This document offers guidance for instructors on incorporating this collection of handouts into Cooking Matters for Adults lesson plans.

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1 Cooking Matters EXTRA for Diabetes A supplement to Cooking Matters for Adults, with specialized information for adults at risk of or living with diabetes. This document offers guidance for instructors on incorporating this collection of handouts into Cooking Matters for Adults lesson plans Share Our Strength, Cooking Matters EXTRA for Diabetes 1

2 Cooking Matters EXTRA for Diabetes was created to improve the health and well-being of lowincome individuals at risk of or living with diabetes. The program focuses on the vital ways that healthy eating and physical activity help with blood sugar maintenance and the prevention or delay of serious short- and long-term health risks associated with diabetes. Cooking Matters EXTRA for Diabetes combines practical advice on healthy eating and physical activity with motivation strategies and goal setting to inspire participants and allow them to take ownership of the changes they can make in their lives. Goal Encourage low-income individuals to adopt healthy eating and lifestyle behaviors that will help them prevent or manage diabetes. Objectives Participants will discuss the following: The importance of healthy eating and physical activity for preventing and managing diabetes Ways to make healthy choices about carbohydrates Ways to make healthy choices when eating out Tips for Instructors In order to successfully incorporate these discussions and handouts into a busy Cooking Matters for Adults curriculum, spend time reviewing both lesson plans in advance. If needed, determine where you can streamline Cooking Matters for Adults content to be sure you also cover Cooking Matters EXTRA for Diabetes information. Allow participants to share what they already know about these topics, and be sure to acknowledge the good things they re already doing to prevent or manage diabetes. As much as possible, ask participants open-ended questions that build on their knowledge and experiences. Be sensitive to the challenges they may face in applying this information, and help them brainstorm possible solutions as a group. Allow participants to share questions, concerns, and successes so they can learn from each other as well as from you. While your qualifications make you an ideal leader for this course, you may still find that participants have very specific questions about medications, diabetic complications, or other topics that you are not able to answer. It s OK to refer them back to their physicians, or to tell participants that you will look into their questions and get back to them during the next session (Try using the resource list on page 3!). Be sure participants understand up front that questions regarding their individual treatment plan will need to be answered by their personal medical team. Introduce the handouts by explaining that they have been developed specifically for people at risk of or living with diabetes to complement the information they are learning in Cooking Matters for Adults. These additional handouts will address common questions participants have about following the healthy-eating strategies explained in Cooking Matters for Adults while facing the additional considerations associated with diabetes Share Our Strength, Cooking Matters EXTRA for Diabetes 2

3 Online Resources General Nutrition MyPlate Dietary Guidelines for Americans Centers for Disease Control, Division of Nutrition, Physical Activity, and Obesity Food and Nutrition Information Center Harvard School of Public Health, The Nutrition Source Diabetes American Diabetes Association Diabetes, a journal of the American Diabetes Association National Diabetes Information Clearinghouse Medline Plus, Diabetes Centers for Disease Control, Diabetes Public Health Resource MayoClinic.com, Diabetes WebMD Diabetes Center Share Our Strength, Cooking Matters EXTRA for Diabetes 3

