Dietary Considerations and Easy Wins December 6, 2018 Karmella - - PowerPoint PPT Presentation

Dietary Considerations and Easy Wins

December 6, 2018 Karmella Thomas, RDN, LD,CDE

AAA Case Study – 48 year old male case study…

• Type 2 Diabetes (dx 2008;

family history)

– Lantus 65 units BID – Humalog 20 units TID (even if no meal) – Metformin 1000 mg BID – Jardiance 10 mg/day

• Hemoglobin A1c is 9.3%

last month

• Denies hypoglycemia
• Peripheral neuropathy
• Pancreatitis (binge drinking)
• Sleep apnea
• Quit smoking 4 yrs ago
• Weight = 222 pounds
• BMI = 38.10
• Blood Pressure 134/85
• Checks BS occasionally

Initial MNT assessment

• Biggest concern is to lose weight (50 pounds)
• High level of stress at home and work
• Emotional/binge eating habits
• 10 years ago: initially dx, lost 50 pounds, tracked his

food, exercised and A1c got down to 6.1% (11%

• riginally)
• Not motivated to change for himself – wants to

change since his family wants him to change

Nutritional concerns

• 24 hour recall = 3,072 calories and 433 grams carbs

– McDonalds: 2 cheeseburgers and 32 oz coke – Popcorn at movie theater and 32 oz coke – Two deep fried sushi rolls, water – ½ cup sunflower seeds and water

• High consumption of sugar sweetened beverages
• Not monitoring blood sugars
• Low level of motivation (importance and confidence)
• Emotional eating
• Burnt out!

Where do we start?

AADE7 Self-Care Behaviors™

• 1. Healthy Eating
• 2. Being Active
• 3. Monitoring
• 4. Taking Medication
• 5. Problem Solving
• 6. Reducing Risks
• 7. Healthy Coping

AADE7 Self-Care Behaviors™

• 1. Healthy Eating
• 2. Being Active
• 3. Monitoring
• 4. Taking Medication
• 5. Problem Solving
• 6. Reducing Risks
• 7. Healthy Coping

Some considerations

• Carbohydrates have the biggest impact on blood

sugars – All carbs except for fiber turn into sugar

• Eliminate sugar sweetened beverages
• Limit snacking

– Wait 3 hours between meals and snacks

• Watch out for condiments
• Record keeping
• Keep fat intake at a moderate level
• Move daily!

Condiments

• Easy to assume these do not impact blood sugars
• Most people do not consume 1 TBSP at each meal
• Ketchup 1 TBSP = 4.7 g of total carbs

– 18grams of carbs for ¼ cup

• BBQ Sauce 1 TBSP = 7g of total carbs
• Teriyaki Sauce 1 TBSP = 5g of total carbs
• Balsamic Vinegar 1 TBSP = 3g of total carbs

Blood Sugar Levels

1 Hour 2 Hours

High Carbohydrate Meal - (oatmeal, fruit, toast, juice) Mixed Meal – (pasta with lean meat sauce and veggies)

What should we prioritize first?

• What does the patient want to do?

– Calorie counting? – Carbohydrate counting?

• The total amount of carbohydrate in meals or

snacks is more important than the source or type

• The more carbohydrates consumed at one

time will have a greater impact on post prandial blood sugars

Franz MJ. Carbohydrate and diabetes: is the source or the amount

• f more importance? Curr Diab Rep, 2001;1(2):177-86

2017 Viewpoint in JAMA

• Steps to include nutrition counseling during

patient appointments:

– Start the conversation – 5 A’s – Assess, Advise, Agree, Assist, Arrange – Focus on the small steps – Use available resources – Do not do it all alone

• Kahan S, Manson JE. Nutrition Counseling in Clinical PracticeHow Clinicians Can Do Better.
• JAMA. 2017;318(12):1101–1102. doi:10.1001/jama.2017.10434

Mindful eating

• Barriers:

– Fast paced world and multitasking – Technology (tv, computers, smart phones) – Guilt associated with eating “bad” foods

• Tools:

– Hershey’s Kiss exercise – Eat at the dinner table only – Aim for 20 minutes to eat a meal – Smaller utensils

Keep fat at a moderate level

• High intake of fat at a meal slows down digestion
• Rapid acting insulin may peak before blood

sugars increase

• Risk is hypoglycemia soon after eating and a

much later rise in blood sugar after meal (few hours later)

• Fat has the most calories per gram = weight

gain = insulin resistance

THANK YOU!