Setting Goals: Stages of Change

Remember!

The goal is to move through the stages of change… not

always to “take action.”

Practice Setting a Goal

• Choose a healthy behavior that you have already been thinking about changing.

• Some ideas: healthy eating, being more active physically, taking your medicine, checking your feet, checking your blood sugar.

• What will you gain if you make this change?

• What will you have to give up?• On a scale of 1-10, how much do you

want to make this change?

My Goal: to lose 5 pounds

My reason for this goal: so I can wear my favorite dress for my son’s wedding

Steps I’ll take:1. Ride the exercise bike for 10 minutes

daily2. Eat a salad and fruit for lunch3. Park my car as far from the door as I can

Who will help me: my best friend 

When I’ll start: this Thursday

When I’ll meet my goal: in 2 months

How I’ll reward myself for making progress toward my goal:

Buy an audio book to listen to on the way to work

Eating Healthy with Diabetes

What is diabetes?

Diabetes is…• Too much glucose,

a form of sugar, in your bloodstream

Having diabetes means…

• Not enough insulin OR• Your body has trouble

using the insulin that you make

Healthy eating is important

Benefits include: – blood sugar as near normal as possible–maintain a healthier weight– improve cholesterol– improve blood pressure – improve overall health

Benefits of Healthy Weight

• Reduces risk for high blood pressure, high cholesterol, diabetes, heart disease, and stroke

• Helps us live longer• Protects our backs and joints• Helps us get well and stay well• Boosts our energy levels

• People with diabetes have a higher risk of heart attack, stroke, and other heart problems

• Low-fat foods– help prevent heart disease–maintain a healthy weight

Diet low in fat & cholesterol reduces risk of heart disease

Basic Nutrition Guidelines

• Eat a variety of foods everyday • Try new foods• Eat high fiber foods: fruits,

vegetables, whole grains, and beans• Use less added fat, sugar and salt• Be physically active every day• Eat meals and snacks at regular

times every day

• Eat about same amount of food each day.• Eat smaller portions• Try not to skip meals• Try to eat out no more than once a week

When you do eat out, make low‐fat choices• Try to do 30 minutes of physical activity

each day• Start slowly: take the stairs, walk more, do

more yard work

Basic Nutrition Guidelines

Keeping & Using a Food Diary

• An important tool in diabetes self-care

• Excellent way to change your eating habits

• Keep track at least three days in a row

• Gives an idea of what your diet is usually like.

Let’s Review!

• Diabetes is too much _____ in your bloodstream.

• Insulin is like a _____ that allows glucose (sugar) to enter the cells.

• How many of the “Basic Nutrition Guidelines” can you remember?

Food Affects Blood Sugar

• Carbohydrate ––main energy source, raises blood sugar quickly

• Protein ––building block for muscles and body organs

• Fat ––stores calories as an energy supply

• All the food you eat will affect your blood sugar! Carbohydrate raises your blood sugar more than protein or fat.

What Are Carbohydrates (carbs)?

• Carbs are found in many foods. • Carbs provide glucose (sugar) for your

body and brain. • Glucose: most important carbohydrate • Glucose used by cells for energy.

• Carbs give energy to walk, climb stairs, and do other physical activities.

• Brain must have glucose to work right.

• Carbs = Energy

What foods have carbs?• Fruits, vegetables, milk, yogurt, rice,

cereals, and bread• Snack foods, such as

pretzels, chips and popcorn• Sweets, regular soda, cakes, candy,

cookies, ice cream, pies, doughnuts

What about sugar?

• Sugars are carbohydrates• “Natural” sugars (honey) and table

sugar are both carbs• All carbohydrates break down into

sugar• Some foods contain a lot of sugar

and have few nutrients (“empty calories”)

What about sugar substitutes?• Sugar alcohols– Xylitol– Sorbitol–Mannitol

• Non-nutritive sweeteners– Aspartame (Equal)– Saccharin (Sweet and Low)– Sucralose (Splenda)

Why Do I Need to Know about Carbs?

