Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: LIFESTYLE| 5-17

(27). Potential barriers to achieving such high-fibre intakes include palatability, limited food choices and possible gastrointestinal side effects.

Glycemic index The glycemic index (GI) indicates the rise in postprandial BG elicited by a carbohydrate food as a percentage of the rise in BG that would occur if the same individual ingested an equal amount of carbohydrate from white bread or glucose. In general, the lower the rating, the better the quality of carbohydrate. The glycemic response is influenced by many factors, including how much food is eaten, how much the food is processed or even how the food is prepared (for example, pasta that is cooked al dente or firm has a lower glycemic response than pasta that is overcooked). Replacing high-GI foods with low-GI foods in mixed meals may help to optimize glycemic control in people with type 1 and type 2 diabetes (60-62). In people with type 1 diabetes, increased use of low-GI foods can reduce both A1C and the number of episodes of hypoglycemia (60,62,63). In people with type 2 diabetes, this dietary strategy leads to improvements in cardiovascular risk factors (61), postprandial glycemia and high-sensitivity C reactive protein (64). High-carbohydrate diets composed primarily of high-GI foods, refined carbohydrates and low fibre may be deleterious, but high-carbohydrate diets based on low-GI foods may be beneficial. A diet deriving up to 60% of total energy from low-GI and high-fibre carbohydrates can improve glycemic and lipid control in adults with type 2 diabetes (65). Although there are potential benefits to using the GI system, the decision to teach people to use it should be based on each patient’s interest and ability; the inclusion of GI in nutrition teaching may be too complicated and limiting in food choices. Nonetheless, general nutrition recommendations encourage intake of whole grains, legumes and less processed foods, which are generally lower-GI foods. Finally, total carbohydrate intake at each meal remains a primary factor in glycemic response to the meal (40). Diabetes Canada has developed a tool intended to help diabetes educators teach people how to choose healthy meals that include the concept of the GI (66). More detailed lists can be found in the International Tables of Glycemic Index and Glycemic Load Values (67).