Carbohydrate Counting
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Medical nutrition therapy for diabetes mellitus, including slides on alcohol intake, exercise, and hypoglycemia.
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Carbohydrate Counting
- 1. Carbohydrate Counting Emily Todhunter
- 2. Goals of MNT Maintain blood glucose levels as near to normal as possible by balancing food intake with medication and activity level Glucose control to prevent or reduce risk of complications Improve cholesterol and triglyceride levels Control blood pressure Manage weight
- 3. Goals of MNT Prevent and treat chronic complications through lifestyle changes in addition to MNT (watch protein intake related to kidney function) Feel better Improve overall health
- 4. Guidelines for Meal Planning Coordinate meals with insulin/medications Pay attention to total energy intake According to the Mayo Clinic, your daily intake of calories should consist of: Carbohydrates 45% to 65% Proteins 15% to 20% Fats 20% to 35% Watch sodium intake Balance meals with exercise
- 5. Meal Spacing Evenly spacing out your meals and snacks throughout the day will help keep your blood sugar levels stable. General guidelines say to wait at least 2 hours (but no more than 5 hours) between meals and snacks during the day.
- 6. Carbohydrate Intake Eat about 2-3 carbohydrate servings (30-45 grams) at each meal for women and 3-4 carbohydrate servings (45-60 grams) at each meal for men. Both men and women should limit carbohydrates at snacks to 1-2 carbohydrate servings (15-30 grams).
- 7. Protein Intake Consider adding a little lean protein to every meal and snack. Small portions of protein do not raise BG levels Protein may help slow down the rate at which carbohydrates are digested, and typically help individual feel full longer.
- 8. Fat Intake Those with diabetes are at increased risk of heart disease and stroke because diabetes can accelerate the development of clogged and hardened arteries. <7% of calories from saturated fats Avoid trans fats Chose monounsaturated (such as olive and canola oils) and/or polyunsaturated (found in nuts and seeds). <300 mg cholesterol
- 9. Fiber Intake Eating fiber-rich foods can help keep BG stabilized because it slows the rate at which carbohydrates are digested. Insoluble fiber (found in whole-wheat flour, wheat bran, nuts and many vegetables) Soluble fiber (found in oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium) Ingestion of large amounts of soluble fiber (approx. 50g) appears to improve BG levels. 25-35 g/day
- 10. Patient Education Teaching which foods are carbohydrates (fruits, grains, starchy vegetables, milk, sweets) Average portion sizes How many servings to select at meals Frequent follow-ups with RD
- 11. Carbohydrate Counting Calculate the total grams of carbohydrate (regardless of source) Advantages: Places emphasis on carbs Nutrition fact labels make any food ok More flexibility in menu planning
- 13. Carbohydrate Counting 1 carbohydrate choice = 15 grams carbohydrate Exchange list: Starch = 15 g carbs Fruit = 15 g carbs Milk = 12 g carbs Vegetables = 15 g carbs (3 servings)
- 14. “Free Foods” <5 g carbs, <20 calories/serving Non-starchy vegetables Leafy Greens Cruciferous vegetables Allium vegetables “Fruits” – cucumbers, squash, peppers, tomatoes Artificially-sweetened coffee and tea, diet soda, sugar-free gelatin, seasonings, condiments, sugar substitutes and non-dairy creamer
- 15. Sample Meal Plan Carbohydrate Breakfast Count 1 scrambled egg 0 2 slices whole-grain toast 2.0 (30 grams) 1 tsp margarine 0 1/2 cup orange juice 1.0 (15 grams) Breakfast Total: 3.0 (45 grams) Carbohydrate Snack 1 Count 1 medium orange 1.0 (15 grams) Snack Total: 1.0 (15 grams)
- 16. Sample Meal Plan Lunch Carbohydrate Count 1 cup skim milk 1.0 (15 grams) 2 slices bread 2.0 (30 grams) Low-fat mayo 0 3 oz. turkey 0 Lettuce and tomato 0 Lunch Total: 3 (45 grams) Snack 2 Carbohydrate Count 6 oz. light yogurt 1.0 (15 grams) Snack Total: 1.0 (15 grams)
- 17. Sample Meal Plan Dinner Carbohydrate Count 1 medium sweet potato 2.0 (30 grams) 1 tsp margarine 0 1 cup skim milk 1.0 (15 grams) 4 oz. baked chicken breast 0 1/2 cup cooked broccoli 0 1 cup salad 0 2 Tbsp low-fat dressing 0 Dinner Total: 3 (45 grams) Snack 3 Carbohydrate Count 1 small apple, sliced 1.0 (15 grams) 2 Tbsp peanut butter 0 Snack Total 1.0 (15 grams)
