TYPE 1 DIABETES & NUTRITION:

IT’S MORE THAN CARBS

Sarah Thelen, MS, RD, CDE
Disclosure

 Sarah Thelen is employed by Insulet, the maker of the OmniPod insulin

pump, for the purposes of this presentation there are no financial
relationships that require disclosure other than the matter of Sarah’s
employment.

 Any reference made about insulin pump therapy will be made in a general reference.

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Objectives

 Attendees will be able to comfortably read, interpret, and adjust the

information presented on food labels to what they are consuming, and/or
purchasing

 Attendees will be able to recognize which foods are significant (and non‐
significant) sources of carbohydrates

 Attendees will have a more robust understanding of how other nutrients

indirectly impact their blood glucose levels

 Attendees will be empowered to make more nutritious choices when

away from the home

 Attendees will be ale to identify hidden sources of gluten

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Cornerstones of Type 1 Management

 The “Diabetes Triangle/Triad”

 If management were this easy….?

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Cornerstones of Type 1 Management

 We all know with certainty “control” is not as simple as these three pillars

 Achieving control may look more like this?

LIFE!

Stress Hormones/Changes

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What is a______Diet?

 Good, balanced, ideal …

 Let’s shift the focus to: “What is a nourishing diet?”

 Finding ways to eat foods that provide nutritional value, flavor, and enjoyment
 Finding ways to eat the above, and balance treatment, and meet treatment
goals
 Finding ways to incorporate foods with less nutritional value (but are still really
fun to eat!!!
 Remember foods are meant to be enjoyed, it’s a way to connect with family
and friends, there are social, & sensory considerations regarding our food &
diet

 It really can be done!!

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What is a(n) (nutritionally) adequate diet?

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Guidelines to Goals
 3 + Cups Vegetables per day  6 ½ ‐ 7 oz protein**
 Aim for a wide variety of colors,  1 oz = 1 egg, meat, poultry, fish,
& textures game, ¼ cup cooked beans, or
 High nutrition value, low in peas
caloric value  Sodium intake: ~2300 mg or less
 2‐2 ½ cups Fruits per day**  Saturated fat aim for 24 g
 Aim for a wide variety of colors  This does allot for butter lovers, &
& textures coconut oil lovers
 7 oz whole grains per day**  1 tsp butter = 1 serving fat
 1 oz = 1 slice Whole grain bread
 1 tsp butter = ~3 – 4 g saturated
 1 oz = ½ cup cooked whole
fat
grains or hot cereal  Added sugar: 55 g or less
 3 cups dairy

** May fluctuate depending on activity level

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Macronutrient Review

 Carbohydrates
 Main source of glucose
 4 calories per gram

 Protein
 Not a source of glucose
 Longer digestion time
 4 calories per gram

 Fat
 Not a source of glucose
 Longer digestion time
 9 calories/gram

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Macronutrient Review: Carbohydrates

 Carbohydrates  Main energy source

 Complex (digest slowly, absorption/glucose elevation later)
 Green vegetables & whole plant foods, whole grains {oats/oatmeal, barley,
whole grain pastas & breads}, beans, lentils, peas, sweet potatoes
 Simple (digest quickly, absorption/glucose elevation faster)
 Simple nutritious
 Fruits
 Yogurt, milk,
 Simple “less nutritious”
 Sugar, sugar containing products (sugar sweetened drinks, candy, refined
grains/grain products)
 Table sugar, molasses, honey, brown sugar, corn syrup, maple syrup

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Macro Review: Proteins

 Animal Proteins
 Fish & Shellfish
 Chicken, turkey & other poultry
 Beef, pork, bison, lamb, venison etc

 Plant Proteins
 Beans, & lentils (combination foods)

 Protein rich foods are a wonderful way to balance out carbohydrate sources,
and promote satiety in between meals
 Protein in and of itself is needed for growth, repair, plays an important role in
immune function, is needed in the production of certain hormones & enzymes
 Protein is also a secondary fuel source when carbohydrates are not available

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Macro Review: Fats

 Animal Based Fats

 Butter, Lard, Tallow
 Fats in cheeses, meats, dairy

 Plant Based Fats

 Olive oil
 Nut oils (almond, walnut, etc)
 Avocado oil
 Coconut oil (*saturated fat)
 Canola & Grapeseed oil

 Fats are needed for growth & development, essential for absorbing fat soluble
vitamins (A, D, E, K), providing cushioning for organs, maintaining cell membranes

