Transcript INTERMEDIATE CARBOHYDRATE COUNTING

Improving Diabetes
Control with
Carbohydrate Counting
The University of Georgia Cooperative
Extension Service
Carbohydrate Counting
Advantages
• Helps improve blood glucose
– A1C goal: Less than 7%
– Blood glucose goals (plasma)
• Before meals: 90-130
• After meals:
less than 180
• Bedtime:
110-150
Carbohydrate Counting
Advantages
• Easier - you only count
carbohydrate
• Allows you more flexibility in food
choices
– Virtually any food can be worked into
your meal plan
What is Carbohydrate
Counting?
• Keeping track of the amount of
carbohydrate eaten at meals and
snacks
• Keeping carbohydrate intake
consistent at meals from day to
day
• Matching insulin injections to
carbohydrate intake (for some)
Why Count Carbohydrate?
Why Count Carbohydrate?
• Amount of carbohydrate eaten
determines how high blood glucose will
rise after a meal
• Carbohydrate begins to raise blood
glucose within 15 minutes of eating
Who Should Count
Carbohydrate?
People wanting to improve diabetes
control who manage their diabetes
with:
• Balanced food intake and
regular physical activity or...
• Diabetes pills or...
• Insulin injections
Nutrients in Foods
• Carbohydrate
• Protein
• Fat
(Vitamins, minerals, water)
What are Carbohydrates?
bread, rice, cereal, potatoes, pasta,
corn, peas, butter beans
fruit, milk, regular sodas, candy,
juices
Combination Foods That Contain
Carbohydrate
• Pizza
• Spaghetti
• Sandwiches
• Casseroles
• Soups
• Stews
Which Contain Carbohydrate?
• Brunswick stew
• Brussels
sprouts
• Sugar-free jello
• Skim milk
• Fat-free frozen
yogurt
• Baked chicken
• Rice
• Orange juice
• Diet soda
• Oreos
Carbohydrate is Healthy
• Most foods containing carbohydrate are
among the healthiest foods to eat:
– grains, fruits, vegetables, low-fat milk and
yogurt
• Carbohydrates are the foundation of a
healthy eating plan
– contain many essential vitamins, minerals,
and fiber
Does the Type of Carbohydrate
Matter?
• Various carbohydrates have slightly
different effects on blood glucose
– processing, cooking, fiber, mixed meals
with with fat or protein affect glucose
response
The Amount of Carbohydrate is
More Important
Than the Type
1 frosted brownie = 2 slices bread
1 cup ice-cream = 1 cup cereal
(30 grams carbohydrate)
Use of Sugar in the Meal Plan
• Can be used in moderation
– share desserts in restaurants
– ask for child-sized portions of ice-cream
– keep large portions of sweets out of the
house
• Substitute for other carbohydrate in the
same meal
• Check effect on your
blood glucose
Use of Sugar in the Meal Plan
Many high-sugar foods:
• are also high in fat
• provide very little nutritional value
(empty calories)
• may replace more healthful foods
2 Ways to Count
Carbohydrate
• Carbohydrate Choices
Food Exchanges or Servings
• Carbohydrate Grams
Specific number of grams of
carbohydrate per meal or snack
Carbohydrate Choices
(servings)
• Each food in fruit, starch, milk
group contains about 15 grams
carbohydrate
• One carbohydrate choice = 15
grams carbohydrate
Carbohydrate Choices
• Lunch:
Exchanges Carbohydrate Choices
2
1
1
3
2
starch
fruit
milk
meat
fat
=
=
=
=
=
2
1
1
0
0
carb
carb
carb
carb
carb
choices
choice
choice
choices
choices
Each Carbohydrate Choice
= 15 grams Carbohydrate
Example:
•
•
•
•
•
Breakfast:
Lunch:
Snack:
Dinner:
Evening
Snack:
3
2
1
3
carb
carb
carb
carb
choices = 45 grams
choices = 30 grams
choice = 15 grams
choices = 45 grams
1 carb choice = 15 grams
How Much Carbohydrate Should
You Have?
• Depends on your:
– calorie needs
– height
– weight
– physical activity
– level of fat in your blood
(triglycerides)
– usual food habits and schedule
Carbohydrate Needs (Example)
1500 Calories: 188 grams/day
–3
–4
–4
–1
carb
carb
carb
carb
choices at breakfast
choices at lunch
choices at dinner
choice at bedtime
Resources for Counting
Carbohydrate
• Food package labels
• Carbohydrate counting books
• Food Exchange booklets
Nutrition Facts Label
• Best resource for
carbohydrate counting
• Pay attention to:
–Serving Size
–Total Carbohydrate
Nutrition Facts
Serving Size 1 cup (228 g)
Servings per Container 8
Calories 170
Calories from fat 18
Total Fat 2 g
Saturated Fat 0 g
Cholesterol 0 g
Sodium 330 mg
Total Carbohydrate 32 g
Dietary Fiber 8 g
Sugars 5 g
Protein 6 g
Vit A 35%
Calcium 10%
Vit C 4%
Iron 20%
Food Label
(Example 1)
• Your meal plan: 2 carb choices
(30 grams carb)
• Food label (ice-cream):
Serving size = 1/2 cup
Total carbohydrate = 15 grams
How much ice-cream should you
have?
