Nutrition for Kids with Type I Diabetes

1. Nutritionfor Kids withType I Diabetes School Nurse Workshop September 2019 Stephanie Etherington, RD, CD, CDE

3. 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

4. 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

5. 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-3s – 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

6. 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

8. Carb Amounts by Age

9. 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

10. Carb Counting

11. Apps and Websites • Personal Favorites • Calorie King (book, website, app) • My Fitness Pal (website, app) • Livestrong MyPlate (website, app)

13. The Exchange List

14. 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

15. Portion estimates Fist = 1 Cup Thumb = 1 Tbs Deck of cards = 3 oz Cupped hand = 1-2 oz

16. 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

17. 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.

18. 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/dL (no correction needed) • How many grams of carbs? • How many units of rapid-acting insulin should be given?

19. 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/dL with a current BG of 200 mg/dL 200 mg/dL – 150 mg/dL = 50/50 = 1 unit correction

20. 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/dL • Lunch: 2 slices pepperoni pizza (Pizza Hut), 1 side salad with 2 TBS ranch dressing, 1 diet coke • Blood sugar: 170 mg/dL • 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?

21. 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/dL • Lunch: ½ cheeseburger, 1 carton of 1% milk, ½ banana , 1 sugar-free pudding • Blood sugar: 200 mg/dL • 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?

22. 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/dL • 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/dL • 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?

23. 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!

24. Questions? Contact Information: Stephanie Etherington, RD, CD, CDE Diabetes Specialist, Confluence Health Stephanie.Etherington@confluencehealth.org 662-1511 ext. 31915 Thank you!