Diabetes and Meal Planning

Transcription

1 Diabetes and Meal Planning

2 This information has been sourced from Diabetes Australia P a g e

3 What is diabetes? Diabetes is the name given to a group of different conditions in which there is too much glucose (sugar) in the blood. The pancreas either cannot make insulin or the insulin it makes is not enough and cannot work properly. Without insulin doing its job, glucose builds up in the blood leading to high blood glucose levels which can lead to complications. Video clip Reflection: This is what happens The body needs a sugar called glucose as its main source of fuel or energy. The body gets glucose from foods containing carbohydrate such as breads, breakfast cereals, rice, pasta, potatoes, milk, yoghurt, fruit and vegetables. The glucose is carried around the body in the blood the level should not go too high or too low. When the glucose goes above a certain level, some has to move out of the blood and into the body tissues, to supply the energy the cells need, to keep your body working properly. Some glucose is also stored in the liver (like you would store food items in the kitchen pantry) so that it can be used later if needed. When the glucose level drops too low, some of the glucose stored in the liver is released into the blood to bring the level back up again. Insulin is a hormone made by the pancreas, a gland sitting just below the stomach. Insulin is like a key that opens the doors (glucose channels) of the body cells and allows the glucose to move from the blood into the cells where it can be used for energy. This process is called glucose metabolism. In diabetes, the pancreas either cannot make insulin or the insulin it does make cannot work properly. Without insulin doing its job, the glucose channels are shut. Glucose builds up in the blood leading to high blood glucose levels which can lead to complications from diabetes. 3 P a g e

4 What is insulin? Insulin is a hormone made by special cells, called beta cells, in the pancreas. When we eat, insulin is released into the blood stream where it helps to move glucose from the food we have eaten into cells to be used as energy. Where is insulin injected? As Support Workers you are not expected to administer insulin. The health professional who will administer it, will most likely use an insulin device known as an injector pen. Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. It is not given into muscle or directly into the blood. Absorption of insulin varies depending on the part of the body into which you inject. The tummy (abdomen) absorbs insulin the fastest and is the site used by most people. The upper arms, buttocks and thighs are also used by some people. While it is essential to give each injection in a slightly different spot within the one site (such as the tummy), it is not advisable to change sites without first discussing it with your doctor or diabetes educator. 4 P a g e

5 What affects the way insulin is absorbed? Absorption is increased by: Injecting into an exercised area such as the thigh High temperatures (eg: shower, bath, hot water bottle, spa, sauna) Massaging the area around the injection site Injecting into muscle (the deeper the injection, the faster the insulin will be absorbed). Absorption can be delayed by: Smoking Scarring due to over-use of the same injection site, which causes the flesh to become hard and leads to erratic absorption of insulin Cold insulin (eg: injecting immediately after taking insulin from fridge) Variation in insulin absorption (either accelerated or delayed) can cause fluctuations in blood glucose levels You may need to support someone with the storage of their insulin: Keep your unopened insulin vials, pen cartridges or pre-filled pens on their side in the fridge. Insulin must not be allowed to freeze. Once opened, insulin may be kept at room temperature (less than 30 degrees) for approximately one month and then thrown away. Insulin can be safely carried in your handbag or pocket. Insulin may be damaged by extreme temperatures. It must not be left where temperatures are over 30 degrees (remember it can get this hot in the glove box of your car) or in direct sunlight. Do not use insulin if: The clear insulin has turned cloudy The expiry date has been reached The insulin has been frozen or exposed to high temperatures Lumps or flakes are seen in the insulin Deposits of insulin are seen on the inside of the vial, pre-filled pen or cartridge and cannot be dissolved by gently rotating. The insulin has been open for longer than one month. 5 P a g e

6 There are two main types of diabetes type 1 and type 2 Type 1 diabetes can occur at any age, but it s usually diagnosed in children and young adults. Type 1 diabetes is the less common form of diabetes, affecting just 10 15% of all people with diabetes. In type 1 diabetes, the pancreas cannot produce enough insulin because the cells that make the insulin have been destroyed by the body s own immune system. This insulin must be replaced. Therefore people with type 1 diabetes must have insulin every day to live. Type 2 is by far the most common form, occurring in 85 90% of all people with diabetes. Lifestyle choices can contribute to the development of type 2 diabetes. It is strongly associated with high blood pressure, abnormal blood fats and the body shape where there is extra weight around the waist. People with type 2 diabetes are usually insulin resistant. This means that their pancreas is making insulin but the insulin is not working as well as it should. The pancreas responds by working harder to make more insulin. Eventually it can t make enough to keep the glucose balance right and blood glucose levels rise. By taking tablets and/or insulin as soon as they are needed, the risk of developing complications caused by diabetes can be reduced. How is diabetes managed? In type 1 and type 2 diabetes, the aim of diabetes management is to get blood glucose levels as close as possible to recommended target ranges. For people with type 1 diabetes: insulin injections every day plus leading a healthy lifestyle. For people with type 2 diabetes: healthy eating and regular physical activity may be all that is required at first, although adding tablets and/or insulin is commonly required later on. Keeping blood glucose levels as close to recommended target ranges as possible will help prevent the short term effects of very low or very high blood glucose levels as well as the possible long term complications from diabetes. These can affect the eyes, kidneys and nerves. 6 P a g e

7 Basic guidelines for looking after diabetes 1. Test blood glucose levels regularly. 2. Always take the medication as prescribed by the doctor. 3. Be as active as often as possible. 4. Follow a healthy eating plan. 5. Achieve and maintain a healthier body weight and shape. 6. Keep a positive mental attitude. 7. Don t be afraid to ask for help. Blood glucose monitoring Testing blood glucose levels at home is a valuable diabetes management tool. Levels can be tested as often as needed or as recommended by the diabetes health care team. What is the target blood glucose range? Type 1 diabetes Type 2 diabetes 4 6 mmol/l before meals 6 8 mmol/l before meals Less than 10 mmol/l two hours after starting a meal 6 10 mmol/l two hours after starting a meal Why is it so important to test blood? Regular testing and recording of blood glucose levels can help monitor changes in blood glucose patterns and can alert us, and the diabetes health care team, about the need for a change in how the diabetes is being managed. Testing blood glucose levels will help to: Develop confidence in looking after the diabetes. Better understand the relationship between blood glucose levels and the physical activity being done, the food being eaten and other lifestyle influences such as travel, stress and illness. Know how lifestyle choices and diabetes medication, if used, are making a difference. Find out immediately if blood glucose levels are too high or too low, when it s best to exercise, and when to seek medical advice. 7 P a g e

8 How should I dispose of used needles? All Support Workers must wear gloves if they are assisting a person to monitor blood glucose levels. Used pen needles and lancets must be disposed of in an approved SHARPS container which is puncture-proof and has a secure lid. These are usually yellow in colour and are available through pharmacies. When SHARPS container becomes full, return it to the pharmacy or hospital and obtain a replacement. What causes glucose levels to go up and down? There are a number of common causes for glucose levels to increase or decrease. These include: Food the time eaten, the type and amount of carbohydrate (eg: bread, pasta, sugar, cereals, starchy vegetables, fruit and milk) Exercise or physical activity Illness and pain Diabetes medication Alcohol Emotional stress Other medications How often and what time of day should a test be done? The doctor or diabetes educator will decide how many tests need to be done each day, when to test and the target range to be aimed for. Many modern meters have memories but Support Workers must always keep written records of blood glucose level readings. Some testing times may be: before breakfast (fasting) two hours after a meal before bed before lunch and dinner when feeling unwell 8 P a g e

9 For people with type 1 diabetes, testing four times a day is usually recommended. Test more often when the person is: Being more physically active or less physically active Sick or stressed Experiencing changes in routine or eating habits eg: when travelling Changing or adjusting insulin or medication Experiencing symptoms of hypoglycaemia (low blood sugar) Experiencing symptoms of hyperglycaemia (high blood sugar) Experiencing night sweats or morning headaches What if the test result doesn t sound right? If you re not convinced that a result is correct, here s a suggested check list: > Have the strips expired? > Is the strip the right one for the meter? > Is there enough blood on the strip? > Has the strip been put into the meter the right way? > Have the strips been affected by heat or light? > Did the person wash and thoroughly dry their hands before doing the test? > Is the meter clean? > Is the meter too hot or too cold? > Is the calibration code correct? > Is the battery low or flat? Diabetes management is all about careful balance between food, activity and diabetes medication. Regular physical activity - How does it help? Improves insulin sensitivity which makes insulin work better and lowers blood glucose levels. Controls blood fats (cholesterol and triglycerides), blood pressure and body weight. Increases bone strength and improve your general sense of wellbeing. The effects of exercise on blood glucose levels are individual, therefore it is important to be aware of the person s responses. This can be done by monitoring blood glucose levels before, during and after exercise and 9 P a g e