- 18. Net Carbs Grams of fiber may be subtracted from total carbohydrate if food contains 5g or more fiber/servings. IE: All-Bran Multi-Grain Crackers 18 crackers = 19 g carbs, 5 g fiber So would count as 14 g of carbohydrate
- 20. Alcohol Include only when BG in good control Alcohol lowers BG Research has shown that acute consumption increases insulin secretion, causing low blood sugar, and can also impair the hormonal response that would normally rectify the low blood sugar. Drinking as little as 2 ounces of alcohol on an empty stomach can lead to very low blood sugar levels
- 21. Alcohol Beverage Serving Size Calories Carbohydrates Beer, regular 12 oz 150 13 g Beer, light 12 oz 100 5g Beer, non-alcoholic 12 oz 75 16 g Distilled spirits* 1.5 oz 100 trace Martini 5 oz 310 4g Wine, red 4 oz 80 2g Wine, white 4 oz 80 1g
- 22. Exercise Helps keep weight down Helps keep blood pressure down Can help raise HDL cholesterol, lower LDL cholesterol Helps body use insulin more effectively Can lower BG levels (May need to adjust carbohydrate intake/insulin dose to avoid hypoglycemia)
- 24. MNT for Hypoglycemia Immediate treatment with carbohydrates is essential If the BG falls below 70 mg/dL, treat with 15g of carbohydrates: 3 glucose tablets Fruit juice or regular soft drinks, ½ cup 6 saltine crackers 1 tablespoon syrup or honey
- 25. MNT for Hypoglycemia Wait 15 minutes and retest. If the BG level remains <70 mg/dL, treat with another 15g carbohydrates Repeat testing and treatment until the BG level returns to within normal range Evaluate the time to next meal or snack to determine need for additional food
- 26. Summary Type II Diabetes affects millions of adults & children in the US 1st priority is to adopt lifestyle interventions that improve abnormalities of glycemia, dyslipidemia, and hypertension. Consistent & regular meal patterns & meal compositions Patient education is key!
Notas do Editor
- These interventions should be implemented as soon as the diagnosis of diabetes is made.If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight. The more you vary from your food plan, the Mayo Clinic informs, the more your blood glucose will fluctuate.
- Eating at regular intervals will help to prevent your blood sugar level from going either too high or too low
- A general recommendation is to:
- Meat & Meat Alternatives = nuts, eggs, tofu, etc.Amount determined by patient’s healthcare professional
- Consume healthy fats in moderation7% of calories from saturated fats = 14 grams on a 1800 calorie/day diet
- Insoluble fiber increases the movement of materials through your digestive system.Soluble fiber is more important for diabetics. It dissolves in water to form a gel-like material and can help lower cholesterol levels.However, it is unknown if regularly consuming that much fiber each day is realistic for most people.
- Follow-ups with an RD can provide problem-solving techniques, encouragement, and support that lifestyle changes require.
- Certain foods do not tend to raise blood sugar levels and can be used to help “fill in” your meal plan with little worry about their blood sugar affects. Have few carbohydrates and calories, count as “0” carb choicesPORTION CONTROL IS KEYLimit to 3 choices a day
- -Controlled diabetes when A1c is less than 7%Moderate consumption = 1 drink/day for women, 2/day for menAlcohol consumption (in excess) can lead to problems with weight control
- Dizziness, confusion, blurred vision all symptoms of hypoglycemia as well as intoxicationSome alcoholic beverages can raise your blood sugar because of their high carbohydrate content. To prevent your blood sugar from going to high, avoid sweet wines, liqueurs, and sweetened drinks like daiquiris, margaritas, pina coladas, etc. and choose lower-carb drinks.
- These five benefits have a DIRECT bearing on how successfully you manage your diabetes. Exercise also has other general health benefits - you sleep better, your mental state improves, etc.
- If it is more than 1 hr to next meal, test again 1 hr after treatment to see if additional carbohydrates are needed.
- If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight.