Use of Glycemic Index In Diabetes Management

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1 Use of Glycemic Index In Diabetes Management Gary Scheiner MS, CDE Owner & Clinical Director Integrated Diabetes Services LLC (877)

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3 Timed Effect on Blood Sugar Levels Meal 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* (~50%) Fat slow digestion, little conversion to glucose** (0%) * In absence of dietary carbs ** may cause insulin resistance in large qty

4 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

5 MEET THE CARBS! Potatoes Rice Noodles/Pasta Cereal Oatmeal Bread Tortillas Pancakes Waffles Crackers Bagels Pizza Beans Corn Pretzels Chips Popcorn Beer

6 The fate of dietary carbohydrates Simple Carbohydrates (sugars) Complex Carbohydrates (starches) Blood Glucose

7 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)

8 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.

9 Glycemic Index (contd) High GI Med GI Low GI 0 hrs 1 hr 2 hrs 3 hrs 4 hrs 5 hrs 6 hrs

10 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 49 Jelly beans 80 Lifesavers 70 M & M, peanut 33 Nestle Crunch 42 Skittles 69 Snickers Bar 40 Twix Bar 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 COMBINATION FOODS Chicken Nuggets 46 Fish fingers 38 Macaroni & Cheese 64 Pizza (cheese) 60 Sausages 28 Stuffing 74 Taco shells 68 DAIRY Chocolate milk 34 Custard 43 Ice cream, vanilla 62 Ice Cream, choc. 68 Milk, skim 32 Milk, whole 27 Pudding 43 Yogurt, low fat 33 FRUITS & JUICES Apple 38 Apple juice 41 Banana 55 Cantaloupe 65 Cherries 22 Cranberry Juice 68 Fruit cocktail 55 Grapefruit 25 Grapes 46 Kiwi 53 Mango 56 Orange 44 Orange juice 52 Peach 42 Pear 37 Plum 39 Raisins 64 Watermelon 72 LEGUMES Baked beans 48 Black beans 30 Black-eyed Peas 42 Butter beans 30 Chick peas 33 Lentils, red 25 Lima Beans 32 Pinto Beans 45 Red kidney beans 19 PASTA/RICE Brown Rice 55 Couscous 65 Fettucini 32 InstantRice 87 Long grain Rice 56 Macaroni 45 Spaghetti, white 41 Spaghetti, wheat 37 Tortellini 50 Risotto 69 SNACK FOODS Corn Chips 74 Granola Bars 61 NutriGrain bars 66 Peanuts 15 Popcorn 55 Potato Chips 54 Pretzels 81 Rice Cakes 77 SOUPS Black Bean 64 Green Pea 66 Lentil 44 Minestrone 39 Split Pea 60 Tomato 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 75 Potato, baked 85 Potato, instant 83 Potato, mashed 91 Potato, boiled 88 Carrots, boiled 49 Carrots raw 47 Corn 46 Sweet potato 44 Tomato Juice 38

11 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

12 G.I. Is NOT An Exact Science! V a i@bl $ Food combinations Quantity being consumed Time since last meal Recent & planned physical activity Individual food sensitivities The winner in the 3 rd race at Belmont

13 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

14 If All Carbs Turn Into Glucose Eventually, Why Is Glyemic Index Important?

15 1. Satiety Low G.I. = Slower Gastric Emptying Leads to Less Consumption, Smaller Portions Less Tendency to Graze

16 Low Glylcemic-Index Foods Are More Satisfying! Jackie Scheiner Age 1

17 2. Mealtime Insulin Timing Goal is to match insulin action to food s effects, prevent high & low BG High G.I.: min prior Moderate G.I.: 0-15 min prior Low G.I.: 0-15min after

18 Normal Pump Bolus with Low-G.I. Meal: Insulin peaks too early (hypoglycemia) Insulin dissipates too soon (hyperglycemia)

19 Insulin Pump Options Square/Extended/Long Bolus Entire bolus is delivered gradually over 30min 8 hrs 1-2 hours is common

20 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

21 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

22 3. Reducing Post-Meal Spikes LOW G.I. FOODS PRODUCE FLATTER BGs! Diabetes Self-Management, August, 2006

23 Factors that lower G.I. Fiber Fat Temperature Solid (vs. liquid) Acidity Non-Processed Type of carb Ripeness Cookedness Fastest Slowest Glucose Dextrose Starch (branched-chain) Sucrose/Corn Syrup Fructose Starch (straight-chain) Lactose Galactose Sugar Alcohols

24 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

25 Examples: Use of GI Meal High-GI Options Lower-GI Options Breakfast Cereal Bagel/Toast Waffle Pancakes Muffins Oatmeal Milk Whole Fruit Nuts Yogurt

26 Examples: Use of GI Meal High-GI Options Lower-GI Options Lunch White Bread Fries Tortillas Fast Food Sourdough Bread Pumpernickel Carrots & Peas Bean Salad Soup

27 Examples: Use of GI Meal High-GI Options Lower-GI Options Dinner (sides) Rice Mashed Potato Baked Potato Rolls Pasta Beans Sweet Potato Tomato

28 Examples: Use of GI Meal High-GI Options Lower-GI Options Snacks Pretzels Chips Crackers Doughnuts Popcorn Nuts Ice Cream Chocolate

29 TIME FOR A POP QUIZ.

30 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

31 Hypoglycemia Treatment High-GI Foods Dry Cereal Pretzels Graham Crackers Vanilla Wafers Jelly Beans Gatorade Regular (non-diet) Soda

32 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

33 5. Hypoglycemia Prevention with Exercise Pre/During Workout: High G.I. Liquids Sport Drinks Regular Soda Juices Solids Crackers Dry Cereal Jelly Beans Hard Candies

34 Hypoglycemia Prevention with Exercise Post-Workout: Low G.I. Milk Chocolate Chocolate Milk Yogurt Veggies Nuts

35 6. IOB: Abide or Override? Assumption: IOB Will Lower BG (IOB units x Correction Factor) But what about FOB (food on board)? If previous meal was med-high GI: ABIDE If previous meal was low GI: OVERRIDE

36 Glycemic Index References Dr. Jennie Brand-Miller The New Glucose Revolution Series