Diabetic Diet Planning

The American Diabetes Association 2009 Position Statement regarding diabetic diet planning includes the following: "Although numerous studies have attempted to identify the optimal mix of macronutrients for meal plans of people with diabetes, it is unlikely that one such combination exists. The best mix of carbohydrate, protein and fat appears to vary depending on individual circumstances.".... "regardless of the macronutrient mix, total caloric intake must be appropriate for the weight management goal."

The individual must actively manage energy intake/output to maintain good glycemic control, thereby reducing the risk of diabetes mellitus (DM) and associated disease. Intensive and ongoing diabetic self-management education (DSME) is required to alter common lifestyle behaviors and practices that increase the risk of DM and its complications. DSME provides information, tools and support to improve glycemic control within a evidence based framework that reflects: personal preferences as well as physical, social and economic circumstances.

Although DSME is intended to meet the needs of the diabetic, much of the science is also applicable to the general population. Assimilating the healthy lifestyle changes promoted by DSME can reduce the risk of pre-diabetes, cardiovascular disease and stroke for most people in the developed world. If you are interested in improving your own health and that of your family, a good source of support and assistance may be as close as your diabetic colleague or friend.

A number of rules and tools have been developed to assist the diabetic to plan meals and manage of caloric intake. They include: macronutrient recommendations, carbohydrate counting, glycemic index, exchange lists, portions models, etc. The patient's DM certified registered dietician may use some of the following rules and tools as part of the DSME to assist the patient to make healthy eating choices that best control his/her A1c.

General Adult Macronutrient Recommendations

Exchange system is a meal planning method that groups similar types of foods into 6 categories. The intent the exchange system is to allow an individual to vary meal components while maintaining caloric goals. A serving of any food within a food group is approximately equal in calories. When a specific number of each exchange is eaten, a constant amount of calories and nutrients is supplied. The foods within each category are interchangeable in the prescribed amounts.

For example:

The National Diabetes Information Clearinghouse provides the following example of an exchange system:

Starch Exchange
1 Starch Exchange (Serving)
  • 1 slice of bread OR
  • 1 small potato OR
  • 1/2 cup cooked cereal or 3/4 cup dry cereal flakes OR
  • 1 six inch tortilla
2 Starch Exchanges (Servings)
  • 1 small potato + 1 small ear of corn OR
  • 2 slices of bread
3 Starch Exchanges (servings)
  • 1 small roll + 1/2 cup of peas + 1 small potato OR
  • 1 cup of rice
Vegetable Exchange
1 Vegetable Exchange (Serving)
  • 1/2 cup cooked carrots OR
  • 1/2 cup cooked green beans OR
  • 1 cup of salad
2 Vegetable Exchange (Servings)
  • 1/2 cup cooked carrots + 1/2 cup cooked green beans OR
  • 1/2 cup vegetable juice + 1/2 cup cooked green beans
3 Vegetable Exchange (servings)
  • 1/2 cup cooked green beans + 1/2 cup broccoli + 1 small tomato OR
  • 1/2 cup cooked green beans + 1 cup tomato sauce
Fruit Exchange
1 Fruit Exchange (Serving)
  • 1 small apple OR 1/2/ cup juice OR 1/2 grapefruit
2 Fruit Exchange (Servings)
  • 1 banana OR 1/2 cup orange juice + 1.25 cup whole strawberries
Dairy Exchange
1 Dairy Exchange (Serving)
  • 1 cup fat-free or low-fat yogurt OR 1 cup fat-free (skim) or low-fat milk
Meat Exchange
1-ounce serving
  • 1 egg OR 2 tablespoons of peanut butter
2-ounce serving
  • 1 slice (1 ounce) of low-fat turkey + 1 slice (1 ounce) of low-fat cheese
3-ounce serving
  • 3 ounces of cooked lean meat, chicken or fish
Fats and Sweets
1 Exchange (Serving)
  • 3 inch cookie OR 1 plain doughnut OR 1 tablespoon maple syrup
  • 1 strip bacon OR 1 teaspoon oil
2 Exchange (Serving)
  • 1 tablespoon regular salad OR 1 tablespoon reduced-fat mayonnaise