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Other Nutrition Considerations

 Fiber
 Do I subtract?
 Carbs are carbs, high fiber snacks and meals still need to be covered with
insulin

 “Non‐Starchy Vegetables”
 For every serving you’re taking in 5 g of carbs
 1 serving = 1 cup cooked vegetables (5 g carb, 25 calories)
 1 serving = ½ cup raw vegetables (5 g carb, 25 calories)
 Veggies should be encouraged, consumed, and enjoyed
 They should also be remember as a source of carbohydrate

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Other Nutrition Considerations:
Sweeteners
 Food Additives
 Defined by FD&C Act (establishes standards for premarket approval, safety, &
data review, additives and new uses for additives are not just realized to market)
 Aspartame
 Sucralose
 Saccharin

 GRAS (Generally Recognized as Safe)

 Safety standard for GRAS foods is same as food additives, experts able to
conclude on validity of evidence, which allows an exemption to the FDA pre‐
market review and approval.
 Stevia
 Monk fruit derived sweetener (SGFE)

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“What’s in a name….”

Other Terms for “Sweeteners” Terms for Added Sugars

 Natural sweetener  Anhydrous dextrose
 Brown sugar
 Synthesized sweetener  Confectioner’s Sugar
 Alternative sweetener  Corn Syrup, High Fructose Corn Syrup, Corn
syrup solids
 Sugar replacer  Dextrose
 Sugar substitute  Fructose
 Low calorie sweetener  Honey
 Invert Sugar
 Reduced calorie sweetener  Lactose
 Sugar alcohol  Malt Syrup
 Polyol  Maltose
 Maple Syrup
 High intensity sweetener  Molasses
 Intense sweetener  Nectar
 Raw Sugar/Coconut sugar/organic sugar
 No calorie sweetener  White Sugar
 Non‐nutritive sweetener

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Other Nutrition Considerations:
Sweeteners
 A variety of sweeteners can be enjoyed in moderation

 Adding caloric sweeteners to foods (i.e. honey) is ADDING SUGAR

 Caloric sweeteners are also considered concentrated carbohydrate

sources – {but can also be balanced out with insulin}

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The Bottom Line: Sweeteners

 Our estimated daily intake (EDI) should not exceed acceptable daily
intake (ADI)
“A 150‐pound adult can safely
consume 2.4 cans of 12‐ounce
soda or 8.6 packets of
sweetener containing saccharin
daily. Similarly, that same adult
can safely consume 17 cans of
12‐ounce soda or 97.4 packets
of artificial sweetener
containing aspartame daily
and not be adversely affected.
Meanwhile, the ADI for
saccharin for a 50‐pound child
is .8 of a 12‐ounce can of soda
daily and 2.8 packets of
sweetener, or 5.6 cans of soda
and 32.4 packets of artificial
sweetener containing
aspartame.”
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Other Nutrition Considerations: Alcohol

 Contains 7 calories per gram, unlike macronutrients‐ provide no

nutritional value for calories

 “One alcoholic drink‐equivalent is described as containing 14 g (0.6 fl oz) of

pure alcohol”

 The CDC Recommends 1 standard drink per day for women, and up to 2
for men (which also align with current Dietary Guidelines)

 Standard drink:
 1 oz spirit
 5 oz wine
 12 oz light beer

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Alcohol consumption & blood glucose
management
 Alcohol metabolized in liver, stopping & slowing other “responsibilities” of the liver (i.e.
glucose release from liver) – a process that can already be imperfect in those with
T1DM

 Accounting for the “temporary vacation” of liver releasing glucose ( hypoglycemia),

and accounting for any carbs in beverages ( hyperglycemia) is not easy
 For every 1 standard drink estimate liver will be “out of commission” of 1 hour per drink (i.e. 12
drinks, expect to go 12 hours without your liver not breaking down any glucose if blood sugars
dip)
 This is MUCH more difficult to account for with MDI!!!!
 Utilizing advanced pump features can make this a less daunting task (temp basals, manual bolus,
extended bolus if eating while drinking)

 Avoiding hypoglycemia {especially while consuming alcohol} is paramount!

 Remember: symptoms of alcohol consumption & hypoglycemia can be similar!