10 working with the diabetes educator to plan a physical activity that will be enjoyed. People with diabetes need to consider factors relating to their feet, eyes, kidneys and heart, so it is important to talk to the doctor before starting any new physical activity program. Food management for people with diabetes What should I eat? To help manage your diabetes, your meals need to be: Regular and spread evenly throughout the day Lower in fat, particularly saturated fat If you take insulin or diabetes tablets, you may need to have between meal snacks Matching the amount of food you eat with the amount you burn up each day is important. Not putting too much fuel in your body (keeping food intake to moderate serves) is vital to getting the right balance. Along with healthy eating, regular physical activity can help you to manage your blood glucose levels, reduce your blood fats (cholesterol and triglycerides) and maintain a healthy weight. Diabetes Australia encourage all people with diabetes to see an Accredited Practising Dietitian in conjunction with their diabetes team for individualised advice. It is important to recognise that one diet does not fit everyone with diabetes. Fat Fats have the highest energy (kilojoule or calorie) content of all foods. Eating too much fat can make you put on weight, which may make it more difficult to manage blood glucose levels. While it is important to try and reduce fat in 10 P a g e

11 your diet, especially if you are trying to lose weight, some fat is good for health. Saturated fat It is important to limit saturated fat because it raises your LDL ( bad ) cholesterol levels. Saturated fat is found in animal foods like fatty meat, milk, butter and cheese. Vegetable fats that are saturated include palm oil (found in solid cooking fats, snack foods or convenience foods) and coconut products such as coconut milk or cream. To reduce saturated fat: Choose reduced or low-fat dairy products Choose lean meat and trim any fat off before cooking Remove the skin from chicken (where possible, before cooking) If using butter or dairy products e.g. use lite or limit the portion size. Limit the amount of cheese you eat and try reduced-fat and low-fat varieties Limit pastries, cakes, puddings, chocolate and cream biscuits to special occasions Limit pre-packaged biscuits, savoury packet snacks, cakes, frozen and convenience meals Limit the use of processed deli meats (devon/polony/fritz/luncheon meat, chicken loaf, salami etc) and sausages Avoid fried takeaway foods such as chips, fried chicken and battered fish and choose BBQ chicken (without the skin) and grilled fish instead Avoid pies, sausage rolls and pastries Rather than creamy sauces or dressings, choose those that are based on tomato, soy or other low fat ingredients. As some tomato and soy sauces can be high in salt, choose low-salt varieties or make them yourself without any added salt. Limit creamy style soups. Polyunsaturated & monounsaturated fats Eating small amounts of polyunsaturated and monounsaturated fats can help ensure you get the essential fatty acids and vitamins your body needs. Polyunsaturated fats include: Polyunsaturated margarines (check the label for the word polyunsaturated ) Sunflower, safflower, soybean, grapeseed and sesame oils The fat found in oily fish such as herring, mackerel, sardine, salmon and tuna. 11 P a g e

12 Monounsaturated fats include: Canola and olive oils Some margarines Avocado Seeds, nuts, nut spreads and peanut oil contain a combination of polyunsaturated and monounsaturated fat. Ideas for enjoying healthy fats Stir-fry meat and vegetables in a little canola oil (or oil spray) with garlic or chilli Dress a salad or steamed vegetables with a little olive oil and lemon juice or vinegar Sprinkle sesame seeds on steamed vegetables Use seeded wholemeal bread Snack on a handful of unsalted nuts, or add some to a stir-fry or salad Spread avocado on sandwiches and toast, or add to a salad Eat more fish (at least three times a week) because it contains a special type of fat (omega-3) that is good for your heart. Do more dry roasting, grilling and stir-frying in a non-stick pan Avoid deep fried, battered and crumbed foods Carbohydrate In following the Australian Guide to Healthy Eating, we recommend eating a moderate amount of carbohydrates. For example, on a plate, approx, 1/4 of the plate should be carbohydrate foods. Carbohydrate foods are the best energy source for your body. When they are digested they break down to form glucose in the bloodstream. Insulin takes the glucose out of the blood and deposits it into the muscles, liver and other cells in the body where it is used to provide energy. A regular carbohydrate intake is required to provide our body and brain with instant energy. Most foods contain carbohydrate and also provide us with fibre, 12 P a g e

