Healthier Living Workshop

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Pre-Diabetes Diabetes Prevent, Delay, Control

• April 23, 2008

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Robin Edelman, MS, RD, CDE

• Diabetes Program Administrator
• Vermont Department of Health
• redelma_at_vdh.state.vt.us
• 802 865-7708

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Risk Factors for Diabetes

• You are more likely to develop Type 2 diabetes if
  you
• Are overweight
• Are over 45 years of age
• Have abnormal blood fats (cholesterol, TG)
• Have high blood pressure
• Have a history of diabetes during pregnancy
• Have given birth to a baby over 9 pounds
• Have an inactive lifestyle

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Definitions

• Pre-diabetes fasting plasma glucose of 100-125
  mg/dL or a 2-hour value in the oral glucose
  tolerance test of 140-199 mg/dL
• Diabetes fasting plasma glucose 126 mg/dL or a
  2-hour value 200 mg/dL

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Healthful Eating for Diabetes

• No diabetic diet
• No special foods (although sugar substitute and
  artificially sweetened soft drinks help)
• All people would be better off if they ate this
  way

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Plate Method for Portion Size Control
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General meal-planning guidelines

• Eat breakfast
• Appropriate (smaller) portion sizes except for
• Vegetables and Fruits eat more
• Whole grains 3 /day
• Healthy fats small to moderate amounts
• Consistent carbohydrates 2-3 choices/meal
• Lean protein 2-3 servings/day

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Other Meal Planning Guidelines

• Besides breakfast, 2 other meals/day
• Optional, 1-2 snacks/day
• Snacks can be mini-meals or opportunities to
  eat what was missed at a meal (fruit)
• To best satisfy hunger eat a combination of
  carbohydrate and protein

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Choose In place of

• Whole grains
• Legumes, fish, lean poultry
• Fat-reduced dairy
• Vegetables, including leafy greens, cruciferous,
  seasoned with plant-based oils
• Monounsaturated and polyunsaturated fats
• Whole fruits, variety of colors, unsweetened
• Water and calorie-free beverages

• Refined grains
• Red meats
• Full-fat dairy products
• Fried potato products, and vegetables with rich
  buttery, cheese-based sauces
• Saturated, partially hydrogenated or trans fats
• Baked goods with refined flour and added sugars
• Beverages with added sugars or caloric sweeteners

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Tips for controlling blood sugar

• Watch what you drink quench your thirst with
  water or sugar-free beverages
• Eat fruit rather than drinking juice
• If you think that your blood sugar is low, eat a
  small amount of carbohydrate rather than
  overshooting your need with a larger amount
• Eat meals/snacks at about the same time each day
• Try to be physically active to help reduce blood
  sugar

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Information about approved sugar subs

• Aspartame (NutraSweet, Equal, blue pkt)
• Acesulfame Potassium (Sunett, Sweet One)
• Saccharin (Sweet n Low, others, pink pkt)
• Sucralose (Splenda, yellow pkt)
• Neotame (used in baked goods, bevs, gum)
• Manitol, Sorbitol, xylitol sugar alcohols
• deemed to be the safest choice, but all are
  approved

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New Diabetes Toolkit Handouts

• http//healthvermont.gov/prevent/diabetes/diabetes
  .aspx
• A1C...Whats Your Number
• How to Prevent or Delay Diabetes
• Carb-Counting and Diabetes
• Move More (Physical Activity)
• Lose a Little Weight Gain a lot of Control
• Blood Pressure and Diabetes
• The Facts about Fats
• Sugars and Sugar Substitutes

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New Resources

• Choose Your Foods Exchange Lists for Diabetes
  (have been updated check with diabetes education
  center nearest you)
• http//www.foodfit.com/ weight control healthy
  nutrition site of Ellen Haas
• http//www.diabetes.org/diabetesfoodsmart new
  eNewsletter by Haas includes healthy choices,
  recipes, lifestyle tips featuring bi-weekly
  diabetes-friendly recipes from FoodFit.com,
  expert advice, American Diabetes Association
  updates

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New Resources continued

• Diabetes Fit Food book by Ellen Haas has easy
  prep recipes, familiar foods, practical nutrition
  info Haas is a former Undersecretary of USDA.
  This book inspired diabetesfoodsmart eNewsletter.
• The EatingWell Diabetes Cookbook by Joyce Hendley
  and EW editors, 2005
• In Defense of Food An Eaters Manifesto by
  Michael Pollan, 2008

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Classic (older) resource

• The Other Diabetes Living and Eating Well with
  Type 2 Diabetes by Elizabeth Hiser, 2002

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Diabetes - Recently on 60 Minutes

• Type 2 diabetes and sleep deprivation (March
  2008)
• lack of deep sleep (w/ aging)
• Drop in hormone leptin (tells you youre full)
• Increase in obesity from hunger
• Gastric bypass surgery and diabetes (April)
• Theres something about the duodenum, when
  attached directly to the small stomach pouch that
  halts diabetes

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Local classes and workshops

• Diabetes Self-Management Education at FAHC,
  taught by dietitian and nurse diabetes educators
  847-4576
• Healthier Living Workshop (see next slide) a 6
  week program to live better with any chronic
  condition. In Chittenden County FAHC Regional
  Coordinator, Julie Witherell, Community Health
  Improvement 847-8929 julie.witherell_at_vtmednet.org

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Symptom Cycle
Disease/Condition
Tense Muscles
Fatigue
Depression
Stress/Anxiety
Anger/Frustration/Fear
Stanford University
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YMCA Free Diabetes Exercise Program Wednesdays
and Fridays 862-9622 to enroll

• MD referral needed
• 900 1000 AM low impact aerobics at Fletcher
  Free Library
• 1000 1100 AM water aerobics at the Y
• Three 12 week sessions Sept-June (but can start
  anytime
• Free A1C, blood pressure and heart rate
• Supported by nursing staff at FAHC

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(No Transcript)
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American College of Sports Medicine AHA PA
Guidelines for adults over age 65(or adults
50-64 with chronic conditions, such as
diabetes) Basic recommendations from ACSM and
AHA Moderately intense aerobic exercise 30
min/day, 5 days a weekOrVigorously intense
aerobic exercise 20 min/day, 3 days/weekAnd8-10
strength-training exercises, 10-15 reps of each
2-3 times/weekAndIf you are at risk of falling,
perform balance exercisesAndHave a physical
activity plan.
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New (2008) Nutrition Guidelines from ADA

• Weight loss plans that restrict CHO or Fat-cals
  are equally effective in short term
• Most important thing about weight loss is ability
  to stick with it
• If low carb, then high pro, so monitor kidneys
• Weight loss seems to have a bigger impact on
  glucose control earlier in diabetes diagnosis. In
  later stages total carbs more important