Efforts of the West Virginia Diabetes Control Program and the the problems of access to diabetes education in areas that experience the highest rates of …
with Diabetes
WVU Extension Service
A Cooking School program for people with diabetes and their families
Extension Service
with Diabetes
WVU Extension Service
A Cooking School program for people with diabetes and their families
Includes organizing strategies, instruction aids, and data collection instruments
This project was sponsored by funding provided through a comprehensive grant from the Centers for Disease Control and Prevention and the West Virginia Bureau for Public Health, Diabetes Control Program
Contents
Preface Introduction : 3 Introduction Introduction : 5 Chapter 1 : Organizing a Dining with Diabetes Program 1:1 Chapter 2 : Dining with Diabetes The Sessions 2:1 Chapter 3 : Data Collection 3:1 Chapter 4 : The Class Reunion and Beyond Follow-up 4:1 Appendix A : PSAs and News Releases Appendix A:1 Appendix B : Overheads Appendix B:1 Appendix C : Recipes Appendix C:1
Dedication The 1999 edition of Dining with Diabetes is dedicated to the memory of Mary Lou Schmidt, WVU Extension Agent and Extension Associate Professor from 1970-1999, whose sensitive, caring spirit remains with us
Programs and activities offered by the West Virginia University Extension
Service are available to all persons without regard to race, color, sex, disability, religion, age, veteran status, political beliefs, sexual orientation, national origin, and marital or family status West Virginia University is governed by the Board of Trustees of the University System of West Virginia
ES99-050
Dining with Diabetes
Introduction : 2
Preface
The lifestyle changes usually prescribed for people with diabetes to manage their disease include diet modifications These changes are neither simple to understand nor easy to master, yet they are often called the cornerstone for management of this chronic and devastating disease Individuals and families affected by diabetes regularly struggle with understanding complicated diet recommendations and separating them from myths and outdated advice of the past The Burden of Diabetes in West Virginia, a 1994 publication of the West Virginia Department of Health and Human Resources, outlined the devastating impact of diabetes on the citizens of West Virginia This report also revealed the disparity of access to diabetes education across the state Efforts of the West Virginia Diabetes Control Program and the West Virginia Association
of Diabetes Educators since that time have helped to increase the number of diabetes educators in the state These efforts, however, have not resolved the problems of access to diabetes education in areas that experience the highest rates of complications and mortality from diabetes In 1997, the West Virginia University Extension Service began a relationship with the West Virginia Diabetes Control Program, a division of the West Virginia Bureau for Public Health This relationship was developed to investigate the impact of delivering diabetes nutrition education through the combined efforts of Extension Educators and health professionals at the county level An innovative program, The Right Bite Diabetes Cooking School for People with Diabetes and Those Who Love Them, was chosen for use in the ensuing programs The Right Bite program, including curriculum and recipes with an Appalachian flavor, was written by Connie Crawley, RD, and colleagues at the Cooperative Extension Service of the University of Georgia The program had been used successfully throughout Georgia Since 1997, the Extension Service has presented 62 modified versions of the Right Bite cooking school program in 44 of
West Virginias 55 counties New relationships between Extension Educators and health professionals have been forged across the state The program has received overwhelmingly positive evaluations from those involved, and many of these persons have requested additional diabetes programming help Dining with Diabetes has been written to respond to the needs of people with diabetes in West Virginia Suggestions from Extension Educators, health professionals, and participants in the Right Bite cooking schools have all been incorporated in the curriculum, which follows Teaching materials have been updated to reflect the most current trends in medical nutrition therapy New recipes have been introduced for two persons, using simple ingredients Data collection instruments have been refined and improved to enhance the research potential of this program The development of this cooking school program involved the expertise and support of many people Countless diabetes educators, including many members of the West Virginia Association of Diabetes Educators, gave generously of their time in the presentation of the cooking schools Extension Educators enthusiastically organized, promoted, shopped for,
and completed endless documentation of the cooking schools Countless volunteers, including many members of the Community Educational Outreach Service organization, prepared foods for tasting, washed dishes, and cleaned up church halls Graduate students Rini Banerji and Amy ODell produced and shipped tons of support
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materials to county Extension offices Sheila Rye developed the guiding theories for Dining with Diabetes Joyce Bower and Susan McCabe patiently edited manuscripts and recipes Terrah Kelso designed the logo and layout Shawn Chillag and Celeste Peggs, WV BPH, gave unwavering support to this project Guen Brown provided constant guidance and encouragement to all of us Participants in the first 62 West Virginia diabetes cooking school programs — the people with diabetes and their family members — provided evaluations and home recipes and continue to be an inspiration to all of us This edition of Dining with Diabetes is offered with the hope of increasing understanding of how we can help people with diabetes to make lifestyle changes to improve their lives and those of their families Carol R Olson, MS, RD, LD, CDE Extension Specialist
– Diabetes Education
Note
In this edition of Dining with Diabetes, the word diabetes is used to mean diabetes mellitus While persons with Type 1 Diabetes and Gestational Diabetes participate frequently in West Virginia diabetes cooking schools, the focus of instruction for Dining with Diabetes continues to be those persons with Type 2 Diabetes, who make up 90 percent of those affected by diabetes mellitus The Dining with Diabetes program is not intended to replace diabetes education delivered by qualified health professionals such as Registered Dietitians and Certified Diabetes Educators This program is not intended to provide individualized meal plans for participants Individualized goals for calories, carbohydrate, fat, and sodium are not provided The lesson plans do not include instructions in the use of Exchange Lists A Food Guide Pyramid for persons with diabetes and the Plate Method are introduced in this program They are intended to supplement but not replace individualized meal planning instruction from qualified health care providers The occasional reference to brand names or products in recipes does not imply endorsement by the WVU Extension Service to the exclusion of
other products that may be equally suitable
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Introduction
Diabetes is a common, serious, and expensive disease in West Virginia The complications of untreated or undertreated diabetes are devastating Many studies show that when blood glucose is well controlled, complications such as retinopathy eye disease that can lead to blindness, kidney failure, and amputations can be delayed or possibly prevented West Virginia University Extension Service has delivered the Right Bite diabetes cooking school program since 1997 Process evaluation based on participants opinions and a need to develop a better tool to evaluate behavior change led to revising the curriculum and changing the name to Dining with Diabetes Dining with Diabetes uses Social Cognitive Theory and Stages of Change to guide the programs objectives and to measure knowledge, expectations, self-efficacy, and behavior change related to food intake and diabetes Nutrition is considered the cornerstone of diabetes management The lessons and recipes in Dining with Diabetes are presented to people with diabetes and to their family members in the hope of helping families manage diabetes through
healthy eating Dining with Diabetes was developed in an effort to help reduce the burden of diabetes by offering a theory-based program that can provide tools for the self-management of this chronic disease Reciprocal determinism, the major construct of Social Cognitive Theory, emphasizes the interaction of environment, participant, and behavior Dining with Diabetes offers a social environment conducive to the transfer of knowledge and skills by interactive cooking demonstrations and the tasting of foods The resulting self-efficacy is further enhanced by the social support of others in the classroom Stages of Change measurements determine if the constructs used in the schools are able to move participants from one stage to the next, thereby effecting behavior change The lecture/demonstration/participation style of the schools, taught by Extension Educators and diabetes health professionals, and the handbook format of the curriculum will support use of this program to aid in nationwide reduction in the burden of diabetes Dining with Diabetes is based on a program developed by the University of Georgia Cooperative Extension Service and is supported by funding through a comprehensive
grant from the Centers for Disease Control and Prevention and the West Virginia Bureau for Public Health, Diabetes Control Program The goals of Dining with Diabetes include: Increasing knowledge of healthy food choices for the diabetic diet Presenting healthy versions of familiar foods that are easy to prepare Demonstrating cooking techniques that use new or more healthful ingredients Encouraging behavior changes by providing tasting of healthy foods Demonstrating the potential of the Extension Service to provide basic diabetes education in partnership with diabetes health professionals Providing opportunities for participants to share and learn from one another
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This manual will help you set up and complete a Dining with Diabetes cooking school The sections that follow contain the following information: 1 Organizing a Dining with Diabetes Program 2 Dining with Diabetes — The Sessions 3 Data Collection 4 The Class Reunion and Beyond — Follow-up
Dining with Diabetes
Introduction : 6
Chapter 1
Organizing a Dining with Diabetes Program
This chapter contains information you will need to organize a Dining with Diabetes program in your
county You will need to complete the following tasks which are described in more detail in this chapter: 1 Choosing a place to hold the school 2 Choosing the best time for the school 3 Selecting faculty members 4 Forming a support team 5 Managing finances 6 Recruiting and registering participants 7 Getting help the Diabetes Education Specialist
Choosing a place to hold the school
Successful diabetes cooking schools have been held in a variety of locations throughout West Virginia Church fellowship halls with adjacent kitchens can be ideal Senior citizens centers with feeding sites are adaptable and are also good places to recruit participants High schools and middle schools with home economics labs, technical education centers, and public libraries with kitchens also have been used successfully Does your 4-H camp offer handicap accessibility, seating, and a nearby kitchen? Partnerships with hospitals can work well, but there can be barriers to success in using the hospital as your teaching site Auditoriums are sometimes too large and impersonal and may be located too far away from the kitchen In addition, volunteers usually are prohibited from working in the hospital kitchen The
site should be accessible to your audience People with diabetes can experience complications that make walking up stairs or for long distances difficult or painful Comfortable seating for 25 to 50 people is essential A projection screen and outlet for the overhead projector are required At least one 6-foot table for demonstrations and another table for serving food are necessary The most important requirement for a cooking school is a kitchen with a conventional not convection or microwave oven that works Take an oven thermometer and check to make sure The kitchen should be attached or very near the room where teaching takes place You will need to check on food preparations during the program without leaving the general area Volunteers are used to bake, finish, and portion recipes for serving Make sure volunteers are permitted to use the kitchen facility at the site you choose Reserve your site far in advance You will need access to the site two hours prior to the program for setup and one hour after the program for cleanup If there is a fee for use of your chosen site, be sure to clear this with Extension Service before proceeding
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Choosing the best time
for the school
Spring and fall are probably best for cooking schools Since each school has three sessions, having to reschedule because of snow and ice can be complicated Summers are difficult because of fairs, vacations, and camp commitments Consider your target audience Will it be composed of mostly elderly or unemployed persons? Would attendees prefer a school that meets during the day? Or are more of your likely participants employed during the day? Are your instructors available during the day or evening? Is the facility you have chosen available during the hours that fit your needs? Tasting recipes is an important part of the cooking school, but we do not provide a meal to participants Therefore, you should avoid the lunch and dinner hours
Choosing faculty members
The faculty for a Dining with Diabetes program should include qualified instructors in the areas of diabetes management, food preparation, and food safety Whenever possible, a Certified Diabetes Educator should be contacted to attend each session of the school Certified Diabetes Educators CDEs are health professionals who have passed a certifying examination after extensive study and completion of many hours in
direct patient teaching The CDE can be a registered dietitian, a registered nurse or nurse practitioner, a pharmacist, a physician, an exercise physiologist, or a social worker A CDE can help present instruction or may simply act as a resource person during the program to answer questions of a medical nature The American Association of Diabetes Educators AADE publishes a directory of members The West Virginia chapter of AADE has been very supportive of the WVU Extension diabetes cooking school programs Contact the Diabetes Education Specialist for referral to CDEs Registered dietitians should be included in the faculty whenever possible These professionals are trained to prepare meal plans for people with diabetes They can present curriculum and recipe demonstrations and can act as resources on diabetes, nutrition, and food safety Other valuable faculty members might include physicians, pharmacists, home economics teachers, WIC nutritionists, and public health nurses Be sure to include a representative of any organized diabetes education program in your community Urge faculty members to bring business cards or brochures that advertise additional diabetes education opportunities for
cooking school participants Three different recipes will be demonstrated at each class session More than one presenter is desirable for this portion of the programs Ask inexperienced presenters to practice the recipe at home and contact you for questions regarding teaching points for the recipe Emphasize that recipes should not be changed without prior consent from you or the Diabetes Education Specialist Additional directions for faculty, as well as lesson plans, information on overhead masters, and teaching materials, can be found in Chapter 2 of this manual This section can be copied for faculty members
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The most important faculty member is the Extension Educator Do not miss this opportunity to present yourself as a valuable resource to people with diabetes in your community Perhaps your background does not include academic preparation in foods and nutrition If that is the case, look for Extension Educators who have completed one or more successful cooking schools They will share their successes and may be available to help teach at your school Contact the Diabetes Education Specialist for additional suggestions
Forming a support team
Dining with
Diabetes depends on team effort to be successful You are in charge of the team Include representatives from diabetes support groups or other stakeholders Community Educational Outreach Service club members CEOS, the former West Virginia Extension Homemakers are valuable resources Participants from college nursing, dietetics, and family and consumer science programs should be recruited when possible You will need four to six dependable volunteers for each session of the program The volunteers will help set up the teaching area, greet and register participants at the door, wash and return demonstration equipment to the teaching area during the program, finish baking or cooking recipes and portion for tasting, and set up the tasting table Two recipes are prepared in advance of each program for tasting along with the three dishes prepared during class Volunteers who can prepare these recipes and bring them to class are needed All faculty and volunteers should receive recipe booklets and other handouts at each class session, but are not enrolled as participants in the program
Managing finances
Since 1997, the diabetes cooking schools sponsored by WVU Extension Service have been offered
free to the public under grant funding These funds have covered the costs of teaching materials, supplies and equipment, and the travel and services of a Diabetes Education Specialist In order to manage finances efficiently, a system of procurement cards has been used to bill county expenses directly to WVU Extension Service Consult with Extension Service accounting personnel for current recommendations on billing and reimbursements The curriculum for the cooking schools has been standardized to control costs and quality All teaching materials will be shipped to you from the state Extension Service office in Morgantown You should contact this office 304-293-2694 well in advance to make sure materials are shipped in time for your program Equipment kits are available from this office also, but they must be reserved in advance You are expected to purchase all foods used in demonstrations and tasting Faculty and volunteers should make arrangements to pick up ingredients from you in advance of the program You will also buy paper plates, cups, etc, for tasting, and coffee or iced tea for beverages We welcome funding partners Donations of paper products, food items, and in-kind services
help stretch grant dollars Samples of salt and sugar replacers, educational literature, and recipes usually can be ordered directly from manufacturers Pharmaceutical and equipment sales representatives have provided door prizes and other supplies in the past Give credit to funding partners on posters and programs
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Recruiting and registering participants
