Slide 1 Hi, this is Janet Beer for the Child Nutrition Programs at the Oregon Department of Education. Schools are required by the American Meal Plans for Serving Students with Diabetes Disabilities Act and USDA to Child Nutrition Programs accommodate the dietary needs of Oregon Department of Education students with diabetes. The purpose of this presentation is to review exchange and carbohydrate meal plans for students with diabetes. Slide 2 Individuals with diabetes should eat regular meals and snacks. These meals Meal Plan Basics - all diets are planned with a variety of methods • Planned meals/snacks including exchanges, and carbohydrate • Variety of foods • No forbidden foods counting. Meal plans are tailored to the • Portion size is critical needs of the individual student. • May include snacks – General fund $ should pay Like all Americans, students with diabetes should eat a variety of healthy foods. Sweets and desserts used to be forbidden but are now considered in the same way as in the regular Food Guide Pyramid. They may be eaten in small amounts if they fit into the students particular food plan. For any meal plan to be successful the portion sizes are critical. Medication dosages are matched to the carbohydrate content of the meal and over or under portioning can upset this balance. If a student with diabetes is required to have snacks that are not part of the school meal program these costs should be reimbursed by the general fund.
Slide 3 Diets for students with diabetes follow Meal Plan Basics - all diets general dietary recommendations. • Reduce Meals are planned to be lower in fat, – fat + saturated fat saturated fat, simple sugars and sweets. – simple sugar + sweets • Increase They should be higher in whole grains – whole grains + fiber and fiber. Meats should be lean and – lean meats + low fat dairy – fruits + non-starchy vegetables dairy products should be low fat. They also include increased consumption of fruits and vegetables. Slide 4 One method of planning meals uses Diabetic Exchanges (will vary) exchange food lists. Exchange lists • Starches provide a pattern to follow rather then • Meat and meat substitutes specifying which foods to eat. • Milk and yogurt • Fruits + fruit juice In the lists foods are grouped so that • Non-starchy vegetables they have similar nutrient levels. • Fats The portion size of each individual • Free Foods product is varied so that each one will have approximately the same amount of calories, carbohydrate, protein and fat. Foods in a group may then be “exchanged” or traded to plan the days meals. The specific food groups and exchange values will vary and it is important that the student use the one provided by their medical care provider.
Slide 5 A sample daily plan for a 2000 calorie diet might include the following Sample daily plan - 2000 calorie exchanges: • Starches - 10 10 starches • Meat and meat subs - 7 ounces 7 meat or meat substitutes • Milk and yogurt - 3 • Fruits + fruit juice - 4 3 milk or yogurts • Non-starchy vegetables - 5 4 fruit or fruit juices • Fats - 10 5 non-starchy vegetables • Free Foods – as allowed 10 fats and free foods as allowed Free foods generally include items like diet drinks, coffee, and dietetic candies. Some may be eaten in any quantity and some will have a daily maximum consumption. The total days exchanges are divided into 3 meals and may or may not include snacks. Slide 6 Sample exchange lists can be found on many web sites, including the Mayo Mayo Clinic Web Site Exchanges Clinic. On this sample list ¼ of a 4 ounce bagel counts as one starch serving as does ½ of an English muffin.
Slide 7 If a student had a meal pattern that Sample Lunch I tems Amount Exchanges included 3 starchs, 2 meat or meat Hamburger Bun One 2 starch substitutes, one non starchy vegetable, Beef Patty Cooked 1 1/2 ounce 1 1/2 meat one fat, one fruit and one milk they American Cheese 1/2 ounce 1/2 meat Tossed Salad 1 cup 1 NS veg might select a lunch that contains these Ranch, Low Fat 2 T 1 fat items. Ketchup 2 T free Apple 1 small 1 fruit A 1.75 ounce hamburger bun counts as NF Choc Milk 8 oz 1 milk + 1 two starch exchanges. starch A 1.5 ounce cooked beef patty is 1 ½ meat exchanges. One slice of American cheese is ½ ounce an counts as ½ meat exchange On cup of tossed salad is one exchange of a non-starch vegetable. Two tablespoons of ketchup is free, but will have a daily maximum amount. One small apple is one fruit exchange. Non-fat chocolate milk has sugar added so it counts as both one milk exchange and one starch exchange. Slide 8 Meals can also be planned by Carbohydrate Counting carbohydrate counting. Carbohydrate • Carbs in foods counted • Wider variety - more flexible content of individual foods is totaled • Easy to learn up to a specific number for the meal or • More accurate = better snack. This is a simpler and more control flexible way to plan a meal. It will • Insulin based on food eaten • Some plans subtract fiber if it provide a greater variety of choices. is > 5 grams Carbohydrate counting provides a more accurate guess of how blood glucose will rise after a meal or snack and may make it easier to match medication amounts to foods consumed. Insulin amounts can be adjusted before each meal based on the grams of carbohydrate in that meal. Some meal plans allow the individual to decrease the carbohydrate count for a food item if it contains 5 or more grams of fiber. It will be necessary to provide the fiber content of foods for these meal plans.
Although all foods are allowed with meals planned by carbohydrate counting this does not mean that an individual can eat two candy bars and count that as their lunch. It is still important to eat a balanced diet that is limited in sweets. Slide 9 Sample carbohydrate counts are listed on this slide. There are a great number Sample Carb Counts of web sites and books that provide the I tem Amount Carbs carbohydrate count of foods. Portions Cereal 1 cup 22 Turkey Sausage, Egg & one 18 can be varied to increase or decrease Cheese Pocket Pineapple Chunks 1/2 cup 15 the carbohydrate content as needed. WW Mini Bagel and Light 1.7 oz bagel, 1 oz. 27 Cream Cheese cream cheese The school nurse will know which Skim Milk 8 oz 13 LF Chocolate Milk 8 oz 28 resource your district prefers to use. Slide 10 A sample breakfast containing 65 grams of carbohydrate could include: Breakfast with 65 carbs One cup of unsweetened cereal I tem Amount Carbs 3/4 cup of fresh pineapple Cereal 1 cup 22 ½ of a 2 ounce bagel Pineapple 3/4 cup 15 Bagel 1/2 13.5 ½ ounce light cream cheese Light Cream Cheese 1/2 oz 0 And 8 ounces of skim milk. Skim Milk 8 oz 13 The total carbohydrate count for this Total Carb 63.5 meal would be 63.5.
Slide 11 There are a number of additional tools ODE Tools for serving students with diabetes. • PPT’s These include a PowerPoint with • General info • Calculating Recipes general information and one on • Carbohydrate Content Lists calculating the carbohydrate and fiber • Generic – fruit/veg and other • ODE commodity content of a recipe. There are detailed • Processed commodity • Branded lists of foods with carbohydrate content • Resource List • Web site and fiber content. These lists include http://www.ode.state.or.us/search/page/?id= 2004 generic items, ODE commodity products, processed commodity items and branded products. There is also a list of additional resources. All of these items can be found at the link on the bottom of this slide. Slide 12 If you have additional questions or comments please contact your specialist Questions? in the Child Nutrition Programs at the Oregon Department of Education. Thank you for your interest in learning For additional information contact your Specialist at about meal plans for serving students Child Nutrition Programs Oregon Department of Education with diabetes. Your efforts to serve 503-947-5891 these students well will make an impact on their immediate and future health.
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