Diabetes: Diagnosis,
Treatment, and Opportunities
Module 2: Self-Management, Nutrition,
Technologies, and Behavior Modifications
Katie Ferraro
Assistant Clinical Professor
School of Nursing
Medical NutritionTherapy for
Diabetes: Part 2
Carbohydrate Containing Foods
o Breads, crackers, cereals
o Pasta, rice, grains
o Starchy vegetables: potatoes, corn, peas
o Nonstarchy vegetables: broccoli, greens, carrots
o Milk and yogurt
o Fruits and juice
o Sweets and desserts
Foods with No Carbohydrate
o Meat, fish, poultry
o Eggs
o Cheese
o Fats, oils, butters
o Water
Carb Counting: Simple Method
There is about 15 grams carbohydrate in:
1 small piece fresh fruit (4 oz)
cup canned or frozen fruit
1 slice bread (1 oz)
1 (6 inch) tortilla
cup dry oatmeal
1/3 cup dry pasta or rice
4-6 crackers
English muffin or hamburger bun
cup of black beans
cup starchy vegetables
large baked potato (3 oz)
2/3 cup plain fat-free yogurt
2 small cookies
2 inch square brownie or cake, no frosting
cup ice cream or sherbet
1 Tbsp syrup, jam, jelly, sugar or honey
2 Tbsp light syrup
6 chicken nuggets
cup casserole
1 cup soup
American Diabetes Association, Carbohydrate Counting, available at: http://www.diabetes.org/food-andfitness/food/planning-meals/carb-counting/
Carb Counting: Inter mediate
Pattern Management:
o Identify BG patterns impacted by food, insulin & exercise
o Identify & interpret patterns to make adjustments in
diabetes regimens
o Rapid or short-acting insulin matched to carbohydrate
o Insulin doses adjusted when deviations from carb made
Every 15-20 g CHO 1-2 U rapid/short acting insulin
Carb Counting: Advanced
o Used by individuals on intensive insulin therapy
o Insulin adjusted on basis or ratio of g carb intake to
doses of rapid or short acting bolus insulin
o Calculate CHO-to-insulin ratio for each meal:
example 45 g CHO (3 CHO choices) at a meal require 5
units insulin (9:1 ratio)
Subtract fiber grams from CHO if fiber 5 g/svg
Large amounts of meat/fat may require adjustments
Exchange System
o Developed by American Diabetes Assoc.
o Groups foods into categories by nutrient
o Meal plan created with specified number of
exchanges spaced throughout the day
o You can trade, ex: 1/3 plantain for 1/3 cup
cooked rice for one carbohydrate serving
Typical Item/Portion
Size
Carbohydrate (g)
Protein (g)
Fat (g)
Energy (kcal)
Starch
1 slice bread (1 oz)
15
0-3
0-1
80
Fruits
1 small apple (4 oz)
15
60
Fat-free, low-fat (1%)
1 c skim milk (8 oz)
12
0-3
100
Reduced-fat (2%)
1c RF milk (8 oz)
12
120
Whole
1 c whole milk (8 oz)
12
160
Sweets & other carbs
2 small cookies
15
varies
varies
varies
Beets (1 cup raw)
25
Lean
Buffalo (1 oz)
45
Medium-fat
Ground beef (1 oz)
4-7
75
High-fat
Cheese (1 oz)
Varies
varies
varies
Plant-based proteins
Black beans (1/2 cup)
Varies
varies
varies
Stick butter (1 tsp)
45
Group/List
Carbohydrate
Milk
Nonstarchy
vegetables
Meat & Meat Substitutes
Fat
Fat
Meal Planning with Exchanges
Time
Breakfast
Snack
Lunch
Snack
Dinner
Snack
Starches
Fruit
Milk
Nonstarchy
Vegetables
Meat &
Meat Subs
Fats
Meal Planning with Exchanges
Time
Starches
Fruit
Milk
Breakfast
Snack
Lunch
Snack
1
Snack
Meat &
Meat Subs
Fats
1 high-fat
1
1
1
Dinner
Nonstarchy
Vegetables
2 lean
3 lean
1 lean
Glycemic Index (GI)
o Rating system based on a scale of 0-100
o Useful to compare glycemic responses of foods
o 50 grams pure glucose = highest GI value 100
o GI of food is determined experimentally
o Consume amount of food with 50 g carb
o Blood glucose response is measured
Glycemic Response
J Am Coll Nutr. 2009 Aug;28 Suppl:446S-449S
Image: Wikimedia Commons
Research: Glycemic Response
o Impact of glycemic response on long-term health
unknown, controversial
o Some studies have demonstrated health benefits
from low-GL diets, other unclear
o Review of 8 RCT, good strength data to report no
significant differences in energy intake or body
weight after the consumption of a low-GI diet
Academy of Nutrition and Dietetics, Evidence Analysis Library, Low Glycemic Index Diet, 2005.
Hypoglycemia Management
o Plasma glucose < 70 mg/dL
o 15-20 g glucose is preferred; however, any
type of carbohydrate with glucose can be used
o Wait 15 minutes, recheck
o If not back up, take another 15 g
o Once normalized, eat meal or snack to prevent
recurrence of hypoglycemia
Diabetes Care. January 2012 vol 35 no Supplement 1 S11-S63.
Sick Day Management
o Check BS more often than usual (every 2-4 hrs)
o Aim to keep BS < 200 mg/dL
o Eat small meals often even with little intake BS
can rise
o May need increased insulin
o Do not exercise vigorously
o Drink plenty of fluids, at least 12 8-oz cups/day
Sick Day Management (cont.)
If dehydrated, drink:
o Water
o Club soda
o Diet soda (caffeinefree)
o Tomato juice
o Chicken broth
If BS < 100 mg/dL, drink:
o 100% juices
o Sports drink
o Tea with honey
o Ginger-ale or lemonlime soda
For More Infor mation
o MedlinePlus, Diabetes When you are Sick:
http://www.nlm.nih.gov/medlineplus/ency/patientinstructi
ons/000079.htm
o MedlinePlus, Hypoglycemia:
http://www.nlm.nih.gov/medlineplus/hypoglycemia.html
o American Diabetes Association Planning Meals:
http://www.diabetes.org/food-and-fitness/food/planningmeals/
o UCSF Diabetes Teaching Center Exchange Lists:
http://dtc.ucsf.edu/pdfs/FoodLists.pdf