This cooking school program is restricted to persons with diabetes and family members Participants are usually easily recruited through religious organizations, pharmacies, CEOS clubs, senior citizens centers, and clinics Posters and flyers can be printed and distributed to interested persons Newspaper and radio advertising can also be helpful Sample newspaper and public service announcements are included in the appendix to this manual Advertising should begin six weeks to one month before the school All registration should be done through the county Extension office Interested callers should be reminded that the school is restricted to persons with diabetes Each participant with diabetes should be encouraged to enroll one family member or caregiver to attend with him or her Enrollment should be limited to
50 people In the rare case that fewer than 20 participants are enrolled, contact the Diabetes Education Specialist to discuss postponing or cancelling until more participants can be recruited Participants are expected to attend all three sessions of the school Persons not able to attend all three sessions should be placed on a waiting list and enrolled only if the class is not filled Reminder phone calls or postcards are very helpful, especially if there is a waiting list for your class Closing enrollment one week before class begins is also a good idea The state Extension Service office in Morgantown requires three to four weeks notice in order to ship your materials on time You may have to estimate enrollment and return unused materials later
Getting help the Diabetes Education Specialist
West Virginia University Extension Service has a Specialist for Diabetes Education The responsibilities for this position include providing diabetes education for Extension personnel as well as training for those wishing to conduct diabetes education events for the public The specialist is a Certified Diabetes Educator and maintains professional relationships with other diabetes educators
across the state Please contact this specialist for help in producing your Dining with Diabetes program
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Chapter 2 Dining with Diabetes The Sessions
This chapter contains lesson plans, overhead masters, and teaching materials for use in the Dining with Diabetes program It is organized as follows: 1 Objectives of the Sessions 2 Format of the Sessions 3 Lesson plans and lecture notes 4 Additional instructions
Objectives of the Sessions
The goals of the Dining with Diabetes program include increasing knowledge of healthful food choices for people with diabetes and presenting healthy versions of familiar foods The goals also include demonstrating proper cooking techniques for such products as artificial sweeteners, reduced fat food replacers, herbs, and spices The Dining with Diabetes program is not intended to replace diabetes education that is delivered by qualified health professionals such as Registered Dietitians and Certified Diabetes Educators This program is not intended to provide individualized meal plans for participants Individualized goals for calories, carbohydrate, fat, and sodium are not provided The lesson plans do not include instructions
in the use of Exchange Lists A Food Guide Pyramid for persons with diabetes and the Plate Method are introduced in this program They are intended to supplement and not to replace individualized meal planning instruction from qualified health care providers All faculty, including Extension Service personnel, as well as invited health professionals, are urged to refrain from adding material to the lesson plans that would change the original goals Likewise, every effort should be made to use all materials and lessons that are provided to achieve quality assurance in this program Questions regarding goals, session format, lesson plans, and teaching materials should be addressed to the Diabetes Education Specialist at WVU Extension Service
Format of the Sessions
The Dining with Diabetes program has three sessions Each session should last about two hours An agenda for the sessions follows
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Time Line
Greeting and announcements 5 minutes The lesson 25 minutes using overhead transparencies Demonstrations of 3 recipes 1 hour Tasting of recipes, discussion 30 minutes
Responsible Persons
WVU Extension Educator WVU Extension Educator, Registered Dietitian,
Certified Diabetes Educator, Nurse Educator, etc WVU Extension Educator or other faculty members All faculty
Teaching is accomplished using transparencies and an overhead projector Black-and-white copies of overheads are found in Appendix B Color transparencies will be provided to WVU Extension Educators Lecture notes are provided for each transparency All faculty members should receive copies of lecture notes to prepare for the sessions Materials for participants are printed by the state Extension Service office to assure quality and to reduce printing costs County Extension Service offices will receive a pocket folder for each participant in which to place handout materials The handout materials include data collection sheets and recipe booklets Numbered data collection instruments are distributed at registration for Session 1 and again at Session 3 and at the six-month Class Reunion For more information about data collection, see Chapter 3 The pocket folder and all data collection sheets are numbered to indicate the location and date of the school as well as individual participants It is the responsibility of the Extension Educator to carefully record names and numbers assigned
to participants to facilitate data retrieval All completed data collection tools must be handled carefully to protect the privacy of participants and to assure accuracy in data entry Participants are given pocket folders when they register in person at the beginning of Session 1 A new recipe booklet is given to each participant at the beginning of each of the three sessions The recipe booklets contain reference materials taken from the teaching lessons as well as recipes for all foods that are demonstrated or offered for tasting As funds permit, participants may also receive handout materials about diabetes and self-care Additional handout materials obtained from diabetes education programs in the area are welcome Material that specifically promotes name-brand medications for the management of diabetes should not be used The recipe demonstration portion of each session is an integral part of the cooking school It is important to show participants that healthful foods can be prepared easily and quickly Three different recipe demonstrations are presented at each session nine demonstrations during the entire cooking school Two or three persons will be needed to present the cooking
demonstrations at each session Two additional recipes are prepared ahead of time for each session of the school and are also available for tasting at each session These foods can be prepared by Extension Educators and faculty members, by members of the organizing team, or by participants in the school Funds for the program should cover expenses of all recipes prepared for tasting
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Please allow adequate time for the tasting party and discussion period Identify health professionals in attendance who can answer additional questions for participants Write down questions that were not answered and refer these to additional health professionals or the Diabetes Education Specialist so that answers can be provided at the next session of the cooking school Conclude each session by announcing the title for the next session and the recipes that will be demonstrated during the next class During Session 3, the date and format for the six-month reunion should be announced Ask participants to put this date on their calendars
Lesson plans and lecture notes
Each lesson plan includes learning objectives for participants and lecture notes for each transparency or slide
used in teaching The lesson plans follow at the end of this chapter
Additional instructions
The Extension Educator should purchase enough paper plates, cups, napkins, plastic forks, and spoons for the tasting of recipes at each session Provide either coffee or unsweetened iced tea as a beverage Purchase several kinds of artificial sweeteners for beverages Arrive early for each session in order to set up the room, provide instructions to helpers, and arrange supplies and implements for the demonstrations Equipment kits are available for cooking demonstrations An inventory of equipment follows
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Dining with Diabetes
Demonstration Equipment Inventory
Flannel-backed vinyl tablecloth Butane burner and 2 cans of butane fuel 1 fire extinguisher product 12 sauté pan with nonstick lining and lid Saucepan with nonstick lining Portable electric mixer with beaters 9 extension cord Minute timer Nested glass mixing bowls 3 bowls 2-quart glass mixing bowl with pouring lip and handle Cutting board 8-oz liquid measuring cup 2 paring knives, serrated knife, 8 chef knife 1 set cardboard food models
Mesh bag containing: 1 set metal dry measuring cups 1 cup, 1/2 cup, 1/3
cup, 1/4 cup 1 set measuring spoons 2 rubber scrapers 1 whisk 1 pair metal tongs 1 can opener 3 plastic or wooden stirring spoons 1 slotted turner 1 oven thermometer Please check inventory before and after cooking school If any items are missing or broken, please replace or contact Carol Olson at 304 422-1094 Additional butane fuel is available at Modern Equipment, 304 342-0101 All faculty members should receive a copy of lecture notes for the lessons In addition, faculty members who will be offering demonstrations should receive a copy of the recipe at least two weeks in advance of the date on which the demonstration takes place The following letter should be sent to all faculty members as soon as possible after the first contact
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Instruction Letter for Invited Faculty
Date Name Address Address Dear instructor: Thank you for agreeing to help with WVU Extension Services Dining with Diabetes program We welcome your expertise and support of our program Here is what you will need to know: Who produces the Diabetes Cooking Schools? How are they funded? The WVU Extension Service is producing a series of Diabetes Cooking Schools This project is sponsored by
funding provided through a comprehensive grant from the Centers for Disease Control and Prevention and the West Virginia Bureau for Public Health, Diabetes Control Program The cooking schools are entirely underwritten; no fees are charged to participants Extension Educators are responsible for the oversight of the cooking schools and for purchasing all supplies A Diabetes Education Specialist is responsible for training Extension Educators who wish to participate What does Extension expect from me? You have been invited to participate in this program because of your expertise in diabetes care, medical nutrition therapy, or food science You may be asked to present some of the teaching lessons in the cooking school All lessons are presented with overhead transparencies You will be supplied with lecture notes for the lessons The curriculum has been revised and standardized under the direction of the Diabetes Education Specialist at West Virginia University who is a Registered Dietitian and Certified Diabetes Educator For purposes of quality assurance and data collection, please do not make changes to the curriculum without contacting the Diabetes Education Specialist You may have been
asked to present a cooking demonstration Our guest chefs add a very special touch to our programs The recipes chosen for the school are delicious and reinforce lessons presented in each session The recipes are easy to prepare and use simple ingredients and equipment The Extension Service will supply the ingredients for your recipe unless you have made different prior arrangements We also supply cooking equipment kits Check with your Extension Educator to see if you need additional equipment All recipes are completed on site and served to participants during the last half-hour of each program Recipe handouts are provided for students One of the most important gifts you bring to this program is your ability to answer medical questions about diabetes We will direct these questions to you It is not our intention to provide individual meal plans, medication, or monitoring directions in this school We are happy to refer participants to your program for these services Please bring handouts from your diabetes education program Business cards and brochures are entirely appropriate We welcome any diabetes literature that does not specifically recommend or endorse brand-name
medications
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What should I expect from the Extension Educator? The WVU Extension Educator is responsible for organizing the cooking school Obtaining a suitable location, convening a faculty and support team, recruiting and registering participants, purchasing supplies, distributing teaching materials to faculty and participants, and gathering important data from the schools are the Extension Educators responsibility Extension Educators may teach some or all of the lessons, depending on their educational background and comfort level with the materials In addition, Extension Educators may do some of the cooking demonstrations They are responsible for all expenditures that will be billed to the WVU Extension Service Extension Educators will recruit volunteers to help with setup, cleanup, and other helpful jobs How can my institution help with the school? Funding partners help us produce more schools in West Virginia Please let us know if your institution can help with supplies or resources for this program Door prizes are always needed We would like to thank your institution for your participation Please give us the appropriate person and address for
thank-you notes Please help us evaluate our program Feedback can go to your Extension Educator or to: Carol Olson, MS, RD, LD, CDE Diabetes Education Specialist WVU Extension Service PO Box 6031 Morgantown, WV 26505-6031 Phone: 304 293-2694 Thank you again for your help with this exciting program Sincerely yours,
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Lesson Plans
Session 1 — Desserts
Learning objectives
Participants will recognize that carbohydrates raise blood glucose Using a Food Guide Pyramid, participants will recognize food groups that are rich sources of carbohydrate in the diet Participants will name usual sources of carbohydrates in dessert recipes Participants will recognize location of carbohydrates on food labels Participants will identify special cooking properties of sugars Participants will identify cooking properties of artificial sweeteners and methods for using them successfully in cooking
Registration at the site
Registration materials will be sent to the county WVU Extension Service office with participant packets Participants sign in on the numbered registration sheet and are given a packet that matches this number Each participant should also receive numbered
data collection sheets demographic information and pretest materials and a recipe booklet at this time Please provide pens for completion of data sheets and note-taking during the program
Introduction and announcements
The WVU Extension Educator should greet participants and introduce the session Use Overhead 1 as a title slide and Overhead 2 to explain the program goals Be sure to state that this program will not provide individual prescriptions for diabetic diets and that it is not intended to replace diabetes education furnished by qualified health care providers
The Lesson
Lecture notes for the lesson follow Note: Instructions for Extension Educators and faculty are presented in italics, while the script or narrative accompanying each overhead is presented in regular type
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Overhead 1
The WVU Extension Educator welcomes the participants to the West Virginia University Extension Service program Dining with Diabetes Before starting the teaching portion of the program, all demographic DWDDemographic and pretest DWDPretest/Posttest forms should be completed and returned to the Extension Educator The WVU Extension Educator should credit all funding
sources and sponsors for the program The educator then introduces all faculty members
Overhead 2
The WVU Extension Educator reads the goals of the program to participants Be sure to state that this program will not provide individual prescriptions for diabetic diets and it is not intended to replace diabetes education furnished by qualified health care providers The faculty member responsible for presenting the lesson begins with Overhead 3
Overhead 3
This overhead shows a car running on gasoline and a person running on food Blood glucose, or blood sugar, is the fuel that our bodies run on Glucose, or blood sugar, is vital to life itself We make glucose from the foods we eat Our bodies can make glucose from all foods that we eat, but some foods are better sources of glucose than others are Can you name some foods that raise blood glucose? Repeat these suggestions to the class If there is a chalkboard or newsprint, write down some of these suggestions Incorrect suggestions should be treated lightly, as in I dont believe meat will raise blood sugar as much as potatoes
Overhead 4
This is a Food Guide Pyramid for people with diabetes It was designed by the American Diabetes
Association and the American Dietetic Association to help people with diabetes in meal planning You have one of these pyramids in your packet today You can see that many of the foods you just named are pictured in the Starches, Fruits, and Milk groups Others are found in the group at the top of the Pyramid, called Sweets Fats All foods that are starchy and all foods that are sweet are rich in carbohydrate Carbohydrate is changed into blood glucose by
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digestion Many foods that are rich in carbohydrate are also very nutritious In fact they are so important to our health that the Food Guide Pyramid suggests we should eat 6 or more servings of Starches, 3-4 servings of Fruits, and 2-3 servings of Milk every day Many people ask, How many carbohydrates should I have each day? The answer depends on how much fuel your body needs for the work you do each day You need to ask your doctor, a registered dietitian, or a Certified Diabetes Educator for a meal plan designed just for you In general, we can say that a person who is not very active or who needs to lose some weight should have at least the smallest number of servings from each of these groups each day A
person who is physically active may need the larger number of servings from each of these groups We also know that dividing those servings between three or more meals, instead of eating them all at once, will help to keep blood sugar more even throughout the day
Overhead 5
What does one serving mean? One serving of starchy food is one slice of bread or half of a bun or bagel If the starchy food is cooked, like rice or potatoes or pasta, one serving is just about 1/2 cup Sometimes we say this is the amount a person can hold in one hand, but we all have different size hands, so learning how big a 1/2-cup portion actually is can help Show and pass a 1/2-cup measure A serving of fruit is a small fresh fruit or 1/2 cup of canned fruit or fruit juice One 8-ounce cup of milk is one serving Hold up and then pass 1-cup measure If the milk is made into pudding or a frozen dessert, the serving size is about 1/2 cup All these serving sizes of starch, fruit, and milk raise blood sugar about the same amount Cardboard food models included in the Equipment Kit can be used to show portion sizes as well as types of food
Overhead 6
