Diabetes & Nutrition:

Managing Type 2 Diabetes

By Christa Justice, Sodexo Dietetic Intern
April 2020
Outline
• Introduction
• Prevalence, risk factors, symptoms
• Diagnosis and treatment
• Importance of nutrition and meal planning
• Carbohydrate counting, exchanges
– Macronutrients and portion sizing
• MyPlate Method
• Nutrition Facts Label
• Physical Activity
• Stress Management and Sleep
Learning Objectives
Describe the development of diabetes mellitus including causes, symptoms, risk,
diagnosis and treatment methods.

Explain the importance of variety of foods in the diet and lifestyle factors

Identify sources of carbohydrates and other macronutrients

Identify proper portion sizing

Identify what to look for on the nutrition facts label

Introduction to Diabetes Mellitus 1
• Type 1 and type 2 diabetes mellitus
• Over 34 million Americans are affected
by diabetes
• Non-Preventable Risk factors:
– Family history
– African American, Hispanic, Asian
American, Pacific islander
– Age

This Photo by Unknown Author is licensed under CC BY-SA-NC

Preventable Risk Factors for Type 2 Diabetes 2
Hypertension

Sedentary
Smoking
Lifestyle

Diabetes

Excessive Overweight
calorie intake or obesity
Causes of Diabetes Mellitus 3
• Type 1 diabetes
– Possibly genetic, autoimmune, idiopathic This Photo by Unknown Author
is licensed under CC BY-SA

– Pancreas no longer produces insulin needed to get glucose (sugar)

from blood → cells of the body
• Type 2 diabetes and pre-diabetes
– Most common
– Diet, lifestyle, genes
– Cells become resistant to insulin released from the pancreas or the
pancreas in not able to produce adequate amounts of insulin
Symptoms of Type 2 Diabetes 4

Increased thirst or
High Blood urination, fatigue,
Sugar blurred vision,
numbness or tingling
(Hyperglycemia) in extremities,
BS more than 200 increased hunger, slow
mg/dl healing sores or
wounds
Symptoms of Type 2 Diabetes Cont. 4

Shakiness,
Low Blood irritability, heart
Sugar palpitations,
(Hypoglycemia) hunger, dizziness,
confusion,
BS less than 70
headache,
mg/dl
sweating
Diagnosis of Type 2 Diabetes 5
Lab Value Normal Pre-Diabetes Diabetes

Hemoglobin Less than 5.7% 5.7% - 6.5% More than 6.5%

A1C
Fasting Less than 100 mg/dl 100-126 mg/dl More than 126 mg/dl
Plasma
Glucose
Oral Glucose Less than 140 mg/dl 140-200 mg/dl More than 200 mg/dl
Tolerance
Test (OGTT)
Type 2 Diabetes Treatment 6

Diet and lifestyle Insulin injection

Medication
change or pump

Carbohydrate Weight
Physical activity
controlled diet loss/management
 Type 2 Diabetes Prevention 5

Early treatment for patients with prediabetes can reverse high blood
glucose levels and prevent T2DM

According to research, a 58% risk reduction for T2DM associated with:

Moderate physical activity

Weight loss of ~7% of body
five days a week for 30 Diet and lifestyle change
weight
minutes
 Meal Planning for Diabetes Mellitus 7
Increase fiber intake with
Eat a variety of foods:
whole-grain foods like
colorful fruits and Limit added sugars
brown rice, oatmeal,
vegetables, lean protein,
whole grain and sweets
whole grains, dairy, nuts
breads/cereals, fresh
and seeds
fruits and vegetables

Limit fat – choose Limit added salt and

lean protein and Eat 3-6 small, frequent
high-sodium foods –
meals and snacks per day
plant-based sources season food with fresh or
with controlled
like nuts, seeds, dried herbs and salt-free
carbohydrate portions
avocado, olive oil seasonings
Carbohydrate Counting 8
• A tool used to keep track of the total amount of carbs in grams
eaten per day to help manage blood glucose levels
• If taking insulin, each unit of insulin must be balanced with a
certain amount of carbohydrates
• Estimated carbohydrate intake is individualized based on many
factors. Recommended carb intake 45%-65% of total daily
calories.
– 1-gram carbohydrate = 4 calories
– Example: 1,800 calories per day with 45% from carbs = 200 grams carbs
 Carbohydrate Exchanges 9
1 carbohydrate (starch) exchange = 15 grams of carbohydrates

• 1 carb exchange = 1 portion/serving of fruit, dairy, grains, starchy vegetables, beans/legumes,

snack foods, candy/desserts, juices, and soda/sports drinks

Recommended: 4-5 carb/starch exchanges per meal (60-75 g carbs) and 1-2
carb/starch exchanges per snack (15-30 g carbs)

