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A Handbook for Diabetic Residents

Created for Northwest Passage RTC
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Introduction
The Passage Way is a collection of eight Core Values created by Northwest
Passage to provide children and adolescents with a foundation for a lifetime of success.1
The eight values are summarized as Nature, Recreation, Relaxation, Nutrition, Exercise,
Relationships, Service, and Spirit. This Handbook emphasizes and supports the Nutrition
component, and is an effort to fuel the residents of Northwest Passage with healthy foods
to support their physical and emotional well being. Northwest Passage as an organization
acknowledges that diabetes management is extremely relevant, especially amongst the
young population who come through residential programming. In order to serve the needs
of a greater audience, this Handbook was designed to assist in diabetes management by
providing education and the appropriate tools needed to help residents, and staff alike,
manage the unique challenges of these residents.
As of 2017, Diabetes mellitus affects more that 30 million people in the United
States.2 It is defined as a metabolic disorder illustrated by chronic hyperglycemia due to
defects in insulin secretion, insulin action, or both.3 Lack of insulin (or insulin activity)
prevents the metabolization of sugar molecules, known as glucose, into energy.
Hyperglycemia occurs when blood glucose molecules build up in the bloodstream faster
than can be taken up by insulin. Long-term hyperglycemia can result in cardiovascular
disease, nerve damage, kidney damage or failure, difficulties with bones and joints,
infections of the teeth and gums, retina damage, as well as other complications.4
Both type 1 and type 2 diabetes may be of concern to residents of Northwest
Passage. Type 1diabetes is an autoimmune condition that results in the complete lack of
insulin production. It is hereditary and unpreventable. Type 2 diabetes occurs in
individuals who are able to produce insulin, however due to a combination of insulin
deficiency and insulin resistance, hyperglycemia still occurs.5 Risk for developing type 2
diabetes can be hereditary, but risk also increases with a sedentary lifestyle and unhealthy
diet.
For the residents and staff of Northwest Passage, diabetes management requires
education on: (1) the use of insulin, (2) blood glucose monitoring, and (3) the importance
of counting carbohydrates.
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1. USE OF INSULIN
Insulin is a hormone produced by the pancreas. It helps the body break down
complex carbohydrates into the most basic sugar – glucose. The body requires glucose
for sustained energy. Individuals with type 1 diabetes require insulin injections in order
for their body to process glucose. Although it is possible for persons with type 2 diabetes
to manage their condition with diet and exercise, if they have had their condition for a
longer period of time they likely will also require insulin injections.
Insulin injections are only given to residents by Northwest Passage’s trained
Direct Care Staff members. The amount of insulin administered is determined by the
individual’s blood glucose concentrations. Blood glucose measurements should be taken
multiple times per day to ensure that levels are in a safe range.

2. BLOOD GLUCOSE MONITORING

At Northwest Passage, blood glucose is measured before and after every meal.
Residents may also request to have their blood glucose checked if they are concerned it is
too high or too low.
Blood glucose measurements are taken by Northwest Passage’s trained Direct
Care Staff. Normal fasting blood glucose measurements for someone with diabetes will
measure between 80 mg/dL – 130 mg/dL. The American Diabetes Association
recommends that these measurements be lower than 180 mg/dL two hours after eating a
meal. Factors that cause blood glucose values to rise include: eating a meal with more
carbohydrates than usual, physical inactivity, stress, illnesses and infections, and changes
in hormonal levels such as menstruation.
Blood glucose values will fall when a meal or snack is missed, more physical
activity is performed than planned, or the resident has received more insulin or other
diabetic medication than needed. It can also decrease due to a side effect of other
medications.
Blood glucose levels that are consistently too high or low indicate that a change to
the individual’s meal plan, physical activity, or dose of diabetic medication should be
evaluated.6 A health care provider should be contacted as soon as possible.
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Emergency Situations: The Direct-Care Staff members at Northwest Passage are

readily available whenever an emergency arises. Low blood glucose measurements, also
known as hypoglycemia, are indicated by light-headedness,6 nervousness, sweating,
shaking, sleepiness, and confusion. If blood glucose measurements read 70 mg/dL or
lower, the individual can be administered one carbohydrate choice such as:
 4 ounces of fruit juice
 1 tablespoon of sugar or honey
 Commercially-made glucose tablets
Check blood glucose measurements again 15 minutes after consuming the
carbohydrate choice. If measurements are still below 70 mg/dL, consume another
carbohydrate choice and repeat until blood glucose returns to a normal range.6