1. Your body turns carbs into glucose (sugar).

2. Insulin moves glucose into your cells. Diabetes means either you don’t make enough

insulin or your body can’t use the insulin you make.

3. Eating the right amount of carbs at each meal and taking diabetes medications may help keep your blood glucose closer to target levels.

Let’s Review!

• “Carbs” is the short name for _____• Do carbs RAISE or LOWER blood

sugar?• Another name for sugar is ________• True or False: “Natural” sugars (like

honey) are not carbs.• True or False: Eating the right amount

of carbs at each meal will NOT help keep your blood glucose at target levels.

How do you count carbs?CARB COUNTING1 carb choice = 15 grams

carbs• Most WOMEN need 3-4 carb

choices per meal OR– 45 to 60 grams of carbs at each

meal– 1 carb choice or 15 grams of

carbs for snacks (if needed)

How do you count carbs?

1 carb choice = 15 grams carbs

• Most MEN need about 4-5 carb choices per meal OR– 60 to 75 grams of carbs at each

meal– 1 to 2 carb choices or 15 to 30

grams of carbs for snacks (if needed)

Carbohydrate Counting• Means keeping track of

the carbohydrates in a meal or snack

• Means controlling the total amount of carbohydrate

• Controls blood sugar levels

• Count carbs and check your blood glucose

Carbs per serving size• Breads:– Muffin, bagel: 45g (3 carb choices)– 6 saltine crackers: 15g (1 carb)– Oatmeal (1 package): 30g (2 carbs)– Whole grain bread (1 slice): 15g (1 carb)

• Fruits:– Apple, orange (medium): 20g (1 1/3 carb)– Banana (medium): 25g (1 2/3 carb)

• Vegetables:– Brocolli, zucchini (1/2 cup): 5g (1/3 carb)– Carrots, peas (1/2 cup): 10g (2/3 carb)– Squash, corn (1/2 cup): 15g (1 carb)

Carbs per serving size

• Meats:– Turkey burger (no bun): 0g (no carbs)– Chicken breast, roasted, no skin: 0 g (no carbs)– 1 egg, hard-boiled: 0.1g (almost no carbs)

• Milk:– Low fat cottage cheese (1/2 cup): 3g (<1/4 carb)– Low fat milk (1 cup): 12g (3/4 carb)– American cheese (1 slice): 0.3g (almost no carbs)

• Oils: – Low fat Ranch dressing: 4 g (1/3 carb)– Butter, margarine: 0.1 g (almost no carbs)

www.CalorieKing.com

Carbohydrate Counting• Means keeping track of

the carbohydrates in a meal or snack

• Means controlling the total amount of carbohydrate

• Controls blood sugar levels

• Count carbs and check your blood glucose

Carbs per serving size

• Meats:– Turkey burger (no bun): 0g (no carbs)– Chicken breast, roasted, no skin: 0 g (no carbs)– 1 egg, hard-boiled: 0.1g (almost no carbs)

• Milk:– Low fat cottage cheese (1/2 cup): 3g (<1/4 carb)– Low fat milk (1 cup): 12g (3/4 carb)– American cheese (1 slice): 0.3g (almost no carbs)

• Oils: – Low fat Ranch dressing: 4 g (1/3 carb)– Butter, margarine: 0.1 g (almost no carbs)

www.CalorieKing.com

Be a Carb Detective!Check the serving size. Is that how much you plan to

eat?

Count the total carbs

You do not need to count the sugars

separately because it is already counted as

part of the total carbs

TO CALCULATE CARB CHOICES:Divide the number of grams of total carbs by 15(because 1 carb choice = 15 grams of carb).Total carb = 31g31 divided by 15 = about 2

Sample of a 4-Carb Meal

• 1 slice of bread• ½ cup mashed potatoes• ½ cup peaches• 1 cup skim milk

Use these foods to round out the meal: • Chicken (size of your hand)• Lettuce salad• 1-2 tablespoons salad dressing

Let’s Review!

