NUTRITION AND EXERCISE

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NUTRITION AND EXERCISE
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Overall goal Optimal student health and
learning
Managing nutrition and exercise are critical to
student success. But just two pieces of a
comprehensive management plan.
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Learning Objectives

• Participants will learn
• Basic meal plans for students with diabetes
• Nutrition calculation methods
• Exercise benefits for students with diabetes
• Exercise guidelines for students with diabetes

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Nutrition Why be concerned?

• Good nutrition is important for everyone for
  optimal health.
• Nutrition planning is essential for good diabetes
  control
• maintain blood-glucose within target range
• to prevent or delay complications
• to help children and teens grow and develop
  properly

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School Nutrition Management

• Students family and health care team determine
  an individualized meal plan.
• Meals snacks need to be carefully timed to
  balance exercise and insulin/medications.
• Encourage healthy eating for all students.

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Basic Meal Plans

• Key Balance insulin/medications with
• carbohydrate intake
• Most students have flexibility in WHAT to eat.
• Exchange System
• Basic Carbohydrate Counting
• Advanced Carbohydrate Counting
• Many students have flexibility in WHEN to eat.
• More precise insulin delivery (pumps, pens)
• New insulins

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Exchange System Meal Plan

• Meal plan comprised of a given number of servings
  from each of major food groups
• carbohydrates (fruit, starch, milk)
• meat/meat substitutes
• vegetables
• fat
• Itemizes number of exchanges from each category
  for each meal/snack.

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Basic Carbohydrate Counting

• Calories from
• carbohydrate
• protein
• fat
• Each nutrient type affects blood sugar
  differently.
• Carbohydrate has the biggest effect on blood
  sugar.
• TOTAL carbohydrate matters more than the source
  (sugar or starch.)

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Advanced Carbohydrate Counting
USING THE INSULIN-TO-CARB RATIO

• The insulin-to-carb ratio
• Varies from student to student.
• Is determined by the students health care team.
• Should be included in the DMMP.
• Usually stated as a ratio of 1 unit of insulin to
  x grams carbohydrate.

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Using Insulin-to-Carb Ratio

• Example 110 Ratio
• 1 unit of insulin to be given per 10 gms
  carbohydrate eaten
• 60 gm meal / 10 gms 6 units of insulin needed

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School Meals Snacks

• Provide school menus and nutrition information to
  student/family in advance.
• Provide sufficient time for eating.
• Monitor actual food intake per DMMP
• young, or newly diagnosed
• picky eaters
• Respect, encourage independence.

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School Meals

• The approximate carbohydrate content of school
  meals can be determined in advance by the school
  nutrition director and can be indicated on the
  school menu for each item.

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Beyond the Routine School Parties

• Provide parent/guardian with advance notice of
  parties/special events.
• Follow the students DMMP and 504 Plan or IEP
• Some students may prefer to bring their own
  foods, but may eat what is available.
• Provide nutritious party snacks to encourage
  healthy eating habits for all.

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What every student with diabetes wants you to
remember

• Sugar is NOT the Enemy
• There is no justification for complete
  restriction of sugar
• Sometimes sugar can be a life-saving friend!
• However, timing matters a lot with diabetes, and
  sometimes sugar (or any carbohydrate) is not a
  good choice at all.
• Consider portion size.

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Beyond the Routine Field Trips

• Bring plenty of snacks to treat hypoglycemia.
• Bring lunch as appropriate.
• Consult with parent/guardian about food and/or
  insulin adjustments for extra activity level.
• Bring diabetes equipment and supplies.
• Bring list of emergency contacts.

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Exercise Diabetes

• Everyone benefits from exercise and physical
  activity.
• Students with diabetes should fully participate.
• In general, exercise lowers blood sugar levels.
• May need to make adjustments to
  insulin/medications and food intake.
• A quick-acting source of glucose, glucose meter,
  and water should always be available.
• PE teachers and coaches must be familiar with
  symptoms of both high and low blood glucose.

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Exercise Blood Glucose Monitoring

• Check before, during, and after exercise per
  DMMP.
• Especially when trying a new activity or sport
• If blood sugar starts to fall, student should
  stop and have a snack
• Students with pumps may disconnect or adjust the
  basal rate downward, in lieu of snacking (per
  DMMP)

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Exercise Insulin/Medication

• Physical activity can raise blood glucose levels
  if there is insufficient insulin.
• follow DMMP for exercise restrictions when
  ketones are present
• Work with parent/guardian to determine the best
  times for physical activity and to adjust snacks,
  insulin, or timing of activity to prevent low or
  high blood glucose levels.