This is a picture of the nutrition label found on almost all foods
sold in this country Look at the portion of the label that tells how much Total Carbohydrate is in the food in order to decide how much it might raise your blood glucose For comparison, one slice of bread or 1/2 cup of mashed potato or one small fruit has about 15 grams of carbohydrate Most of the carbohydrate in bread comes from the starch in flour, and very little from sugar One teaspoon of table sugar, or sucrose, has 4 grams of carbohydrate Our bodies change all the starch, as well as the sugar, into glucose, or blood sugar Be sure to look at Total Carbohydrate and not just at Sugars to see if a food will raise your blood sugar
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Overhead 7
What about eating sugar and sweets? Studies show us that sugar and sweets do not raise blood glucose more than other foods that are rich in carbohydrate If people with diabetes had to avoid all sugars in order to be healthy, they would not be able to eat fruits or drink milk because fruits and milk are good sources of natural sugars People with diabetes, just like all other people, should avoid substituting sweets for healthy foods at every meal When they do eat sweets, having a nutrition label helps them to know
how much to eat and how to count sweets as part of the total carbohydrate allowance for the meal
Overhead 8
In todays demonstrations, we will show you some ways to reduce the extra carbohydrate in desserts Familiar home recipes for desserts may contain large portions of sugar Sugar does more than just make a recipe sweet Sugar helps a recipe to be tender and moist It also helps make the familiar golden brown color of baked desserts and breads Sometimes sugar makes up a lot of the volume of a recipe as it does in cakes and cookies When it does, replacing sugar entirely with artificial sweeteners may produce a cake that is tough, flat, and dry, as well as gray in color Remember that artificial sweeteners only make a recipe sweet Recipes which usually do well with sugar substitutes include beverages, frozen desserts, pie fillings, sauces, gelatins, and puddings Cakes, cookies, and meringues depend on large amounts of sugar for more of their finished properties You should not replace more than 1/2 cup of sugar with an artificial sweetener in those products
Overhead 9
Many people use fruit purees and fruit juices to replace sugar in recipes These products may not be any lower in
carbohydrate than the sugar they replace However, they do help with moisture and volume Be sure to read the label on fruit purees and on fat-free baking products to see how much carbohydrate they add to the recipe
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Overhead 10
Guidelines for using artificial sweeteners help you learn how they act when heated and which ones have a bitter aftertaste when used in large amounts This chart is also in your recipe booklet The chart was made by using the manufacturers directions for the common artificial sweeteners now being sold at stores The best way to begin using artificial sweeteners in home cooking is to read label directions carefully Sending for recipe booklets from manufacturers or looking for recipes that manufacturers place on Internet Web sites are good ways to begin The chart shows that aspartame, sometimes marketed as NutrasweetTM, EqualTM, NatratasteTM, and other names, has very little aftertaste but it tends to denature, or lose its sweet taste, when it is heated Saccharin, sold as Sweet n LowTM and Sweet TwinTM, and as a brown sugar substitute, is very stabile for baking, but it has a noticeable aftertaste when used in large quantities
Acesulfame potassium, sold as Sweet OneTM or Swiss SweetTM, has less aftertaste than saccharin and it is more stabile when heated than aspartame SucraloseTM, with the trade name of SplendaTM, is a new artificial sweetener that is made from sugar with certain chemical changes It has the same volume and taste as sugar and it is stabile to heat It is not currently marketed for home use but is being used as a food additive Most artificial sweeteners are 100 or more times sweeter than sugar They need to be used in small amounts at first and increased only gradually to avoid an overly sweet taste or unpleasant aftertaste Herbal alternatives to sugar are available at natural foods stores Since these products are not marketed as food additives, they have not had the same kinds of testing as the other artificial sweeteners listed This does not mean that they are not safe, but it does mean that we dont know as much about them as we know about sweeteners that are used as food additives
Overhead 11
It is possible to use less to get more When two different classes of artificial sweeteners are combined such as saccharin with aspartame or acesulfame potassium with aspartame, the result is a much
sweeter taste than it is when one kind is used alone in cooking If a recipe calls for 6 packages of saccharin sweetener, for instance, try using a total of only 3 packages of sweetener, but use two different kinds, such as one package of saccharin and two packages of aspartame We know that aspartame usually loses its sweet taste when exposed to high heat in baking If aspartame is combined with another class of sweetener such as saccharin or acesulfame potassium or if the
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recipe includes a very acidic ingredient such as lemon juice, aspartame becomes more stabile and does not lose its sweet taste Aspartame can also be added just after baking by sprinkling it on top of pies or cakes It then is slowly absorbed into the cooling product and the sweet taste is retained Since 1 teaspoon of sugar has only 4 grams of carbohydrate, using a small amount of sugar in a recipe can help reduce the need for artificial sweeteners while increasing tenderness and browning Usually 1 teaspoon of sugar per serving is acceptable for most people with diabetes This is news to many people with diabetes, but studies show that this amount of added sugar does not seem to raise
blood sugar significantly
Overhead 12
Are they safe? Saccharin, aspartame, acesulfame potassium, and SucraloseTM underwent years of testing before manufacturers were permitted to add them to foods They have each been determined by the Food and Drug Administration to be safe for use by all people The exception is for those very rare people who are born with a condition called phenylketonuria These people cannot metabolize foods that contain large amounts of phenylalanine, one of the ingredients in aspartame They must avoid aspartame and many other high-protein foods There have been some scary reports on the Internet about artificial sweeteners While the Internet can be a wonderful source of information, it is also a place where incorrect information can be distributed quickly and widely We need to look for information about food safety from reliable sources, such as the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators, all of whom maintain Web sites
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Session 2 — Main Dishes
Learning objectives
Participants will state that Heart Healthy eating may help lower the risk of
cardiovascular disease in persons with diabetes Participants will name two food sources of saturated fat Participants will be able to recognize total fat and saturated fat on food labels Participants will learn how to use olive oil and other sources of monounsaturated fatty acids in cooking Participants will state that fat-free food products do not have the same cooking properties as the foods they replace Participants will name two ways to replace salt when seasoning foods
Introduction and announcements
The WVU Extension Educator should use Overhead 1 Welcome participants and introduce faculty members for this session The instructor begins with Overhead 2
Lecture notes for Session 2
The lecture notes for Session 2 follow:
Overhead 1
The WVU Extension Educator will welcome participants and introduce faculty members for this session The instructor begins with Overhead 2
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Overhead 2
People who have diabetes have twice the risk of heart attacks as people without diabetes People with diabetes who have a heart attack are much more likely to die or to have a second, fatal heart attack than people without diabetes The risk of stroke is increased by
four times for people with diabetes Women with diabetes have a greater risk of death from heart attacks and strokes than men with diabetes have These are pretty grim statistics The experts think that high blood glucose and high blood pressure in people with diabetes may cause some changes in blood vessels These changes may explain why people with diabetes have such high rates of heart disease, stroke, and bad circulation to the legs and feet This also may be one reason for high rates of impotence in men with diabetes The experts recommend that all people with diabetes should try to get their blood glucose and blood pressure under control and should try to follow Heart Healthy patterns of eating
Overhead 3
Heart Healthy eating includes cutting down on saturated fats and cholesterol All animals, including people, make cholesterol Some people make too much cholesterol in their bodies, but others get too much cholesterol by eating too many animal foods, such as meat, eggs, cheese, and high-fat dairy products Heart Healthy eating suggests eating less of these foods Saturated is a word that refers to the chemical structure of some fat Saturated fats are usually firm or hold their shapes
at room temperature The fat that is on meat as well as the marbling within meat can be a major source of saturated fat in the diet The fat in most red meat is more saturated than the fat in chicken, turkey, and fish Be sure to buy the leanest cuts of red meats and to trim all the fat that you can see from meat before cooking Removing the skin from poultry helps to remove most of the fat
Overhead 4
We also get saturated fat and cholesterol from shortenings used to prepare many foods You have a chart like this one in your packet It lists many kinds of fats and oils used for cooking There are many kinds of shortening and oils to choose from Each kind has a different cooking quality Lard, bacon fat, and butter add a taste to foods that many of us like Since they are high in cholesterol and saturated fat, lard, bacon fat, and butter should be avoided for daily use This chart shows some properties of regular, reduced-fat, and fatfree margarine Fat-free margarine may work well as a spread on bread or toast, but it does not melt well, so it is not appropriate for
Dining with Diabetes 2 : 14
frying or sautéing It also does not work well in baked desserts Reduced-fat margarine is fine for
spreading and can work well in many baked desserts It does not work well in frying because it contains water and will cause spattering or burning Regular margarine melts well and works well in baking It is often used as a spread, but it contains more trans-fatty acids than reduced-fat or fat-free margarine Trans-fatty acids are made when vegetable oils are hardened, or hydrogenated, to produce margarine Experts think that eating too much trans-fatty acid may be almost as harmful as eating too much saturated fat Be sure to choose liquid vegetable oils for cooking more often than solid shortenings Liquid oils have fewer saturated fatty acids and trans-fatty acids than solid shortenings Olive oil is rich in something called monounsaturated fatty acids Monounsaturated fat may help protect against heart disease Olive oil, canola oil, and certain nuts such as almonds, walnuts, and peanuts are good sources of these special fats and should be chosen whenever possible for cooking and food preparation
Overhead 5
Remember that all fats are high in calories, so people who are trying to lose weight will want to go easy on these healthful oils while avoiding saturated and trans-fatty acids
whenever they can
Overhead 6
Dairy products made from whole milk or 2 reduced-fat milk contain both cholesterol and saturated fat To lower the risk of heart disease, choose skim or 1 milk more often There is no difference in cooking properties of these kinds of milk When using cheese, cream, or sour cream, look for the lowest fat kind that will work well in a recipe Fat-free cheese can add flavor to some dishes, but it does not melt well It is not appropriate for baked dishes Instead, adding a very small amount of strong-flavored, highfat cheese, such as Parmesan, to a baked dish can add flavor without adding too much fat Evaporated skim milk is thick and creamy It is ideal for use in sauces and desserts that call for higher fat creams Fat-free cream cheese is suitable for spreads, but it does not hold up well for recipes where beating or baking is required In those recipes a kind of
Dining with Diabetes 2 : 15
reduced-fat cream cheese, called Neufchatel noo-sha-TELL, works very well and is lower in fat, saturated fat, and calories than regular cream cheese
Overhead 7
The Nutrition Facts label for food lists the amount of Total Fat near the top of the label Be sure to look at
and compare the amount of Saturated Fat in spreads, cheeses, and meats Saturated Fat is always listed under Total Fat on the label Some labels for spreads, oils, and shortenings also list the amount of Monounsaturated Fat We are encouraged to eat more monounsaturated fat and less saturated fat for Heart Healthy eating Activity Cardboard food models from the Dairy Council are supplied with the Equipment Kits Choose models of meats, fast foods, and combination foods such as lasagna Give the food models to volunteers who will each hold one model at the front of the room The remaining participants then try to arrange food models in order from most fat to least fat by asking the volunteers to move about the front of the room Allow about 5 minutes for this activity; then ask the volunteers to read the Total Fat information on the food model and move to the appropriate spot in the lineup
Overhead 8
Some people with high blood pressure are very sensitive to large amounts of sodium in their diets Sodium is measured in milligrams, or mg One teaspoon of salt contains 2400 mg of sodium A diet that is moderate in sodium might have 3,000 mg of sodium An important way to begin reducing sodium is
to stop adding salt at the table According the American Diabetes Association, hidden salt may be the biggest source of sodium in our diets Hidden salt is found in fast food, restaurant food, and canned food Compare the sodium content of frozen and canned vegetables by looking at the Nutrition Facts labels
Overhead 9
Preparing food at home is one of the best ways to begin cutting back on sodium as well as unhealthy fats and hidden sugars Here are some suggestions: Salt makes the flavor of most foods taste stronger Herbs, lemon juice, hot sauce, and spices change the flavor of food by adding a new strong flavor Try using small amounts of fresh or dried herbs to learn these new tastes when salt must be reduced Herbs should be added toward the
Dining with Diabetes 2 : 16
end of cooking time because they lose flavor and color when they are overcooked Dried herbs are two or three times as strong as fresh herbs Read labels carefully when you buy seasoning mixtures Garlic salt is made from salt with just a small amount of garlic powder added Choose garlic powder instead Some herb mixtures, such as Mrs DashTM, are very spicy and flavorful with no added salt Start with small amounts to get
the taste you like
Overhead 10
Be careful when choosing salt substitutes Some commercial salt substitutes are made from potassium chloride This type of substitute is not safe for all people Be sure to ask your doctor before using salt substitutes that contain potassium chloride
Overhead 11
The Food Guide Pyramid for people with diabetes, designed by the American Diabetes Association and the American Dietetic Association, suggests 2 to 3 servings of meats or meat substitutes each day Be sure to choose these foods carefully Meats can be high in calories and they are sources of cholesterol and saturated fat Choose small portions and choose the very leanest cuts Try to use dried beans instead of meats sometimes Beans are high in fiber, low in total fat and saturated fat, and are a good meat substitute The Food Guide Pyramid does not suggest a number for servings from the Sweets Fats group These foods are often sources of saturated fats and trans-fatty acids They should be used occasionally and should not replace more healthful foods every day
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Session 3 — Side Dishes
Learning objectives:
Participants will identify the role of low-fat dairy products
in a healthful diet Participants will learn how to prepare vegetables and fruits in appetizing dishes Participants will identify vegetables as low-calorie sources of important nutrients in the diet Participants will identify foods that contain fiber and state how fiber may be helpful in preventing disease Participants will recognize the Plate Method as one way to plan balanced meals for people with diabetes Participants will state how to find additional help in meal planning for people with diabetes
Introductions and announcements
The WVU Extension Educator will welcome participants Use Overhead 1 to introduce Session 3 Data collection forms for evaluation of the program should be distributed and the purpose explained to the class Introduce faculty members The instructor begins with Overhead 2
Lecture notes for Session 3
Overhead 1
The WVU Extension Educator will welcome participants Data collection forms for evaluation of the program will be distributed and the purpose explained to the class Faculty members should be welcomed and introduced The instructor begins with Overhead 2
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Overhead 2
Having diabetes to some people means having to give up
favorite foods In Session 1, we learned that foods rich in carbohydrate can raise blood sugar You may be finding that you need to limit or balance carbohydrates with medication and exercise in order to control your blood sugar In Session 2, we learned that not all fats are created equal Eating too much saturated fat and trans-fatty acid may increase the high risk of blood vessel disease in people with diabetes You may find that you need to limit the amount of these foods you eat to be healthy In todays session, you will learn that it is important to eat more of certain foods because they actually help lower your risk of some chronic conditions Osteoporosis is a painful and crippling disease that results when the bones become too thin This can happen with age and happens most often to women Getting enough calcium all through life, but especially during the growing years, is one of the best ways to prevent osteoporosis Some authorities think that getting enough calcium is also important in preventing high blood pressure and blood vessel disease Dairy products are the best source of calcium in the diet Removing the fat from dairy products does not remove calcium, so choose skim or
very low fat milk, yogurt, and cheeses whenever possible to get enough calcium
Overhead 3
Fruits and vegetables are natures health food factories They are the best sources of some very important nutrients in our diet The color of fruits and vegetables is sometimes a guide to choosing the most nutritious varieties Deep green and dark yellow fruits and vegetables are rich sources of beta-carotene The bright red pigments in cherries, tomatoes, and apples as well as the blue pigment in the skin of blueberries contain special chemicals that may help our bodies fight off changes that cause cancer These substances may also help keep our blood vessels healthy and free of fatty plaque Remember that fruits are rich sources of carbohydrate If you are not very active, eating too much fruit or fruit juice can make the blood sugar too high Try limiting fruit to 1 serving at meals or snacks Vegetables are a real nutrition bargain They are rich in vitamins, minerals, and antioxidants Because they are also good sources of fiber and are lower in carbohydrate than fruit, they can be eaten in much larger servings and more often than fruit One-half cup of most cooked vegetables or 1 cup of most raw
