Hi, This Is Janet Beer for the Child Nutrition Programs at the Oregon Department of Education

Slide 1 Hi, this is Janet Beer for the Child Nutrition Programs at the Oregon Department of Education. Meal Plans for Serving Students Schools are required by the American with Diabetes Disabilities Act and USDA to Child Nutrition Programs Oregon Department of Education accommodate the dietary needs of 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

Meal Plan Basics - all diets regular meals and snacks. These meals • Planned meals/snacks are planned with a variety of methods • Variety of foods including exchanges, and carbohydrate • No forbidden foods counting. Meal plans are tailored to the • Portion size is critical • May include snacks needs of the individual student. – 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 – simple sugar + sweets saturated fat, simple sugars and sweets. • Increase They should be higher in whole grains – whole grains + fiber – lean meats + low fat dairy and fiber. Meats should be lean and – 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 • Meat and meat substitutes provide a pattern to follow rather then • Milk and yogurt specifying which foods to eat. • Fruits + fruit juice • Non-starchy vegetables In the lists foods are grouped so that • Fats they have similar nutrient levels. • Free Foods The portion size of each individual 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 Sample daily plan - 2000 calorie diet might include the following exchanges: • Starches - 10 • Meat and meat subs - 7 ounces 10 starches • Milk and yogurt - 3 7 meat or meat substitutes • Fruits + fruit juice - 4 3 milk or yogurts • Non-starchy vegetables - 5 • Fats - 10 4 fruit or fruit juices • Free Foods – as allowed 5 non-starchy vegetables 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 Mayo Clinic Web Site Exchanges many web sites, including the Mayo 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 Items Amount Exchanges included 3 starchs, 2 meat or meat Hamburger Bun One 2 starch

Beef Patty Cooked 1 1/2 ounce 1 1/2 meat substitutes, one non starchy vegetable, American Cheese 1/2 ounce 1/2 meat one fat, one fruit and one milk they Tossed Salad 1 cup 1 NS veg

Ranch, Low Fat 2 T 1 fat might select a lunch that contains these Ketchup 2 T free items. Apple 1 small 1 fruit A 1.75 ounce hamburger bun counts as NF Choc Milk 8 oz 1 milk + 1 starch two starch exchanges. 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 Carbohydrate Counting Meals can also be planned by • Carbs in foods counted carbohydrate counting. Carbohydrate • 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 control snack. This is a simpler and more • Insulin based on food eaten flexible way to plan a meal. It will • 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 Sample Carb Counts on this slide. There are a great number

Item Amount Carbs of web sites and books that provide the Cereal 1 cup 22 carbohydrate count of foods. Portions Turkey Sausage, Egg & one 18 Cheese Pocket can be varied to increase or decrease Pineapple Chunks 1/2 cup 15 WW Mini Bagel and Light 1.7 oz bagel, 1 oz. 27 the carbohydrate content as needed. Cream Cheese cream cheese Skim Milk 8 oz 13 The school nurse will know which LF Chocolate Milk 8 oz 28 resource your district prefers to use.

Slide 10 A sample breakfast containing 65

Breakfast with 65 carbs grams of carbohydrate could include: One cup of unsweetened cereal Item Amount Carbs

Cereal 1 cup 22 3/4 cup of fresh pineapple Pineapple 3/4 cup 15 ½ of a 2 ounce bagel Bagel 1/2 13.5 ½ ounce light cream cheese Light Cream Cheese 1/2 oz 0

Skim Milk 8 oz 13 And 8 ounces of skim milk. Total Carb 63.5 The total carbohydrate count for this meal would be 63.5.

Slide 11 There are a number of additional tools ODE Tools for serving students with diabetes. • PPT’s • General info These include a PowerPoint with • Calculating Recipes • Carbohydrate Content Lists general information and one on • Generic – fruit/veg and other calculating the carbohydrate and fiber • ODE commodity • Processed commodity content of a recipe. There are detailed • Branded • Resource List lists of foods with carbohydrate content • Web site http://www.ode.state.or.us/search/page/?id=2004 and fiber content. These lists include 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 Questions? comments please contact your specialist in the Child Nutrition Programs at the Oregon Department of Education.

For additional information contact your Thank you for your interest in learning Specialist at Child Nutrition Programs about meal plans for serving students Oregon Department of Education 503-947-5891 with diabetes. Your efforts to serve these students well will make an impact on their immediate and future health.