Transcript Diabetes in Your School - Encouraging Healthy Nutrition Donna Amundson, RN, CDE Diabetes Care Center Medcenter One.

Diabetes in Your School
- Encouraging Healthy
Nutrition
Donna Amundson, RN, CDE
Diabetes Care Center
Medcenter One
Food (mainly carbohydrate)
is one of the major
influences on blood sugar
levels in people with
diabetes.
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.”
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.
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

To help attain
normal growth and
development for
children and achieve
appropriate weight
for everyone
 To help prevent
severe low blood
sugar reactions

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).
 Protein: One of the energy nutrients. It is
found in meat, eggs, fish ,milk, yogurt and, in
lesser amounts, in vegetables and other nonmeat 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
 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
body’s blood, the body fluids and the
body’s transport system. Serves as a
coolant, shock absorber and waste
remover. Our bodies are made up of
about 2/3 water.
 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.
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

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.
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

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.
It’s important for
the family to meet
with a registered
dietitian to develop
a meal plan that
meets the needs of
the child.
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!
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.

Examples of Carb Counts









Medium apple…15 gms
Medium banana… 30 gms
1 cup milk………15 gms
1 cup chocolate milk…30
gms
1 slice bread……15 gms
⅓ cup pasta…… 15 gms
½ cup corn………15 gms
Hamburger bun…30 gms
1 cup hotdish……30 gms








1 hard shell taco…15 gms
1/8 12” thin pizza…15 gms
Small order fries…30 gms
One 3” cookie……15 gms
Frosted cupcake…30 gms
3 cups popcorn….. 15 gms
½ cup ice cream….15 gms
1 cup bean, noodle or
vegetable soup…15 gms
Sample breakfast…



1 ½ cups unsweetened cereal
 30 gms
1 medium banana
 30 gms
1 cup milk
 15 gms
Total Carbs:
75 gms
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
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
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
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 1:15, 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.
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.
How are insulin adjustments
made for food and blood
sugar levels?
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.
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

The most common correction dose is one
unit of rapid acting insulin per 50mg/dl of
blood sugar above 100mg/dl.
So, if the child’s 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.
Every child is different,
however, so the correction
factor must be individualized
by the child’s family and
diabetes healthcare team
working together.
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.


The parents should also help the
school staff learn what they need to
know about their child’s individual
diabetes care.
 A health care plan should outline the
child’s 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.
 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 that’s part
of the child’s heath care plan
know how to recognize and
treat hypoglycemia
 know when and how to give a
glucagon injection
 know the child’s meal plan
and work with the parents to
coordinate it with the
schedule of the other children
in the class

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.
Resources



Children’s Diabetes Foundation
(800)695-2873
www.childrensdiabetesfdn.org
Juvenile Diabetes Foundation International
(212)785-9500
www.jdfcure.org
American Diabetes Association
(800)232-3472
www.diabetes.org