Introduction to Carbohydrate Counting

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Introduction to Carbohydrate Counting

• Sheila Croy, RD
• Clinical Dietitian

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Purpose

• To provide a basic understanding of carbohydrate
  counting.

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Objectives

• At the end of the inservice, you will be able to
• Explain why carbohydrate control is important for
  diabetic patients
• Define 3 nutrients that affect blood glucose
  levels
• Identify 4 different groups of foods that contain
  carbohydrates
• Be able to appropriately substitute one
  carbohydrate containing food for another

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The Old Adage

• Years ago it was thought that individuals with
  diabetes could not consume any sugar at all!!
• Now, due to many years of research, it has been
  found that it is appropriate for diabetics to
  consume sugar as long as it is counted.
• The recommended way of controlling diabetes
  through meal planning is called Carbohydrate
  Counting.

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Reasons for Carbohydrate Counting

• Maintain blood glucose levels as close to the
  normal range as possible.
• Maintain blood lipid levels as close to the
  normal range as possible.
• Prevent, delay or treat diabetes-related
  complications (exkidney heart dz)
• Improve health through optimal nutrition
• Carbohydrate counting is not considered a diet
  since a food item or food group is not being
  excluded from the patients intake

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Nutrients Found In Food

• Carbohydrate
• Protein
• Fat
• Vitamins
• Minerals
• Water

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Nutrients That Affect Blood Glucose Levels

• Carbohydrates
• Protein
• Fat

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Carbohydrates

• It is the primary fuel source for our brain
  muscles.
• 100 of carbohydrate is converted to blood sugar
  by the body.
• DO NOT AVOID, but instead make carbohydrate
  intake consistent at meals and snacks.

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Where are Carbohydrates Found?

• Starch Group
• Breads, cereals, grains, starchy veggies
• Milk Group
• Milk, yogurt
• Vegetable Group
• Non-starchy veggies
• Fruit Group
• Fresh, frozen, canned

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Protein

• Protein is responsible for the building and
  repairing of all body tissues.
• Contribute to the structure and function of
  hormones, enzymes, fluids, and the immune system.
• 50 of protein is converted to blood sugar by the
  body.

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Sources of Protein

• Meat
• Cheese
• Eggs
• Peanut butter
• Meat substitutes

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Fat

• It provides the body with the essential fat
  soluble vitamins A, D, E, and K.
• Provides flavor to food and fullness after meals.
• Less than 10 of fat is converted to blood sugar
  by the body.

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Sources of Fat

• Margarine or butter
• Mayonnaise
• Nuts
• Salad dressing
• Oils

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Carbohydrate Counting

• Individuals with diabetes are now encouraged to
  consume meals which are consistent in total
  carbohydrates because whether you are eating
  complex or simple sugar the end result within the
  body is the same.
• This is a process of counting grams of
  carbohydrate at every meal and snack.
• It does not matter as much where the
  carbohydrates come from, but that intake is
  consistent.

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What counts as a carbohydrate serving?

• Different foods have different serving sizes to
  give an amount equal to one carbohydrate serving.
  
• One carb serving is equal to 15 grams of
  carbohydrate
• The following 4 slides provide listed items in
  the serving size to equal one carbohydrate
  serving (15 grams of carbohydrate).

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Starch GroupEach of the following servings
contain 15 grams of Carbohydrate

• ½ C. Corn
• 1/3 C. Peas
• 3 oz. Baked Potato
• ½ C. Mashed Potato
• 1/3 C. Beans
• 3 C. Popcorn
• ½ C. Cooked Pasta
• 1/3. Cooked Rice

• 1 slice of Bread
• ½ C. Cooked Cereal
• ¾ C. Unsweetened Cereal
• ½ Hot Dog or Hamburger Bun
• ½ Small Bagel
• ½ English Muffin

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Milk GroupEach of the following servings contain
15 grams of Carbohydrate

• 8 oz. Milk
• Recommend at least 2 or lower
• Yogurt
• Varies by brands whether table sugar or a sugar
  substitute is part of the ingredients

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Vegetable GroupEach of the following servings
contain5 grams of Carbohydrate1 Cup Raw or ½
Cup Cooked

• Asparagus
• Green/Wax Beans
• Broccoli
• Carrots
• Brussel Sprouts
• Lettuce
• Bell Peppers

• Cauliflower
• Mushrooms
• Onions
• Spinach
• Tomatoes
• Beets
• Turnips
• Celery

Great way to add more to meals without having
much affect on blood sugar
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Fruit GroupEach of the following servings
contain15 grams of Carbohydrate