4 Suggested Incorporation of Cooking Matters EXTRA for Diabetes Handouts The Dish on Diabetes, pages 1-2 Take Control of Diabetes, page 3 When to Introduce: Cooking Matters for Adults Lesson 1, page I-2, during the Nutrition lesson Open the dialogue by asking participants to share what they know about diabetes what it is and how it works. Refer to The Dish on Diabetes handout and use the graphics to clarify what happens in a body with and without diabetes. Emphasize that for people without diabetes, sugar flows freely through the blood and into the cells with the help of insulin, which enters the insulin receptor to open the cell for sugar so it can be used for energy. For people with diabetes, a lack of insulin or insulin resistance means that insulin cannot open the cell for sugar, so sugar piles up in the bloodstream, creating many health problems. Review with participants the risk factors for diabetes, making sure to explain the meaning of pre-diabetes. Ask participants to identify which risk factors they can and cannot change. Point out that by working on the risk factors they can change, people at risk of diabetes can prevent or delay its development. Discuss symptoms, but point out that, often, people with diabetes do not experience symptoms until their blood-sugar levels are already consistently very high. Explain that people can live for years without being diagnosed, which may mean that the disease is at an advanced stage by the time of diagnosis. Emphasize that people with multiple risk factors should get their blood-sugar levels checked annually. Point out the list of questions they may want to ask their doctor at each visit. Ask: Why is it so important to maintain control of blood-sugar levels? Refer to the Take Control of Diabetes handout and discuss possible short- and long-term complications of irregular blood-sugar levels. Encourage participants to check with their physician regarding ideal blood-sugar levels. Point out that people at risk of diabetes can prevent or delay its development, and people living with diabetes can prevent or delay complications, by following the same basic principles of healthy eating and active living recommended for the general population. Ask participants how they would describe eating healthy, allowing them to share their ideas with the group for 2 to 3 minutes before transitioning to a discussion on MyPlate. INSTRUCTOR TIP: Many participants believe that diabetics must eat special foods or avoid entire categories of foods because of their disease. Emphasize throughout the course that the basic MyPlate themes such as eating from every food group every day, choosing whole grains, choosing lean proteins apply to everyone, including people at risk of or living with diabetes Share Our Strength, Cooking Matters EXTRA for Diabetes 4

5 Put a Plan in Place, page 4 When to Introduce: Cooking Matters for Adults Lesson 1, page I-3, after the Nutrition lesson step 5. Remind participants that the tools for healthy eating and active living can help them prevent or manage diabetes. Refer to the Put a Plan in Place handout and review additional steps that persons with diabetes should take to stay healthy, such as checking blood-sugar levels frequently and working closely with a medical team. Discuss setting modest goals to start including healthy habits in their daily routine. Review the goal-setting tips in the handout. If time permits, have participants write their own lists or discuss aloud the reasons they want to prevent or manage their diabetes. Guide participants in setting an initial goal they can start working on right away, and encourage them to write the goal in the appropriate box on the handout. Be Carb Smart, page 5 When to Introduce: Cooking Matters for Adults Lesson 2, page I-8, during the Nutrition lesson As you explain that fruits, vegetables, and whole grains are the foundation of a healthy diet, point out that many foods in these groups contain carbohydrates (or carbs ). Ask: What do you know, or what have you heard, about carbs? Refer to the Be Carb Smart handout and gently address misconceptions as needed. Discuss how carbohydrates are the body s main source of energy and that everyone needs these foods for their health. Emphasize that while carbs do raise blood-sugar levels more than other nutrients, people with diabetes need (and can enjoy) carbs too. But it s particularly important for people living with diabetes to make smart choices about the types and amounts of carbs they eat, in order to maintain steady blood-sugar levels. Address grains, fruits, and vegetables as directed in steps 2 through 5 of the Cooking Matters for Adults Nutrition lesson. Refer back to the handout as needed to emphasize making smart choices from each group and adhering to appropriate portion sizes. Use food models or other visuals to reinforce correct portion sizes. Encourage participants to talk to their doctor or dietitian about how many servings of carbs are right for them at each meal. Point out that standard recommendations allow women to have 3 to 4 servings of carbs at each meal and men to have 4 to 5 servings. Both women and men can have 1 to 2 servings of carbs in a snack. Briefly review the tips for making smart choices and choosing appropriate portions for milk and milk products, and explain that you will review these points in more detail during next week s lesson. INSTRUCTOR TIP: Participants may have misconceptions or fears about carbs, in general, or about specific carbs such as fruit. Guide participants to understand that carbs are a necessary part of their diet and can provide many important nutrients Share Our Strength, Cooking Matters EXTRA for Diabetes 5