• 1 Carb choice = ____ grams carbs• Women need MORE or FEWER carb

servings than men every day. • True or False: If you count carbs, you

do not need to check your blood sugar.

• To calculate carbs, divide the total carbohydrate grams by ____ because there are 15 grams in each carb choice.

The Diabetes Food Guide Pyramid

• Choose most foods from lowest levels: – Grains, starchy

vegetables, & beans– Non-starchy

vegetables – Fruits

• Fewer choices from the milk, meats, and other protein groups

• Very few choices from fats, oils, sweets and alcohol

What’s a Portion Size?Portion size is the amount that you actually eat of a specific food. It can be different for each person. Your portion size may be larger than the serving size listed on the food package. Check the nutrition facts label to find the carbs you are actually eating.

Portion Size

Portion sizes keep getting bigger and bigger! The larger the portion, the

more people tend to eat!

More About Portion Sizes

http://hp2010.nhlbihin.net/portion/

20 years ago:333 calories

20 years ago:210 calories

Today:590 calories

Today:610 calories

“Rules of Thumb”

• Meat portion= deck of cards

• Cheese portion= domino

• Butter portion= die• Salad dressing= golf

ball• Rice, pasta,

casseroles, potatoes= the size of your fist

More “Eating Out” Tips

• Select fruits and veggies• Avoid soups, sauces, gravies and broths• Avoid bread and rolls with salty, buttery

crusts• Order salad dressing on the side- dip

your fork into the dressing, then pick up the lettuce

• Select grilled, broiled, or roasted meat, fish or poultry

Let’s Review!

• The Food Guide Pyramid and understanding ________ sizes are the keys to making good choices when eating out.

• What food are on the lower two levels of the Food Guide Pyramid? (eat more of these)

• What foods are on the top level? (avoid these)• A meat serving is the size of a _______• A rice or casserole serving is the size of the

_______ ____ ______ ________

How to Use a Nutrition Facts Label

• What is the serving size?

• What are the servings per container?

• How much carbohydrate is there in one serving?

• If you eat the entire container, how much carbohydrate will you get?

• How much dietary fiber is there in one serving?

How to Use a Nutrition Facts Label

• How much Total Fat is there in one serving?

• How much of that is Saturated Fat?

• How much of that is Trans Fat?

• How many Calories are in a serving?

• How many Calories in each serving come from Fat

• How much Cholesterol is in one serving?

Let’s Talk About…

Fiber Fat

Role of Fiber

• Fiber= carbs that can’t be digested.

• High fiber diets make you feel “full” longer.

• High fiber diets may help protect you from heart disease and diabetes.

Two Types of Fiber • Insoluble fiber– speeds up passage of food through the

digestive tract– is found in whole grain bread, cereal, wheat

bran, fresh fruit and vegetables

• Soluble fiber– slows down the passage of food through the

digestive system– is found in oat bran, rice bran, dried beans,

peas, and lentils.

Eating For a Healthy Heart

• Limit total fat to 30% or less of calories

• Decrease total fat, saturated fat, and trans fat

• Increase omega 3 fats found in fish oil, canola oil, and flax seed

• Decrease omega 6 fats (vegetable oils) • Use “healthy fats” such as olive oil for

sauces and dressings

The Dash Diet Blood Pressure can

be lowered by following the “Dietary Approaches to Stop Hypertension” (DASH) diet

DASH diet is rich in fruits and vegetables

Fresh fruits and veggies have little or no salt

DASH eating plan makes it easier to eat less salt.

Dash Eating Plan

Mediterranean Diet

• Key facts about Mediterranean Diet– Get plenty of exercise.– Eat meals with family or friends.– Eat at least 5 servings daily of fruits and vegetables.– Use olive oil and canola oil.– Use herbs and spices instead of salt to flavor food.– Eat small portions of nuts (20 unsalted nuts/day).– Eat fish at least twice a week– Eat very little beef or red meat.

Making the Changes