2. The University of Georgia Cooperative Extension Service Improving Diabetes Control with Carbohydrate Counting

3. Carbohydrate Counting Advantages 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

4. Carbohydrate Counting Advantages Easier - you only count carbohydrate Allows you more flexibility in food choices –Virtually any food can be worked into your meal plan

5. 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)

6. Why Count Carbohydrate?

7. 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

8. 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

9. Nutrients in Foods Carbohydrate Protein Fat (Vitamins, minerals, water)

10. What are Carbohydrates? bread, rice, cereal, potatoes, pasta, corn, peas, butter beans fruit, milk, regular sodas, candy, juices

11. Combination Foods That Contain Carbohydrate Pizza Spaghetti Sandwiches Casseroles Soups Stews

12. Which Contain Carbohydrate? Brunswick stew Brussels sprouts Sugar-free jello Skim milk Fat-free frozen yogurt Baked chicken Rice Orange juice Diet soda Oreos

13. 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

14. 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

15. 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)

16. 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

17. 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

18. 2 Ways to Count Carbohydrate Carbohydrate Choices Food Exchanges or Servings Carbohydrate Grams Specific number of grams of carbohydrate per meal or snack

19. Carbohydrate Choices (servings) Each food in fruit, starch, milk group contains about 15 grams carbohydrate One carbohydrate choice = 15 grams carbohydrate

20. Carbohydrate Choices Lunch: Exchanges Carbohydrate Choices 2 starch = 2 carb choices 1 fruit = 1 carb choice 1 milk = 1 carb choice 3 meat=0 carb choices 2 fat = 0 carb choices

21. 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

22. 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

23. 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

24. Resources for Counting Carbohydrate Food package labels Carbohydrate counting books Food Exchange booklets

25. Nutrition Facts Label Best resource for carbohydrate counting Pay attention to: –Serving Size –Total Carbohydrate

27. Food Label (Example 1) Your meal plan: 2 carb choices (30 grams carb) Food label (ice-cream): Serving size = 1/2 cup Total carbohydrate = 15 grams How much ice-cream should you have?

28. Food Label ( Example 2) If your meal plan at breakfast is: 45 grams carbohydrate Food label: Cereal Milk Serving size: 1/2 cup 1 cup Total Carb: 15 grams 12 grams How much cereal and milk should you have?

29. 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

30. Food Exchange Booklet Gives average carbohydrate values for many foods Pocket Guide available

31. Practice Counting Carbs #1 BreakfastChoices Grams 1 large bagel (4 oz) 1 tsp. margarine 1/2 cup orange juice 1 cup skim milk

32. Practice Counting Carbs #2 Dinner Choices Grams Spaghetti noodles 1  cups Spaghetti sauce,  cup Tossed salad with lettuce, tomato Garlic bread, 2 slices (2 oz) Diet Coke

33. 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

34. Write down: Carbohydrate eaten Times of meals Blood glucose results Diabetes pills or insulin Physical activity/exercise

35. What Else Affects Your Blood Glucose? Portions sizes –Large portions of carbohydrate increase blood glucose

36. What Else Affects Your Blood Glucose? Timing of food intake –Space food throughout day –Eat at regular times –Don’t skip meals

37. Measuring and Weighing Foods You can’t accurately count carbohydrate without weighing and measuring Weigh at least once a week Practice, practice, practice!

38. What to Weigh and Measure Weigh : Bread, rolls, bagels, some fruits, baked potatoes Measure : mashed potatoes, popcorn, pasta, rice, vegetables, fruit juice

39. Mixed Foods Containing Carbohydrate Macaroni & Cheese Soups Casseroles Lasagna Subs Beef Stew Spaghetti and Meatballs

40. Restaurant Dining 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

41. 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

42. Fast Food Restaurants #1 Subway® CarbExchanges Classic Italian 43 g2 1/2 starch 2 meat,1 veg, 1 fat Tuna - 6” 42 g2 1/2 starch 1 meat, 1 veg 5 fat

43. Fast Food Restaurants #2 McDonalds® CarbExchanges Hamburger 34 g2 starch, 1 meat, 1/2 fat 6-pc Chicken 15 g1 starch, 2 meat, McNuggets1 1/2 fat French Fries 57 g4 starch, 3 fat medium

44. Other Factors to Consider Fat –Slows down time your stomach takes to empty –Delays rise in blood glucose –High in calories

45. Other Factors to Consider Protein –Very little effect on blood glucose –Usually combined with fat

46. Weight Gain and Carbohydrate Counting You can gain weight if you: Count carbohydrate, but ignore fat content of foods Eat more high-calorie foods

47. 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

48. 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

49. So, enjoy the increased variety and flexibility with Carb Counting.....but watch the fat and calories!

50. Activity