Use of Glycemic Index In Diabetes Management Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648 www.integrateddiabetes.com [email protected].
Download ReportTranscript Use of Glycemic Index In Diabetes Management Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648 www.integrateddiabetes.com [email protected].
Use of Glycemic Index In Diabetes Management Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877) 735-3648 www.integrateddiabetes.com [email protected] Timed Effect on Blood Sugar Levels M e al 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs Carbohydrate…….rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols….moderate digestion, partial absorption as glucose (50%) Protein……………..slow digestion, partial conversion to glucose* (~40%) Fat……………………slow digestion, little conversion to glucose** (0%) * In absence of dietary carbs ** may cause insulin resistance in large qty MEET THE CARBS! Fruit Fruit Juice Candy Regular Soda Punch Wine Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly MEET THE CARBS! • • • • • • Potatoes Rice Noodles/Pasta Cereal Oatmeal Bread • • • • • • Tortillas Pancakes Waffles Crackers Bagels Pizza • • • • • • Beans Corn Pretzels Chips Popcorn Beer The “fate” of dietary carbohydrates Simple Carbohydrates (sugars) Blood Glucose Complex Carbohydrates (starches) Does the Type of Carbohydrate Matter? Glycemic Index • All carbs (except fiber) convert to blood glucose eventually • G.I. Reflects the magnitude of blood glucose rise in the first 2 hours • G.I. Number is % of rise relative to pure glucose (in dextrose form) Glycemic Index (contd.) Example: Spaghetti GI = 37 • 37% of spaghetti’s carbs turn into blood glucose in the first 2 hours. • The rest will convert to blood glucose over the next several hours. Glycemic Index (contd) High GI Med GI Low GI 0 hrs 1 hr 2 hrs 3 hrs 4 hrs 5 hrs 6 hrs Glycemic Index Values BREAD/CRACKERS Bagel 72 Crispbread 81 Croissant 67 French baguette 95 Graham Crackers 74 Hamburger bun 61 Kaiser roll 73 Melba toast 70 Pita bread 57 Pumpernickel 51 Rye, dark 76 Saltines 74 Sourdough 52 Wheat Thins 67 Wheat Bread, 68 White Bread 71 CAKES/COOKIES/MUFFINS Angel Food Cake 67 Banana Bread 47 Blueberry Muffin 59 Chocolate Cake 38 Corn Muffin 102 Cupcake with icing 73 Donut 76 Oat Bran Muffin 60 Oatmeal cookies 55 Pound Cake 54 Shortbread cookies 64 Vanilla wafers 77 CANDY Chocolate Jelly beans Lifesavers M & M, peanut Nestle Crunch Skittles Snickers Bar Twix Bar 49 80 70 33 42 69 40 43 CEREALS/BREAKFAST All-Bran 42 Bran Chex 58 Cheerios 74 Corn Flakes 83 Cream of Wheat 70 Crispix cereal 87 Golden Grahams 71 Grape Nuts 67 Oatmeal 49 Pancakes 67 PopTarts 70 Puffed Wheat 67 Raisin Bran 73 Rice Krispies 82 Shredded Wheat 69 Special K 66 Total 76 Waffles 76 FRUITS & JUICES Apple Apple juice Banana Cantaloupe Cherries Cranberry Juice Fruit cocktail Grapefruit Grapes Kiwi Mango Orange Orange juice Peach Pear Plum Raisins Watermelon 38 41 55 65 22 68 55 25 46 53 56 44 52 42 37 39 64 72 COMBINATION FOODS Chicken Nuggets 46 Fish fingers 38 Macaroni & Cheese 64 Pizza (cheese) 60 Sausages 28 Stuffing 74 Taco shells 68 LEGUMES Baked beans Black beans Black-eyed Peas Butter beans Chick peas Lentils, red Lima Beans Pinto Beans Red kidney beans 48 30 42 30 33 25 32 45 19 DAIRY Chocolate milk Custard Ice cream, vanilla Ice Cream, choc. Milk, skim Milk, whole Pudding Yogurt, low fat 34 43 62 68 32 27 43 33 PASTA/RICE Brown Rice Couscous Fettucini InstantRice Long grain Rice Macaroni Spaghetti, white Spaghetti, wheat Tortellini Risotto 55 65 32 87 56 45 41 37 50 69 SNACK FOODS Corn Chips Granola Bars NutriGrain bars Peanuts Popcorn Potato Chips Pretzels Rice Cakes 74 61 66 15 55 54 81 77 SOUPS Black Bean Green Pea Lentil Minestrone Split Pea Tomato 64 66 44 39 60 38 SPORTS BARS/DRINKS