nutrition and exercise julia socke rd, ldn, cde diabetes educator and outreach coordinator kovler...

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

Thank you!

jsocke@uchicago.edu