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Other “Nutrition‐Related” Factors

 Amounts, Timing, & Frequency

 Three factors, often overlooked when assessing overall picture of a diet
 How often do you enjoy something that has lower nutritional value
 Eating 3 girl scout cookies every day or every other day does not a bad diet
make
 Eating 3 boxes of girl scout cookies in 10 days – that could raise some flags
 Some subscribe to “90/10” or “80/20”
 Can do what works for you
 Portion distortion is a common saboteur, and often overlooked
 Use measuring cups to occasionally reign in portions
 Timing as it specifically pertains to insulin is also important

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Decoding Food Claims

 “No sugar added”

 No sugar, or no sugar containing ingredient or equivalent was added into a
product in the processing

 “Sugar free”
 Less than ½ gram sugar per serving

 “Low cholesterol”
 20 mg or less of cholesterol
 Cholesterol is found in animal products
 This labeling on plant based foods = gimmick!!!

 “Fat free”
 Less than ½ gram of fat per serving

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Label Reading

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Label Reading Exercise

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“Fad” Diets: Food should never promise to
be anything other than tasty!
 Paleo/High Fat High Protein
 Growing body of evidence indicating this is not successful for sustained loss
 Room for RAPID weight regain 2/2 glycogen binding with water

 Gluten free (not a fad for everyone)

 A gluten free brownie is still a brownie
 But some people NEED a GF brownie when they want a brownie

 Juicing
 “Attractive marketing”
 BG spikes, bottoming out
 Fancy way to starve

 “Cleanses” or “Detoxes”
 We have livers and kidneys for this
 Attractive marketing

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Gluten Free Guidelines: Avoid Unless
Expressly Labeled “Gluten Free”
 Beer  Matzo
 Breads
 Pastas, noodles, grains
 Breakfast foods (waffles, pancakes –
and their mixes, cereals, toast,  Processed lunch meats
biscuits, crepes)  Salad dressings
 Cakes, cookies, cheesecakes (crust  Sauces (i.e. soy sauce)
and filling), pies, candies, granola
bars, fruit & cheese fillings  Fried foods
 Cereals  Seasoning mixes
 Communion wafers  Seasoned snack foods
 Croutons
 Pre seasoned meats
 French fries
 Gravies  Soups and soup bases
 Imitation meats

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Hidden Gluten
 OTC drugs/meds: including MVI’s and other supplements
 Shampoo, conditioner, soap, sunscreen
 Hydrolyzed vegetable protein
 Lotion & Makeup
 Pet foods (handling)
 Bleu Cheese
 Soy sauce, imitation pepper, malt
 Candies (licorice)
 Play Dough
 Hydrolyzed plan protein
 Hot chocolate
 Graham, bulgur, farina, spelt
 Hot dogs
 Ales, lagers, beers, malted beverages
 Frozen Vegetables in a sauce
 Toothpaste
 Pickles

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MyPlate in the Real World

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MyPlate in the Real World

 When ordering foods (formal or fast casual) focus on:

 Ensuring you are getting your veggies
 Turn burritos into salads
 Order vegetable sides versus rice, pastas, potatoes

 Limit caloric beverages when dining out (or in general)

 Focus on incorporation of proteins and vegetables – carbs both nutritious

and “non” will always be readily available

 Do a mental check list when ordering (veggies, protein, whole grain/fruit),

and do not be afraid to ask for extra veggies (there’s rarely an upcharge)

 Get sauces and dressings on the side

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Sarah’s Favorites

 Quark  Hardboiled eggs

 All eggs
 Icelandic Skyr

 Greek Yogurt with fruit  Dark chocolate

 Macro Bars  Sriracha/Hot Sauce

 RX Bars  Fresh herbs

 Larabars  Weekend meal prep

 Nuts & Olives  Nut butters

 Seasonal veggies & fruits  Oils

 Measuring cups  Cookbooks

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Pearl’s for a Nutritious Diet

 Embrace some weekend/weekly  When dining out utilize the “plate

meal prep method”

 Utilize your freezer  When traveling try to follow the

same “plate method”
 Allow yourself enjoyment of all
foods  Remember that your favorite
“fun” foods will always be there
 Aim for incorporating your food
groups before opting for  It’s entirely ok not to clean your
indulgences plate
 Veggies before cupcakes

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Helpful Tech

 Lifestyle
 MyFitnessPal
 Calorie King
 Utilizing pumps’ advance features
 Utilizing Integrative technology
 Healthy Out {Gluten Free}

 Teaching/Reference
 Figwee

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Questions?

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