3. CARBOHYDRATE COUNTING
Carbohydrate counting is essentially the estimation of carbohydrates in a
predetermined amount of food. The benefit of counting carbohydrates is it enables the
Direct Care Staff to match the dose of insulin directly to the foods that has been
consumed. To make this estimation as accurate and efficient as possible, this Handbook
contains collective lists of the foods that Northwest Passage serves to its residents. It also
contains daily charts for the Northwest Passage staff to track how much the resident has
eaten during their meals and snacks.
Along with these nutritional tools, the Passage Way encourages recreation as a
means to live a healthy and balanced lifestyle. All residents of Northwest Passage are
encouraged and given opportunities to be physically active. Although exercise has not
been significantly proven to help control blood glucose concentrations, it does reduce the
risk for cardiovascular complications later in life.7 Through the combination of
Recreation with healthy nutritional practices specifically tailored to manage the diabetic
condition, Northwest Passage hopes to build stronger Relationships with our residents
and guide them on a successful path.
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Exchange Lists & Carbohydrate Counting

Exchange lists help mitigate large spikes in blood glucose. The lists are divided into six
different groups of foods that are similar in regards to the amount of carbohydrate, fat,
protein, and calories that they contain. These groups are: starch/bread, meat, vegetables,
fruit, milk, and fat.7

Starch/Breads – one carbohydrate choice is equal to 15 grams of carbohydrate, 3 grams

of protein, trace amounts of fat, and 80 calories. The general rule for measuring a serving
of starch or bread is:

½ cup cereal, grain, or pasta = one serving

1 ounce of a bread product = one serving

Fruits – a choice fruit will contain about 15 grams of carbohydrates and 60 calories. The
general rule for measuring a serving of fruit is:

½ cup of fresh fruit or fruit juice = one serving

¼ cup dried fruit = one serving

Vegetables – a serving of vegetables is about 5 grams of carbohydrate, 2 grams of

protein, and 25 calories. The general rule for a serving of vegetables is:

½ cup cooked vegetables or juice = one serving

1 cup raw vegetables = one serving

Meats – the contents of a serving of meat vary on the kind of meat. Meats are divided
into categories of very lean, lean, medium-fat, and high-fat. Generally, 1 ounce of each
kind of meat will have 7 grams of protein. The amount of fat and calories are as follows:

Very lean = 0-1 grams fat, 35 calories

Lean = 3 grams fat, 55 calories
Medium-Fat = 5 grams fat, 75 calories
High-Fat = 8 grams fat, 100 calories

Milk – a serving of milk contains about 12 carbohydrates and 8 grams of protein.

Calories will depend on the percentage of milk chosen. The higher the percentage, the
more fat and calories there will be.

Fat – a serving of fat contains about 5 grams of fat and 45 calories. There may be trace
amounts of protein. These would include nuts, seeds, salad dressing, oil, butter, cream,
and bacon among others.

The following lists were created by the American Diabetes Association and the American
Dietetic Association. There were included in this project to be used as a legitimate and
credible resource.8
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Starch/Bread Lists
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Fruits
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Vegetables

Meats
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Milk
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Fat
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Reference Food Listings used by Northwest

Passage
These lists were created by Northwest Passage staff and intended to be used by
the Northwest Passage organization. The information in these lists was cross-referenced
for accuracy. Numbers were rounded to nearest whole number.

*It is recommended to check food labels as often as possible to make sure that the
carbohydrate amount on the item is correct.

