Carbohydrate Counting

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1 Carbohydrate Counting

2 Goals of Nutrition Control of blood glucose Normal growth and development Healthy meals and snacks

3 What Foods Can I Eat? Healthy, balanced meals and snacks Foods with sugar in moderation Milk, water or sugar free drinks Fresh fruit instead of fruit juice The same foods recommended for a person without diabetes!

4 Making Healthy Food Choices Choose fresh or frozen vegetables and fruits daily Use whole grain breads, cereals, pasta, and rice Choose lower fat food choices more often Parents can set an example by eating a variety of foods.

5 Why Count Carbohydrate? Carbohydrate has the greatest effect on blood glucose (BG) 100% of carbohydrate turns to glucose after eating It is the first source of energy and important in a healthy diet Higher carbohydrate foods are not bad Allows you to adjust insulin based on grams of carbohydrate eaten An Insulin to carbohydrate ratio is used (example: 1unit per 15 grams carbohydrate) Protein and Fat have little or no effect on BG

6 What Foods Have Carbohydrate? Main sources include: Breads, Cereals, Grains, Starchy Veggies Fruit and Juice Milk and Yogurt Sweets and Desserts

7 What Foods Have Carbohydrate? Additional, smaller sources include: High protein foods such as peanut butter and cottage cheese Non-starchy vegetables Some salad dressings Nuts and seeds Condiments; such as, catsup, BBQ sauce Count all carbohydrates, even those low in carbohydrate!

8 Sugar Containing Beverages Beverages not recommended due to rapid spikes in blood glucose 100% fruit juice and fruit flavored drinks Regular soda pop Sport drinks Kool Aid Other sweetened beverages Choose milk, water or a sugar-free version instead

9 Where do I get Carbohydrate Information? Food Labels How Food Counts handout Calorie King book Websites Apps

10 How Food Counts Shows serving sizes of foods containing 5 to 15 grams of carbohydrate Foods in 15 gram servings of carbohydrate: Grains & Starch, Fruit, Combination foods, Sweets Foods in 12 gram servings: Milk and yogurt Foods in 5 gram servings: Non-starchy vegetables Contains helpful tips about each food group

11 Reading Food Labels Food labels contain the most accurate carbohydrate information 1. Check the Serving Size Not the gram weight of the serving located by serving size 253g is the weight of 1 cup of chili 2. Check food labels for grams of Total Carbohydrate 1 cup chili = 22g Carbohydrate Do not use net Carbs if listed

12 My Favorite Foods Prepare a list of foods commonly eaten at meals and snacks for a quick reference at home Measure the quantity typically eaten Indicate the grams in this portion

13 Keeping Breakfast Healthy Use Healthy Breakfast Guide for healthy food choices Choose breakfast cereals with: 8 grams or less of Sugar per serving 3 grams or more of Fiber per serving Choose whole grains more often, avoiding overprocessed, pre-sweetened foods Balance food choices (Milk, Whole grain, Fruit, and Protein)

14 Snacking Choices Choose whole grain snacks with dietary fiber Offer fruits, vegetables, and dairy foods Protein foods are not free foods Refer to Healthy Snacks handout for ideas

15 Planning Healthy Meals

16

17 How much should I eat? Eat to appetite Monitor growth at each clinic visit Good blood glucose control contributes to normal growth and development

18 Healthy Eating Division of Responsibilities Parent/Caregiver Responsibilities: What foods are offered When and where they are offered Family dining table No TV distraction Parents be a role model Child Responsibilities: What they eat How much they eat

19 Tips for Mealtimes Schedule meals and snacks Avoid grazing between meals Avoid short-order cooking Have family meals Encourage, don t force new foods Offer choices within limits Would you like fruit or yogurt for snack? Offer a variety of food groups

20 Reading Food Labels for Serving Size Carbohydrate Content Total Carbohydrate Dietary Fiber / Sugar Alcohols Very few foods will require total carbohydrate adjustment for fiber and sugar alcohols grams Adjusting grams of Carbohydrate for portion sizes

21 Reading Food Labels Higher Fiber Foods Lower BG may occur after a high fiber meal. Fiber is not completely broken down by the body. If 5 or more grams of Dietary Fiber are listed per serving, subtract half (1/2) the fiber grams from Total Carbohydrate Higher fiber cereals (ex. Raisin Bran, Wheat Chex, Shredded Wheat) Beans (Kidney, Pinto, Navy, etc)

22 Lite or Sugar Free Foods Does not mean carbohydrate free May contain sugar alcohols (words ending in ol) Sorbitol, mannitol, xylitol, maltitol, etc If 5 or more grams of Sugar Alcohol are listed per serving on the label, subtract half (½) the sugar alcohol grams from Total Carbohydrate Sugar alcohols affect BG at a slower rate and may cause gas and diarrhea The only SF or lite foods recommended are SF beverages (which do not contain sugar alcohols)

23 Adjusting Carbohydrate grams for Portion Size What if you want 20 crackers? Cheez-It Crackers Serving Size = 27 crackers (30g) Total Carbohydrate g = 16g Dietary Fiber = Less than 1g Carbohydrate grams Label serving size x Your Portion 16 grams 27 x 20 = 11.8 or 12 Total Carbohydrate grams

24 Determining Grams in Recipes Use the Calorie King booklet Use similar food labels Use Cooking Information handout Add grams of each ingredient Divide by the number of portions

25 Eating Out and Special Occasions Use labels, Apps or the Calorie King booklet to help plan meals when eating out Look up restaurant websites using Fast Food Websites Foods for Occasional Use contains carbohydrate information on candy and sweets

26 Using Your Insulin Ratio Lunch Grams Hamburger on Bun 22g 2 Tbsp Catsup 3g 8 Tator Tots 15g 8oz 2% Milk 11g ½ cup Green Beans 3g 1 apple 14g Total Grams 68g Ratio=1unit Humalog for 15 grams 4.5 units (68 15 = 4.5 units)

27 Educating School/Day Care Providers Refer to the School Section handouts in the notebook Do not withhold food for high blood glucose readings Check school district website for carbohydrate information. If not available, request it from the district food service director or food service supervisor Extra carbohydrate may be needed for PE General guide: 15 grams for min of more strenuous activity

28 Exercise Be active or exercise 60 minutes/day Exercise may lower blood glucose up to 24 hours after activity Strenuous exercise may require exercise carbs (carbs you do not dose for) Look at BG patterns to see if you need exercise carbs Check blood glucose before, during, and after activities

29 Bedtime Blood glucose goal: 110 to 150mg/dl If less than 110, Give a 15 gram carbohydrate snack containing fat without dosing insulin (crackers & cheese or peanut butter, ½ cup ice cream) If less than 70, Treat the low with 15 grams of fast acting carbohydrate Follow with a high fat, 15 gram carbohydrate snack without dosing insulin

30 Nutrition Education Summary Measure foods for 1-2 weeks using measuring cups, spoons, and food scale Read labels and count grams of carbohydrate at all meals and snacks Use your ratio to calculate insulin dose Bedtime BG goal: 110 to 150mg/dl

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