Food Label (Example 2)
If your meal plan at breakfast is:
45 grams carbohydrate
Food label:
Cereal
Milk
Serving size:
1/2 cup
1 cup
Total Carb:
15 grams
12 grams
How much cereal and milk should you
have?
Carbohydrate Counting Books
• Use for foods without a
Nutrition Facts Label
– Fresh fruits
– Fresh vegetables
– Breads from a bakery or farmer’s
market
– Restaurant foods
Food Exchange Booklet
• Gives average carbohydrate values for
many foods
• Pocket Guide available
Practice Counting Carbs #1
Breakfast
Choices
1 large bagel (4 oz)
1 tsp. margarine
1/2 cup orange juice
1 cup skim milk
Grams
Practice Counting Carbs #2
Dinner
Choices
Spaghetti noodles
1 cups
Spaghetti sauce,  cup
Tossed salad with lettuce,
tomato
Garlic bread, 2 slices (2 oz)
Diet Coke
Grams
Matching Insulin to
Carbohydrate Intake
• Useful for people taking at least 3-4 insulin
injections per day or on insulin pump
• Carbohydrate to insulin ratio is determined
– Example: Ratio of 15:1 means that 1 unit of
insulin needed for every 15 grams
carbohydrate
• Insulin dose depends on planned
carbohydrate intake at meal
Write down:
• Carbohydrate eaten
• Times of meals
• Blood glucose results
• Diabetes pills or insulin
• Physical activity/exercise
What Else Affects Your Blood
Glucose?
• Portions sizes
– Large portions of carbohydrate
increase blood glucose
What Else Affects Your Blood
Glucose?
• Timing of food intake
– Space food throughout day
– Eat at regular times
– Don’t skip meals
Measuring and Weighing
Foods
• You can’t accurately count
carbohydrate without
weighing and measuring
• Weigh at least once a week
• Practice, practice, practice!
What to Weigh and Measure
• Weigh: Bread, rolls, bagels,
some fruits, baked potatoes
• Measure: mashed potatoes, popcorn,
pasta, rice, vegetables,
fruit juice
Mixed Foods Containing
Carbohydrate
• Macaroni &
Cheese
• Soups
• Casseroles
• Lasagna
• Subs
• Beef Stew
• Spaghetti and
Meatballs
Restaurant
Dining
• Dining Out in Restaurants
– Use books on restaurant eating
– Estimate carbohydrate content
• Check blood glucose 2 hours after meal
• Take-out (Example: Chinese)
– Measure food at home to determine
carbohydrate content
Fast Foods
Get carbohydrate information from:
• Web site or toll-free number for chain
restaurants
– i.e. www.mcdonalds.com
• Extension web site for fast foods
• Carbohydrate counting books
Fast Food Restaurants #1
Subway®
Carb Exchanges
Classic Italian
43 g
Tuna - 6”
42 g
2
starch
2 meat,1 veg,
1 fat
2 1/2 starch
1 meat, 1 veg
5 fat
1/2
Fast Food Restaurants #2
McDonalds® Carb Exchanges
Hamburger
34 g
meat,
6-pc Chicken
15 g
meat, McNuggets
French Fries
57 g
medium
2 starch, 1
1/2 fat
1 starch, 2
1 1/2 fat
4 starch, 3 fat
Other Factors to Consider
• Fat
– Slows down time your stomach takes
to empty
– Delays rise in blood glucose
– High in calories
Other Factors to Consider
• Protein
– Very little effect on blood glucose
– Usually combined with fat
Weight Gain and
Carbohydrate Counting
You can gain weight if you:
• Count carbohydrate, but ignore
fat content of foods
• Eat more high-calorie foods
Fiber and Carbohydrate
Counting
• Included in total carbohydrate
• Does not convert to glucose
• For more than 5 grams insoluble fiber
per serving: subtract amount of fiber
from the Total Carbohydrate
Fiber and Carbohydrate
Counting
• For example:
1 cup cereal = 30 gm Total Carbohydrate
- 7 grams insoluble dietary
fiber
23 grams
Count as 23 grams carbohydrate
So, enjoy the increased variety and
flexibility with Carb Counting...
..but watch the fat and calories!
Activity