Let’s Count Carbs ™ Speaker: (Local CDE name) (CDE work location) Sponsored by: CCS Medical

What is a Carbohydrate (Carb)? Body’s main energy source 4 calories per gram 45-65% of calories Cereal, grains, fruit, milk and starchy vegetables 100% turns to glucose

Why Count Carbs? Helps stabilize blood glucose levels To feel better and have more energy No more “dieting” Gives you more flexibility to enjoy all foods

Guess Which Foods Have Carbs?

How Many Carbs Do I Need? Carbs per Meal ChoicesGrams Most Women Most Men

Portion Control Size of a deck of cards 1 Fist Light bulb Egg ½ Baseball 1 and ½ Baseballs 3 oz. 1 cup 6 oz. 1/3 cup ½ cup 1 ½ cups Visual ItemServing Size

Two Ways to Count Carbs Carb Choices  1 Carb Choice = 15 grams of Carb  1 Starch = 1 Fruit = 1 Milk Grams of Carb  Add up the total grams of Carb for all foods 1 cup milk & 1 small apple 15 grams + 15 grams = 30 grams

Plate Method

How Many Carbs? 3 oz. Pork Chop½ large corn on Cob 1-1/2 cups broccoli Milk 12 grams Pork chop 0 grams Corn on cob 15 grams Broccoli 15 grams Applesauce + 15 grams ½ cup sugar free applesauce 1 cup milk TOTAL = 57 grams or 4 choices

3 meat balls 1 small dinner roll 1 cup pasta 1 cup tossed salad greens Wine 0 grams Meat balls 0 grams Pasta w/ tomato sauce 30 grams Dinner roll 15 grams Salad greens 0 grams Salad dressing + 0 grams Wine* - 5 oz 2 Tbsp. Salad dressing * According to the ADA, “If adults with diabetes choose to use alcohol, daily intake should be one drink per day or less for adult women and two drinks per day or less for adult men”. How Many Carbs? TOTAL = 45 grams or 3 choices

How Many Carbs? Coffee w/ sugar 15 grams Salmon 0 grams French fries 15 grams Cabbage 15 grams Grapes + 15 grams 1 cup coffee w/ 3 sugar packets 3 oz salmon 17 grapes 1 cup french fries 1 ½ cups cooked red cabbage 0 15 TOTAL = 60 grams or 4 choices

Carb Counting vs. Carb Guessing Carb Guessing  Hypoglycemia  Hyperglycemia Carb Counting  Use measuring cups 1 time per week  Use references:  Calorie King book  Food Exchange Lists for Diabetes   Food labels

Combination Foods Casseroles: 1 cup = 2 Carbs (30 grams) + 2 meats Soup / stew: 1 cup = 1 Carb (15 grams) + 1 meat fats Sandwiches: 1 = 2 Carbs (30 grams) meats

More Combination Foods Submarine Sandwich: 6 inch = 3 Carbs (45 grams) + 2 meats Pizza: Thin crust, ¼ of a 12 inch (6 oz) = 2 ½ Carbs (37 ½ grams) + 2 meats + 1 ½ fats

Snacks For in-between meal snacks: Snack Ideas 1-2 Carb choices (15-30 grams) ¾ oz pretzels or chips 15 grams ½ cup regular ice cream or 2 “fun size” candy bars 22 ½ grams ½ cup regular pudding 30 grams 5 vanilla wafers or 2 small cream filled cookies 15 grams 3 cups popcorn 15 grams

Not All Carbs Are Created Equal Healthy eating is an important part of Carb counting  Whole wheat pastas, breads, grains and fruits High fiber foods may slow the rise of blood glucose after eating Some fiber is not digested or absorbed Some fiber can be subtracted from the Total Carbohydrate on the nutrition label  Low-fat dairy for heart health

Fiber and Sugar Alcohols For example: Total Carbohydrate 30 grams Dietary Fiber 10 grams 30 grams (Total Carbohydrate) - 5 grams (half of dietary fiber) 25 grams of Carb to count The same rule applies for sugar alcohol

What About These Foods? Pizza Chinese food Mexican food Movie popcorn with butter Ribs Burger & fries Pancakes with butter & syrup Buffets Holiday meals High-Fat & High-Carb

How to calculate insulin dose by counting Carb choices Insulin prescribed by a Doctor: “1 unit of insulin for every Carb choice” ¾ cup cereal + ½ banana + 1 cup milk How many Carb choices are in this meal? How many units of insulin are needed? 1 unit x 3 Carb choices = 3 units of insulin 3

Insulin prescribed by MD: “1 unit of insulin for every 15 grams of Carb” 1 burger patty + 1 hamburger bun + ½ cup peas + 1 small apple How many grams of Carb is in this meal? How many units of insulin are needed? How to calculate insulin dose by counting Grams of Carbs grams of Carb ÷ 15 = 4 units of insulin

How Do I Know If I Counted Right? Check blood glucose before meals and 1-2 hours after meals  Before meal blood glucose shows if basal insulin or long-lasting insulin is sufficient  After meal blood glucose shows how different amounts of Carb and insulin affect blood glucose Goals:Before Meals1-2 hours After Meals ADA mg/dLless than 180 mg/dL AACEless than 110 mg/dLless than 140 mg/dL ADA - American Diabetes Association AACE - American Association of Clinical Endocrinologists

What If I Counted Wrong? Blood glucose too high – too many Carbs Blood glucose too low – not enough Carbs Check portion sizes Rate of digestion/absorption:  Simple sugars = minutes  Complex Carbs = ½ hours or more  Fat and protein take several hours

What Can I Do Better Next Time? Importance of keeping records  To recall how different foods effect blood glucose levels  Individual effects Learn from your mistakes  Review what you ate  Check blood glucose to see if it was too much or too little

Tools You Can Use CCS Medical Log book

Other Tools From CCS Medical: Let’s Count Carbs Teaching sheet CCS Medical Education Book Healthy Options Restaurant Guide Others: ADA’s Choose Your Foods Bowes & Church’s Food Values The Calorie King ADA’s Restaurant Guide

Thank you! Questions?

Local Resources CDE Name: Contact info: Location: Classes offered: Support Groups:

References American Diabetes Association and American Dietetic Association, “Choose Your Foods: Exchange Lists for Diabetes”, Start_ final.pdf onsistency.pdf Hope S. Warshaw, MMSc, RD, CDE; Karmeen Kulkarni, MS, RD, CDE. Complete Guide to Carb Counting, 2001.

References “American Diabetes Association: Diabetes Care,” volume 32, Supplement 1, January 2009, S 22. “Endocrine Practice,” volume 13, Supplement 1, May/June 2009, p. 16 CCS Medical educational materials:  Let’s Count Carbs ™  Diabetes Nutrition Placemat  Healthy Options Restaurant Guide

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