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Gary Scheiner, MS, CDE Improving Diabetes Control with Accurate Carb Counting.

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Presentation on theme: "Gary Scheiner, MS, CDE Improving Diabetes Control with Accurate Carb Counting."— Presentation transcript:

1 Gary Scheiner, MS, CDE Improving Diabetes Control with Accurate Carb Counting

2 Carbohydrate Counting Advantages –Fewer high BGs –Fewer low BGs –No off limits foods –Flexibility in meal & snack quantities The Frozen Tundra

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4 Carbohydrate…. rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols.. moderate digestion, partial absorption as glucose (50%) Protein…………… slow digestion, partial conversion to glucose* (~40%) Fat…………………. slow digestion, little conversion to glucose** (<20%) Timed Effect on Blood Sugar Levels * In absence of dietary carbs ** may cause insulin resistance in large qty

5 MEET THE CARBS! Glucose Fructose (fruit sugar) Galactose Dextrose Lactose (milk sugar) Sucrose (table sugar) flavored simple sugars: Maltose High-Fructose Corn Syrup Molasses Brown Sugar Honey

6 MEET THE CARBS! Fruit Fruit Juice Candy Regular Soda Punch Wine Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly

7 MEET THE CARBS! branched chain G – G – G – G – G - G G – G / \ / G – G G G – G – G G – G – G \ / \ / G – G – G – G – G – G G – G – G – G – G – G \ \ G – G – G G – G – G – G – G straight chain G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G

8 MEET THE CARBS! Potatoes Rice Noodles/Pasta Cereal Oatmeal Bread Tortillas Pancakes Waffles Crackers Bagels Pizza Beans Corn Pretzels Chips Popcorn Beer

9 Now meet the lesser known carbs (discount 100%!) (discount 50%!) Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol (Rare… can ignore!)

10 The fate of dietary carbohydrates Simple Carbohydrates (sugars) Complex Carbohydrates (starches) Blood Glucose

11 Does the Type of Carbohydrate Matter? Glycemic Index All carbs (except fiber) convert to blood glucose eventuallyAll carbs (except fiber) convert to blood glucose eventually G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestionG.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours)G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours)

12 Does the Type of Carbohydrate Matter? Glycemic Index (contd.) Example:Spaghetti GI = 37 Only 37% of spaghettis carbs turn into blood glucose in the first 2 hours. The rest will convert to blood glucose over the next several hours.

13 Does the Type of Carbohydrate Matter? Slow StuffAverage StuffFast Stuff Pasta Legumes Salad Veggies Dairy Chocolate Fruit Juice Pizza Soup Cake Breads/Crackers Salty Snacks Potatoes Rice Cereals Sugary Candies

14 Ultimately, The Amount of Carbohydrate is More Important Than the Type

15 CARB BASICS QUIZ – True or False Equal amounts of sugar and starch will raise blood glucose the same amount. Fiber will raise blood glucose levels a little bit. Sugar-Free chocolate (made with sugar alcohol) will not raise blood glucose levels.

16 Methods for Counting Carbs Accurately The Exchange system Food package labels Resource listings Portion estimation Carb factors

17 The Exchange System Foods with common nutrient values are grouped together.

18 Practice Counting Carbs Using the Exchange system Breakfast Exchange/# Grams 1 large bagel (4 oz)starch (4) x 15 60g 1 tsp. margarine fat (1)x0 0g 1/2 cup orange juice fruit (1) 15g 6 oz skim milkmilk (3/4) x 12 9g Total Carbs: 84g

19 Nutrition Facts Label Method Labels are the best resource for carbohydrate counting Pay attention to: –Serving Size –Total Carbohydrate –Fiber & Sugar Alcohol (if any)

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21 Fiber and Carbohydrate Counting Included in total carbohydrate Does not convert to glucose Subtract fiber from the Total Carbohydrate

22 Fiber and Carbohydrate Counting For example: 13 g Total Carb - 3 g dietary fiber Count as 10 grams carbohydrate

23 Sugar Alcohols and Carbohydrate Counting Artificial Sweeteners Found in chewing gum, mints, yogurt, ice cream, cookies and candy Digest slowly and partially ( 50%) Can cause diarrhea

24 Carbohydrate Counting Using Books Use for foods without a Nutrition Facts Label –Fresh fruits –Fresh vegetables –Ethnic foods –Fresh baked goods –Restaurant foods

