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Carbohydrate awareness

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  1. Carbohydrate awareness

  2. Body weight and hyperglycaemia It is important for patients with diabetes (particularly type 2 diabetes) to maintain a healthy body weight. “Moderate weight loss in overweight/obese individuals with type 2 diabetes results in improved control of hyperglycaemia as well as in a reduction in risk factors for cardiovascular disease.” Sheard NF et al. Diabetes Care 2004;27:2266–71.

  3. Course overview • What are carbohydrates and how are they utilised by the body • Balance of good health • Daily recommendations of carbohydrates • Activity • Understanding food labels • Weight management

  4. General diet principles • Dietary advice should: • Focus on maintaining and improving health • Aim to support optimal metabolic and physiological outcomes: • As near to normoglycaemia as possible (without hypoglycaemia) • Management of body weight, dyslipidaemia and hypertension • Be individualised and take into account: • Shift patterns • Nutritional inadequacies • Cultural or religious beliefs Diabetes UK Nutrition Subcommittee. Diabet Med 2003;20:786–807

  5. Carbohydrates and blood glucose All foods must be converted into glucose before they can be used as fuel. Carbohydrates are more easily converted into glucose than protein or fat, and are considered to be the body's "preferred" source of energy, and the brain's essential source of energy. http://www.annecollins.com/how-carbs-affect-blood-sugar.htm (accessed May 2011)

  6. The balance of good health

  7. CARBOHYDRATES Bread, pasta, rice, cereal, potato Sugar: sucrose Fruit: fructose Milk: lactose Glucose (Energy) PROTEINS Meat, fish, eggs, cheese, nuts, pulses Amino acids (Growth & repair) FATS Margarine, butter, lard, oils, ghee, cream Fatty acids (Insulation & storage) VEGETABLES parsnip, onion, broccoli, celery Fibre & water

  8. Daily allowance of carbohydrates ? 10–14 portions

  9. What is a portion? • 1 thin slice of bread • 2 table spoons cooked rice or pasta • 2-4 table spoons cereal • 1 egg size new potato • ½ medium baked potato • 1 ice cream scoop mashed potato • 5 chips • 1 portion of fruit e.g. Fruit that fits into hand • 2 teaspoons of sugar • 1/3 pt of milk

  10. Are we eating more calories than in the past? ”Following significant changes over the past few years, the British diet is probably as healthy as it's ever been. As a nation, our intake of saturated fat is decreasing in line with Government targets. But we are not there yet. We still need to reduce our consumption of fat, sugar and salt, and eat more fruit and vegetables.There is still more work to do to build on this progress (and that includes being more physically active) if we are to see a reduction in conditions such as heart disease, stroke, some cancers and obesity.” http://www.food.gov.uk/multimedia/webpage/66549/samverdict(accessed May 2011)

  11. Physical activity need not involve a formal exercise regimen • Guidelines are the same as for people without diabetes • Aim for 30 minutes of activity, at least 5 days per week • Can include: • Gardening • Housework • Walking http://www.diabetes.org.uk/Guide-to-diabetes/Treatment__your_health/Keeping_active/Activities_to_get_you_started/ (accessed May 2011) http://www.diabetes.org.uk/Guide-to-diabetes/Treatment__your_health/Keeping_active/Before_you_start/ (accessed May 2011)

  12. Workshops

  13. Food labels

  14. Weight and self management

  15. Diabetes requires life-long self-management • No time off! • “The diabetes self-management regimen is one of the most challenging of any for chronic illness”1 • 99.98% of time patients are on their own Diabetes Reduced psychological well-being Increased risk of depression? Exhaustion; feeling ‘fed-up’ and demotivated 1. Schillinger D et al. JAMA 2002;288:475–82

  16. Patients should be at the centre of the healthcare system Patient-centred care involves: Respect Choice and empowerment Patient involvement in health policy Access and support Information Patient-centred care is important to support self-management Secondary care Primary care Patient Other providers http://www.patientsorganizations.org/attach.pl/31/268/IAPO%20Declaration%20on%20Patient-Centred%20Healthcare%20-%20Colour.pdf (accessed May 2011)

  17. Shared decision-making is a key element of patient-centered care Exchange information Together, build a consensus about preferred treatment Together, agree to implement preferred treatment Healthcare provider Patient Building a relationship Charles C et al. Soc Sci Med 1997;44:681–92 Charles C et al. Soc Sci Med 1999;49:651–61

  18. Education helps patients self-manage Education Knowledge Skills Motivation Ability to assess risks Understanding of the benefits of behaviour or lifestyle change Ability to act on understanding to engage in appropriate behaviours

  19. “People who take on greater responsibility for the management of their diabetes have been shown to have reduced blood glucose levels, with no increase in severe hypoglycaemic attacks, a marked improvement in quality of life and a significant increase in satisfaction with treatment” NSF for Diabetes “Offer structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review. Inform people and their carers that structured education is an integral part of diabetes care” NCC-CC/NICE guidelines for type 2 diabetes management http://www.nice.org.uk/nicemedia/pdf/CG87QuickRefGuide.pdf (accessed May 2011)http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002951 (accessed May 2011)

  20. Initial treatment options for type 2 diabetes Behavioural modifications such as diet and exercise may provide glycaemic control in some patients Lifestyle: diet and exercise are always the underlying theme of care Nathan DM et al. Diabetes Care 2009;32:193–203

  21. Lifestyle choices: increased weight is associated with mortality *Data adjusted for age, gender, smoking and duration of diabetes Mulnier HE et al. Diabet Med 2006;23(5):516–21

  22. Lifestyle: the importance of weight • Decreased calorie intake combined with increased physical activity can result in:1 • Weight loss • Improved glucose control • Improved cardiovascular fitness 1. The Look AHEAD Research group. Diabetes Care 2007;30:1374–83

  23. The balance of good health

  24. Key summary points • Carbohydrates play a key role in the management of both patients with type 1 and type 2 diabetes • The balance of good health also plays a key role however needs to be adapted to patients with type 2 diabetes • Increased weight has been shown to lead to an increased risk in mortality

  25. Thank you for listening Any questions?