Improving Diabetes Control with Carbohydrate Counting The University

Improving Diabetes Control with Carbohydrate Counting The University of Georgia Cooperative Extension Service

Carbohydrate Counting Advantages • Helps improve blood glucose – A 1 C 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 • Baked chicken • Brussels • Rice sprouts • Orange juice • Sugar-free jello • Diet soda • Skim milk • Oreos • Fat-free frozen yogurt

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 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 choices choices

Each Carbohydrate Choice = 15 grams Carbohydrate Example: • • • Breakfast: Lunch: Snack: Dinner: Evening Snack: 3 2 1 3 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 – 1 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

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!

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 Mc. Donalds® Carb Exchanges Hamburger 34 g meat, 6 -pc Chicken 15 g meat, Mc. Nuggets 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!

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