Starch/Breads/Sugars
Food Portion Carbohydrate (g)
Baked Potato 1 potato 63
Banana Bread 1 slice 30
Biscuit 1 biscuit 32
Blueberry Bagel 1 bagel 59
Bran Muffin 1 muffin 27
Bread, Wheat 1 slice 23
Bread, White 1 slice 13
Cheerios 1 cup 21
Cheesy Potatoes 1 cup 38
Corn Bread 2”x2” square 28
Corn Flakes 1 bowl 31
Couscous 1 cup (cooked) 36
Cinnamon Raisin Bagel 1 bagel 33
Cinnamon Toast Crunch Cereal Bar 1 bar 33
Crackers, Saltines 2 per package 5
Curly Fries 75 grams 28
Dinner Rolls 2 rolls 30
English Muffin (Crystal Farms) 1 muffin 24
Flatbread 1 piece 38
French Toast 1 slice 14
French Toast Sticks 4 sticks 42
Garlic Bread 1 slice 17
Graham Crackers (Honey Maid Lil’
Squares) 1 package 24
Granola ½ cup 33
Hamburger Bun 1 bun 31
Hotdog Bun 1 bun 28
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Macaroni and Cheese ½ cup 22

Malt-o-Meal ¼ cup, dry 38
Manicotti 1 stuffed noodle 40
1 packet (2.1
Maple Syrup oz) 43
Mashed Potato 1 cup cooked 34
Muffin 1 muffin 55
Multigrain Bread 2 slices 15
Munchies 1 package 17
Oatmeal, Old Fashioned 1 bowl (1 cup) 27
Oatmeal, Instant 2 packets 51
Oats n’ Honey (Nature Valley) 1 package 29
Pancakes, Whole Grain (4”) 1 pancake 21
Pasta Salad 1 cup 27
1/8 slice + 1/16 29 (1/8 slice)
Pizza, 4-Cheese Medley (Freschetta) slice 15 (1/16 slice)
Pizza Bagel 1 bagel 29
Pizza Dippers 4 pieces 52
Rice, Brown 1 cup cooked 46
Rice Krispies 1 ¼ cup 29
Rice Pilaf 1 cup cooked 33
Scone 1 scone 55
Spaghetti Noodles 6 oz. 44
Spanish Rice 1 cup 44
Special K Cereal 1 bowl 27
Stir Fry (Veggies and Rice) 1 cup 27
Stuffing ½ cup 20
Tortilla (6”) 1 tortilla 13
Tortilla (12”) 1 tortilla 43
Vegetable Lasagna 2”x2” square 35
Waffle 1 waffle 26
Wheat Bread 1 slice 15

Fruits

Food Portion Carbohydrate (g)

Apple 1 fruit 19
Applesauce, unsweetened 1 serving 13
Apricots 2 halves 10
Banana 1 fruit 20
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Blood Orange 1 fruit 15

Cantaloupe 1/8 of melon 5
Cranberry Sauce ¼ cup 25
Grapes 10 grapes 9
Juice Box (Thirster 100% apple juice) 1 carton 15
1 fruit w/o skin,
Kiwi medium 11
Mandarin Oranges 1 cup 24
Mixed Fruit (Dole Tropical Fruit
Salad) ½ cup 24
Orange 1 fruit 19
Orange Juice 8 oz. 15
Peached, Diced ½ cup 9
Peaches, Halved 2 halves 12
Pears, Diced ½ cup 19
Pears, Halved 2 halves 12
Pineapple 1 cup 20
Raisins 1 pack 16
Strawberries 3 Berries 6

Vegetables

Food Portion Carbohydrate (g)

Broccoli 1 stalk 5
1 cup,
Cabbage shredded 1.5
Carrots, sliced ½ cup 6
Carrots, whole 6 each 10
Cream of Corn ½ cup 23
Coleslaw ½ cup 21
Corn Kernel ¼ cup 8
Corn on the Cob ½ ear 16
Egg Roll 1 piece 22
Green Beans ½ cup 4
Mixed Veggies 10 oz. 36
Pasta Sauce (Dei Fratelli) ½ cup 12
Peas ½ cup 12
Salad 1 cup 2
Salsa ¼ cup 4
Sauerkraut, shredded 1 oz./2 Tbsp 1
Scalloped Potatoes ½ cup 30
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Meat

Food Portion Carbohydrate (g)