vegetables has only 25 calories Most raw vegetables can also be counted as Free Foods on a diabetic diet
Dining with Diabetes 2 : 19
There are only a few exceptions to this advice about eating lots of vegetables Potatoes, corn, peas, lima beans, winter squash, sweet potatoes, and dried beans are healthy vegetables, but they are higher in carbohydrate and they have more calories Be sure to count them as part of your total carbohydrate for meals and snacks
Overhead 4
Fiber is found only in plant foods There are two main kinds of fiber found in plants One kind, called insoluble fiber, is what Grandma used to call roughage It is not digestible and it provides bulk in the intestines It is found mainly in the outer shell of grains and in the skins of fruits and vegetables Most experts still think this kind of fiber is very important for preventing diverticulosis and may also help to prevent certain cancers of the bowel Soluble fiber is found mainly in dried beans, root vegetables, citrus fruits, berries, oats, and barley One kind of soluble fiber, pysillium, is sold in supplements We think that eating foods containing soluble fiber may help the body to get rid of some of the
cholesterol in our diet It may also help slow down the rate at which glucose is absorbed into the blood after food is digested In that way it may help keep blood sugar lower after meals
Overhead 5
You may have heard some people call diabetes a balancing act Getting just enough carbohydrate, calories, vitamins, minerals, and fiber while limiting harmful fats, exercising, and controlling weight is not very easy Exercising safely is important to everyone, but when people with diabetes exercise their blood sugar can go down, or even go up in some cases On top of all of this, many people with diabetes need to use special medications, such as pills or insulin These medications need to be carefully matched with food in order to avoid very high or very low blood sugars This is why people with diabetes often are given written meal plans Getting a meal plan that fits you is like getting a new pair of shoes that do not hurt and yet look good too If you do not have a meal plan that works for you, maybe it is time to get another one
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Overhead 6
Lets look again at the Food Guide Pyramid for persons with diabetes You can divide the recommended servings from each
section of the pyramid into three daily meals One serving of Fruit, 2 or more servings of Starches, and 1 serving of Milk at each meal will balance the foods rich in carbohydrate Adding 1 or 2 servings of Vegetables and 1 serving of something from the Meat group at each meal makes a balanced daily intake This plan may not work for everyone, but it is a good start for most people
Overhead 7
One easy way to remember this plan is by using the Plate Method A group of registered dietitians in the state of Idaho found that the Exchange System of meal planning did not work for everyone, so they designed this method for planning meals It fits very well with the Food Guide Pyramid for people with diabetes that we have been using in each session of this cooking school In your packet today there is a form for using the Plate Method As we review this plan, you can make notes on the form Using the Plate Method, at most meals, no more than one-fourth of the plate should be covered by starchy foods such as bread, grains, or potatoes This can represent 1 or 2 servings of these foods For Heart Healthy eating, no more than one quarter of the plate should be covered by something from the meat group
Vegetables should cover the rest of the plate The small circles represent single servings of milk and fruit Since milk, fruit, and starches raise blood sugar in the same way, they can be changed sometimes to match your taste and nutrition needs Can you think of a breakfast meal that would fit this plan? One suggestion might be an omelet, made with one egg or egg substitute and lots of vegetables Another suggestion is to omit vegetables at breakfast but keep all the other servings the same How about lunch? Dinner? Have someone write down the suggestions on a blackboard or newsprint If that is not available, repeat each suggestion so that the entire class can hear Notice that there is room on your meal planning form to include up to three daily snacks This might be another way to include the extra servings from a group that did not fit on the plate in your drawing But what about serving size? What if my plate looks like the drawing, but the portions are heaped up on the plate? You may not lose weight this way, but studies show that eating about the same amount of food every day can lead to more evenly controlled blood sugar — even if we eat too much every day So balancing your
intake of food with a meal plan is a good way to start balancing your diabetes
Dining with Diabetes 2 : 21
Overhead 8
Changing some habits is easier than changing others We know that most people get used to a lower sodium diet within one or two months, but we also know that most people who lose weight tend to gain it back within one year People with diabetes need more help and support to change eating habits than we can provide in the Dining with Diabetes cooking school Here is a list of health professionals who are qualified to help you with diabetes meal planning questions Depending on where you live, some of these professionals may be available for individual appointments Your insurance plan may cover diabetes education and nutrition therapy but a referral from your doctor may be required At this point you may add an overhead with names, addresses and phone numbers of local diabetes health professionals You may also want to provide a printed handout of this information and/or business cards from various health professionals
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Chapter 3
Data Collection
This chapter contains data collection instruments and directions for their use in the Dining with
Diabetes program It is organized as follows: 1 Purpose of data collection 2 How to administer data collection instruments 3 Data collection instruments
Purpose of data collection
The careful analysis of data collected during and following programs such as Dining with Diabetes helps us answer the larger question, So what? It is vitally important to ascertain the outcome of educational programs that represent large commitments of resources The analysis of demographic data helps answer questions about the targets of the program Did we reach the intended audience? Will analysis show that we reached segments of the population that are most likely to be affected by the problem we are studying? Process evaluation is also important for those striving to improve programs Data collection instruments that invite participants to report on our successes and failures are valuable to us Dining with Diabetes was designed to provide self-management skills to individuals and families affected by diabetes The ultimate goal of this program is reducing the burden of diabetes to individuals, families, and society For this reason, measures of behavior change have been designed to accompany the cooking
school itself, as well as the sixmonth Class Reunion
How to administer data collection instruments
Printed and numbered data collection instruments will be sent from the state Extension Service office with all teaching materials During on-site registration, all participants should be asked to sign a numbered roster sheet provided by the state Extension Service office The roster is numbered to represent the date and location of the school On signing the roster sheet each participant is assigned a personal number that will appear on data collection sheets At the beginning of Session 1, one copy of the following letter, which begins Dear Participant, one demographic form DWD Demographics, one pretest instrument DWD Pretest/Posttest, and a pencil should be given to each participant upon registration The letter to participants is a requirement of the Institutional Review Board and should be read, if necessary, to make sure participants do not feel pressured to participate in data
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collection efforts Encourage participants to begin filling out the forms as they wait for class to begin These forms are to be completed by all participants, not just those who
have diabetes Extension Educators should make sure that each person is able to complete the data collection instruments This may involve reading parts or all of the forms, if necessary Remind participants that each person should provide answers that describe his or her own behaviors, not those of the family member with diabetes The pretest includes both knowledge questions and behavior questions Participants are not expected to know all the answers to the knowledge questions Please do not supply answers to questions Emphasize that completing the forms is voluntary but that the input of participants is vital to improving all Extension programs All completed forms should be collected and placed in a mailing envelope before commencing the lesson appointed for Session 1 At Session 3, the program evaluation instrument DWD Program Evaluation should be distributed during the tasting and discussion period The forms are not numbered, and participants should not include their names on forms Encourage all participants to complete the instruments in order to provide input for improvements in the Dining with Diabetes program Following Session 3, all completed forms should be placed in a secure
mailing envelope and sent as soon as possible to the state Extension Service office, to the attention of the Diabetes Education Specialist The county Extension Educator should retain the numbered roster for use at the Class Reunion At the Class Reunion, held six months following the initial Dining with Diabetes program, the posttest form DWD Pretest/Posttest should be administered In addition, a recipe utilzation form DWD Reunion is administered The class roster should be used to match numbered forms to participants All completed forms should be placed in a secure mailing envelope and sent as soon as possible to the state Extension Service office, attention of the Diabetes Education Specialist Once all data collection instruments have been collected and returned to the state office, the Extension Educator should destroy the numbered class roster to protect confidentiality of participants
Data collection instruments
The data collection instruments designed for use in Dining with Diabetes follow
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Extension Service
Dear Participant, WVU Extension has been offering Diabetes Cooking Schools in West Virginia since 1997 As of June 30, 1999, 62 cooking
schools have been conducted in 45 counties with more than 2,000 individuals attending the sessions Dining with Diabetes cooking schools is a series of three 2-hour sessions held over a three-week period This three-week series of classes is followed up with a Class Reunion six months later The major purpose of the schools is to provide diabetes nutrition education along with easy-touse recipes appropriate for people with diabetes We have been delighted with the positive responses and helpful comments we received from people who have attended the classes As part of our on-going effort to evaluate and improve the program, we ask participants to complete a demographic form and two surveys, which tell us how effective the classes have been and how we could make changes to better satisfy their needs Completion of the surveys is voluntary and you do not have to answer every question All answers on the surveys are kept strictly confidential and you will not be identified in any way If you have any questions, please ask the person conducting the Dining With Diabetes cooking school Thank you for your time in completing the surveys as we continue to strive to deliver a quality program to
reduce the burden of diabetes in West Virginia Sincerely,
Guendoline Brown, PhD Nutrition and Health Specialist July 15, 1999
Center for 4-H and Youth, Family, and Adult Development
Phone: 304 293-2694 Fax: 304 293-7599 wwwwvuedu/exten/ Knapp Hall PO Box 6031 Morgantown WV 26506-6031
Equal Opportunity/Affirmative Action Institution
Dining with Diabetes Demographics
To help us learn more about you, please check the one best response to each of the following questions: 1 Do you have diabetes? ___ Yes ___ No ___ I dont know 2 Do you choose most of the food used in your home? ___ Yes ___ No 3 Do you prepare most of the food eaten in your home? ___ Yes ___ No 4 What is your age? ___________ 5 Are you: ___ White/non-Hispanic ___ White/Hispanic heritage ___ African-American/Black ___ Asian-American ___ Native American/American Indian ___ Other ________________________________ 6 Are you ___ Female ___ Male 7 How would you describe your general health? ___ Excellent ___ Good ___ Fair ___ Poor
WVUES 1999-2000
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Dining with Diabetes Pretest/Posttest
The following questions ask what you know about certain foods 1 Check each of the foods that are rich sources of
carbohydrate: ___ Hamburger patty ___ Apple ___ Cookie ___ Bread ___ Potato ___ Milk ___ Orange juice ___ Sugar ___ Olive oil ___ Butter
2 Check the sweetener that loses its sweet taste in baking ___ Aspartame NutrasweetTM ___ Saccharin Sweet n LowTM ___ Acesulfame Potassium Sweet OneTM ___ Sucralose SplendaTM 3 When two kinds of artificial sweeteners are used together they are much sweeter than when either is used alone ___ True ___ False 4 Check all of the following foods that are high in saturated fat ___ Butter ___ Olive oil ___ Lard ___ Corn oil 5 Check all of the following foods that are high in monounsaturated fat ___ Butter ___ Olive oil ___ Lard ___ Corn oil 6 Check all of the following reasons that fiber is important in the diet ___ To provide roughage ___ To provide a quick source of energy ___ To help the body get rid of some of the cholesterol we eat ___ To help slow down absorption of glucose 7 Which one of the following is NOT usually printed on the Nutrition Facts Label on packaged foods? ___ Starch ___ Sugar ___ Total Fat ___ Cholesterol
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WVUES 1999-2000
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Dining with Diabetes Pretest/Posttest
continued
The following questions ask what
you do about eating and preparing or following a diabetes meal plan 8 Do you use herbs or spices in place of salt? ___ YES 
If yes, how long have you been using herbs or spices in place of salt? ___ Less than six months ___ Six months or more ___ NO If no, which one sentence best describes you: ___ I am not thinking of using herbs and spices in place of salt ___ I am thinking about starting to use herbs and spices in place of salt ___ I am definitely planning to use herbs and spices in place of salt in the next month 9 Do you use olive oil or canola oil? ___ YES If yes, how long have you been using olive oil or canola oil? ___ Less than six months ___ Six months or more ___ NO If no, which one sentence describes you: ___ I am not thinking of using olive oil or canola oil ___ I am thinking about starting to use olive oil or canola oil ___ I am definitely planning to use olive oil or canola oil in the next month 10 Do you use artificial sweeteners in desserts? ___ YES If yes, how long have you been using artificial sweeteners in desserts? ___ Less than six months ___ Six months or longer ___ NO If no, which one sentence best describes you? ___ I am not thinking about using artificial
sweeteners in desserts ___ I am thinking about using artificial sweeteners in desserts ___ I am definitely planning to use artificial sweeteners in desserts in the next month
WVUES 1999-2000
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Dining with Diabetes Pretest/Posttest
11 Do you try to control the amount of carbohydrate you eat? ___ YES
continued
If yes, how long have you been trying to control the amount of carbohydrate you eat? ___ Less than six months ___ Six months or longer ___ NO If no, which one sentence best describes you? ___ I am not thinking of trying to control the amount of carbohydrate I eat ___ I am thinking about trying to control the amount of carbohydrate I eat ___ I am definitely thinking about trying to control the amount of carbohydrate I eat within the next month 12 How sure are you that you can change your diet to control the amount of carbohydrate you eat? Check only one answer ___ Very sure ___ Kind of sure ___ Kind of unsure ___ Very unsure 13 How sure are you that you can prepare healthy meals for someone with diabetes? Check only one answer ___ Very sure ___ Kind of sure ___ Kind of unsure ___ Very unsure 14 I know how to use Nutrition Facts labels found on
packaged foods to prepare healthy meals Check only one answer ___ Agree ___ Somewhat agree ___ Somewhat disagree ___ Disagree 15 Following a healthy meal plan helps to control diabetes Check only one answer ___ Agree ___ Somewhat agree ___ Somewhat disagree ___ Disagree
WVUES 1999-2000
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Dining with Diabetes Pretest/Posttest
continued
16 Controlling my blood sugar is important to me Check only one answer ___ Agree ___ Somewhat agree ___ Somewhat disagree ___ Disagree ___ I dont have diabetes 17 How often do you test your blood sugar? Check only one answer ___ Once a day ___ Twice a day ___ Before every meal ___ Other______________________________ ___ I dont test my blood sugar ___ I dont have diabetes 18 How hard or easy would it be for you to prepare healthy meals for someone with diabetes? Check only one answer ___ Very hard ___ Somewhat hard ___ Somewhat easy ___ Very easy 19 What problems do you have with using a diabetes meal plan? Please check all that apply to you ___ Not enough time ___ Too expensive ___ Too confusing ___ Family wont eat it ___ Dont know how to get started ___ Benefits not worth the effort ___ Not real important to me ___ Not
motivated ___ Too hard to get started ___ Other ______________________
Thank you The information you have provided will help us to improve diabetes education in West Virginia
WVUES 1999-2000
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Dining with Diabetes Program Evaluation
Please do not sign your name 1 What did you like most about Dining with Diabetes?
__________________________________________________________________ __________________________________________________________________ __________________________________________________________________
2 What are some of the things you learned that you did not know or that surprised you?
__________________________________________________________________ __________________________________________________________________ __________________________________________________________________
3 What things do you still want or need to learn about meal planning or cooking for people with diabetes?
__________________________________________________________________ __________________________________________________________________ __________________________________________________________________
4 What did you like least about Dining with
Diabetes?