Gatorade 78 Power Bar 58 SUGARS & SPREADS Glucose tablets 102 Corn syrup 62 Honey 58 Strawberry Jam 51 Syrup 66 Table Sugar 64 VEGETABLES French fries Potato, baked Potato, instant Potato, mashed Potato, boiled Carrots, boiled Carrots raw Corn Sweet potato Tomato Juice 75 85 83 91 88 49 47 46 44 38 What About MIXED Meals? • Tends toward G.I. of primary food in meal (i.e. bread in sandwich) • Eating low-g.i. food first lowers G.I. of entire meal G.I. Is NOT An Exact Science! a V • • • • • • i@bL$ Food combinations Quantity being consumed Time since last meal Recent & planned physical activity Individual food sensitivities The winner in the 3rd race at Belmont G.I. Gereralization Slow Stuff Average Stuff Fast Stuff Pasta Legumes Salad Veggies Dairy Chocolate Fruit Juice Pizza Soup Cake Breads/Crackers Salty Snacks Potatoes Rice Cereals Sugary Candies If All Carbs Turn Into Glucose Eventually, Why Is Glyemic Index Important? 1. Satiety • Low G.I. = Slower Gastric Emptying • Leads to Less Consumption, Smaller Portions • Less Tendency to “Graze” Low Glylcemic-Index Foods Are More Satisfying! Jackie Scheiner Age 1 2. Mealtime Insulin Timing • Goal is to match insulin action to food’s effects, prevent high & low BG – High G.I.: 15-30 min prior – Moderate G.I.: 0-15 min prior – Low G.I.: 0-15min after Normal Pump Bolus with Low-G.I. Meal: • Insulin peaks too early (hypoglycemia) • Insulin dissipates too soon (hyperglycemia) Insulin Pump Options Square/Extended/Long Bolus • Entire bolus is delivered gradually over 30min – 8 hrs • 1 -2 hours is common Insulin Pump Options Dual/Combo/Combination Bolus • Part of bolus delivered up-front, remainder over time • 30% Up-Front is common, remainder over 2 hrs 3. Reducing Post-Meal Spikes • Glucose variability is associated with increased complication risk, emotional distress, and diminished physical & intellectural performance • Injected/infused “rapid” insulin is much slower than insulin produced by the pancreas • The amylin hormone is lacking or deficient 3. Reducing Post-Meal Spikes LOW G.I. FOODS PRODUCE FLATTER BGs! Diabetes Self-Management, August, 2006 Factors that lower G.I. • • • • • • • Fiber Fat Temperature Solid (vs. liquid) Acidity Non-Processed Type of carb Fastest Glucose Dextrose Starch (branched-chain) Sucrose/Corn Syrup Fructose Starch (straight-chain) Lactose Galactose Slowest Sugar Alcohols Starch Structure Affects G.I. “straight chain” G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G “branched chain” G–G–G–G–G -G G–G / \ / G–G G G–G–G G–G–G \ / \ / G–G–G –G–G–G G–G–G–G–G–G \ \ G–G–G G–G–G–G–G Examples: Use of GI Meal Breakfast High-GI Options Lower-GI Options Cereal Bagel/Toast Waffle Pancakes Muffins Oatmeal Milk Whole Fruit Nuts Yogurt Examples: Use of GI Meal Lunch High-GI Options Lower-GI Options White Bread Fries Tortillas Fast Food Sourdough Bread Pumpernickel Carrots & Peas Bean Salad Soup Examples: Use of GI Meal Dinner (sides) High-GI Options Lower-GI Options Rice Mashed Potato Baked Potato Rolls Pasta Beans Sweet Potato Tomato Examples: Use of GI Meal Snacks High-GI Options Lower-GI Options Pretzels Chips Crackers Doughnuts Popcorn Nuts Ice Cream Chocolate 4. Treating Hypoglyemia • High-GI foods convert to glucose rapidly (faster recovery) • Lower-GI foods take longer to work, may lead to over-treatment and significant posttreatment hyperglycemia Hypoglycemia Treatment High-GI Foods • Dry Cereal • Pretzels • Graham Crackers • Vanilla Wafers • Jelly Beans • Gatorade • Regular (non-diet) Soda Hypoglycemia Treatment DEXTROSE Rules! (GI=100) Dex Products •Glucose Tablets •Glucose Gel •Liquid Blasts Dextrose-Sweetened Candies •Sweet Tarts •Smarties •Spree •Air Heads •Nerds •Runts Glycemic Index References Dr. Jennie Brand-Miller The “New Glucose Revolution” Series