25 Carbohydrate Counting Using Websites USDA Food Composition –www.nal.usda.gov/fnic/foodcomp/search/www.nal.usda.gov/fnic/foodcomp/search/ Calorie King –www.calorieking.comwww.calorieking.com Fast food companies or food manufacturers websites

26 Arbys: Boston Market: Burger King:www.bk.com/Food/Nutrition/NutritionWizard/index.aspxwww.bk.com/Food/Nutrition/NutritionWizard/index.aspx Dairy Queen: US/Menus+and+Nutrition/Nutrition+Charts/default.htmwww.dairyqueen.com/en- US/Menus+and+Nutrition/Nutrition+Charts/default.htm Dennys: Dunkin Donuts: KFC: McDonalds: Old Country/Hometown Buffet: Pizza Hut: Starbucks: Subway: Taco Bell: Wendys:

27 Insulin Pump Carb Databases Accu-Chek Spirit Palm Software Animas IR 1200, 1250, 2020 Deltec Cozmo 1800 OmniPod PDM

28 Portion Estimation Method Use common, everyday objects to measure the portion size of food –Soda can (12 fl.oz.) = 1 ½ cups –Baseball or adults fist = 1 cup –Childs fist = ½ cup –Adults spread hand = 8 diameter –Adults palm = 4 diameter

29 Portion Estimation Method Examples of 1-cup Carb Estimates: Potato: 40g Pasta: 40g Rice: 50g Rolls: 25g Cereal: 25g Fruit: 20g Cooked Veggies: 10g Salad Veggies: 5g Corn: 30g Peas: 30g Beans: 40g Pretzels: 25g Chips: 15g Popcorn: 5g Ice Cream: 35g Cake: 45g

30 Portion Estimation Method Estimate the carbs: 20g/cup X 1 ¼ cups 25g

31 Portion Estimation Method Estimate the carbs: 5g / cup X 3 cups 15g

32 Portion Estimation Method Estimate the carbs: 25g / cup X 1 ½ cups 38g 12g / cup X 1 cup = 12g Total = 50g

33 Portion Estimation Method Other tricks: Long Sandwiches 8g per inch Pizza 30g per adult hand-sized piece (fingers together) Cookies 20g per adult-sized palm Breaded meat/veg/cheese 4g small (thumb/nugget sized) 10g large (patty/palm-sized)

34 Portion Estimation Method Estimate the carbs: 30g / hand X 1 1/3 hands 40g

35 Carbohydrate Factor Method Weigh a portion of food Multiply the weight by its carb factor* Get total carb count *A carb factor is the percentage of the foods weight that is carbohydrate. The rest is water, protein, fat, minerals

36 Carbohydrate Factor Method Salter 1450

37 Carbohydrate Factor Method Carb Factor Examples: Apple:.13 Apple Pie:.32 Bagel:.51 Carrot (raw):.06 Chocolate Cake:.51 Cornbread:.45 Pancake:.28 For carb factors for more than 6000 foods (in Excel spreadsheet format), go to: factor.xls factor.xls Pizza (cheese):.32 Potato, baked:.22 Potato Salad:.09 Rice:.27 Spaghetti:.26 Vanilla Ice Cream:.23 Watermelon:.06

38 Carbohydrate Factor Method How much carb is in a baked potato weighing exactly 300 grams? A.36g B.46g C.66g D.86g 300 x.22g = 66g carb

39 Measuring and Weighing Foods To be an accurate carb counter, weigh/measure at least once a week Practice, practice, practice! Test yourself against the label

40 Other Factors to Consider Fat –Lengthens time your stomach takes to empty –Delays rise in blood glucose –May cause temporary insulin resistance Protein –Very little effect on blood glucose (unless carb diet) –Usually combined with fat

41 Weight Gain and Carbohydrate Counting Your can gain weight if: Count carbohydrate, but ignore fat/calorie content of foods No limits placed on portion sizes Frequent snacking

42 Write it down! Blood glucose results Carbohydrate eaten Insulin or other meds Physical activity/exercise

43 Only count the carbs you actually consume! Jackie Scheiner Age 1

44 The Ultimate Guide to Accurate Carb Counting Gary Scheiner MS, CDE Integrated Diabetes Services In-Office, Phone & Online Consults 333 E. Lancaster Ave., Suite 204 Wynnewood, PA USA (877)


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