__________________________________________________________________ __________________________________________________________________ __________________________________________________________________
5 Do you have any suggestions about how we could change Dining with Diabetes to make it better? Please use back of page if needed
__________________________________________________________________ __________________________________________________________________ __________________________________________________________________
WVUES 1999-2000
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Dining with Diabetes Reunion
Please check one box beside each Dining with Diabetes recipe to tell whether you used or didnt use the recipes from the cooking school
I USED this recipe I DIDNT USE this recipe
Recipe Carrot Cake Apple-Berry Crisp Lemon Cake Banana-Pineapple Delight Double Layer Pumpkin Pie Spicy Grilled Chicken Oven Poached Fish Italian Beef Stir-Fry Baked Pork Chops Spinach Lasagna Double Corn Bread Glazed Carrots Spinach Salad Cole Slaw Four-Bean Salad
_____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____
_____ _____ _____ _____ _____ _____ _____
_____ _____ _____ _____ _____ _____ _____ _____
1 Which recipe should get the Gold Ribbon? ________________________________________________________________ 2 Please tell us how you used the information you got from Dining with Diabetes to change your eating habits ________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Are you interested in being part of a diabetes support group? If so, please fill in the blanks below: Name ___________________________________________________________ Address _________________________________________________________ ________________________________________________________________ Phone number _______________________
Dining with Diabetes
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3 : 10
Chapter 4
The Class Reunion and Beyond Follow-up
This chapter contains information about important follow-up steps for the diabetes cooking school It is organized as follows: 1 Purpose of the follow-up sessions 2 Format of the Class Reunion 3 Planning additional follow-up
Purpose of the follow-up sessions
The Class
Reunion, conducted six months after the conclusion of the cooking school, is essential to assess the quality and the outcome of this diabetes education program Gathering data such as number of schools conducted and number of participants is important, but it does not tell us about outcome The data collection tools designed for use at the Class Reunion are aimed at determining the outcome — the So what? for this program The reunion is also a chance for participants to share with you and with each other their success stories, suggestions for improvements, and ongoing needs
Format of the Class Reunion
A date for the Class Reunion should be set before Session 3 of the cooking school Announce this date at Session 3 so participants can reserve the time Using class rosters, send written invitations for the Class Reunion approximately one month in advance Participants should be encouraged to call the WVU Extension Service county office to register for the event Phone call reminders to all who enroll as well as to those who do not respond can increase turnout significantly The format for the Class Reunion does not need to be highly structured There is no formal curriculum The important
elements include distributing and collecting the follow-up data instruments, listening to and recording comments from participants, and planning for additional follow-up You may choose to include recipe demonstrations and tasting at the Class Reunion These features are always popular with participants and set an informal tone for the event There are recipe booklets available for both spring and fall reunions The booklets contain seasonal menus with accompanying recipes Please order these supplies three to four weeks before you plan to use them Some counties have invited reunion participants to prepare some of these recipes and have furnished recipes and ingredients to each volunteer The grant funds for this program should be sufficient to cover the cost of additional recipe demonstrations and tasting supplies plates, cups, napkins, etc The class reunion is a perfect time to feature recipes that reflect the ethnic heritage of various populations Consider asking participants to bring favorite family recipes Invite a registered dietitian to suggest more healthful versions of the recipes
Dining with Diabetes 4:1
Chapter 3 contains important information about the number and kinds of
data collection instruments used in this program Preprinted forms using the same numeric coding as the original materials will be sent to the Extension Service county office for use at the Class Reunion Please allow three to four weeks for delivery of any additional materials for use at reunion sessions The Extension Educator should greet participants and welcome them to the reunion Introduce any invited health professionals or returning faculty Invite participants to share their experiences with the cooking school recipes, changing their eating habits, and diabetes management Recording these changes will help you to be able to complete annual program reports If there is to be a cooking demonstration, introduce the person in charge After the demonstration or if there is no demonstration, distribute pens and the follow-up data collection instruments, DWD Pretest/Posttest and DWD Reunion Give any required verbal instructions and ask participants to complete the instruments Tasting and/or refreshments can follow this activity Door prizes are always a hit at this time If you intend to offer further diabetes education programming, this is a good time to ask for suggestions for day,
time, and programs All completed data collection instruments should be returned to the state Extension Service office attention: Diabetes Cooking School Program as soon as possible Information is entered into a database for subsequent reporting All original data collection sheets are retained at the state office, but roster sheets that connect names with participant numbers will be destroyed, after follow-up information is entered into the database, to assure confidentiality of participants
Planning additional follow-up
In the first two years of using the Diabetes Cooking School programs in West Virginia, several counties reported the need and desire to form support groups for people with diabetes Extension Service can become a catalyst for this service where the need exists Here are some suggestions for forming and nurturing a support system Identify stakeholders in the community Be sure to include consumers with diabetes as well as caregivers Is there a diabetes education program at a local hospital or clinic? Ophthalmologists and optometrists, podiatrists, internists, and nurse practitioners have a real interest in helping to diagnose diabetes and work toward preventing
complications The Health Department may have one or more caregivers interested in diabetes care The Lions Club has a longstanding outreach program for the prevention of blindness, a complication of diabetes Dont forget senior citizens centers Enlist support of those who supply diabetes care products to your community Pharmacies, home health agencies, and pharmaceutical representatives can supply speakers, door prizes, and educational literature They may offer financial support as well
Dining with Diabetes
4:2
Keep it simple Elaborate programs are not necessary in communities where there is no ongoing diabetes support group A chance to be with other people who are coping with this chronic disease, a chance to bring questions to qualified health professionals outside the medical office setting, and a chance to have safe refreshments are all that is necessary Highly structured programs may result in declining attendance over time Avoid sharing horror stories and old wives tales You will find that these abound in groups of people with diabetes The best protection for all involved is to include a qualified health professional in each meeting A Certified Diabetes Educator is ideal
Other health professionals skilled in teaching, such as nurse practitioners, registered dietitians, and diabetes teaching nurses can manage these incidents with grace and skill You already have a format that works Consider organizing regular meetings around a recipe or a menu suitable for people with diabetes You might invite a guest chef an optometrist, the nurse practitioner, a dentist to help demonstrate a new recipe and then answer questions about diabetes Follow this with tasting and give each participant a copy of the recipe A list of suitable diabetes cookbooks is available from the Diabetes Education Specialist The American Diabetes Association and the Juvenile Diabetes Foundation may be interested in forming affiliate chapters in your area Along with providing planned activities and excellent educational literature, these groups may expect chapters to raise funds for their national organizations Your core group of stakeholders will need to decide whether affiliation fits the needs of people with diabetes in your area Be aware of opportunities to integrate other Extension Service programs into your efforts to meet the needs of people with diabetes Active For Life, a
program that encourages flexibility and aerobic exercise, may work for some Your 4-H camp might benefit from diabetes education programming Is there an opportunity to begin a research program with your core group? Contact the Diabetes Education Specialist to keep informed and to relay ideas to other counties
Dining with Diabetes
4:3
appendix a
PSAs and News Releases
Sample Radio PSAs
30 seconds
Do you have diabetes? Are you bored with eating the same old thing? Then Dining with Diabetes is for you West Virginia University Extension Service in county name and the West Virginia Diabetes Control Program are offering a series of three classes beginning date and time of first class at location of classes Youll learn how to cut fat, sugar, and sodium in cooking without cutting out taste To register, call phone number Classes are free, but spaces are limited This is agent name, county name, West Virginia University Extension Agent Educator
30 seconds
Does Diabetic Diet, low sugar, low fat, or low sodium mean no taste to you? Then you need Dining with Diabetes What is it?– a series of three classes starting date and time classes begin at location of classes Youll learn nutritious
and delicious ways to cut sugar, salt, and fat in your favorite recipes Dining with Diabetes is sponsored by the WVU Extension Service and the West Virginia Diabetes Control Program Call the Extension office at phone number to register now This free school is limited to people with diabetes and their family members
Dining with Diabetes
Appendix A : 1
Sample News Release
Contact: ____________________________________________ For Immediate Release
____________________ County to Hold Diabetes Cooking School
If you have diabetes, selecting and preparing foods that are low in sugar, fat and sodium can be a real challenge The county name office of the West Virginia University Extension Service, in partnership with the West Virginia Diabetes Control Program and other sponsoring agencies will offer a series of cooking classes for people with diabetes and their family members or caretakers Dining with Diabetes will meet every day of the week and time of class for three weeks beginning on date of first class at location of classes How to cook with artificial sweeteners, low-fat products, and herbs and spices will be discussed by extension educators name and names of instructors Class
participants will get recipe booklets, watch cooking demonstrations, and taste foods made with less fat, sugar and salt This grant-funded program is free to people with diabetes and family members or caretakers No products will be sold at the classes Spaces are limited, so call phone number to enroll now
Dining with Diabetes
Appendix A : 2
Sample News Release for Counties Repeating Cooking Schools
Contact: ____________________________________________ For Immediate Release
Dining with Diabetes Comes to ____________________ County
People with diabetes in __________________ County will have another chance to learn how to prepare good-tasting and healthy foods at the new Dining with Diabetes cooking school sponsored by the ___________ County office of the West Virginia University Extension Service and the West Virginia Diabetes Control Program Dining with Diabetes follows Extensions earlier successful program, the Right Bite Diabetes Cooking Schools Dining with Diabetes offers all new recipes and up-to-date information for nutrition and meal planning People with diabetes, as well as their family members or caretakers, are encouraged to attend Classes will be held every day of the
week beginning on date of first class at time of day at location of classes Call phone number by deadline to register The classes are free but spaces are limited, so call now to enroll Diabetes is a common, serious, and costly disease in West Virginia In 1994, 72,523 adults, or 53 percent of the adult population, had diagnosed diabetes It is estimated that only half of people with diabetes have been diagnosed and know they have this disease Authorities estimate that 25 percent of West Virginians over age 65 have diabetes Diabetes poses a major public health problem, but much of the health and economic burden of the disease can be prevented with early diagnosis and proper care Dining with Diabetes is aimed at helping West Virginias families lead more healthy and productive lives
Dining with Diabetes
Appendix A : 3
appendix b
Overheads
Extension Service
with Diabetes
WVU Extension Service
session one
desserts
Goals of this program
to increase knowledge about healthy foods to present healthy versions of familiar foods to demonstrate new cooking techniques to provide taste testing of new recipes to provide basic information about diabetes and nutrition to provide
opportunities for people with diabetes to share and learn from one another and from diabetes health professionals
1
2
Fats, Sweets,
Alcohol
Milk
2-3 servings
Meat
2-3 servings
Vegetables
3-5 servings
Fruits
3-4 servings
Starches
6 or more servings
1997 American Diabetes Association 3
How big is a serving?
4
Nutrition Facts
Serving Size 1/2 cup 114 g Servings Per Container 4
Amount Per Serving______________
Calories 90 Calories from Fat 30
Daily Value
Total Fat 3 g Saturated Fat 0 g Cholesterol 0 mg Sodium 300 mg
5 0 0 13
Total Carbohydrate 13 g Dietary Fiber 3 g Sugars 3 g
4 12
Protein 3 g
Vitamin A 80 Vitamin C 60 Calcium 4 Iron 4 ____ Percent Daily Values are based on a 2,000 calorie diet Your daily values may be higher or lower depending on your calorie needs: Calories: 2,000 2,500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400 mg 2,400mg Total Carbohydrate 300g 375 g Dietary Fiber 25 g 30 g______ Calories per gram: Fat 9 Carbohydrate 4 Protein 4
Carbohydrate Fiber Sugar STARCH
5
What about dessert?
6
SUGAR Sweet taste Color Tenderness Moistness Volume
ARTIFICIAL SWEETENERS Sweet
taste
7
Apple
sauce
uree tp
CAUTION
Frui t jui
Frui
ce
Some fat-free baking products are HIGH in carbohydrate READ THE LABELS 8
USING ARTIFICIAL SWEETENERS IN COOKING
Saccharin types1 Replace Sugar 1-2 tsp 1/4 cup 1/3 cup 1/2 cup 1 cup Heat stable Aftertaste
1 2
Aspartame types2 Liquid 1 drop 1-1/2 tsp 2 tsp 1 Tbsp 2 Tbsp Yes Yes Packets 1 6 8 12 24 No No Granulated 1-2 tsp 1/4 cup 1/3 cup 1/2 cup 1 cup No No Equal for Recipes 1/4 tsp 1-3/4 tsp 2-1/2 tsp 3-1/2 tsp 7-1/4 tsp No No
Packets 1 6 8 12 24 Yes Yes
Granulated 1 tsp 1/4 cup 1/3 cup 1/2 cup 1 cup Yes Yes
Brown 1 tsp 1/4 cup 1/3 cup 1/2 cup 1 cup Yes Yes
Acesulfame -potassium Packets 1 3 4 6 12 Yes Some
Manufacturer does not recommend replacing more than 1/2 cup sugar with saccharin sweetener in baked recipes Contains phenylalanine People with phenylketonuria must avoid this sweetener
Check measurements on product packages for most accurate information Sucralose, marketed as Splenda , is a new sweetener approved as a food additive It is not yet available for home use It has the same volume, taste, and baking characteristics as sugar
9
Use LESS and get MORE
10
Are They Safe?
11
Extension Service
with
Diabetes
WVU Extension Service
session two
main dishes
Diabetes is hard on all these parts — and more
1
HEART HEALTHY eating includes
Eating less Saturated fat Cholesterol Trans-fatty acid
Choosing more Monounsaturated fat
2
CHOOSING FATS AND OILS
Margarine: Contains: Cholesterol Saturated Fat Trans-Fat Monounsaturated Fat Healthy Choices: Spreading Baking Frying Salad dressing Avoid Avoid Avoid No Avoid Avoid Avoid No Avoid Avoid Avoid No Yes Yes No No Yes No No No No Yes BEST BEST No Yes Yes Yes Lard and Bacon fat High High None Some Butter High High None Some Regular stick None Some Most Some Reduced fat None Some Some Some Fatfree None None None None
Olive and Canola oil None Some None High
