NUTRITION FOR KIDS WITH TYPE I DIABETES SCHOOL

NUTRITION FOR KIDS WITH TYPE I DIABETES SCHOOL NURSE WORKSHOP SEPTEMBER 2019 STEPHANIE ETHERINGTON, RD, CDE

WHAT IS A CARB? • Body’s preferred, immediate energy source – Fats and protein are more long-term • Some examples: breads, cereals, grains, pasta, rice, crackers, fruits, beans, potatoes, corn, peas, milk, yogurt, most desserts, sugar-containing beverages like juice or soda • Simple versus Complex - Glycemic Index • Sugar – Recommended intake <10% added sugar

PROTEIN • Provides building blocks for cells and tissues • Important for bone and muscle growth • Some examples: beef, poultry, pork, fish, eggs, soy, cheese, cottage cheese, nuts, peanut butter • Choose lean cuts and lower fat options

FAT • Important energy source needed for growth • Aim for healthy fats • Some examples: – Monounsaturated fats – olive oil, canola oil, avocado, most nuts – Polyunsaturated fats – corn oil, soybean oil, sunflower oil, sesame oil – Omega-3 s – fish oil, salmon, sardines, oysters, walnuts, ground flax seed and flax oil – Saturated fats – animal fats, butter, cheese, bacon, sausage, hot dogs, chips, fried foods – Trans fats – baked goods, fried foods, shortening, donuts, stick margarine

WHAT IS THE IDEAL DIET? • There is NO ‘diabetic’ or ‘ADA’ diet • For both type I and type II, the goal is simply a healthy diet from which ALL kids would benefit • In general, a healthy diet should contain: – 5 or more fruits and vegetables – 4 or more servings from grains (preferably whole grain, non-processed) – 3 -4 servings of dairy – Total fat intake between 20 – 35% of total calories (<6 -8 teaspoons/day) – Protein 2 -3 servings per day

Nutrient 4 -8 years 9 -13 years 14 -18 years Female 1200 1400 1800 Male 1400 1800 2200 25 -35% Female 3 5 5 Male 4 5 6 Female 1. 5 Male 1. 5 2 Female 1 2 2. 5 Male 1. 5 2. 5 3 Female 4 5 6 Male 5 6 7 Calories Fat, % of calories Lean meat/beans, oz Fruits, cups Vegetables, cups Grains, oz

CARB AMOUNTS BY AGE 5 -12 years old Teens- Adults Females 45 -60 gm per meal 60 -75 gm per meal Males 45 -60 gm per meal 60 -75+ gm per meal Snacks: 15 -20 gm, as needed

DIET AND TYPE I DIABETES • The balance between all carbohydrate eaten and the insulin dosage is one of the major keys to diabetes management • Goals: – Balance insulin and carb intake in order to keep blood sugar values as close to normal as possible – Prevent severe hypoglycemia – Help attain normal growth and development for children – Keep cholesterol and triglycerides at desired levels – Prevent high blood pressure – Avoid long-term complications

CARB COUNTING

APPS AND WEBSITES • Personal Favorites – Calorie King (book, website, app) – My Fitness Pal (website, app) – Livestrong My. Plate (website, app)

THE EXCHANGE LIST

EXCHANGE LIST GO-TO’S • 1 slice of bread • 1/2 C potato • 1/3 C pasta • 1/3 C rice • 1 C milk or yogurt • 1 C fresh fruit • 1/2 C canned fruit • 1 Tbs jam, honey, sugar

PORTION ESTIMATES Fist = 1 Cup Thumb = 1 Tbs Deck of cards = 3 oz Cupped hand = 1 -2 oz

INSULIN TO CARB RATIOS • One unit of insulin for each particular amount of carbs consumed – Allows for greater freedom and flexibility in food choices • The Rule of 500 – 500 divided by Total Daily Dose • Ex) If 33 units of insulin (both long acting and rapid acting) were taken per day: 300 / 33 = 15 1 unit of rapid acting insulin per every 15 gm carb consumed • Carb ratios may change at different meals Example) If consuming 60 gm carbs with a 1 per 15 ICR, then deliver 4 units 60 / 15 = 4 units

ASSESSING ACCURACY • Check 2 hours post-prandial – If BG is consistently high following a meal, an increase in the aggressiveness would be needed • Ex) 1/15 may adjust to a 1/10 to give MORE insulin – If BG is consistently low following a meal, a decrease in the aggressiveness would be needed • Ex) 1/15 may adjust to a 1/20 to give LESS insulin • The correction factor may be also added • Exercise, stress, illness, hormones can affect BGs.

LET’S PRACTICE • Case Study: – Jamie, 10 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 15 gm carbohydrate – Lunch: 1 peanut butter and jelly sandwich (2 slices bread, 1 TBS peanut butter, 1 TBS jelly), 1/2 C baby carrots, ½ C sliced peaches in unsweetened fruit juice, 1 small carton of milk, and 2 oreo cookies – Blood sugar: 115 mg/d. L (no correction needed) – How many grams of carbs? – How many units of rapid-acting insulin should be given?

CORRECTION FACTOR • Designed to help bring a high blood sugar down into goal range • Consider active insulin, exercise, meals/snacks previously consumed • One unit will bring blood sugars down by an expected number of points • Rule of 1800 • Ex) If 30 units of insulin (both long acting and rapid acting) were taken per day: 1800 / 30 = 60 1 unit of rapid acting insulin would decrease blood sugars by 60 points Example) Correction factor of 1/50 > 150 mg/d. L with a current BG of 200 mg/d. L – 150 mg/d. L = 50/50 = 1 unit correction

LET’S PRACTICE • Case Study: – Jordan, 12 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 10 gm carbohydrate and a correction factor of 1/40 > 120 mg/d. L – Lunch: 2 slices pepperoni pizza (Pizza Hut), 1 side salad with 2 TBS ranch dressing, 1 diet coke – Blood sugar: 170 mg/d. L – How many grams of carbs? – How many units of rapid-acting insulin should be given for his meal? – How many units of rapid-acting insulin should be given for correction? – How many total units should we provide and when?

LET’S PRACTICE • Case Study: – Kailey, 7 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 20 gm carbohydrate and a correction factor of 1/60 > 150 mg/d. L – Lunch: ½ cheeseburger, 1 carton of 1% milk, ½ banana , 1 sugar-free pudding – Blood sugar: 200 mg/d. L – How many grams of carbs? – How many units of rapid-acting insulin should be given for his meal? – How many units of rapid-acting insulin should be given for correction? – How many total units should we provide and when?

LET’S PRACTICE • Case Study: – Rob, 16 year old with type I diabetes uses an insulin-to-carb ratio of 1 unit per 7 gm carbohydrate and a correction factor of 1/35 > 130 mg/d. L – Lunch: 1 hot dog with ketcup, ½ C corn, 1 single serve bag of Doritos, 1 Snickers bar, 1 Powerade Zero – Blood sugar: 190 mg/d. L – How many grams of carbs? – How many units of rapid-acting insulin should be given for his meal? – How many units of rapid-acting insulin should be given for correction? – How many total units should we provide and when?

CONCLUSION • The goal is to provide a balanced diet to promote growth and development • Kids will be kids • Variety of methods to calculate grams of carbs • Be flexible!

QUESTIONS? THANK YOU! Contact Information: Stephanie Etherington, RD, CDE Diabetes Specialist, Confluence Health Stephanie. Etherington@confluencehealth. org 662 -1511 ext. 31915