Examples of portions that contain ~15 grams carbohydrates:

• 1 slice of bread, 1/3 cup rice, (1) 6-inch flour tortilla, 1/3 cup pasta
• ½ cup fresh fruit, fruit juice or small piece of fruit (apple, orange)
• ½ cup beans or starchy vegetable like mashed potatoes, peas, or corn, ¾ cup dry cereal or ½ cup
cooked cereal
• Dairy – 8 oz milk, 6 oz. yogurt – 12 g carb
 Carbohydrates are GOOD for you! 10,11
• Preferred fuel source for the body – provides energy to think, move,
and grow!
• Carbohydrates will impact blood glucose levels
– It important to portion throughout the day to avoid high or low blood
sugar
• Simple and complex carbohydrates

This Photo by Unknown Author is licensed under CC BY-SA-NC

This Photo by Unknown Author is licensed under CC BY
MyPlate Method 12

https://www1.nyc.gov/assets/doh/downloads/pdf/csi/obesity-plate-planner-13.pdf
Protein 9
• Promote satiety – keeps you full for longer
• Helps manage blood glucose – slows the release of glucose into
the blood by slowing down digestion
• Maintains lean body mass
• Meat, poultry, eggs, fish, legumes, tofu, nuts and seeds, dairy
products (milk/yogurt), and soy.
• Contain no carbohydrates (unless breaded/plant/milk)
• Protein Exchange: 7 g protein per serving
– 1 oz. meat, fish, poultry, nuts, cheese
– 8 oz milk, 6 oz. yogurt – 8 g protein

This Photo by Unknown Author is licensed under CC BY-NC-ND

 Fats 9
• Help promote satiety – keep you fuller for longer
• Slows down digestion – improved blood glucose control
• Unsaturated fat
– Olive oil, nuts/nut butter, seeds, canola oil, avocado oil
• Limit: saturated fat and trans fat from animal products
– Butter, bacon, sausage, lunchmeat, cream cheese, lard, high fat meats,
highly processed or fried foods, and coconut
• Fat Exchange: 5 grams of fat per serving
– 1 oz. nuts or seeds
– 1 tsp. oil (olive, peanut, safflower, corn, soybean)

This Photo by Unknown Author is licensed under CC BY-NC-ND

Fruits and Vegetables 9
Carbohydrate Exchanges:
• Vegetables: 5 grams of
carbohydrate per ½ cup Rich in vitamins, minerals, and fiber
cooked or 1 cup raw
• Broccoli, asparagus, carrots, Recommended 3-5 servings per day or
lettuce, spinach, edamame, half your plate in non-starchy vegetables
onion, bell peppers

• Fruit: 15 grams of carb per Low-calorie, low-fat, low-carb

serving
• Bananas, berries, grapes,
kiwi, mango, etc.
Fiber and Hydration 13
• High fiber foods: fruit, vegetables, whole grains, beans, lentils, popcorn,
nuts and seeds
• Recommended 20 to 35 grams of fiber per day (or 14 g per 1,000 calories
consumed)
• Fiber and Fluid needs are individualized
• Fiber slows digestion, promote satiety, no calories/added sugars, may
reduce risk for heart disease, colon cancer, and type 2 diabetes.
• Goal: Add fiber slowly and increase fluid intake to prevent constipation
• Tip: Eat a fiber-rich food at every meal or snack
– Example: oatmeal or fresh fruit at breakfast or whole grain bread or brown rice at
lunch/dinner

• Hydrate with fluids: water, broth, tea, watermelon This Photo by Unknown Author is
licensed under CC BY-NC-ND
Free Foods 9
• A food is considered free when it is under 20 calories or less than
5 grams of carbohydrate per serving because it does not have to
be counted toward total carbohydrate intake
• If consumed in excess, it will affect blood glucose
• Examples with max serving sizes considered free:
– Coffee creamer 2 Tbsp., Condiments: ketchup 1 Tbsp, taco sauce 1 Tbsp,
salad dressing 2 Tbsp., Syrup 1-2 Tbsp., jellies, jams 2 tsp.
• Examples of free foods with no serving size limit:
– Coffee, unsweetened tea or sugar-free drinks/hard candies, sugar
substitutes (aspartame, Splenda), sugar-free gelatin, mustard, fresh
herbs and seasonings
Nutrition Facts Label 14
• Two main key points to look for on the
Nutrition Facts Label:
– Serving Size (example: 1 cup)
– Servings Per Container (example: 2)
– Total Carbohydrate in grams (example: 31 g)
• Sugars in grams (example: 5 g) does not
accurately depict the total carbohydrate
amount that will affect blood glucose.
• If you have 2 servings, double the amount
of carbohydrates for 1 serving:
– (example: 31 g x 2 = 62 g carbs for 2 servings =
4 carb exchanges)
 Snacks
• May be needed in addition to meals to reduce
risk for hypoglycemia
• Include 1 protein and 1-2 carb choices
• Incorporate snacks if physical activity increases
• Bedtime snack – to reduce hypoglycemia over
night
• Snack ideas
– 1 small apple with 6 oz of Greek yogurt or 2 Tbsp. PB
– 1 serving whole grain crackers with 1 oz. string cheese