Other vegetable oils None Some None Some
3
CAUTION
Even Heart Healty fat is high in calories
4
AVOID: Whole milk 2 milk High-fat cheese Regular evaporated milk
CHOOSE MORE: Skim, 1/2 , 1 milk Low-fat cheese Evaporated skim milk
5
Nutrition Facts
Serving Size 1/2 cup 114 g Servings Per Container 4 Calories 90 Calories from Fat 30
Amount Per Serving______________
Daily Value
Total Fat 3 g Saturated Fat 0 g Monounsaturated Fat 0 g Cholesterol 0 mg
5 0 0 0
Sodium
300 mg 13 Total Carbohydrate 13 g 4 Dietary Fiber 3 g 12 Sugars 3 g Protein 3 g
Vitamin A 80 Vitamin C 60 Calcium 4 Iron 4 ____ Percent Daily Values are based on a 2,000 calorie diet Your daily values may be higher or lower depending on your calorie needs: Calories: 2,000 2,500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg Total Carbohydrate 300g 375 g Dietary Fiber 25 g 30 g______ Calories per gram: Fat 9 Carbohydrate 4 Protein 4
6
CAUTION
7
AVOID: Salt Seasoned salt Herb salt CHOOSE INSTEAD: Herbs and spices Lemon juice or wine Salsa, picante sauce
8
CAUTION
Ask your doctor about salt substitutes containing potassium chloride
9
Fats, Sweets, Alcohol Milk
2-3 servings
Meat
2-3 servings
Vegetables
3-5 servings
Fruits
3-4 servings
Starches
6 or more servings
1997 American Diabetes Association 10
Extension Service
with Diabetes
WVU Extension Service
session three
side dishes
1
2
SOLUBLE FIBER INSOLUBLE FIBER Whole grains Cereals Hulls, peels, seeds Dried beans Berries Citrus fruits Oats, barley Root vegetables
3
FOOD
EXERCISE MEDICATIONS
4
Fats, Sweets, Alcohol Milk
2-3
servings
Meat
2-3 servings
Vegetables
3-5 servings
Fruits
3-4 servings
Starches
6 or more servings
1997 American Diabetes Association 5
Fruit Starches Vegetables Meat
Milk
6
FOR MORE HELP -Registered Dietitians Certified Diabetes Educators Nurse Practitioners
7
appendix c
Recipes
Recipe Sets Explanation
The following pages contain three sets of recipes arranged in groups of desserts, main dishes, and side dishes The recipe sets, along with the accompanying pages, are to be used as handouts at the three sessions of Dining with Diabetes The additional pages in each handout food guide pyramids, nutrition facts label, etc accompany the lecture material for each session The recipes are arranged within the handouts in the order in which they are used at each session of Dining with Diabetes Three recipes are demonstrated at a session, and the two remaining recipes should be prepared ahead of time for tasting at the conclusion of the program Recipes selected for demonstration can be easily completed if they are prepared in the order that follows:
Session one — Desserts
Carrot Cake — The ingredients are mixed and the cake is baked for 30 minutes while the next recipes are
being demonstrated One recipe of Carrot Cake can be cut into enough pieces to provide tastes for as many as 50 people Apple-Berry Crisp — One recipe will provide tastes for 12-18 persons For classes of 24-50 people, you may choose to assemble one additional recipe before the school and bake it at the school Lemon Cake — One angel food cake can be cut into 50 small pieces This recipe can be prepared while the first two recipes are being finished in the oven The next two recipes are not demonstrated, but should be prepared for tasting at the session Share any preparation tips and the Points to remember about each recipe Banana-Pineapple Delight — This should be made before the school and chilled until serving time One recipe provides enough tastes for 40-50 people Double Layer Pumpkin Pie — Prepare in 12 x 15 pan at least 4 hours before class time Fifty small tastes can be served from one recipe
Session Two — Main Dishes
Spicy Grilled Chicken — Prepare first and send to kitchen to be baked Four chicken breast halves will provide 24-32 small tastes For larger classes, use 6-8 pieces of chicken Oven Poached Fish — One pound of fish will serve 24 tastes For larger classes,
use 2 pounds of fish Fish bakes quickly at same temperature as chicken Italian Beef Stir-Fry — Makes a dramatic finale to demonstrations Cook pasta before program One recipe will provide 20 or more tastes For larger classes, double recipe, but prepare extra recipe before class
Dining with Diabetes Appendix C : 1
The next two recipes are not demonstrated, but should be prepared for tasting Share with participant any tips for preparation and the Points to remember about each recipe Baked Pork Chops — Four chops will provide 24 tastes For larger classes, double recipe Chops can be breaded before class and finished in the oven during class Spinach Lasagna — One recipe will provide 50 small tastes Assemble before class If lasagna is to be baked at the school, allow sufficient time for it to bake thoroughly and to stand before you cut tastes
Session Three — Side Dishes
Double Corn Bread — One recipe will provide at least 30 small tastes For a larger class, double recipe Cornbread bakes while other recipes are demonstrated Glazed carrots — Carrots should be cooked before class Demonstration consists of showing participants how to make a sauce thickened with cornstarch One
recipe provides 15 or more tastes Increase recipe for large classes Spinach Salad — Assemble as a finale to the demonstrations Prepare pasta and chicken or shrimp before class and cool One recipe provides 20 small tastes For larger classes, double recipe The next two recipes are not demonstrated, but should be prepared for tasting Share with participants any preparation tips and the Points to remember about each recipe Cole Slaw — This recipe is prepared four hours or more ahead of time One recipe provides 24 small tastes For larger classes, double recipe Four-Bean Salad — This recipe is prepared one day before class One recipe provides 18 or more tastes For larger classes, double recipe
Dining with Diabetes
Appendix C : 2
Extension Service
with Diabetes
WVU Extension Service
session one
desserts
A Food Guide Pyramid for People with Diabetes
Used with permission 1997 American Diabetes Association
Sample Nutrition Facts Label
Saccharin types 1
Granulated 1 tsp 1/4 cup 1/3 cup 1/2 cup 1 cup Yes Yes Yes Yes No Yes Yes No 1 cup 2 Tbsp 24 1/2 cup 1 Tbsp 12 1/2 cup 1 cup No No 1/3 cup 2 tsp 8 1/3 cup 1/4 cup 1-1/2 tsp 6 1/4 cup 1-3/4 tsp 2-1/2 tsp 3-1/2 tsp 7-1/4 tsp No
No 1 tsp 1 drop 1 1-2 tsp 1/4 tsp 1 3 4 6 12 Yes Some Brown Liquid Packets Granulated EqualTM for Recipes Acesulfamepotassium Packets
Aspartame types 2
Replace Sugar
Packets
1-2 tsp
1
1/4 cup
6
1/3 cup
8
1/2 cup
12
1 cup
24
Heat stabile
Yes
Using Artificial Sweeteners In Cooking
Aftertaste
Yes
1 Manufacturer does not recommend replacing more than 1/2 cup sugar with saccharin sweetener in baked recipes 2 Contains phenylalanine People with phenylketonuria must avoid this sweetener
Check measurements on product packages for most accurate information
Sucralose, marketed as SplendaTM, is a new sweetener approved as a food additive It is not yet available for home use It has the same volume, taste, and baking characteristics as sugar
Carrot Cake
Youll need:
1-1/4 cups raisins 1/2 cup water 1 packet saccharin-type sweetener like Sweet n LowTM 1 packet aspartame-type sweetener like EqualTM 1/2 cup canola oil 3 cups grated carrots about 1/2 lb carrots 1-1/4 cup unsweetened applesauce 3/4 cup egg substitute or 1 whole egg plus 4 egg whites 1 tsp vanilla extract 1-1/2 tsp cinnamon 1/2 tsp allspice 4 packets aspartame-type sweetener 2 packets saccharin-type sweetener 1
tsp baking soda 1 Tbsp baking powder 1-1/2 cup all-purpose flour 1/2 cup whole wheat flour Nonstick cooking spray
16 Servings
Take out:
small saucepan knife measuring cups measuring spoons mixing spoon large mixing bowl small mixing bowl 9 x 13 baking pan
Directions:
1 Preheat oven to 350 2 Combine raisins, water, and 1 packet each of saccharin and aspartame sweeteners in small saucepan Simmer over medium heat until water is absorbed Stir occasionally Or place raisins, water, and sweeteners in heatproof bowl and microwave on High for 2 minutes Remove from heat and let cool 3 In large bowl, combine raisins, oil, grated carrots, applesauce, eggs or egg substitute, and vanilla extract 4 In smaller bowl, combine cinnamon, allspice, 2 packets saccharin, 4 packets aspartame, baking soda, baking powder, all-purpose flour, and whole wheat flour Stir to combine 5 Add dry mixture to fruits in large bowl Mix well 6 Coat 9 x 13 baking pan with nonstick spray Pour batter into the coated pan Bake in preheated 350 oven for 40 minutes or until the cake is light brown 7 Serve warm or cooled Cut into 16 or more servings
Dining with Diabetes Recipes Session 1 Desserts : 1
Nutrition
information:
For 16 servings: Calories: 178 Carbohydrate: 25 g Fat: 75 g For 48 servings: Calories: 59 Carbohydrate: 85 g Fat: 25 g Sodium: 67 mg Protein: 1 g Exchanges: 1/2 Starch and 1/2 Fat Sodium: 200 mg Protein: 4 g Exchanges: 1 Fruit, 1 Starch and 1 Fat
Points to remember about Carrot Cake recipe:
1 To make this recipe in a food processor, use grating disk to grate carrots Unplug food processor and carefully remove grating disk, leaving carrots in the processor bowl Insert metal blade Place cooked raisins, applesauce, oil, egg or egg substitute, and vanilla extract in bowl Replace cover and turn on and off quickly two times to mix In separate bowl, measure flours, seasonings, sweeteners, baking powder, and baking soda Stir to mix Add all at once to food processor bowl Replace cover and turn on and off three or four times, just enough to mix in dry ingredients Scrape into 9 x 13 pan that has been lightly coated with nonstick spray Bake as for recipe above 2 This recipe is high in fiber, potassium, and beta carotene The addition of whole wheat flour gives the recipe a nutty taste without adding fat 3 If nuts are added to this recipe, fiber, fat, and calories will be increased
Many nuts are rich in monounsaturated fat, which is thought to help protect against heart disease Nuts are low in carbohydrate, so they do not raise blood sugar significantly If 1/2 cup of chopped pecans is added to this recipe and the cake is cut into 16 pieces, each piece would then have 203 calories and 10 g fat
Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 1 Desserts : 2
Apple-Berry Crisp
Youll need:
1 8-oz apple 3/4 cup fresh or frozen blueberries 1 packet aspartame sweetener like EqualTM 1 packet saccharin sweetener like Sweet n LowTM 1/4 tsp cinnamon 1/4 cup uncooked rolled oats 1/4 cup all-purpose or whole wheat flour 1 Tbsp brown sugar 1 Tbsp chopped pecans 1 packet aspartame sweetener like EqualTM 1-1/2 Tbsp low-fat not fat-free margarine Nonstick baking spray
4 servings
Take out:
vegetable peeler measuring cups measuring spoons sharp knife mixing bowl mixing spoon measuring spoons 1-quart baking dish
Directions:
1 Preheat oven to 350 2 Coat inside of 1-quart heat-proof baking dish with nonstick spray 3 Peel and slice apple into dish Add fresh or frozen blueberries and toss lightly 4 Combine cinnamon and sweeteners in mixing bowl
Sprinkle over fruit 5 In same mixing bowl combine oats, flour, brown sugar, pecans, and remaining one packet of sweetener Add margarine and mix with fork until crumbly Sprinkle over fruit in baking dish 6 Bake for 20 minutes or just until fruit juices bubble up on sides and in the middle of the dish 7 Serve warm with frozen whipped topping or milk or vanilla frozen dessert Remember that milk or frozen dessert topping will add more calories and carbohydrate, while 2 tablespoons of frozen whipped topping are a Free Food
Nutrition information:
Calories: 133 calories Carbohydrate: 24 g Fat: 42 g Sodium: 21 g Protein: 23 g Exchanges: 1-1/2 Starch
Dining with Diabetes
Recipes Session 1 Desserts : 3
Points to remember about Apple-Berry Crisp recipe:
1 Fruit and fruit juice can replace sugar in some dessert recipes They add moistness and volume, or bulk, to the recipe, but they are high in carbohydrate Dont forget to count fruit as part of the carbohydrate in a recipe 2 Blueberries contain special phytochemicals in the colored portion of the skins These phytochemicals may be important in helping the body fight off chronic diseases Eating a wide variety of fruits and vegetables is a
good way to get vitamins, minerals, and phytochemicals, which occur in very small amounts in food 3 Apples contain soluble fibers that help the body get rid of some of the cholesterol taken in at meals The insoluble fibers in the skins of apples and other foods are important in regulating bowel function 4 Whole wheat flour and nuts are other important sources of fiber in the diet In addition, certain nuts are sources of helpful monounsaturated fat 5 Combining the two types of sweeteners, saccharin and aspartame, makes a much sweeter taste than if the saccharin or aspartame were used alone In this way, the recipe can be made with less total artificial sweetener
Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 1 Desserts : 4
Lemon Cake
Youll need:
1 purchased angel food cake 1 box 4-serving size lemon instant sugar-free pudding 1/2 cup skim milk 1 8-oz carton lemon-flavored fat-free, no-sugar-added yogurt 1/2 of an 8-oz tub Lite frozen whipped topping, thawed
Serves 16-24
Take out:
mixing bowl measuring cups serrated knife electric mixer or wire whisk serving plate
Directions:
1 Cut angel food cake in half, horizontally, using serrated knife in
a sawing motion Place bottom layer on serving plate 2 Beat pudding with milk until thickened, about 1 minute Stir in yogurt 3 Fold thawed reduced-calorie whipped topping into pudding mixture 4 Frost bottom layer of cake with lemon mixture You may then place top layer on cake and frost with remaining mixture, or make a second cake with remaining topping mixture Chill until served Garnish with thin strawberry, lemon, or kiwi slices 5 Makes 16 medium servings or 24 small servings Note: Other flavors of pudding and/or yogurt could be used Check label carefully to make sure the new flavor does not have more carbohydrate than the original flavors chosen for this recipe
Nutrition information for 16 24 servings:
Calories: 143 95 Carbohydrate: 28 g 18 g Fat: 2 g 14 g Sodium: 317 mg 218 mg Protein: 36 g 24 g Exchanges: 2 Starches 1 Starch
Dining with Diabetes
Recipes Session 1 Desserts : 5
Points to remember about Lemon Cake recipe:
1 Angel food cake is always fat free, but it is high in carbohydrate Desserts made with angel food cake should be cut into small servings 2 A homemade angel food cake would be delicious in this recipe, but a purchased cake is quick and easy Keep a purchased
angel food cake and a carton of Lite whipped topping in the freezer for a last-minute dessert 3 Angel food cake should be cut with a serrated knife, using a light sawing motion Cutting with a regular knife, or pressing down on the cake, will make very unattractive servings 4 Sugar-free instant pudding is not a Free Food because it is made with cornstarch and milk It must be counted as part of the carbohydrate in recipes Sugar-free gelatin is a Free Food 5 Flavored yogurt can be very high in carbohydrate because of added sugar Look for no-sugar-added or artificially sweetened yogurt to cut down on carbohydrate 6 Frozen nondairy whipped topping is made with tropical oil, containing highly saturated fat It is fine for occasional use, but should not be used daily 7 This is a very quick, easy, and delicious dessert
Adapted from a recipe contributed by Susan Gianato, Extension Educator, Mercer County, West Virginia Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 1 Desserts : 6
Banana-Pineapple Delight
Serves 16 cut into 16 squares
Youll need:
1-1/2 cup graham cracker crumbs 1/3 cup reduced-fat margarine 2 bananas 1 8 oz package reduced-fat cream
cheese Neufchatel, softened 1-1/2 cups skim milk 1 package four servings sugar-free instant vanilla pudding 1 20 oz can crushed pineapple, drained 1/2 of an 8-oz tub frozen Lite whipped topping, thawed
Take out:
9 x 12 glass baking dish fork or pastry cutter measuring cups knife mixing bowl mixer or wire whip large spoons rubber scraper plastic wrap
Directions:
1 Mix graham cracker crumbs and reduced-fat margarine with fork or pastry cutter until margarine is cut into crumbs Wet fingers and press mixture into bottom of baking dish No baking is required 2 Slice bananas and spread evenly over crumb mixture 3 Beat softened cream cheese until very smooth and gradually add milk, beating until smooth Add pudding mix and beat 1 minute or until mixture begins to thicken Spoon evenly over bananas and spread with rubber scraper 4 Spread drained crushed pineapple over the pudding layer 5 Spread whipped topping over pineapple layer with rubber scraper, making sure to spread to edges of baking dish 6 Refrigerate at least one hour, but refrigerating three or more hours is best 7 Cut into 16 slices and serve chilled
Nutrition information:
Calories: 164 Carbohydrate: 22 g Fat: 7 g Sodium: 141
mg Protein: 7 g Exchanges: 1 Starch, 1/2 Skim Milk, and 1 Fat
Dining with Diabetes
Recipes Session 1 Desserts : 7
Points to remember about Banana-Pineapple Delight recipe:
1 Reduced-fat margarine is made by whipping water into the more solid, regular margarine It works best in recipes where the quantity of margarine is small It does not work well for sautéing or frying, as the water content will cause spattering 2 Reduced-fat cream cheese Neufchatel does well in recipes where beating or baking is required It has much of the taste of regular cream cheese with 1/3 less fat Fat-free cream cheese is sometimes made with gelatin and may become very soupy if beaten with other ingredients 3 Graham cracker crumb crusts can be lower in fat and calories than regular piecrusts, but only if they are homemade Check labels on purchased graham cracker pie shells to see how much fat and sugar have been added 4 Other fruits could be used in this recipe When substitutions are made, be careful to know how much carbohydrate is in the new fruit 5 Frozen light whipped topping adds some sweetness and volume to recipes It does contain some hydrogenated fat, so it should not be used daily
Recipe from
Jean Holmes, Ohio County, West Virginia Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 1 Desserts : 8
Double Layer Pumpkin Pie
Serves 16-32 makes 2 pies or 1 pan 12 x 15
Youll need:
1-1/2 cups graham cracker crumbs 4 Tbsp reduced-fat margarine 4 oz reduced-fat cream cheese Neufchatel 2 Tbsp skim milk 2 packets artificial sweetener EqualTM or aspartame 1 8-oz tub Lite frozen whipped topping, thawed 1 cup skim milk 2 boxes sugar-free instant vanilla pudding 4 serving size 1 15-oz can pumpkin NOT pie mix 1 tsp cinnamon 1/2 tsp ginger 1/4 tsp ground cloves or use 1-1/2 tsp pumpkin pie spice in place of cinnamon, ginger, and cloves
Take out:
2 pie pans or 12 x 15 pan fork for mixing 2 mixing bowls measuring cups measuring spoons electric mixer or wire whisk rubber scraper
Directions:
1 Mix graham cracker crumbs and reduced-fat margarine with fork until well blended Press into bottom of two 9 pie pans or one 15 x 22 pan Bake for 5-7 minutes at 350 Cool while mixing next layer 2 Beat softened reduced-fat cream cheese until very smooth Beat in 2 tablespoons skim milk and the artificial sweetener Carefully stir in half of the carton of thawed
reduced-calorie frozen whipped topping Spread on cooled graham cracker crust Place in refrigerator while mixing next layer 3 Pour skim milk into chilled bowl Sprinkle both boxes of pudding mix on milk Beat with wire whisk or mixer on low speed for 1-2 minutes Mixture will be very thick Stir in pumpkin and spices Fold in remaining half carton of frozen whipped topping Spread on cream cheese layer 4 Chill for at least 1 hour May be made the night before serving The dessert can be garnished with additional whipped topping, toasted nuts increases calories and fat or slices of strawberry, if desired 5 Cut into 16 32 pieces for serving Refrigerate unused portions
Dining with Diabetes
Recipes Session 1 Desserts : 9
Nutrition information for 16 servings 32 servings:
Calories: 149 75 Carbohydrates: 18 g 9 g Fat: 74 g 37 g Sodium: 115 mg 58 mg Protein: 3 g 15 g Exchanges: 1 Starch and 1-1/2 Fat 32 servings: 1 Vegetable and 1 Fat
Points to remember about Double Layer Pumpkin Pie recipe:
1 Graham cracker crumb crusts can be high in calories, so this recipe uses just enough to cover the bottom of the pans Using reduced-fat margarine helps to keep the calories and fat low in the recipe 2
Reduced-fat cream cheese works well in recipes that are beaten or baked Fat-free cream cheese does not work as well 3 Sugar-free pudding mixes contain cornstarch, a carbohydrate-rich food They are not Free Foods Sugar-free gelatin mixes are Free Foods 4 Pumpkin is rich in beta-carotene, from which the body makes Vitamin A Beta-carotene is also an antioxidant, which may have many health-giving properties 5 Frozen nondairy whipped toppings contain highly saturated tropical oils, so choose Lite or fat-free varieties and use only occasionally
Recipe from Susan Gianato, Extension Educator Mercer County, West Virginia Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 1 Desserts : 10
Extension Service
with Diabetes
WVU Extension Service
session two
main dishes
A Food Guide Pyramid for People with Diabetes
Used with permission 1997 American Diabetes Association
Sample Nutrition Facts Label
Nutrition Facts
Serving Size 1/2 cup 114 g Servings Per Container 4
Amount Per Serving
Calories 90 Calories from Fat 30
Daily Value
Total Fat 3 g Saturated Fat 0 g Cholesterol 0 mg Sodium 300 mg Total Carbohydrate 13 g Dietary Fiber 3 g Sugars 3 g Protein 3
g
Vitamin A 80 Calcium 4
s s
5 0 0 13 4 12
Vitamin C 60 Iron 4
Percent Daily Values are based on a 2,000 calorie diet Your daily values may be higher or lower depending on your calorie needs: Calories: 2,000 2,500 Total Fat Less than 65 g 60 g Sat Fat Less than 20 g 25 g Cholesterol Less than 300 mg 300 mg Sodium Less than 2,400 mg 2,400 mg Total Carbohydrate 300 g 375 g Dietary Fiber 25 g 30 g Calories per gram: Fat 9 Carbohydrate 4 Protein 4
Margarine:
Lard and Bacon Fat Butter High None Some Most Some Some None Some None Some None Some None n High None None High None Some None Fat-free High High None Some None Some None Some Regular Stick Reduced Fat Olive and Canola Oil Other Vegetabe Oils
Contains:
Cholesterol
Saturated Fat
Choosing Fats and Oils
Trans-Fat
n Monounsaturated Fat
n Healthy Choices: Avoid Avoid Avoid No No Avoid Avoid No Avoid Avoid Avoid Avoid n Yes n Yes No No n Yes No No No No n Yes n BEST n BEST No n Yes n Yes n Yes
Spreading
Baking
Frying
Salad dressing
Spicy Grilled Chicken
Youll need:
2 whole skinless chicken breasts 4 pieces, about 1 pound 1/2 cup bottled salsa
Serves 4
Take out:
large mixing bowl measuring cup tongs grill or broiler and
grilling tools or baking dish and nonstick spray
Directions:
1 About 15 minutes before cooking, measure the salsa into a large bowl 2 Rinse and pat dry chicken pieces Remove any remaining skin and fat Place in the large bowl and turn with tongs to coat completely Place bowl in refrigerator until ready to cook chicken 3 Wash tongs and all surfaces that have touched the chicken with hot, soapy water Wash hands thoroughly under running water for at least 20 seconds 4 When ready to cook, lift chicken pieces from bowl and place on hot grill or broiler pan Grill or broil about 5 minutes on each side Chicken is done when all juices are clear and when a cut into the thickest part of the meat shows no pink Chicken can also be baked Coat baking dish lightly with nonstick spray Place chicken in baking dish and pour salsa over chicken Cover tightly and bake at 400 for 20 minutes Test for doneness, as in grilling directions 5 Wash tongs, bowl, and hands with hot soapy water before touching any other foods Discard remaining salsa or heat to boiling before using as a sauce Boiling the marinade will kill any germs, but uncooked marinade can be the source of foodborne illness 6 Serve immediately
or refrigerate to use in salads or sandwiches
Nutrition information:
Calories: 135 Carbohydrate: 2 g Fat: 14 g Sodium: 304 mg Protein: 26 g Exchanges: 3 Lean Meat exchanges
Dining with Diabetes
Recipes Session 2 Main Dishes : 1
Points to remember about Spicy Grilled Chicken:
1 Germs that are sometimes found on raw chicken can make people very sick Keep chicken refrigerated until ready to cook to keep germs from multiplying Freezing and refrigerating do not kill germs Heat kills germs 2 Use care to wash hands, fingernails, work surfaces, and all tools that have touched raw chicken before touching any other foods Use hot, soapy water to wash these things Be careful to discard wrappings from raw chicken before touching any other food 3 Thoroughly cooked chicken is very safe to eat Chicken breast is low in fat and saturated fat and can be a delicious part of a healthy diet 4 Salsa is usually fat-free and low in added sugar It makes a quick and delicious marinade for mild foods like chicken, fish, or lean, trimmed pork Try this recipe with fish
Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 2 Main Dishes : 2
Oven Poached Fish
Youll need For 4
persons
1 pound fresh or frozen fish fillets 1/2 cup skim milk 1/4 cup seasoned bread crumbs Black pepper 1 Tbsp grated Parmesan cheese Nonstick baking spray
Serves 4
For 2 persons
1/2 pound fish fillets 1/4 cup skim milk 2 Tbsp seasoned bread crumbs Black pepper 2 tsp grated Parmesan cheese Nonstick baking spray
Take out
oven-proof baking dish measuring cups measuring spoons
Directions:
1 Preheat oven to 400 2 Rinse fish fillets and pat dry Spray baking dish lightly with nonstick spray Put fish in single layer in baking dish 3 Pour skim milk over fish fillets Sprinkle bread crumbs on the tops of the fillets and season with black pepper 4 Sprinkle Parmesan cheese on tops of the fillets Spray quickly with nonstick spray 5 Bake at 400 for 15 minutes, or until fish is white and hot to the touch in the thickest part of the fillet Do not overcook, since fish will be dry and not as tasty Note: Baking time depends on thickness of fillets Any firm, white skinless fish fillets will work very well in this recipe Haddock, flounder, sole, orange roughy, and catfish are good choices
Nutrition information:
Calories: 146 Carbohydrate: 6 g Fat: 2 g Sodium: 244 mg Protein: 24 g Exchanges: 3
Very Lean Meat exchanges
Dining with Diabetes
Recipes Session 2 Main Dishes : 3
Points to remember about Oven Poached Fish recipe:
1 Fish is naturally low in fat It is a good source of Omega-3 fatty acids, which are thought to offer protection against heart disease Although fish is expensive and fresh fish may be difficult to find in some areas, it is a very healthy and tasty addition to the diet 2 Choosing fresh fish is not difficult with a little practice Fresh whole fish should appear firm and the eyes should be shiny Fillets should be firm and moist Fresh fish smells like seaweed and is never fishy Refrigerate fish immediately, placing fillets or whole fish on ice crushed or cubes in a large container and cover loosely with plastic wrap Store in the coldest part of the refrigerator Frozen fish should be thawed in the refrigerator To thaw quickly, place the unwrapped fish in a leakproof plastic bag and immerse in a large container of cold tap water Change the water, adding cold tap water, every 30 minutes until fish is flexible Cook immediately if possible The wrappings from fresh or frozen fish will develop an unpleasant odor quickly if left at room temperature Try storing
fish papers in the freezer until time for garbage pickup 3 Poaching fish in simmering liquid on top of the stove or in the oven is an ideal way to prepare fish for hardened fish haters The poaching liquid absorbs most of the fishy taste, leaving a mild and moist main dish 4 Parmesan cheese is high in fat, but it is very flavorful when only a small amount is used Limit to 1 or 2 Tablespoons per recipe 5 Fish is a very delicate food and should never be overcooked Look for a change in color, from grayish white to solid white, to indicate doneness If unsure, make a tiny cut in the thickest part of the fish and test to make sure the fish is hot and white all the way through White liquid coming from the fish is a sign of overcooking; remove immediately from the heat if this happens
Recipe from Janet Ogilvie Wood County, West Virginia Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 2 Main Dishes : 4
Italian Beef Stir-Fry
Youll need For 4 persons
1 pound beef round tip steak, frozen 1-1/2 cups uncooked medium bow-tie or shell pasta 2 cloves garlic 1/4 tsp black pepper 3 cups 8 oz sliced mushrooms 1 cup cherry tomato halves or 2 medium tomatoes 1 Tbsp
chopped fresh parsley 1 Tbsp olive oil 1/4 cup prepared fat-free Italian salad dressing 1 Tbsp grated Parmesan cheese
Serves 4
For 2 persons
1/2 pound beef 3/4 cup pasta 1-2 cloves garlic 1/8 tsp pepper 4 oz mushrooms 1 tomato 2 tsp parsley 1-1/2 tsp oil 2 Tbsp dressing 2 tsp cheese
Take out
sharp knife cutting board large saucepan aluminum foil to cover platter wooden or plastic stir-fry spoon measuring spoons measuring cups serving platter 12 nonstick skillet
Directions:
1 Remove beef from freezer and allow to partly thaw while assembling ingredients If beef is fresh, place in freezer for 30 minutes to firm 2 Cook pasta according to package directions, but do not add salt to cooking water Drain cooked pasta and keep warm 3 Cut garlic cloves into thin slices or use garlic press Slice mushrooms Cut cherry tomatoes in half or slice tomatoes in thin wedges Chop parsley 4 With very sharp knife, cut beef into thin diagonal slices 5 Heat oil in large nonstick skillet over medium-high heat Place half of beef strips in skillet and stir-fry 1 minute or until outside surface is no longer pink Do not overcook Remove to warm platter Stir-fry the rest of the beef with the sliced or crushed
garlic cloves Remove to warm platter Sprinkle with black pepper Cover with foil and a towel to keep warm 6 In same skillet, add mushrooms and stir-fry for 2 minutes Add tomatoes, beef, and Italian dressing Heat through 7 Spoon beef mixture over hot pasta Sprinkle with cheese and parsley Serve immediately Makes a one-dish meal in a hurry
Dining with Diabetes Recipes Session 2 Main Dishes : 5
Nutrition information:
Calories: 462 Carbohydrate: 39 g Fat: 21 g Sodium: 270 mg Protein: 29 g Exchanges: 2 Starches, 3 Lean Meats, 1 Vegetable, and 1 Fat
Points to remember about Italian Beef Stir-Fry:
1 Stir-fry recipes are good choices for hurry-up meals Start with frozen meat and add only three or four vegetables 2 Cut all vegetables and assemble near the stove before heating the skillet Cut up meat last to prevent any possible cross-contamination from cutting surfaces 3 Meat for stir-fry can be cut up easily if it is partly frozen Cutting across the grain of meat into thin slices reduces cooking time and promotes tenderness 4 It is never safe to thaw beef at room temperature for long periods of time Quick-thawing of beef for this recipe should be done in the microwave or by placing the
meat in a leakproof plastic bag and placing the bag in a container of cold tap water After quick-thawing the meat, it must be cooked immediately 5 The leanest cuts of beef are from the round or the loin To cut down on saturated fat, buy only the leanest cuts of beef, trim all visible fat before cooking, and keep portion sizes small 6 Olive oil is a good choice for stir-frying It is high in monounsaturated fat, which seems to help raise the HDL cholesterol the good cholesterol and may help prevent blood vessel disease 7 Using a nonstick skillet or sauté pan and a small amount of olive oil helps keep the calories low in this dish 8 This is a quick and delicious one-dish meal A green vegetable, such as broccoli, could be added for extra nutrition
Recipe from Gloria Wagner, Extension Educator Preston County, West Virginia Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 2 Main Dishes : 6
Baked Pork Chops
Hot n Spicy Seasoning:
1/4 cup paprika 2 tsp chili powder 2 Tbsp dried oregano, crushed 1 tsp black pepper
Serves 4
1 tsp garlic powder 1/2 tsp red cayenne pepper 1/2 tsp dry mustard
Mix all ingredients together Store in airtight container
Youll
need For 4 persons
4 lean boneless pork chops, 4 ounces each 1 egg white 1/4 cup evaporated skim milk 1/2 cup cornflake crumbs 1 Tbsp Hot n Spicy Seasoning Nonstick spray coating
For 2 persons
2 chops 1 egg white 2 Tbsp evaporated skim milk 1/4 cup cornflake crumbs 1 tsp Hot n Spicy Seasoning
Take Out:
sharp knife shallow bowl plastic bag baking dish measuring cups and spoons
Directions:
1 Trim all fat from chops and discard 2 Beat egg white with evaporated skim milk Place chops in milk mixture Let stand for 5 minutes, turning chops once 3 Mix together cornflake crumbs and Hot n Spicy Seasoning in plastic bag 4 Remove chops from milk mixture Drop in plastic bag and shake to coat thoroughly 5 Spray a 13 x 9-inch baking pan with nonstick spray Place chops in pan Sprinkle all remaining crumb mixture on chops 6 Bake at 375 for 15 minutes Turn chops; bake 5 -10 minutes more or until no pink remains
Dining with Diabetes
Recipes Session 2 Main Dishes : 7
Nutrition information:
Calories: 205 Carbohydrate: 13 g Fat: 6 g Sodium: 205 mg Protein: 24 g Exchanges: 3 Lean Meat and 1 Starch
Points to remember about Baked Pork Chops recipe:
1 Spicy seasoning mixtures add a new taste to
recipes, which have the salt reduced or eliminated The Hot n Spicy Seasoning mixture keeps well and can be used on many foods, such as chicken, fish, beef, and salads 2 Modern pork production has reduced the amount of fat in the meat The leanest cuts of pork include the tenderloin, sirloin chops, loin roast, and top loin chops Pork is a good source of protein, iron, zinc, and B vitamins When used in small portions and when the leanest cuts are chosen, pork can be part of a healthy diet 3 Evaporated skim milk gives a nice flavor to the coating for the pork chops Regular skim milk can be used if this is not available 4 Cornflake crumbs are tasty and somewhat salty No additional salt is needed when the chops are breaded in this mixture 5 This recipe is excellent with chicken, turkey cutlets, or fish If fish is used, reduce baking time to 15 minutes total