13 vitamins and minerals. Very low carbohydrate diets are not recommended for people with diabetes. If regular meals are eaten and the carbohydrate foods are spread evenly throughout the day, it will help maintain energy levels without causing large rises in your blood glucose levels. If taking insulin or diabetes tablets, between meal snacks may be recommended. Discuss this with your doctor, dietitian or Diabetes Educator. All carbohydrate foods are digested to produce glucose but they do so at different rates some slow, some fast. The glycemic index or GI is a way of describing how a carbohydrate containing food affects blood glucose levels. The type of carbohydrate you eat is very important as some can cause higher blood glucose after eating. The best combination is to eat moderate amounts of carbohydrate and include high fibre foods that also have a low GI. Sugar A healthy eating plan for diabetes can include some sugar. However, it is important to consider the nutritional value of the foods you eat. In general, foods with added sugars should be consumed sparingly (manufacturers sometimes use fruit juice or other sources of sugar to avoid using table sugar). In particular, high energy foods such as sweets, lollies and standard soft drinks should not be consumed on a regular basis. Alternative sweeteners The jury is still out. Protein Choose protein foods that are also low in fat. This will help to reduce the amount of saturated fat you eat. Protein foods include lean meat, poultry without the skin, seafood, eggs (not fried), unsalted nuts, soy products such as tofu, beans and lentils. Herbs, condiments & drinks You can use these following foods to add flavour and variety to your meals. Herbs, spices, garlic, chilli, lemon juice, vinegar and other seasonings. Tea, coffee, herbal tea, water, soda water, plain mineral water. Limit your alcohol intake if you choose to drink. 13 P a g e

14 Choose Limit Avoid Wholegrain or wholemeal breads and rolls added seeds helps White breads Sweets Lollies White crackers Soft drinks Cakes Sweet biscuits Chocolate Chips Jam Honey High fibre break cereals such as Cordial and soft Rolled oats drinks with All-Bran artificial Untoasted muesli (without dried fruit) sweeteners Pasta: Wholemeal Rice: Doongara, Basmati or Brown Barley, bulgur, quinoa Fruit whole 2 per day Lowest GI: apples, oranges, peaches, bananas Berries Alcohol limit to 2 standard drinks per day, have with meals If you need to lose weight, reduce alcohol further. Melons Kiwi fruit Plums Fruit based dessert with low-fat crumble topping or carb food. Have some alcohol-free days. Dairy foods, low fat varieties Milk Soy milk Yogurt (low sugar & low fat) Vegetables Yams Sweet corn Potatoes Sweet potato Salads Green vegies Carrots, pumpkin etc If you eat more carbohydrate than usual, without increasing your physical activity or your insulin, your blood glucose level can rise too high. If you eat too little carbohydrate or skip a meal, your blood glucose level can drop too low. That s why you need to find the right balance of carbohydrate-containing foods. Achieving a more flexible eating pattern should be discussed with the diabetes educator. 14 P a g e

15 To help manage diabetes, meals need to be: > An appropriate size appropriate to each individual > Regular and spread evenly throughout the day > Lower in fat, particularly saturated fat > Based on high fibre carbohydrate foods such as wholegrain breads and cereals, dried beans, lentils, starchy vegetables and fruits. Healthy eating for people with diabetes is no different than what is recommended for everyone. There is no need to prepare separate meals or buy special foods, so everyone in the household can enjoy healthy eating together. Healthy choices Oily fish such as herring, mackerel, sardine, salmon and tuna Seeds, nuts, nut spreads and coconut oil Avocado Eggs Stir-fry meat and vegetables in a little coconut, rice bran or olive oil with garlic or chilli Use seeded bread and spread with a little butter Add a few unsalted nuts to stir fries and salads Snack on a handful of unsalted nuts/seeds Dress a salad or steamed vegetables with a little olive oil with either lemon juice or balsamic vinegar, or sprinkle with sesame seeds 15 P a g e