• 4 ½ inch Banana
• Small Apple
• 1 C. Cube of Cantaloupe
• ½ Small Grapefruit
• ½ C. Grapes
• Small Orange
• Small Peach
• 1/3 C. Pineapple

• Small Pear
• 1 C. Raspberries
• 1 ¼ C. Strawberries
• 1 ¼ C. Watermelon
• 4 oz. Apple or Orange Juice
• 3 oz. Grape or Cranberry Juice
• ½ C. Cherries

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Meats Fats

• Meats fats do not contain a significant amount
  of carbohydrates, however, continuous overeating
  of these 2 food groups may cause negative changes
  in blood glucose levels.
• It does not hurt looking on pkg labels of these
  foods to see if they contain ANY carbohydrates.
• Portion control very important for blood sugar
  weight control as well as heart health.
• There are suggested of servings a patient
  should receive daily for both food groups. The
  following 2 slides indicate serving sizes.

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Protein Group

• 1oz Portion size
• 1 oz Meat
• 1 oz cheese (1 slice or 4-5 cubes)
• ¼ cup cottage cheese

• 1 whole egg
• 2 tablespoons peanut butter
• ½ cup cooked beans
• 1/3 cup nuts

Protein group is not a significant source of
carbohydrate. However, portion size is important
because 50 of protein turns to blood sugar.
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Fat/Oil Group

• 1 teaspoon Margarine or Butter
• 1 teaspoon Mayonnaise (2 tsp for Lite)
• 1 Tablespoon Cashews or 20 peanuts
• 1 Tablespoon Regular Salad Dressing (2 tbsp for
  Lite)
• 1 Teaspoon Oil (Olive, Canola, Peanut)

The fat oil group is not a significant source
of carbohydrate. However, portion size is
important because 10 of fat turns to blood sugar.
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How many carbohydrates does my patient get for
each meal?

• The amount of carbohydrate at each meal snack
  should be determined by the dietitian.
• She will also determine how many meat fat
  servings the patient should consume for the day.
• If the dietitian is not available to convert an
  ADA diet over to carbohydrates per meal, there
  will be a cheat sheet at each nursing station
  to do that for you.
• of meat fat servings will also be suggested
  next to each calorie level.

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Cheat sheet for converting ADA diet to carbs/meal

• When carb counting, a diet order should be for
  grams of carbs/meal. You may still see ADA diets
  still ordered. The following list can be used to
  convert ADA diet to carbs/meal
• 1200 ADA 45-60g/meal, 5oz protein, 3 fats
• 1400 ADA 45-60g/meal, 5oz protein, 4 fats
• 1500 ADA 45-60g/meal, 5oz protein, 4 fats
• 1600 ADA 60-75g/meal, 5oz protein, 4 fats
• 1800 ADA 60-75g/meal, 6oz protein, 5 fats
• 2000 ADA 75-90g/meal, 6oz protein, 5 fats
• 2200 ADA 75-90g/meal, 7oz protein, 6 fats

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Diet Order Example

• If Doctor X wrote a diet order for an 1800 ADA
  diet, the patient would be able to receive
• 60-75g carbohydrates per meal x 3 meals
• 15-30g carbohydrates for HS snack
• This will always be the recommended amount for an
  HS snack
• 6oz protein/day
• 5 fat servings/day

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Sample Meal

• How many total grams of carbohydrates, ounces of
  protein fat servings will your patient consume
  for this breakfast
• ½ cup orange juice
• 1 slice toast with 1 tsp margarine
• 1 whole egg
• 1 cup black coffee
• ½ cup oatmeal
• 8 oz skim milk
• 60 grams carbs 1oz protein 1 fat serving

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Offering Substitutes

• When offering a substitute, be sure that the
  substitute food has the same amount of
  carbohydrates as the food item being replaced.
• Remember, that 15g carbs 15g carbs.
• You can almost substitute with anything that
  equals 15 grams of carbohydrates.

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Free Foods

• Please do not worry about counting carbohydrates
  for the following food items
• Black coffee tea
• Condiments in small amounts
• Carbohydrate-free food items

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General Guidelines to Remember

• To recap, your patient with diabetes should
  remember to
• Eat three meals a day at about the same time.
  Never Skip Meals!
• A bedtime snack is a must.
• Keep carbohydrate intake consistent at meals and
  snacks.
• Keep your eye on portion sizes at meals and
  snacks.

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Need Any Further Information?

• Contact
• Sheila Croy, RD
• Clinical Dietitian _at_ AGH
• scroy_at_aghosp.com
• [phone]