Transcript INTERMEDIATE CARBOHYDRATE COUNTING
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Improving Diabetes Control with Accurate Carb Counting
Gary Scheiner, MS, CDE
Carbohydrate Counting Advantages
– Fewer high BGs – Fewer low BGs – No “off limits” foods – Flexibility in meal & snack quantities “The Frozen Tundra”
Timed Effect on Blood Sugar Levels
Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs Carbohydrate….
rapid digestion, total absorption/conversion to glucose (100%)
Sugar Alcohols..
glucose (50%)
Protein……………
moderate digestion, partial absorption as slow digestion, partial conversion to
Fat………………….
glucose** (<20%) slow digestion, little conversion to
MEET THE CARBS!
Glucose Fructose (fruit sugar) Galactose Dextrose Lactose (milk sugar) Sucrose (table sugar) • • • • “flavored” simple sugars: • Maltose High-Fructose Corn Syrup Molasses Brown Sugar Honey
MEET THE CARBS!
Fruit Fruit Juice Candy Regular Soda Punch Wine Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly
MEET THE CARBS!
“straight chain” G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G “branched chain” G – G – G – G – G - G G – G / \ / G – G G G – G – G G – G – G \ / \ / G – G – G – G – G – G G – G – G – G – G – G \ \ G – G – G G – G – G – G – G
MEET THE CARBS!
• • • • • • Potatoes Rice Noodles/Pasta Cereal Oatmeal Bread • • • • • • Tortillas Pancakes Waffles Crackers Bagels Pizza • • • • • • Beans Corn Pretzels Chips Popcorn Beer
Now meet the lesser known carbs
(discount 100%!) (discount 50%!)
Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol
(Rare… can ignore!)
The “fate” of dietary carbohydrates
Simple Carbohydrates (sugars)
Blood Glucose Complex Carbohydrates
(starches)
Does the Type of Carbohydrate Matter?
Glycemic Index
• • • All carbs (except fiber) convert to blood glucose eventually G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours)
Does the Type of Carbohydrate Matter?
Glycemic Index (contd.)
Example: Spaghetti GI = 37 • Only 37% of spaghetti’s carbs turn into blood glucose in the first 2 hours. • The rest will convert to blood glucose over the next several hours.
Does the Type of Carbohydrate Matter?
Slow Stuff Pasta Legumes Salad Veggies Dairy Chocolate Average Stuff Fruit Juice Pizza Soup Cake Fast Stuff Breads/Crackers Salty Snacks Potatoes Rice Cereals Sugary Candies
Ultimately, The Amount of Carbohydrate is More Important Than the Type
CARB BASICS QUIZ – True or False • Equal amounts of sugar and starch will raise blood glucose the same amount. • Fiber will raise blood glucose levels a little bit.
• “Sugar-Free” chocolate (made with sugar alcohol) will not raise blood glucose levels.
Methods for Counting Carbs Accurately
• • • • • The “Exchange” system Food package labels Resource listings Portion estimation Carb factors
The “Exchange” System
• Foods with common nutrient values are grouped together.
1 Starch 1 Fruit 1 Milk 1 Vegetable 1 Meat 1 Fat 0 5 10 15
Practice Counting Carbs Using the Exchange system
Breakfast Exchange/# Grams 1 large bagel (4 oz) starch (4) x 15 1 tsp. margarine fat (1)x0 1/2 cup orange juice fruit (1) 6 oz skim milk 60g 0g 15g milk (3/4) x 12 9g
Total Carbs: 84g
Nutrition Facts Label Method
• Labels are the best resource for carbohydrate counting • Pay attention to: – Serving Size – Total Carbohydrate – Fiber & Sugar Alcohol (if any)
Fiber and Carbohydrate Counting
• • • Included in total carbohydrate Does not convert to glucose Subtract fiber from the Total Carbohydrate
Fiber and Carbohydrate Counting
• For example: 13 g Total Carb - 3 g dietary fiber Count as 10 grams carbohydrate
Sugar Alcohols and Carbohydrate Counting • • • • Artificial Sweeteners Found in chewing gum, mints, yogurt, ice cream, cookies and candy Digest slowly and partially ( Can cause diarrhea 50%)
Carbohydrate Counting Using Books
• Use for foods without a Nutrition Facts Label – Fresh fruits – – Fresh vegetables Ethnic foods – – Fresh baked goods Restaurant foods
Carbohydrate Counting Using Websites • USDA Food Composition – www.nal.usda.gov/fnic/foodcomp/search/ • Calorie King – www.calorieking.com
• Fast food companies’ or food manufacturers’ websites
Arby’s: www.arbys.com/nutrition/ Boston Market: www.bostonmarket.com/restaurant Burger King: www.bk.com/Food/Nutrition/NutritionWizard/index.aspx
Dairy Queen: www.dairyqueen.com/en US/Menus+and+Nutrition/Nutrition+Charts/default.htm
Denny’s: www.dennys.com/en/cms/Nutrition/Allergens/23.html
Dunkin’ Donuts: www.dunkindonuts.com/aboutus/nutrition/ KFC: www.kfc.com/kitchen/nutrition.htm
McDonald’s: www.mcdonalds.com/usa/eat/nutrition_info.html
Old Country/Hometown Buffet: www.buffet.com/nutritioncontent.htm
Pizza Hut: www.pizzahut.com/menu/nutritioninfo.asp
Starbuck’s: www.starbucks.com/retail/nutrition_info.asp
Subway: www.subway.com/applications/NutritionInfo/index.aspx
Taco Bell: www.tacobell.com/ Wendy’s: www.wendys.com/food/NutritionLanding.jsp
Insulin Pump Carb Databases
• Accu-Chek Spirit Palm Software • Animas IR 1200, 1250, 2020 • Deltec Cozmo 1800 • OmniPod PDM
Portion Estimation Method
•
Use common, everyday objects to measure the portion size of food
– Soda can (12 fl.oz.) = 1 ½ cups – Baseball or adult’s fist = 1 cup – Child’s fist = ½ cup – Adult’s spread hand = 8” diameter – Adult’s palm = 4” diameter
Portion Estimation Method
• Examples of 1-cup Carb Estimates:
Potato: 40g Pasta: 40g Rice: 50g Rolls: 25g Cereal: 25g Fruit: 20g Cooked Veggies: 10g Salad Veggies: 5g Corn: 30g Peas: 30g Beans: 40g Pretzels: 25g Chips: 15g Popcorn: 5g Ice Cream: 35g Cake: 45g
Portion Estimation Method
•
Estimate the carbs:
20g/cup X 1 ¼ cups 25g
Portion Estimation Method
•
Estimate the carbs:
5g / cup X 4 cups 20g
Portion Estimation Method
•
Estimate the carbs:
25g / cup X 1 ½ cups 38g 12g / cup X 1 cup = 12g Total = 50g
Portion Estimation Method
• Other “tricks”:
Long Sandwiches Pizza Cookies Breaded meat/veg/cheese 8g per inch 30g per adult hand-sized piece (fingers together) 20g per adult-sized palm 4g small (“thumb/nugget sized”) 10g large (“patty/palm-sized”)
Portion Estimation Method
•
Estimate the carbs:
30g / hand X 1 1/3 hands 40g
Carbohydrate Factor Method
• • • Weigh a portion of food Multiply the weight by its carb factor* Get total carb count *A carb factor is the percentage of the food’s weight that is carbohydrate. The rest is water, protein, fat, minerals
Carbohydrate Factor Method
Salter 1450
Carbohydrate Factor Method
Carb Factor Examples: Apple: .13
Apple Pie: .32
Bagel: .51
Carrot (raw): .06
Chocolate Cake: .51
Cornbread: .45
Pancake: .28
Pizza (cheese): .32
Potato, baked: .22
Potato Salad: .09
Rice: .27
Spaghetti: .26
Vanilla Ice Cream: .23
Watermelon: .06
For carb factors for more than 6000 foods (in Excel spreadsheet format), go to: www.friendswithdiabetes.org/files/Carb factor.xls
Carbohydrate Factor Method
How much carb
is in a baked potato weighing exactly 300 grams?
300 x .22g = 66g carb
A. 36g B. 46g C. 66g D. 86g
Measuring and Weighing Foods
• You can’t accurately count carbohydrate without weighing and measuring periodically • Weigh at least once a week • Practice, practice, practice!
• Test yourself against the label
Other Factors to Consider
• Fat – – – Lengthens time your stomach takes to empty Delays rise in blood glucose May cause temporary insulin resistance • Protein – Very little effect on blood glucose (unless carb diet) – Usually combined with fat
Weight Gain and Carbohydrate Counting
Your child can gain weight if:
• • • Count carbohydrate, but ignore fat/calorie content of foods No limits placed on portion sizes Frequent snacking
Write it down!
• • • • Blood glucose results Carbohydrate eaten Insulin or other meds Physical activity/exercise
Only count the carbs you actually consume!
Jackie Scheiner Age 1
The Ultimate Guide to Accurate Carb Counting
Gary Scheiner MS, CDE
Integrated Diabetes Services In-Office, Phone & Online Consults 333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 (877) 735-3648 www.integrateddiabetes.com