1. ARE ALL CARBS CREATED EQUAL?
Cory Eck MCN RD LD
Diabetes Educator
Texas Health Presbyterian Plano
June 6th 2015

2. Cory Eck
MCN RD LD
Education:
 BS Nutritional Sciences, Penn State
University
 Penn State Varsity Track and Field, NCAA
Academic All-American
 Masters of Clinical Nutrition, UT
Southwestern
Type 1 diabetic, 13 years
@TheEcksfactor
2
Professional:
Cook Children's Fort Worth, TX
Pediatric Endocrinology Dietitian, 2.5
years
Texas Health Presbyterian Plano
Diabetes Educator since February
2015

3. Objectives
Understand the difference between fast and
slow carbs
Understand the basics of the Glycemic Index
Understand effects of fat and fiber on
carbohydrate absorption
Understand how to modify insulin injections
for high fat meals, i.e. pizza

4. Carbohydrates
Simple: Glucose or
fructose or Lactose
Complex: Starches
and fibers
 Fast: Juice, Hard
candy, Soda and low-
fat sugary desserts
 Slow: Breads, starchy
vegetables, whole
fruits and milk and
yogurt
Simple vs. Complex Fast vs. Slow

5. Simple Vs. Complex
5
Chocolate bar
Potato
Banana
Lifesaver
Agave Nectar
Wheat Bread
Milk
Greek Yogurt
Orange Juice
Jello
Brownie
Peanut Butter
Pizza
Ketchup
White Bread

6. Fast Vs. Slow
6
Chocolate bar
Potato
Banana
Lifesaver
Agave Nectar
Wheat Bread
Milk
Greek Yogurt
Orange Juice
Jello
Brownie
Peanut Butter
Pizza
Ketchup
White Bread

7. Glycemic Index
Measurement of how much a
food raises your blood sugar
 Compared to plain white sugar
 Scale of 0-100: Low <55, Medium 56-69,
High ≥70
 Must also consider amount of carbs or
the glycemic load
Benefits of Low GI foods
 Less increase in blood sugar
 Increased fullness due to increased fiber
 Lower your risk of heart disease

8. Glycemic Index
What lowers a foods GI?
 Type of carbohydrate it contains
 Increases in fiber
 Less processing
 The amount of fat the food contains
Are all low GI foods good for me?
Baked Potato Potato Chips Sweet Potato
GI = 76 GI = 54 GI = 61

9. Glycemic Index
GI is affected by cooking method
 Frying vs. Baking
 Hot vs. Cold
 Acids that are added
Need to consider the glycemic load
 Rise in BG also depends on the amount of carbs
 Are their too many variables to consider?
9

10. Glycemic Index
Food Type
Low GI (≤55)
Choose most often
Medium GI (56-69)
Choose more often
High GI (≥70)
Choose less often
Breads
100% ground wheat/grain
Pumpernickel
Whole wheat or rye
bread/bagel/tortilla
Pita- white or wheat
White
bread/bagel/tortilla
Kaiser roll
Cereals
All-BranTM
Oat BranTM
Oatmeal or quick oats
Puffed wheat
GrapenutsTM
Rice KrispiesTM
Corn Flakes
Bran Flakes
Grains
Parboiled or converted
rice
Barley, bulgur or quinoa
Pasta/noodles
Brown rice
Basmati rice
Couscous
Short grain rice
Other
Legumes- Lentils, chick
peas, kidney, soy, black,
baked
Potato Chips
White/red/sweet(yam)
potato
Sweet or Popped corn
Wheat thins or rye crackers
Bean soups
French Fries
Baked potato
Pretzels
Soda crackers
Rice cakes
Fruit
Whole fresh or frozen
fruit
Cantaloupe, pineapple
Fruit Juice
Watermelon
10

11. Fat and Fiber
Slows stomach
emptying
Slows carbohydrate
absorption
Can create
temporary insulin
resistance
Slows stomach
emptying
Improves post meal
satiety
Reduces overall rise
in blood sugar
Keeps you regular
Fat Fiber

12. Fat and Fiber
Meal 1 Hour 2 Hour 3 Hour 4 Hour
BloodGlucose
White Bread
Legumes
French Fries
Insulin
Target Blood
Sugar
Insulin Onset Peak Duration
Humalog®, Novolog®, Apidra® 10-15 minutes 60-90 minutes 3.5-5 hours

13. Adjusting Insulin Administration
Provide insulin 15-20 minutes early with most meals
 If blood sugar <100mg/dL wait till meal time
 If blood sugar >150mg/dL consider 30 minutes
With Multiple Daily Injections:
Provide meal bolus insulin pre- and post- meal:
 High fat foods with carbs
 Correction and 50% of meal bolus before, remaining 50% of meal bolus 30
minutes-1hr later

14. Adjusting Insulin Administration
With Insulin Pump Therapy
Calculate all meal and correction boluses utilizing the
bolus calculators
 Use can reduce average BG by 25mg/dL
 Pumps can provide insulin for ALL carbs!!!
Utilize advanced bolus features
 High fat foods with carbs, grazing, or at party
 Combo/Dual Wave or extended/square wave bolus
 ≥1 advanced bolus per day can produce better blood sugar control

15. Carbohydrate Counting Pizza
Identify all sources of carbohydrate:
 Crust-
 Thin crust pizzas are usually 5g less per slice
 Subtract 5-10g carb/crust that doesn’t get eaten
 Sauce-
 Cheese-
 Toppings-
 1/8 12” Pizza = 25g, +5g w/ each additional inch
Yes, choose wheat to lower GI
Yes, ½ cup = 10-15g carb; more for BBQ sauce
Yes and No; Yes for fruits, potato's, noodles or
sweets
No, but the more you add the more fat their is

16. Taking Insulin for Pizza
MDI:
 2 Injection: Correction and 50% 15 minutes early, remaining
50% following meal
 The more fat there is the more the delay
Insulin Pumps:
 Low fat Pizza- 15-20 minutes early
 High fat Pizza (>10g fat)- Utilize combo/dual wave bolus
 50% 15-20 minutes early
 50% over the next 2-4 hours
 Start with 2 hours and extend longer as needed

17. Conclusions
Identify your carbohydrates
Determine the GI of the food
 Simple vs. complex, fiber, fat and how processed the food is
Count ALL your carbs!
Adjust you insulin administration times
 Open that Ferrari up on the highway of life

18. Questions?