Diabetes in Your School - Encouraging Healthy Nutrition

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Diabetes in Your School - Encouraging Healthy
Nutrition

• Donna Amundson, RN, CDE
• Diabetes Care Center
• Medcenter One

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Food (mainly carbohydrate) is one of the major
influences on blood sugar levels in people with
diabetes.
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In 1994, the Position Statement of the ADA stated

• Today, there is no one diabetic or ADA diet.
  Medical nutrition therapy for people with
  diabetes should be individualized, with
  consideration given to usual eating habits and
  other lifestyle changes.

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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.
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Objectives of the Nutrition Plan

• To balance insulin and carbohydrate intake to
  help keep blood sugars as close to normal as
  possible
• To keep cholesterol at desired levels
• To improve overall health by maintaining the best
  possible nutrition
• To help avoid long term complications

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• To help attain normal growth and development for
  children and achieve appropriate weight for
  everyone
• To help prevent severe low blood sugar reactions

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The Six Major Nutrient Groups

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

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• Protein One of the energy nutrients. It is found
  in meat, eggs, fish ,milk, yogurt and, in lesser
  amounts, in vegetables and other non-meat
  products, such as nuts, seeds and beans.
• Fat Another of the energy nutrients. Total fat
  includes
• Polyunsaturated fat
• Monounsaturated fat
• Saturated fat
• Trans-fatty acids

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• Vitamins and Minerals Important for growth,
  formation of blood cells, healthy skin, good
  vision and strong teeth and bones.
• Water The most important nutrient for survival.
  It makes up much of the bodys blood, the body
  fluids and the bodys transport system. Serves as
  a coolant, shock absorber and waste remover. Our
  bodies are made up of about 2/3 water.

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

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The six main nutritional factors important for
good glucose control are

• Following some sort of meal plan
• Avoiding extra snacks
• Avoiding over-treatment of low blood sugars
• Promptly treating high blood sugars
• Adjusting insulin dosages for meals
• Consistent night snacks

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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.
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Types of Meal Planning Approaches

• Constant Carbohydrate Meal Plan
• Carbohydrate Counting Meal Plan
• A third approach, the Exchange Meal Plan, is
  sometimes used for type 2 diabetes

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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.
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Its important for the family to meet with a
registered dietitian to develop a meal plan that
meets the needs of the child.
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Constant Carbohydrate Meal Plan

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

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Carbohydrate Counting Meal Plan

• Involves counting the grams of carbohydrate that
  are to be eaten and then giving a matching dose
  of insulin.
• Allows for greater freedom and flexibility in
  food choices.
• Often used with intensified diabetes management
  with multiple daily insulin injections or insulin
  pump therapy.

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Examples of Carb Counts

• 1 hard shell taco15 gms
• 1/8 12 thin pizza15 gms
• Small order fries30 gms
• One 3 cookie15 gms
• Frosted cupcake30 gms
• 3 cups popcorn.. 15 gms
• ½ cup ice cream.15 gms
• 1 cup bean, noodle or vegetable soup15 gms

• Medium apple15 gms
• Medium banana 30 gms
• 1 cup milk15 gms
• 1 cup chocolate milk30 gms
• 1 slice bread15 gms
• ? cup pasta 15 gms
• ½ cup corn15 gms
• Hamburger bun30 gms
• 1 cup hotdish30 gms

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Sample breakfast

• 1 ½ cups unsweetened cereal
• 30 gms
• 1 medium banana
• 30 gms
• 1 cup milk
• 15 gms
• Total Carbs 75 gms

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Sample Lunch

• Peanut Butter and Jelly Sandwich
• 30 gms for 2 slices of bread
• 15 gms for 1Tbsp jelly
• 1 cup milk
• 15 gms
• 15 taco chips
• 15 gms
• Total Carbs 75gms

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Another example

• 1 cup hamburger hotdish
• 30 gms
• 1 medium apple
• 15 gms
• 2 sugar cookies (3 inches across)
• 30 gms
• 1 cup sugar free koolaid
• 0 gms
• Total Carbs 75 gms

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One more

• 1 hamburger with bun
• 30 gms
• 1 small order french fries
• 30 gms
• 1 medium apple
• 15 gms
• 1 can diet pop
• 0 gms
• Total Carbs 75 gms

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Insulin to Carb Ratio

• Refers to the amount of rapid acting insulin
  given for the amount of carbohydrate eaten at a
  meal or snack
• For example, for a carb ratio of 115, 1 unit of
  rapid acting insulin would be given for each 15
  grams of carb eaten.
• If the meal consisted of 45 grams, 3 units of
  insulin would be given.

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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.
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How are insulin adjustments made for food and
blood sugar levels?
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Correction Factor

• When giving a dose of rapid acting insulin,
  thinking about the blood sugar level and the food
  to be eaten is always important.
• A correction (or sensitivity) factor can be used
  to determine how much extra insulin should be
  added to the insulin dose which will be given to
  cover the carb eaten.

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• The correction (or sensitivity) factor refers to
  the amount of insulin needed to correct a blood
  sugar level
• The goal is to return the blood sugar level into
  the desired range

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The most common correction dose is one unit of
rapid acting insulin per 50mg/dl of blood sugar
above 100mg/dl.So, if the childs 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.
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Every child is different, however, so the
correction factor must be individualized by the
childs family and diabetes healthcare team
working together.
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Roles and Responsibilities

• A key part of ensuring good diabetes care for
  children at school is a clear understanding of
  who will be responsible for each task.
• In general, the parents are responsible for
  providing all diabetes equipment and snacks.

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• The parents should also help the school staff
  learn what they need to know about their childs
  individual diabetes care.
• A health care plan should outline the childs
  treatment, his target blood glucose range,
  insulin schedule, eating plan and usual blood
  glucose testing times.
• It should also include instructions on what to do
  in various situations, such as treatment of
  hypoglycemia.

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• An adult and a back up adult
• should know how to test blood glucose
• know what to do if the blood glucose is out of
  range
• know how to give (or supervise) an insulin
  injection if thats part of the childs heath
  care plan

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• know how to recognize and treat hypoglycemia
• know when and how to give a glucagon injection
• know the childs meal plan and work with the
  parents to coordinate it with the schedule of the
  other children in the class

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• Diabetes well managed not only helps young
  people avoid long term complications, it also
  allows them to feel better and to be happier and
  more productive at school and at play.

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Resources

• Childrens Diabetes Foundation
• [phone]
• www.childrensdiabetesfdn.org
• Juvenile Diabetes Foundation International
• [phone]
• www.jdfcure.org
• American Diabetes Association
• [phone]
• www.diabetes.org