Eat what you want with Type 1 Diabetes

1. Eat what you want withType 1 Diabetes By Penny Lock-Pullan Diabetes Dietitian Gloucestershire Hospitals NHS Trust

2. Background • Lines/ exchanges systems • 1980’s plate model/healthy eating • Insulin developments - basal-bolus system • Possibility of a more liberal approach • UK DAFNE trial published 2002

3. Diabetes UK - Diet 2003 • To provide consensus-based recommendations drawing on ESAD and ADA technical reviews • To look at the practical implementation of nutritional advice in UK in the context of the NSF and the Expert Patient

4. DM UK - aims of diet advice • To provide the information required to make appropriate choices on the type and quantity of food which they eat • Need to respect the Individual’s wishes, and willingness to change • Specific needs may change with time and circumstances

5. “Who”can eat what they want? • Type 1 • Basal – bolus insulin (including pumps) • Regular home blood glucose monitoring • Motivated • Have access to education and support to acquire the necessary skills and knowledge

6. “How” can you eat what you want? • Count Carbohydrates • Match the dose of insulin to the amount of carbohydrate to be/eaten 90-100% of digestible starches and sugars eaten appear in the blood as glucose from 15 minutes – 2+hours after they are consumed

7. Carbohydrate Sources • Cereal derived starch products: bread, grains, breakfast cereals, rice, pasta, couscous, flour based products (eg pastry,biscuits) thickeners • Vegetable starch: potatoes & legumes • Fructose: fruit, fruit juice • Lactose foods:milk,yoghurt, icecream, custard • Sucrose(table sugar): confectionary, ordinary soft drinks, cakes, biscuits, desserts etc

8. Don’t forget……………… • Meat or fish with coatings (flour or breadcrumbs etc) • Pastries • Processed meats • Sauces • Mixed salads/dressings, if fruit based • Vegetarian foods

9. How do we count Carbohydrate (CHO)? • Some patients still remember/use a 10g exchange system –not always accurate! • 15g portions are used by some centres • We teach new patients in grams of CHO • It doesn’t matter how the patient counts as long as it works and they are consistent

10. Teaching methods • Lists of common foods with their Carbohydrate (CHO) content in grams • Food photograph atlas • Scales, • Handy measures • Food models • Packaging with food labelling

11. Learning to adjust insulin • Food diaries to record CHO, insulin dose pre & 2-3 hour post prandial glucose • Follow up appointment with dietitian and DSN to interpret food diaries • Initially it takes extra time and effort

12. Calculating insulin ratios • 500 – rule • Divide 500 by total daily insulin to get ratio and test to check response correct • Eg 10/10/10/20 average daily insulin = 50 units total 500 ÷ 50 = 1:10 ratio 1 unit insulin for every 10g CHO

13. Eating out • Takeaways/meals out are more difficult to estimate – practice makes perfect! • Meals out may contain a lot more OR a lot less CHO than typical meals at home • The larger the CHO load the more digestion may be delayed • It might be better to split the insulin dose if using analog insulin

14. Healthy eating • Giving patients more freedom doesn’t mean they will eat chocolate, cakes and meat pies all the time! • Patients are encouraged to eat what they want in the context of a healthy diet • Patients can eat sugary foods as long as they give an appropriate bolus of insulin

15. Gain Eat more/more insulin Eating higher calorie food ( choc, puddings) Forgetting about healthy eating basics Feel well-more exercise –muscle vs fat Efficient glucose storage Loss Less insulin Fewer snacks-less insulin Skipping meals/smaller servings Eating to hunger rather than to treat hypos Feel well–more exercise Weight and CHO Counting

16. The future • Patients should be able to make an informed choice about the insulin system that best suits their needs • Patients need to have greater knowledge and understanding of their diabetes if they want good glycemic control and to eat what and when they want