This Photo by Unknown Author is licensed under CC

BY-SA-NC
Self-Monitoring Blood Sugar 15
Individualized plan may require blood sugar records several times
a week or several times a day

Checking glucose consistently can help identify trends in glucose

and can help the diabetes team provide individualized diet,
treatment, and lifestyle interventions to improve glycemic control

Hemoglobin A1c – indicator of long-term glycemic control for the

past 2-3 months (average life of a RBC ~120 days)
Insulin Management 16

• Flexible insulin therapy: carbohydrate counting with protein

and fat consideration and insulin dosing can help manage
glycemic control
• Fixed insulin therapy: consistent carbohydrate intake specific
to time and dose of insulin to help manage glycemic control.
• Insulin-to-CHO ratio
– Number of grams of carbs that 1 unit of insulin will cover
– Individualized, typically start with 1:15

This Photo by Unknown Author is licensed under CC BY

Physical Activity 17

• Benefits: may improve glycemic control, increased

insulin sensitivity, overall fitness, cardiovascular
strength, weight control, quality of life
• Potential risk: hypoglycemia
– Prevent by scheduling exercise after meals when blood
glucose is higher
– Monitor blood glucose before exercise
• If blood glucose < 100 mg/dl, consume a snack of 15-30 g
carbohydrates and check glucose again in 30 to 60 minutes
– Adjust dose of insulin or medication if needed
This Photo by Unknown Author is licensed under CC BY-NC-ND
Stress Management 18
• Stress can negatively impact blood sugar control
– Emotional stress influences diet, exercise, and ability to
rest
– May lead to unhealthful coping strategies
• The increase of stress hormones can increase blood
pressure, raise heart rate, and increase blood sugar
• How to reduce stress
– Take medications as prescribed and follow healthy diet
plan
– Adequate sleep average 7 hours per night
– Relaxing techniques such as deep breathing or
meditation
– Exercise
This Photo by Unknown Author is licensed
under CC BY-NC-ND
Importance of Adequate Sleep 19,20
• Lack of sleep (~5 hrs) can increase risk for type 2
diabetes and insulin resistance
– Leads to less insulin production from the pancreas
(meaning less regulation of blood sugar)
– Increase in stress hormones (cortisol) leads to
reduced effectiveness of insulin
• Lack of adequate sleep can increase weight gain
due to possible changes in appetite-regulating
hormones leptin (satiety) and ghrelin (hunger)
• Goal: Aim for 7 to 9 hours per night
This Photo by Unknown Author is
licensed under CC BY-SA
Conclusion
To prevent and/or treat type 2 diabetes and potential complications – the
primary focus is modification of diet and lifestyle factors

There are several dietary methods to promote glycemic control

Carbohydrate exchange
Carbohydrate counting MyPlate
(choice)

Lifestyle Factors and proper medication use

References
1. https://www.diabetes.org/resources/statistics/statistics-about-diabetes

2. https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes

3. https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes

4. https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes#symptoms

5. https://www.diabetes.org/a1c/diagnosis

6. Marín-Peñalver JJ, Martín-Timón I, Sevillano-Collantes C, Del Cañizo-Gómez FJ. Update on the

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8. https://www.diabetes.org/nutrition/understanding-carbs/carb-counting

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10. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-
activity/carbohydrate-counting
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12. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate-vs-usda-myplate/
https://www1.nyc.gov/assets/doh/downloads/pdf/csi/obesity-plate-planner-13.pdf

13. https://www.ncbi.nlm.nih.gov/books/NBK279012/

14. https://www.niddk.nih.gov/news/media-library/8943

15. https://www.ncbi.nlm.nih.gov/books/NBK279012/ & Integrating CGM into Your Practice article

16. https://www.ncbi.nlm.nih.gov/books/NBK279012/

17. https://www.ncbi.nlm.nih.gov/books/NBK279012/

18. https://my.clevelandclinic.org/health/articles/14891-diabetes-stress--depression

19. https://www.sleepfoundation.org/articles/link-between-lack-sleep-and-type-2-diabetes

20. Arora T, Taheri S. Sleep Optimization and Diabetes Control: A Review of the Literature. Diabetes Ther.
2015;6(4):425‐468. doi:10.1007/s13300-015-0141-z

21. https://www.freepik.com/free-vector/diabetes-symptoms-infographic_2819185.htm