Type I Diabetes School Nurse Workshop September 2019 Stephanie Etherington RD CD CDE What is a carb Bodys preferred immediate energy source Fats and protein are more longterm Some examples breads cereals grains pasta rice crackers fruits beans potatoes corn peas milk y ID: 1030242
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1. Nutrition for Kids with Type I DiabetesSchool Nurse WorkshopSeptember 2019Stephanie Etherington, RD, CD, CDE
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3. What is a carb?Body’s preferred, immediate energy sourceFats and protein are more long-termSome examples: breads, cereals, grains, pasta, rice, crackers, fruits, beans, potatoes, corn, peas, milk, yogurt, most desserts, sugar-containing beverages like juice or sodaSimple versus Complex - Glycemic IndexSugar – Recommended intake <10% added sugar
4. ProteinProvides building blocks for cells and tissuesImportant for bone and muscle growthSome examples: beef, poultry, pork, fish, eggs, soy, cheese, cottage cheese, nuts, peanut butterChoose lean cuts and lower fat options
5. FatImportant energy source needed for growthAim for healthy fatsSome examples: Monounsaturated fats – olive oil, canola oil, avocado, most nutsPolyunsaturated fats – corn oil, soybean oil, sunflower oil, sesame oilOmega-3s – fish oil, salmon, sardines, oysters, walnuts, ground flax seed and flax oilSaturated fats – animal fats, butter, cheese, bacon, sausage, hot dogs, chips, fried foodsTrans fats – baked goods, fried foods, shortening, donuts, stick margarine
6. What is the ideal diet?There is NO ‘diabetic’ or ‘ADA’ diet For both type I and type II, the goal is simply a healthy diet from which ALL kids would benefitIn general, a healthy diet should contain:5 or more fruits and vegetables4 or more servings from grains (preferably whole grain, non-processed)3-4 servings of dairyTotal fat intake between 20 – 35% of total calories (<6-8 teaspoons/day)Protein 2-3 servings per day
7. Nutrient4-8 years9-13 years14-18 yearsCalories Female120014001800 Male140018002200Fat, % of calories25-35%25-35%25-35%Lean meat/beans, oz Female355 Male456Fruits, cups Female1.51.51.5 Male1.51.52Vegetables, cups Female122.5 Male1.52.53Grains, oz Female456 Male567
8. Carb Amounts by Age5-12 years oldTeens- AdultsFemales45-60 gm per meal60-75 gm per mealMales45-60 gm per meal60-75+ gm per meal Snacks: 15-20 gm, as needed
9. Diet and Type I DiabetesThe balance between all carbohydrate eaten and the insulin dosage is one of the major keys to diabetes managementGoals:Balance insulin and carb intake in order to keep blood sugar values as close to normal as possiblePrevent severe hypoglycemiaHelp attain normal growth and development for childrenKeep cholesterol and triglycerides at desired levelsPrevent high blood pressureAvoid long-term complications
10. Carb Counting
11. Apps and WebsitesPersonal FavoritesCalorie King (book, website, app)My Fitness Pal (website, app)Livestrong MyPlate (website, app)
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13. The Exchange List
14. Exchange list go-to’s1 slice of bread 1/2 C potato1/3 C pasta1/3 C rice1 C milk or yogurt1 C fresh fruit1/2 C canned fruit1 Tbs jam, honey, sugar
15. Portion estimatesFist = 1 CupThumb = 1 TbsDeck of cards = 3 ozCupped hand = 1-2 oz
16. Insulin to Carb RatiosOne unit of insulin for each particular amount of carbs consumedAllows for greater freedom and flexibility in food choicesThe Rule of 500500 divided by Total Daily DoseEx) If 33 units of insulin (both long acting and rapid acting) were taken per day: 300 / 33 = 15 1 unit of rapid acting insulin per every 15 gm carb consumedCarb ratios may change at different mealsExample) If consuming 60 gm carbs with a 1 per 15 ICR, then deliver 4 units60 / 15 = 4 units
17. Assessing AccuracyCheck 2 hours post-prandialIf BG is consistently high following a meal, an increase in the aggressiveness would be neededEx) 1/15 may adjust to a 1/10 to give MORE insulinIf BG is consistently low following a meal, a decrease in the aggressiveness would be neededEx) 1/15 may adjust to a 1/20 to give LESS insulinThe correction factor may be also addedExercise, stress, illness, hormones can affect BGs.
18. Let’s practiceCase Study:Jamie, 10 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 15 gm carbohydrateLunch: 1 peanut butter and jelly sandwich (2 slices bread, 1 TBS peanut butter, 1 TBS jelly), 1/2 C baby carrots, ½ C sliced peaches in unsweetened fruit juice, 1 small carton of milk, and 2 oreo cookiesBlood sugar: 115 mg/dL (no correction needed)How many grams of carbs?How many units of rapid-acting insulin should be given?
19. Correction FactorDesigned to help bring a high blood sugar down into goal rangeConsider active insulin, exercise, meals/snacks previously consumedOne unit will bring blood sugars down by an expected number of pointsRule of 1800Ex) If 30 units of insulin (both long acting and rapid acting) were taken per day: 1800 / 30 = 60 1 unit of rapid acting insulin would decrease blood sugars by 60 pointsExample) Correction factor of 1/50 > 150 mg/dL with a current BG of 200 mg/dL 200 mg/dL – 150 mg/dL = 50/50 = 1 unit correction
20. Let’s PracticeCase Study:Jordan, 12 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 10 gm carbohydrate and a correction factor of 1/40 > 120 mg/dLLunch: 2 slices pepperoni pizza (Pizza Hut), 1 side salad with 2 TBS ranch dressing, 1 diet cokeBlood sugar: 170 mg/dL How many grams of carbs?How many units of rapid-acting insulin should be given for his meal?How many units of rapid-acting insulin should be given for correction?How many total units should we provide and when?
21. Let’s PracticeCase Study:Kailey, 7 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 20 gm carbohydrate and a correction factor of 1/60 > 150 mg/dLLunch: ½ cheeseburger, 1 carton of 1% milk, ½ banana , 1 sugar-free puddingBlood sugar: 200 mg/dL How many grams of carbs?How many units of rapid-acting insulin should be given for his meal?How many units of rapid-acting insulin should be given for correction?How many total units should we provide and when?
22. Let’s PracticeCase Study:Rob, 16 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 7 gm carbohydrate and a correction factor of 1/35 > 130 mg/dLLunch: 1 hot dog with ketcup, ½ C corn, 1 single serve bag of Doritos, 1 Snickers bar, 1 Powerade ZeroBlood sugar: 190 mg/dL How many grams of carbs?How many units of rapid-acting insulin should be given for his meal?How many units of rapid-acting insulin should be given for correction?How many total units should we provide and when?
23. conclusionThe goal is to provide a balanced diet to promote growth and developmentKids will be kidsVariety of methods to calculate grams of carbsBe flexible!
24. Questions?Thank you!Contact Information:Stephanie Etherington, RD, CD, CDEDiabetes Specialist, Confluence HealthStephanie.Etherington@confluencehealth.org662-1511 ext. 31915