AN INTRODUCTION TO CARBOHYDRATE COUNTING

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1 AN INTRODUCTION TO CARBOHYDRATE COUNTING Information Leaflet Your Health. Our Priority.

2 Page 2 of 10 Carbohydrate counting The aim of carbohydrate counting is to allow you to have the freedom to choose whatever food you wish to eat or drink and still maintain good blood glucose levels. To do this, you will need to be able to calculate the right dose of insulin for the food you have chosen to eat or drink. What is carbohydrate? Carbohydrate is often abbreviated to CHO. It is the main nutrient in our food that affects blood glucose (sugar) levels. Digestion breaks down the food we eat. The carbohydrate in food is broken down to glucose, which is then released into the blood. Blood glucose is the body s main source of fuel and requires insulin to enable it to pass from the blood stream into the body cells. Why count carbohydrate? Carbohydrate is the main nutrient that affects blood glucose levels. Carbohydrate counting allows insulin to be matched to the food eaten. By estimating your carbohydrate intake, you can learn to predict your blood glucose response to different foods. Experience has shown that to begin with, for many people, eating 10grams (g) of carbohydrate will need 1 unit of bolus insulin. For example, if you estimate the carbohydrate content of a meal to be 60g you will need to give yourself 6 units of bolus insulin. Will I need to change my diet? Your carbohydrate intake will continue to be based on what you eat at present. Your dietician will be able to help you estimate the carbohydrate content of your meals and snacks. You will not need to make changes to your diet, but you are encouraged to follow a balanced, varied diet. What is the advantage? By estimating the amount of carbohydrate in your food, you will be able to match your insulin accordingly. Carbohydrate counting, and adjusting your insulin dose, can lead to improved diabetes control. This gives you the freedom to eat when you want, what you want and the amount you want according to your appetite.

3 Page 3 of 10 Sources of carbohydrate Starchy CHO CHO as sucrose CHO as fructose CHO as lactose / glucose These foods often form the basis of meals, e.g. potatoes, rice, breakfast cereals, bread, chapattis, couscous, noodles, pasta Starchy CHO can be absorbed slowly or quickly, depending on its glycaemic index. These are an important part of a balanced, varied diet as they provide energy, fibre, vitamins & minerals. Food and drink with large amounts of sugar / added sugar including: sugar, honey, sugary drinks, jellied sweets, boiled sweets, dextrose tablets, ordinary fizzy pop, fruit juices These raise blood glucose levels very quickly. If eaten regularly they may cause weight gain / erratic blood glucose control. Whether dried or fresh, fruit is naturally sweetened by fructose including: apple, orange, raisins, strawberries, mango. When eaten whole, these will raise blood glucose levels gradually. These are an important part of a balanced, varied diet as they provide essential fibre, vitamins & minerals. Liquid dairy products can contain a milk sugar called lactose e.g. milk, yoghurts, ice cream, crème fraiche, fromage fraise. These will raise blood glucose levels gradually. These are an important part of a balanced, varied diet as they provide essential vitamins & minerals. *Cheese is a protein * Condiments such as ketchup, bbq sauces, sweet chilli sauce, chutneys, pickles, and relishes contain carbohydrate. Salad dressings and balsamic vinegars often have sugar added. Other sources of carbohydrate include breadcrumbs, batter and pastry on meat, poultry, fish and vegetables e.g. fish fingers, sausage rolls, pastry lid and bases on pies, vegetable samosa and dumplings. Breadcrumbs and rusk can also be added to sausages and burgers during manufacturing, so please check food labels for the amount of carbohydrate. High fat foods Occasionally you may have foods than are higher in fat than usual e.g. take away foods such as pizza, or puddings such as profiteroles. Fat slows down the absorption of carbohydrate. This can mean that when you give your bolus insulin, it might have finished working before all your carbohydrate has been absorbed.

4 Page 4 of 10 How do I count carbohydrate? You will also be given a food reference list with this booklet which you may find useful to help estimate the amount carbohydrate you eat. As well as using the list, you can also estimate the amount of carbohydrate by looking at the nutrition label on packaging. When estimating carbohydrate content from packaging, look at the Total Carbohydrate value given (not carbohydrate from sugars ). Tools for counting carbohydrate: Digital weighing scales Measuring cups/spoons Food labels Food photographs To start, remember. 10g carbohydrate increases blood glucose levels by 2-3mmols on average. The following foods contain approximately 10g carbohydrate: 1 tablespoon of cooked rice (30g in weight) 1 tablespoon cooked pasta (30g in weight) 1 egg sized potato (60g in weight) 3-4 medium cut chips (40g in weight) 1 scoop of mashed potato 10g carbohydrate is also known as 1 CP (carbohydrate portion). Top tips for carbohydrate counting Handy things to have in the kitchen: scales, calculator, measuring cups Serve rice/pasta separate to sauce Become familiar with personal portions using favourite plates, bowls, cups Create your own lists of the common foods you eat Practice makes perfect

5 Page 5 of 10 Calculating carbohydrate using reference lists Reference lists are often known as food tables. They often give carbohydrate values in 2 ways: 1) Per serving / portion If you prefer to use per serving/portion you will need to check that your portion matches those given. 2) Per 100g If you prefer to use per 100g you need to know the weight of the portion you are having, to calculate the CHO content. Equation for calculating amount of carbohydrate in weighed foods Weight of food (g) x amount of CHO per 100g = CHO in portion 100 Example 1 87g cooked rice (CHO content = 32g per 100g) 87 x 32 = 28g CHO 100 Example 2 75g boiled potatoes (CHO content 16g per 100g) 75 x 16 = 12g CHO 100 In time, with practice and by using handy measures, you will learn to estimate the carbohydrate content of foods. Please note you can also work out carbohydrate by using this calculation: Amount of carbohydrate per 100g x weight of food (g) 100

6 Page 6 of 10 Calculating carbohydrate using food labels Example 1 Pepperoni pizza (300g) Typical values Per 100g Per serving 150g energy 295kcal 443kcal carbohydrate 27.6g 41.4g of which sugars 3.4g 5.1 fat 12.2g 18.3 If you ate the whole pizza, you would have consumed 2 servings. 2 x 41.4 = 82.8g carbohydrate (or 9 CPs). Example 2 Pasta shapes 90g of dry pasta will typically produce180g of cooked product. Typical values (dry Per 90g Per 100g weight) energy 314kcal 349 kcal carbohydrate 66.2g 69.1g of which sugars of which starches fat 1.5g 1.7g This information above tells you that the pasta doubles in weight when cooked according to the instructions. It is usually more practical to weigh food like pasta and rice after cooking, but the values above for dry pasta. If you weigh this product once cooked, you could halve the amount and then compare with the values shown, but it is important to follow the cooking instructions. So 150g of cooked pasta is equal to 75g dry weight pasta Therefore use the equation on previous page 75/100 x 69.1g = 51.8 carbohydrate (or 5 CP s)

7 Page 7 of 10 Working out carbohydrates using recipes Checking ready meal labels can help you to estimate the carbohydrate in homemade versions. However, it is worth working out the carbohydrate content of your favourite recipes to make sure you have accurate values. To work out carbohydrate in homemade foods: 1) Write down all the ingredients. Note: a. the amount of carbohydrate each ingredient has per 100g (CHO/100g) b. the weight of each used ingredient in the recipe (g). 2) Work out how much carbohydrate is in each ingredient using the method below. Weight of food (g) 100) x amount of carbohydrate per 100g = CHO value 3) Add all the ingredients carbohydrate values together. This is the total amount of carbohydrate in the whole recipe. 4) Divide this total by the number of portions to give the amount of carbohydrate per portion. The examples below show you how to work out the carbohydrate for two recipes. Cherry Scones Makes 8 scones Ingredients CHO/100g Weight (g) Calculation CHO/ingredient flour x margarine - 50g - - sugar g x milk 5 125mls x egg - 1 egg - - glace cherries x whole recipe Total carbohydrate in scone = 28g Macaroni Cheese serves 2 Ingredient CHO/100g Weight (g) Calculation CHO/ingredient mararoni x (uncooked weight) cheese - 150g - - flour 67 40g x margarine - 40g - - milk 5 375mls x whole recipe 113 Total carbohydrate per serving macaroni = 57g

8 Page 8 of 10 Useful resources for counting carbohydrate Carbs & Cals: A Visual Guide to Carbohydrate & Calorie Counting for People with Diabetes by Chris Cheyette 4 th Edition (released 29 Nov 2010) available at and Collins Gem Calorie Counter Published by Collins Food and Diet Counter Published by Hamlyn CARBS COUNT by Diabetes UK available at diabetes UK website. It is printable and has an accompanying app available for smart phones.

9 Page 9 of 10 Weights and measures conversion chart Imperial Metric ½ oz 10g 1 oz 25g 2 oz 50g 3 oz 75g 4 oz 110g 5 oz 150g 6 oz 175g 7 oz 200g 8 oz (1/2 lb) 225g 12oz (3/4 lb) 350g 16 oz (1 lb) 450g 1 teaspoon (tspn) 5ml 1 tablespoon (tbspn) 15ml 5 fl oz (1/4 pint) 150ml 10 fl oz (1/2 pint) 275ml 15 fl oz (3/4 pint) 425ml 20 fl oz (1 pint) 575ml 1 cup = 250mls standard metric cup Contact us Dietitian s name: Dietetic contact numbers: Acute Dietitian Nutrition and Dietetics, Inpatient Therapies, Stepping Hill Hospital, Stockport, SK2 7JE Tel: Community Dietitian Nutrition and Dietetic Service, Regent House, Heaton Lane, Stockport SK4 1BS Tel:

10 Page 10 of 10 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number OUT39 Publication date August 2014 Review date August 2016 Department Inpatient Therapies Location Stepping Hill Hospital

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