6 Stay Heart Healthy, page 6 When to Introduce: Cooking Matters for Adults Lesson 3, page I-14, during the Nutrition lesson As you discuss the importance of choosing good fats and avoiding bad fats, point out that people living with diabetes are at higher risk for heart disease and that heart-healthy living can help reduce that risk. Refer to the suggestions on the Stay Heart Healthy handout, relating the tips to previous discussions or pointing out tips that will be discussed in greater detail in future lessons (such as exercise, which will be discussed in Lesson 6). Eating Out, Eating Smart, page 7 When to Introduce: Cooking Matters for Adults Lesson 4, page I-22, during the Nutrition lesson step 2. As participants provide ideas on how to apply what they ve learned to making healthy choices when eating out, affirm their ideas and refer to the Eating Out, Eating Smart handout for additional suggestions. Remind them that these principles are useful for people without diabetes, too. Create Your Plate, page 8 When to Introduce: Cooking Matters for Adults Lesson 4, page I-22, after the Nutrition lesson step 2. Transition to discuss the Plate Method as a way of using all that participants have learned so far about healthy eating and portion sizes to create balanced meals. Refer to the graphic on the Create Your Plate handout. Ask: What do you notice about the size of each section of the plate? How does this compare to the way your plate normally looks? How does this compare to MyPlate? Review each section of the graphic and have participants tell you what they have learned from each one about making healthy choices. Point out that while beans are a lean protein, they are considered a starchy food for the purposes of the Plate Method because of the amount of carbs they provide compared to other protein-rich foods. Have participants practice planning a healthy meal using the Plate Method. Provide food models or pictures for participants to sort through as they do this activity, and have them lay their choices in the proper location on an actual 9-inch plate. Explain that the Plate Method can be used for breakfast by covering up the ½ plate for non-starchy vegetables and using only the remaining half ¼ of the plate for lean protein and the other ¼ of the plate for starchy foods. Fruit and milk remain the same. INSTRUCTOR TIP: Reinforce participant learning by having them set their plates according to the Plate Method during the Eating Together section. Be sure to emphasize using 9-inch plates to stick to appropriate portion sizes Share Our Strength, Cooking Matters EXTRA for Diabetes 6

7 Get Movin, page 9 When to Introduce: Cooking Matters for Adults Lesson 6, page I-40, during the Nutrition lesson As participants discuss the benefits of physical activity, explain the role of exercise in regulating blood-sugar levels independently of diet. Refer to the Get Movin handout and discuss tips for adding physical activity to your day and staying safe. Emphasize the importance of talking to your medical team prior to beginning an exercise routine. Point out other tips for people with diabetes, such as checking blood sugar before and after exercise, carrying a source of sugar, and wearing identification that indicates that you have diabetes. Sweet Choices, page 10 When to Introduce: Cooking Matters for Adults Lesson 6, page I-41, during the Nutrition lesson steps 2 and 3. As you discuss sweetened beverages, ask participants what they know about the difference between sugars, sugar alcohols, and sugar substitutes. Refer to the Sweet Choices handout and gently correct misconceptions as needed. Point out that sugar and sugar alcohols will raise blood sugar, while sugar substitutes will not. Have participants review ingredient lists for popular beverages. Point out how to identify sugars (e.g., words with syrup or ending in -ose ), sugar alcohols (e.g., words ending in -ol ), and sugar substitutes (such as those shown in the handout) in ingredient lists. You may also wish to show packets of sugar substitutes that are often added to tea and coffee for this discussion. As you discuss snacks and celebration foods, show participants a variety of popular sugar-free or no sugar added snacks. Ask: How would you determine if this food will raise your blood sugar? Guide participants to understand that label claims about sugar can be misleading these foods can still have sugar alcohols or other carbs that will raise blood sugar! Point out that participants must read the Nutrition Facts panel carefully to find out whether foods will raise their blood sugar and count toward their carbs for the day. Highlight the Nutrition Facts panel for sugar-free cookies on the handout showing 0g of sugar, but 16g of carbs. Have participants practice reading labels for Total Carbohydrates. Clarify why we look at Total Carbohydrates instead of Sugars on the label. Emphasize that people with diabetes can still eat foods made with sugar from time to time, but it s important to choose appropriate portion sizes and to track the total amount of sugar they eat over the course of the day. Encourage participants to reduce gradually the amount of foods they eat made with sugar and to experiment with foods made with sugar substitutes that they may enjoy. INSTRUCTOR TIP: Consider making celebration foods or snacks using sugar substitutes as part of the cooking lesson this week Share Our Strength, Cooking Matters EXTRA for Diabetes 7

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