Asian Chicken & Veggies 1 cup 29
Beef Stroganoff 1 cup 15
BBQ Pork ½ cup 3
BBQ Wings 4 each 24
Beef Stick 1 beef stick 0
Chicken-a-la-King 10 oz. 43
Chicken Gravy ¼ cup 4
1 average
Chicken Pot Pie prepared pie 45
Chicken Royal 1 sandwich 23
Chicken Strips 2 pieces 11
Chili 1 cup 17
Corn Dog 1 corn dog 20
4 mini corn
Corn Dogs, Mini dogs 22
Fuse Burger (w/o bun) 1 burger 11
Ham, Sliced 1 slice 1
Ham Roast 1 slice 0
Hamburger (w/o bun) 1 each 0
Hot Dog (w/o bun) 1 each 5
Meatballs 4 each 14
Pizza Burger (w/o bun) 1 burger 34
Pork Roast 1 slice/6 oz. 0
Quesadilla, Cheese 1 each 40
Roast Beef, Sliced 1 slice 1
Salami, Sliced 1 slice 1
Shepard Pie 1 cup 34
Sloppy Joe, Beef (w/o bun) ¼ cup 6
Steak Gravy ¼ cup 20
Turkey Gravy ¼ cup 4
Turkey, Sliced 1 slice 1
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Milk

Food Portion Carbohydrate (g)

American Cheese, Sliced 1 slice 2
Cheddar Cheese, Sliced 1 slice 0
Cheese Stick 1 each 0
Chocolate Milk 8 oz. 32
Cottage Cheese, Low-fat ½ cup 6
Cream Cheese 1 packet 1
Fudgsicle 1 each 15
Greek Yogurt , Nonfat Vanilla
(Glenview Farms) 8 oz. 21
1 each (2
Grilled Cheese (With Bread) halves) 30
Milk, Skim 8 oz. 13
Milk, Whole 8 oz. 12
Milk, 1% 8 oz. 12
Milk, 2% 8 oz. 12
M&M’s Ice Cream Cookies 1 each 35
Ice Cream, Vanilla, Old Fashioned ½ cup 20
Ice Cream Bar, Heath (Blue Bunny) 1 bar 26
Ice Cream Bar, Vanilla (Blue Bunny) 1bar 19
Provolone Cheese, Sliced 1 slice 0
Sour Crème 1 packet 1
Swiss Cheese, Sliced 1 slice 1
Yogurt, Nonfat (Upstate Farms) 1 each 19
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Other Foods
Food Portion Carbohydrate (g)
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References
1. The Passage Way: Living a therapeutic lifestyle. Northwest Passage Web site.
http://nwpltd.org/passageway/. Accessed November 1, 2017.

2. Diabetes Quick Facts. Centers for Disease Control and Prevention Webs site.
https://www.cdc.gov/diabetes/basics/quick-facts.html. Updated July 24, 2017. Accessed
November 1, 2017.

3. Scottish Intercollegiate Guidelines Network (2013). Management of Diabetes: a

National Clinical Guideline. http://bit.ly/1tZCc0H. Accessed October 31, 2017.

4. Hyperglycemia in diabetes. Mayo Clinic Web site.

https://www.mayoclinic.org/diseases-
conditions/hyperglycemia/basics/complications/con-20034795. Published April 18, 2015.
Accessed November 1, 2017.

5. Hamilton, H., Knudsen, G., Laura Vaina, C., Smith, M., Prosad Paul, S. Children and
young people with diabetes: recognition and management. British Journal of Nursing.
March 23, 2017;26(6):340-347. Accessed November1, 2017.

6. All About Blood Glucose. American Diabetes Association web site.

https://professional.diabetes.org/sites/professional.diabetes.org/files/media/All_about_Bl
ood_Glucose.pdf. Accessed November 29, 2017.

7. Kavookjian, J., Elswick, B. M., Whetsel, T. (2007) Interventions for being active
among individuals with diabetes: a systematic review of the literature. Diabetes
Education. 33(6):962-988-990. https://dx.doi.org/10.11.77/014572170308411

8. American Diabetes Association, American Dietetic Association. The Diabetic

Exchange List (Exchange Diet). Glycemic Research Institute.
http://glycemic.com/DiabeticExchange/The%20Diabetic%20Exchange%20List.pdf.
Accessed November10, 2017.