Recipe from Down Home Healthy Cookin, National Cancer Institute, NIH Publication 96-3408SV Contributed by Charlie Rickman, Extension Educator, Cabell County, West Virginia Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 2 Main Dishes : 8
Spinach Lasagna
Youll need:
2 tsp olive oil 2 cloves garlic,
minced 1 8-oz can no salt added tomato sauce 1 16-oz can diced tomatoes 1/4 tsp pepper 1/2 tsp oregano 2 tsp olive oil 1/4 cup chopped onions 1 10-oz package fresh spinach, washed, stemmed, and chopped or 1 10-oz package frozen chopped spinach, thawed 8 oz uncooked lasagna noodles 12 oz 1 fat cottage cheese or 12 oz reduced-fat ricotta cheese 8 oz shredded part-skim Mozzarella cheese 1/4 cup grated Parmesan cheese Nonstick baking spray
Serves 8
Take out:
9 x 12 baking dish saucepan skillet stirring spoons measuring spoons can opener sharp knife rubber scraper measuring cups
Directions:
1 Preheat oven to 375 Lightly coat baking dish with nonstick spray 2 In large saucepan over low heat, saute garlic in 2 teaspoons olive oil over low heat for 1 minute Do not let garlic brown Add tomato sauce and tomatoes, pepper and oregano Simmer gently over low heat, uncovered, while preparing other ingredients 3 In large skillet over low heat, sauté onions in remaining 2 teaspoons olive oil, stirring constantly, until onions are transparent but not brown Add chopped spinach, stirring constantly to separate and heat spinach 4 Layer uncooked lasagna noodles, sauce, spinach mixture, cottage
cheese, and mozzarella in baking pan Repeat, using all ingredients, ending with a layer of sauce Sprinkle top with Parmesan cheese 5 Cover baking dish tightly with foil Bake for one hour at 375 or until lasagna noodles are cooked If noodles are cooked before assembling lasagna, bake uncovered and reduce baking time to 25 minutes 6 Lasagna can be assembled and frozen, uncooked To prepare lasagna that has been frozen, defrost in refrigerator for 3-4 hours, and then bake, covered, for 1-1/2 hours or more Lasagna is done when cheese in center is melted, all noodles are cooked, and casserole is very hot all the way to the center
Dining with Diabetes Recipes Session 2 Main Dishes : 9
Nutrition information:
Calories: 263 Carbohydrate: 26 g Fat: 9 g Sodium: 508 mg Protein: 19 g Exchanges: 2 Lean Meats, 1 Starch, 2 Vegetables, and 1/2 Monounsaturated Fat
Points to remember about Spinach Lasagna recipe:
1 Traditional lasagna is very high in fat because it contains large amounts of cheese This recipe uses reduced-fat cheese and keeps amounts small Fatfree cheese can be used, but it does not melt well Lasagna made with fat-free cheese will be stringier and less creamy than traditional
lasagna 2 Look for tomatoes and other vegetables canned with no added salt 3 Spinach is high in folate, vitamin A, and potassium It makes a healthy and tasty addition to this and many other dishes Try adding some raw spinach leaves to salads and at the very end of stir-fry dishes 4 Olive oil is very good for sautéing garlic and onions It adds some healthy monounsaturated fat and very traditional flavor to this recipe 5 Using uncooked lasagna noodles reduces preparation time Be sure to cover casserole tightly so that the noodles get enough moisture to cook properly 6 This is a good dish to assemble and freeze for baking later Be sure to bake frozen uncooked lasagna long enough to heat all the way through the dish Improper reheating of frozen dishes can result in food spoilage and foodborne illness
Recipe from Carol R Olson, RD, CDE Extension Specialist, West Virginia University Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 2 Main Dishes : 10
Extension Service
with Diabetes
WVU Extension Service
session three
side dishes
Idaho Plate Method
Helena Rizor, RD, LD, CDE; Kathleen Thomas, RD, LD; Julie Harker, RD, LD; Marisue Smith-Banes, RD, LD,
CDE; Marjorie Rich, RD, LD, CDE
BREAKFAST Time ______
AM Snack _______________________ _______________________ _______________________
LUNCH Time ______
PM Snack _______________________ _______________________ _______________________
DINNER/SUPPER Time ______
BEDTIME Snack _______________________ _______________________ _______________________
Double Corn Bread
Makes 12 muffins, 9 x 9 pan, or one 8 skillet
Youll need:
1 cup cornmeal 1/2 cup all-purpose flour 4 tsp baking powder 2 egg whites or 1/4 cup egg substitute 1/2 cup fat-free sour cream 2 Tbsp canola oil 1 85-oz can 1 cup creamed corn Nonstick baking spray
Take out:
muffin tin or 9 x 9 pan or 8 iron skillet large mixing bowl small mixing bowl measuring cups measuring spoons can opener mixing spoon rubber scraper
Directions:
1 Preheat oven to 425 If using iron skillet, place skillet in oven to heat 2 Combine cornmeal, flour, and baking powder in large mixing bowl Mix well 3 Separate eggs or measure egg substitute and place in small bowl Add sour cream, oil, and creamed corn and mix well 4 Add corn mixture to dry ingredients and stir only enough to dampen flour 5 If using muffin tins or 9 x 9 pan, spray with
nonstick baking spray If using iron skillet, remove from oven and hold away from face and oven while spraying lightly with nonstick baking spray 6 Spoon batter into muffin tin or pan Spray top lightly with baking spray 7 Bake muffins for 20 minutes, pan or skillet bread for 25 minutes 8 Remove from oven and serve warm Cut bread into 12 servings
Nutrition information:
Calories: 101 Carbohydrate: 19 g Fat: 26 g Protein: 3 g Sodium: 237 mg Exchanges: 1 Bread/starch and 1/2 Fat
Dining with Diabetes
Recipes Session 3 Side Dishes : 1
Points to remember about Double Corn Bread recipe:
1 Fat-free sour cream gives desired flavor to this recipe without added fat 2 Whole wheat flour could be used to increase fiber in this recipe 3 Baking powder is high in sodium; therefore, do not add salt to the recipe 4 Creamed corn has some added sugar, which helps to make the recipe tender The total carbohydrate in creamed corn is not much higher than regular canned corn, but the creamed corn makes a more tender product 5 One whole egg, two egg whites or 1/4 cup egg substitute could be used in this recipe One egg yolk adds 5 calories, 04 g fat, and 18 mg cholesterol to each serving, but it does not
raise blood glucose If blood lipids are normal, a whole egg can be used in this recipe 6 Canola oil and olive oil are good sources of monounsaturated fat and should be used whenever possible in recipes 7 Using an iron skillet adds color and flavor to this recipe Be sure to coat with baking spray to prevent sticking
Adapted from a recipe contributed by Mindy Zook-Weaver, RD, Monongalia County Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 3 Side Dishes : 2
Glazed Carrots
Youll need:
2 cups carrots, peeled and sliced 1/2 cup orange juice, fresh or frozen 1 Tbsp cornstarch 1 tsp brown sugar 1/4 tsp cinnamon 1/8 tsp ground cloves 1 tsp reduced fat margarine
Serves 4
Take out:
vegetable peeler sharp knife saucepan stirring spoon or whisk measuring cup measuring spoons
Directions:
1 Peel and slice carrots Cook in small amount of water on top of stove or in microwave until just tender 2 In small saucepan, dissolve cornstarch in cold orange juice Stir in brown sugar, cinnamon, and cloves 3 Over medium heat, bring juice mixture to a slow boil, stirring constantly until thickened Add margarine and carrots Stir to coat evenly
Nutrition
information:
Calories: 65 Carbohydrate: 14 g Fat: 07 g Sodium: 57 mg Protein: 1 g Exchanges: 1 Fruit
Points to remember about Glazed Carrots recipe:
1 Carrots and other deep yellow and deep green vegetables and fruits are rich in beta-carotene Beta-carotene may help to protect against some chronic diseases 2 Sauces thickened with cornstarch require little or no fat Cornstarch should always be mixed with cold liquid, then heated to a gentle boil Fat-free gravy: To make fat-free gravy with cornstarch, pour water or liquid from cooking vegetables in bottom of pan in which meat has been cooked Stir and scrape up all brown bits from bottom of pan Pour all liquid into clear measuring cup or gravy separator Chill in refrigerator or freezer until fat rises to top of container Skim off all fat Mix with cornstarch and bring to gentle boil as in recipe above
Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 3 Side Dishes : 3
Spinach Salad
Youll need For 4 persons
Dressing: 2 Tbsp olive oil 1 Tbsp cider vinegar 1 Tbsp chopped fresh parsley 1 tsp lemon juice 2 packages artificial sweetener Salad: 2 cups cooked bowtie or rotini noodles 2 cups torn raw spinach
3/4 cup sliced celery 1/4 cup sliced green onions 1 medium tomato or 1 cup cherry tomatoes 1 cup seedless grapes 1/2 cup raw snow peas 1/2 pound cooked shrimp or 8 oz grilled chicken breast
Serves 4
For 2 persons
1 Tbsp olive oil 2 tsp vinegar 1 tsp chopped parsley 1/2 tsp lemon juice 1 package artificial sweetener
1 cup cooked noodles 1 cup torn raw spinach 1/3 cup sliced celery 2 Tbsp sliced green onions 1/2 cup cherry tomatoes 1/2 cup seedless grapes 1/4 - 1/2 cup snow peas 1/4 pound cooked shrimp or 4 oz grilled chicken
Take out
pint jar with lid measuring cups measuring spoons large bowl sharp knife cutting board large salad bowl salad tongs or mixing spoons
Directions:
1 Cook noodles according to package directions, but do not add salt to water Drain, rinse, and cool 2 Place all dressing ingredients in pint jar, close with lid, and shake well 3 Place torn fresh spinach in large salad bowl Chop celery and green onions Slice fresh tomato into small wedges or cut cherry tomatoes into halves Wash grapes and snow peas and add all to salad bowl 4 If using fresh or frozen shrimp, remove peels and veins If using chicken, cut into bite-size pieces using separate cutting board
Add to salad bowl 5 Place drained and cooled pasta in salad bowl Shake dressing well and pour over salad Toss with salad tongs or 2 large spoons
Dining with Diabetes Recipes Session 3 Side Dishes : 4
Nutrition information:
Calories: 276 Carbohydrate: 32 g Fat: 85 g Sodium: 85 mg Protein: 18 g Exchanges: 2 Starches, 2 Very Lean Meats, 1 Monounsaturated Fat
Points to remember about Spinach Salad:
1 Spinach and other deep green leafy vegetables are excellent sources of folate and beta carotene Folate is important for reproduction and growth Beta carotene is converted into Vitamin A Choose deeply colored vegetables every day 2 Raw vegetables are low in calories and high in fiber They help make a dish seem satisfying and filling without raising blood sugar 3 This salad could be made with canned shrimp, canned tuna, or canned chicken breast The result would be higher in sodium, but there would be little difference in calories 4 This is a very colorful salad It would make a wonderful company dish as well as an attractive dish for a covered-dish supper
Recipe from Margaret Miltenberger, Extension Educator Mineral County, West Virginia Diabetes Education Program WVUES 1999-2000
Dining
with Diabetes
Recipes Session 3 Side Dishes : 5
Cole Slaw
8 Servings Serving size: 1/2 cup
Youll need:
1 bag shredded cole slaw mixture or 3 1/2 cups shredded cabbage and 1/4 cup shredded carrots 2 Tbsp finely chopped onion 1/4 cup chopped celery 1/4 cup chopped green or red pepper
Take out:
food processor, shredder, or grater sharp knife large mixing bowl mixing spoons mixing spoons measuring cups and spoons rubber scraper
Dressing:
1/4 cup mayonnaise 1 Tbsp vinegar plain or red wine type 3 packets artificial sweetener 1/4 tsp salt 1/4 tsp pepper
Easy mixing directions:
Place all dressing ingredients into bottom of large bowl and mix with rubber scraper to blend Chop onion, celery, and pepper on cutting board or in food processor Buy shredded cole slaw mixture or use food processor fitted with shredding disk for cabbage and carrots Add chopped and shredded vegetables to large bowl Toss well to blend and refrigerate Can be made the night before
Traditional method:
Shred cabbage and grate carrots Chop onion, celery, and pepper Mix dressing ingredients in bottom of large bowl Add shredded and chopped vegetables Mix well and chill to blend flavors
Nutrition information per
serving:
Calories: Carbohydrate: 3 g Fat: Sodium: 116 mg Protein: 1 g Exchanges:
With regular mayonnaise: 52 calories, 6 g fat, Free Food and 1 Fat With reduced-fat mayonnaise: 30 calories, 3 g fat, Free Food and 1/2 Fat With fat-free mayonnaise: 17 calories, 0 g fat, Free Food
Dining with Diabetes
Recipes Session 3 Side Dishes : 6
Points to remember about Cole Slaw recipe:
1 Cabbage is a cruciferous vegetable Studies seem to show that cruciferous vegetables, such as cabbage, cauliflower, broccoli, brussels sprouts, bok choy, spinach, collard greens, and others, may help protect against certain types of cancerous changes in the body The word cruciferous refers to the cross-shaped flower on these plants 2 This salad can be made even more attractive by using red cabbage and red or yellow sweet peppers 3 Preparing salad dressings in the bottom of salad bowls is a good way to reduce the amount of fat used The dressing ingredients are carefully measured into the bowl and then the raw vegetables are tossed in the bowl just until the leaves appear shiny 4 Fat-free and reduced-fat mayonnaises are acceptable substitutes for regular mayonnaise in recipes containing other
strong-flavored ingredients, such as cole slaw Be sure to read the label to make certain that these substitutes are not high in carbohydrate 5 A Free Food is a food that has less than 20 calories and less than 4 g carbohydrate in the serving that you eat Raw vegetables are generally considered Free Foods When a salad of raw vegetables is used at a meal, that meal can also contain a cooked vegetable for the person with diabetes 6 All salads that are made one day, and served the next day need very special handling to prevent foodborne illnesses All knives, cutting boards, and food handling surfaces should be thoroughly cleaned before placing washed vegetables on them Arrange to prepare the dish quickly by getting all ingredients and utensils ready before beginning preparation Clean hands thoroughly, washing them in hot, soapy water for at least 20 seconds before beginning to handle food Chop, shred, and mix quickly Cover dish securely and place in coldest part of refrigerator If carrying salad to a picnic, place the salad bowl in a large cooler or on ice until serving time Discard any unused salad that has not been refrigerated or kept on ice throughout the serving time
Diabetes
Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 3 Side Dishes : 7
Four-Bean Salad
Youll need:
1 can 85 oz cut green beans, drained 1 can 85 oz cut wax beans, drained 1 can 85 oz lima beans, drained 1 can 85 oz kidney beans, drained 1/2 cup thinly sliced red onion rings 1/2 cup chopped celery 1/4 cup diced green pepper
Makes 8 1/2 cup servings
Take out:
colander can opener sharp knife large mixing bowl small mixing bowl whisk or mixing spoon mixing spoon plastic wrap or bowl cover
Dressing:
2 tsp Dijon mustard 2 Tbsp vinegar 1/2 tsp sugar 1/2 tsp dried thyme or 1 tsp chopped fresh thyme 1/2 tsp black pepper 1 clove garlic, crushed or minced 1/4 cup olive oil
Directions:
1 In a large mixing bowl, combine all the beans, onion, celery, and green pepper 2 In a smaller mixing bowl whisk together the mustard, vinegar, sugar, thyme, pepper, and garlic Whisking continually, add the oil in a slow, thin stream Whisk until well blended 3 Pour the dressing over the bean mixture and toss to coat well Cover and refrigerate 1-2 days before serving
Nutrition information:
Calories: 121 Carbohydrate: 12 g Fat: 7 g Sodium: 172 mg Protein: 33 g Exchanges: 1/2 Starch, 1
Vegetable, and 1 Monounsaturated Fat
Dining with Diabetes
Recipes Session 3 Side Dishes : 8
Points to remember about Four-Bean Salad:
1 Canned vegetables are higher in sodium than fresh cooked or frozen vegetables Draining liquid and rinsing canned vegetables helps reduce sodium 2 Kidney beans and lima beans are legumes These vegetables are rich in soluble fiber, which helps slow down digestion of carbohydrates and may help keep blood sugar more even after meals Legumes also may help reduce absorption of cholesterol from other foods in the same meal They are also a great source of protein with no saturated fat 3 Olive oil is a good source of monounsaturated fat, which helps protect against heart disease Although olive oil is as high in fat as butter, lard, and other shortenings, it should be included in the diet when possible for its health-giving benefits 4 This recipe uses highly flavored vegetables, such as onion and garlic, as well as spices, to give flavor when salt is not added 5 Four-Bean Salad will keep well for several days if tightly covered and refrigerated 6 One tablespoon of Four-Bean Salad is only 15 calories, a Free Food Try putting one tablespoon on salads as a
tasty, low-sodium garnish
Recipe reprinted with permission from Healthy Hearty Diabetes Cooking Diabetes Self-Management Books Copyright 1993 RA Rapaport Publishing, Inc Diabetes Education Program WVUES 1999-2000
Dining with Diabetes
Recipes Session 3 Side Dishes : 9
