the university of georgia cooperative extension service improving diabetes control with carbohydrate...
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The University of Georgia Cooperative The University of Georgia Cooperative Extension ServiceExtension Service
Improving Diabetes Control with
Carbohydrate Counting
Carbohydrate CountingAdvantages
• 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 CountingAdvantages
• 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?
• 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
What are Carbohydrates?
bread, rice, cereal, potatoes, pasta, corn, peas, butter beans
fruit, milk, regular sodas, candy, juices
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 Choices2 starch = 2 carb choices1 fruit = 1 carb choice1 milk = 1 carb choice3 meat = 0 carb choices2 fat = 0 carb choices
Each Carbohydrate Choice
= 15 grams Carbohydrate
Example:• Breakfast: 3 carb choices = 45 grams • Lunch: 2 carb choices = 30 grams• Snack: 1 carb choice = 15 grams• Dinner: 3 carb choices = 45 grams• Evening
Snack: 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 carb choices at breakfast– 4 carb choices at lunch – 4 carb choices at dinner– 1 carb 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 FactsServing Size 1 cup (228 g)Servings per Container 8Calories 170 Calories from fat 18Total Fat 2 gSaturated Fat 0 gCholesterol 0 gSodium 330 mgTotal Carbohydrate 32 gDietary Fiber 8 gSugars 5 gProtein 6 gVit A 35% Vit C 4%Calcium 10% Iron 20%
Food Label (Example 1)
• Your meal plan: 2 carb choices (30 grams carb)• Food label (ice-cream):
Serving size = 1/2 cupTotal 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 MilkServing size: 1/2 cup 1 cupTotal Carb: 15 grams 12
gramsHow 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
Practice Counting Carbs #1
Breakfast Choices Grams
1 large bagel (4 oz)1 tsp. margarine 1/2 cup orange juice
1 cup skim milk
Practice Counting Carbs #2
Dinner Choices GramsSpaghetti noodles
1 cups
Spaghetti sauce, cup
Tossed salad with lettuce,
tomato
Garlic bread, 2 slices (2 oz)
Diet Coke
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
RestaurantDining
• 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 ExchangesClassic Italian 43 g 2 1/2 starch
2 meat,1 veg,1 fat
Tuna - 6” 42 g 2 1/2 starch1 meat, 1 veg 5
fat
Fast Food Restaurants #2
McDonalds® CarbExchanges
Hamburger 34 g 2 starch, 1 meat, 1/2 fat
6-pc Chicken 15 g 1 starch, 2 meat, McNuggets 1 1/2 fat
French Fries 57 g 4 starch, 3 fatmedium
Other Factors to Consider
•Fat– Slows down time your stomach
takes to empty– Delays rise in blood glucose– High in calories
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!