An example of a 1200 calorie meal plan for one day
Starches
Fruit
Milk
Vegetable
Meat or Substitute
Fat
Menu
Breakfast
1
1
1
1 small banana
3/4 cup corn flakes
1 cup fat-free milk
Lunch
2
1
1
2
1
Sandwich:
2slices whole wheat bread
2 oz. lean turkey
1 tablespoon reduced-fat mayo
1 cup celery & carrot sticks
1/2 cup juice
Snack
1
6 oz. non-fat sugar-free fruit in yogurt
Dinner
2
1
1
2
3
2 oz. lean beef steak
1/2 baked potato
1.5 tablespoons low-fat sour cream
1/2 cup cooked green beans
1 strip bacon
1tablespoon salad dressing
1 cup romaine lettuce
1 cup strawberries sugar-free sweetener
Total Exchanges
5
3
2
2
4
4


INSTANT FEEDBACK:

When using a food exchange system, foods within a group are interchanged within prescribed amounts.
True
False



Portion control models

Deck of Cards

1 serving = 3oz. cooked meat or substitute

Baseball

1 cup serving of salad greens

Dice

3 dice sized cheese cubes = 1 oz. serving.

 

Butter pat

1 serving = 1 teaspoon

Bread slice

1 slice = 1 serving

 

Ping-Pong Ball

2 Tbsp. of peanut butter, jam or salad dressing = 1 serving

 

Fist

1 cup is approximately the size of an average woman's fist.

CD

1 CD sized slice = 1 oz. serving of lean turkey or cheese.

Mouse

1 serving baked potato about the size of a computer mouse.

Tennis ball

1/3 cup cooked pasta = 1 serving.

1/2 baseball

1/2 cup ice cream= 1 serving.

 

Shot glass

1 shot glass = 1 serving of M&Ms.

2 shot glasses = 1 serving of nuts

Carbohydrate counting is an integral part of food and meal planning for persons with both type 1 and type 2 diabetes. In the past, diabetic patients were prescribed nutrition in the form of an "ADA" diet. The term "ADA" diet is no longer used because the American Diabetes Association (ADA) doesn't endorse any specific meal plan or specified percentages of protein, carbohydrates, and fats in the diet. Instead, recommended meal planning provides enough carbohydrate and protein to maintain blood glucose within the individuals target range while sustaining muscle mass. Meal plans that promotes consistent energy intake at meals and snacks, appropriate fat modifications, and consistent timing of meals and snacks can help keep blood glucose within the target range. Frequent self blood glucose monitoring and carbohydrate counting can help diabetics adjust energy intake. As a guide the ADA suggests an adult target of 45-60 grams of carbohydrate per meal depending on activity, medication and metabolic factors.

When starting a carbohydrate counting system, the diabetic person needs to know some important basics:

Diabetics should be taught how to first determine the portion size on a food label, as all the information on the label is based on portion size. Next, the individual is taught to determine the total amount of carbohydrate in a specific food serving and to assess total carbohydrate grams provided. Although protein and fat content of foods have a minimal effect on blood glucose, the amounts of protein and fat must be evaluated as they contribute calories to the meal.

As the individual gains more experience with the basics of carbohydrate counting, he or she can begin to more effectively manage diabetes by balancing the relationships between food, activity, and blood glucose levels. Individuals who use intensive insulin therapy or insulin pumps learn how to use carbohydrate-to-insulin ratios to determine how much rapid acting or short acting insulin to use to cover the amount of carbohydrate that will be consumed in the meal. As a guideline, one unit of insulin is usually taken for each 12-15 gm of carbohydrate contained in the meal.

The ADA offers the following examples of carbohydrate content, each item contains about 15 grams of carbohydrate:

1 small piece of fresh fruit (4 oz)
½ cup of canned or frozen fruit
1 slice of bread (1 oz) or 1 (6 inch) tortilla
½ cup of oatmeal
? cup of pasta or rice
4-6 crackers
½ English muffin or hamburger bun
½ cup of black beans or starchy vegetable
¼ of a large baked potato (3 oz)
? cup of plain fat-free yogurt or sweetened with sugar substitutes
2 small cookies
2 inch square brownie or cake without frosting
½ cup ice cream or sherbet
1 Tbsp. syrup, jam, jelly, sugar or honey
2 Tbsp. light syrup
6 chicken nuggets
½ cup of casserole
1 cup of soup
¼ serving of a medium french fry


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