2. IMAM REZA HOSPITAL Z. SAEEDREZAEE-NUTRITIONIST Jun 7, 2012

4. Estimating the carbohydrate content of food so that you can adjust your insulin dose to match the amount of carbohydrate you want to eat.

5.  Good glycemic control  Freedom to eat when you want to  Freedom to eat as little or as much as you wish ( more flexible in the diet & lifestyle)

7. SUGARS GLUCOSE CARBOHYDRATE STARCH FIBER Blood Stream Insulin Cells of body

8. CHO Starchy Vegetables & CHO

9. Approximately 15 grams of CHO Per serving CHO :  Starch  fiber

10. Fruit Group Approximately 15 grams of CHO per serving CHO  Sugar (Fructose, glucose, sucrose, Sugar alcohol)  Fiber  Low starch

11. Milk Group Approximately 12 grams of CHO per serving CHO : Sugar (lactose)

12. Other Carbohydrate Group Approximately 15 grams of CHO per serving CHO:  starch  Sugar  Low fiber

13. 1)Sugar occurs naturally in some unprocessed food : milk, fruit, vegetables, some grain 2)Added sugars that is added to foods and beverages : Include table sugar, brown sugar, corn syrup, molasses (saccharose, glucose,fructose,lactose, maltose, dextrose, maltodextrine, sorbitol)

14. Artificial sweeteners currently approved by the Food and Drug Administration (FDA) are:  Acesulfame potassium  Aspartame  Neotame  Saccharin  Sucralose

15. SUGAR FREE NO CARBOHYDRATE FREE

16. 1. Look at the “Serving size” 2. Look at the “Total Carbohydrate” in grams Total Carbohydrate: includes grams of sugar, sugar alcohol, starch, and dietary fiber 3. Subtract fiber and sugar alcohol from the “Total Carbohydrate”

18. the amount of rapid acting insulin given for the amount of carbohydrate eaten at a meal or snack Age (yr)Units Added Per 15 g CHO at meal 0 - 50/5 5- 120/75 12- 181-2 Ref:rence : Alemzade R,Wyatt DT.Diabetes Mellitus in Children.ln:Behrman RE,et al.Nelson,textbook of pediatrics.19 th ed,2010.

19. A correction (or sensitivity) factor can be used to determine how much extra insulin should be added to the insulin dose which will be given to cover the carb eaten. Age (yr)Units Added Per 100 mg/dl Above Target 0 - 50/5 5- 120/75 12- 181-2 Ref:rence : Alemzade R,Wyatt DT.Diabetes Mellitus in Children.ln:Behrman RE,et al.Nelson,textbook of pediatrics.19 th ed,2010.

20. BG befor breakfast : 130 Bread 2 slice (60 gr ) 2 U insulin Egg without CHO Milk ( 1 cup) 1 U insulin Apple jam( 1 tablespoon) 1 U insulin 4 U insulin Aspart inject After 2 h check BG

21. Small snack <15 gr CHO – no insulin needed Larger snack over 15 gr CHO insulin may be required

22. BG before lunch : 300 Cooked rice (1 cup) 3 U insulin Cooked lentils (1/2 cup) 1 U Meat,salad without CHO Yogurt (1/2 cup) 0/5 U 4.5 U insulin + 1.5 U insulin After 2 h check BG

23. Before Breakfast 2 hours after breakfast Befor lunch 2 hours after lunch Befor dinner 2 hours after dinner 3 am

24.  Quick acting: French bread,mashed potato, cake inject before meal  Slow acting : pasta, whole bread, legums inject after eating  High fat &/or high protein slows up rise in blood sugar : Pizza, fish & chips ½ insulin just after eating and the other ½ 30 – 45 minutes later

25.  Need to skilled in making calculation  Possible weight gain if high calorie foods intake is not monitored

26.  Low sugar, avoid sugary drinks  Low fat, especially low in saturated fat  1 – 2 portions of oily fish per week  Good intake of fruit & vegetables

27. Thank you