Transcript arbohydrate Counting for Patients With Type 1 Diabetes

IMAM REZA HOSPITAL
Z. SAEEDREZAEE-NUTRITIONIST
Jun 7 , 2012
Estimating the carbohydrate
content of food so
that you can adjust your insulin
dose to match the amount of
carbohydrate you want to eat.
Good glycemic control
Freedom to eat when you want to
Freedom to eat as little or as much as you wish
( more flexible in the diet & lifestyle)
CARBOHYDRATE
STARCH
SUGARS
GLUCOSE
Blood Stream
Insulin
Cells of body
FIBER
Starchy Vegetables
&
CHO
CHO
CHO
Approximately
15 grams of CHO
Per serving
CHO :
Starch
fiber
Fruit Group
Approximately
15 grams of CHO
per serving
CHO
Sugar (Fructose
, glucose,
sucrose,
Sugar alcohol)
Fiber
Low starch
Milk Group
Approximately
12 grams of CHO
per serving
CHO :
Sugar
(lactose)
Other Carbohydrate Group
Approximately
15 grams of CHO
per serving
CHO:
starch
Sugar
Low
fiber
1)Sugar occurs naturally in some unprocessed food :
milk , fruit , vegetables , some grain
2)Added sugars that is added to foods and beverages :
Include table sugar, brown sugar, corn syrup, molasses
(saccharose , glucose ,fructose ,lactose,
maltose , dextrose , maltodextrine , sorbitol)
Artificial sweeteners currently
approved by the Food and Drug
Administration (FDA) are:
 Acesulfame potassium
Aspartame
 Neotame
Saccharin
Sucralose
SUGAR FREE NO CARBOHYDRATE FREE
Shredded Wheat
Nutrition Facts
1. Look at the “Serving size”
Serving Size 2 biscuit (1.6 oz.)
Servings per container: 10
Total Calories: 155 Calories from fat: 9
Fat
Saturated
Trans Fat
Cholesterol
Sodium
Total Carbohydrate
Dietary Fiber
Sugars
Protein
Vitamin A
Calcium
0%
2%
1g
0.2 g
0g
0mg
3mg
36.2g
5.5g
0.4g
5.2g
Vitamin C 0%
Iron
6%
2. Look at the “Total
Carbohydrate” in grams
Total Carbohydrate:
includes grams of
sugar, sugar alcohol,
starch, and dietary fiber
3. Subtract fiber and sugar
alcohol from the “Total
Carbohydrate”
the amount of rapid acting insulin given for the
amount of carbohydrate eaten at a meal or snack
Age (yr)
Units Added Per 15 g CHO at meal
0-5
0/5
5- 12
0/75
12- 18
1-2
Ref:rence : Alemzade R,Wyatt DT.Diabetes Mellitus in Children.ln:Behrman RE,et
al.Nelson,textbook of pediatrics.19 th ed,2010.
A correction (or sensitivity) factor can be used to
determine how much extra insulin should be added to
the insulin dose which will be given to cover the carb
eaten.
Age (yr)
Units Added Per 100 mg/dl Above Target
0-5
0/5
5- 12
0/75
12- 18
1-2
Ref:rence : Alemzade R,Wyatt DT.Diabetes Mellitus in Children.ln:Behrman RE,et
al.Nelson,textbook of pediatrics.19 th ed,2010.
BG befor breakfast : 130
Bread 2 slice (60 gr )
2 U insulin
Egg
without CHO
Milk ( 1 cup)
1 U insulin
Apple jam( 1 tablespoon)
1 U insulin
4 U insulin Aspart inject
After 2 h check BG
Small snack <15 gr CHO – no insulin needed
Larger snack over 15 gr CHO insulin may be required
BG before lunch : 300
Cooked rice (1 cup)
3 U insulin
Cooked lentils (1/2 cup)
1U
Meat ,salad
without CHO
Yogurt (1/2 cup)
0/5 U
4.5 U insulin + 1.5 U insulin
After 2 h check BG
Before
Breakfast
2 hours
after
breakfast
Befor
lunch
2 hours
after
lunch
Befor
dinner
2 hours
after
dinner
3 am
Quick acting: French bread ,mashed potato , cake
inject before meal
Slow acting : pasta , whole bread , legums
inject after eating
High fat &/or high protein slows up rise in blood sugar :
Pizza , fish & chips
½ insulin just after eating and the other ½ 30 – 45
minutes later
Need to skilled in making calculation
Possible weight gain if high calorie foods intake is
not monitored
Low sugar, avoid sugary drinks
Low fat, especially low in saturated fat
1 – 2 portions of oily fish per week
Good intake of fruit & vegetables
Thank
you