16 Spread avocado on sandwiches and toast, or add to a salad Eat more fish (twice a week) because it contains a type of fat (omega 3) that is good for your heart Weight management Being overweight, especially around the waistline makes it more difficult to manage diabetes and increases the risk of heart disease. If you are overweight a small weight loss (5 10% of body weight) can make a big difference to your health. Aim to lose weight gradually and set small achievable goals. Measuring your waistline is a great way of checking your progress rather than weighing yourself regularly. In general, women should aim for a waist circumference less than 80 cm and men should aim for less than 94 cm. 16 P a g e

17 If you are carrying excess weight around the middle, try to lose some of it by: Reducing your portion sizes and following a diet plan lower in kilojoules and total fat. Doing regular physical activity such as walking, dancing, riding a bike or swimming. Seeking advice from your doctor, diabetes educator or dietician. An example of a typical meal plan for one day Choose foods you like and which satisfy you and remember to include carbohydrate foods in each meal or snack to help manage your blood glucose levels. Carbohydrate containing foods are in italics. Breakfast example 1/2 cup of hot oatmeal (made with water) 1 cup skim milk ½ cup blueberries Snack 1 small banana Lunch 1 slice of wholemeal seeded bread, 1 cup salad vegetables A small serve of lean meat, skinless poultry, seafood e.g. 90 gm can of tuna in brine, egg. 1 piece of fruit Snack 2 Tablespoons hummus Celery and carrots sticks Dinner - Stir fry maybe ½ cup cooked brown rice or quinoa 1 cup (or more) salad green or cooked greens Portion of lean protein 1 piece of fruit OR small amount of low fat yoghurt 17 P a g e

18 People with diabetes on certain types of tablets or insulin may require one snack between each meal and for supper. However, most people aiming to control their body weight may not need a snack between every meal. To find out what is best for you, discuss this with your diabetes educator or dietician. Reading food labels The labels on all packaged foods must contain the following information. By reading these labels you will be able to judge where the food fits into your eating pattern. The Ingredient List All packaged foods must have an ingredient list on their labels. All ingredients are listed in descending order by weight (ie: the ingredient that weighs the most is listed first and the ingredient that weighs the least is listed last). This allows you to work out roughly how much of the ingredient the food contains, which can help you decide whether or not you want to buy the food. Percentage labelling Some packaged foods show the percentage of the key ingredients in the food product. For example in strawberry yoghurt, strawberries are a key ingredient, so the percentage of strawberries is indicated. In some cases, such as plain milk or bread, there are no key or characterising ingredients. Nutrition claims To attract the shopper s attention, food manufacturers may make a nutrition claim on their packaging such as low fat, high fibre or reduced salt. Rather than relying on these claims to make a choice, refer to the Nutrition Information Panel to assess whether the product is a healthy option. The Nutrition Information Panel Most packaged foods must have a Nutrition Information Panel. Exceptions include small packages and foods like herbs and spices, tea, coffee as well as foods sold unpackaged or made and packaged at the point of sale. Nutrition Information Panels provide information on: Energy (kilojoules/calories) Protein Total fat Total carbohydrate and sugars (including added sugar and sugar that is present naturally) Sodium (salt) Dietary fibre (only appears if a claim is made about the fibre or sugar content of the food, eg: high fibre or low sugar ). 18 P a g e

19 The Nutrition Information Panel provides very useful information that can be used to decide whether a food is suitable for someone with diabetes and for choosing the better option from a range of similar products. How to find healthy foods when shopping To decide if a food is a healthy choice, ask: Is the food lower in fat? Tip: Healthier options have less than 5g total fat per 100g or 5 10g total fat per 100g. Is the food lower in salt (sodium)? 19 P a g e

20 Tip: Healthier options have less than 450mg sodium per 100g. Low sodium foods have less than 120mg sodium per 100g. Is the food high in fibre? Tip: Healthier options have more than 3g dietary fibre per 100g. Remember that many foods do not have dietary fibre listed in the Nutrition Information Panel. Activity 1: Choose two food packets. Study the Nutrition Information panels and decide whether the food item is suitable for managing blood glucose levels, or not. Activity 2: Using foodband sheets, compare the difference in fat and sugar between fast food and homemade options. Activity 3: With another member of the group, create one day of healthy meals suitable for a person who is trying to manage their blood glucose levels. 20 P a g e

21 Drinks BREAKFAST Drinks SNACK Drinks LUNCH Drinks SNACK Drinks DINNER Drinks SUPPER 21 P a g e