Transcript Improving Diabetes Control with Accurate Carb Counting

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
M e al
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..
moderate digestion, partial absorption as glucose (50%)
Protein……………
slow digestion, partial conversion to glucose* (~40%)
Fat………………….
slow digestion, little conversion to glucose** (<20%)
* In absence of dietary carbs
** may cause insulin resistance in large qty
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
Average Stuff
Fast Stuff
Pasta
Legumes
Salad Veggies
Dairy
Chocolate
Fruit
Juice
Pizza
Soup
Cake
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/#
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
milk (3/4) x 12
Total Carbs:
Grams
60g
0g
15g
9g
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 ( 50%)
• Can cause diarrhea
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/enUS/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
Corn: 30g
Pasta: 40g
Peas: 30g
Rice: 50g
Beans: 40g
Rolls: 25g
Pretzels: 25g
Cereal: 25g
Chips: 15g
Fruit: 20g
Popcorn: 5g
Cooked Veggies: 10g
Ice Cream: 35g
Salad Veggies: 5g
Cake: 45g
Portion Estimation Method
• Estimate the carbs:
20g/cup
X 1 ¼ cups
 25g
Portion Estimation Method
• Estimate the carbs:
5g / cup
X 3 cups
 15g
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
8g per inch
Pizza
30g per adult hand-sized piece
(fingers together)
Cookies
20g per adult-sized palm
Breaded meat/veg/cheese
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?
A. 36g
B. 46g
C. 66g
D. 86g
300 x .22g = 66g carb
Measuring and Weighing
Foods
• To be an accurate carb
counter, weigh/measure 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 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
USA (877) 735-3648
www.integrateddiabetes.com
[email protected]