fast Foods Breakdown
• Carbohydrate:
-2 hours
• Protein:
-7-8 hours
• Fat:
-20 hours
Percentage Of Nutrients Changed To Blood Glucose
100% Carbohydrates
50-60% Proteins
Less than 10% Fats
Glucose
Total Carbohydrates Count!
• The amount of carbohydrate at one time has the most significant impact on
blood sugar
Starches
• 1 slice of bread• ½ pita bread• 1/3 c rice• 1/3 c pasta• 6” flour tortilla• 4” corn tortilla• ¾ c unsweetened cereal• ½ c unsweetened hot
cereal (made with water)
• 1 small potato • ½ c mashed• ½ c corn• 1 c winter squash• ½ c beans• ½ english muffin• 3 c popcorn• 6 saltine crackers
Fruit
• ½ banana• 1 small apple, pear,
peach, orange, kiwi (5oz)
• 1 c whole strawberries
• 15 grapes• 1c cubed watermelon• 1/3 c cantaloupe
• 12 cherries• ¾ c blueberries• 3 prunes• 2 tbsp raisins• ½ c orange juice• ¾ c fresh pineapple• ½ small mango or
papaya• 2 figs
Milk and Yogurt
• 1c (8oz) milk
• 1c buttermilk
• 6-8oz yogurt (plain)
• 6-8oz yogurt using artificial sweetener
• 6-8oz yogurt without added sugar
• 1/3 c nonfat dry milk powder
• ½ c evaporated skim milk
Carbohydrate Counting and Coverage
• Do your best and utilize carb counting tools available
• Use past experiences to help guide you• When at a gathering, bring a dish and/or dessert
from home• Look ahead at menus• Can carbs in recipes be reduced?• If possible, give insulin lead time to start working
before eating• Check 2 hours after meals
Consider Extended Bolus
• Meals high in fat, protein, and carbs may break down much slower
• The end result is an elevated BG 4-5 hours post meal even though the 2 hr pp sugar is normal
• Try giving 50% upfront and then the other 50% over 2-4 hour time span
• Check prior to meal + every 2 hours for 6 hours• Goal to be within 30-50 points at each interval
Food Labels
Carbohydrate and Recipe Resources
American Diabetes Association
www.diabetes.org
Jewish Diabetes Association
www.jewishdiabetes.org
SELF Nutrition Data
http://nutritiondata.self.com/
Smart Phone Apps
• Carb counting with Lenny
• Fooducate
• Calorie King
• ChooseMyPlateSuperTracker
• EveryoneEat!
• GoMeals
• MyFitnessPal
Sugar Alcohols
• A type of reduced calorie sweetener
• Their effects on blood sugar can vary
• Rule: 5g or more per serving then subtract ½ from total carb
• Can have a laxative effect
Fiber
• Part of the plant that your body cannot digest
• Slows the digestion of carbohydrates
• If greater than 5g, 1/2 can be subtracted from total carb
Glycemic Index
Determine how quickly a food will raise blood sugar
Low glycemic foods can promote fullness for a longer period of time
Remember basic healthy eating principles when interpreting low/high glycemic foods
2011 MyPlate
Balanced Meal Planning:The Plate Method
How Does Summer Vacation Impact Diabetes?
• Children may be out of their typical routine
• Different foods are often consumed
• Larger quantities of higher carbohydrate foods available
• Changes in physical activity level
• Travel
Summer Eating Tips
• Your child can still eat their favorites!• Encourage your child to focus on carb
foods that are most desired• Limit snacking between meals or
encourage non-carb foods• Plan ahead!
Travel Tips
• Obtain letter from healthcare team• Allow enough time for TSA to check bags• Bring prescriptions and insurance cards• Medical ID is a must• Check BG often• Consult with healthcare team if travelling across time
zones• Avoid exposing insulin to extreme temperatures • If in foreign country, insulin strength is different than in
the U.S.
Travel Supplies
IN CARRY-ON BAGGlucometer and test stripsMedicationBatteriesGlucose TabsGlucagonKetone strips Insulin and needlesSnacks in case of delaysPack at least twice the amount of supplies
you think will be needed!
Get Moving!
• Physical activity can help to control BG
• Exercise lowers insulin need
• Use caution if blood sugar is >250
• Please contact your healthcare team if lows often occur as a result of exercise
• Avoid injecting insulin into an active site
Exercise and Blood Sugar
• Sulfonylurea and insulin both work to lower sugar
• Consider a decrease in medication prior to exercise or eat a snack before
• Take note of differences in sugar with different activities
• Sometimes there is a delayed effect on blood sugar hours later