Carbohydrate Counting at Different Levels: USA Management Guidelines Suha Khoury, RD - PowerPoint PPT Presentation

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Carbohydrate Counting at Different Levels: USA Management Guidelines Suha Khoury, RD

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Title: Carbohydrate Counting at Different Levels: USA Management Guidelines Suha Khoury, RD


1
Carbohydrate Counting at Different Levels USA
Management Guidelines
Suha Khoury, RD
2
Purpose of Presentation
  • To explain the carbohydrate counting approach and
    to demonstrate ways for applying it in diabetes
    nutrition management

1
3
Topics of Discussion
  • Defining carbohydrate counting approach and
    highlighting reasons behind popularity
  • Explaining the goals and objectives for the
    levels of carbohydrate counting
  • Presenting recommended teaching aids
  • Discussing case studies

2
4
Definition and Reasons Behind Popularity
  • Definition
  • Carbohydrate Counting is a meal planning approach
    based on the following ideas1
  • Carbohydrates is the main nutrient affecting
    post-prandial glycemic response
  • Total amount of carbohydrates is more important
    than source of carbohydrates
  • Reasons behind popularity
  • Effectiveness2
  • Flexibility3
  • Ease of implementation4

3
1. Using Carbohydrate Counting in Clinical
Practice, JADA 2,3,4. Practical Carbohydrate
Counting, American Diabetes Association, 2001
5
2. The Three Levels of Carbohydrate Counting1
  • 2.1. Level 1 Getting Started
  • 2.2. Level 2 Moving On
  • 2.3. Level 3 Using InsulinCarbohydrate Ratios

4
1. Carbohydrate Counting Getting Started, The
American Diabetes Association and The American
Dietetic Association, 1995.
6
2.1. Level 12.1.1. Goals
  • Goals of Level 1 of carbohydrate counting1,2,3
  • Regulate blood glucose by balancing carbohydrate
    intake with the diabetes medication and physical
    activity
  • Achieve and maintain consistency of carbohydrate
    intake at meals and snacks at similar times each
    day

1. Carbohydrate Counting Getting Started, The
American Diabetes Association and The American
Dietetic Association, 1995. 2. Practical
Carbohydrate Counting, American Diabetes
Association, 2001. 3. Using Carbohydrate
Counting in Clinical Practice, JADA, 1988, v98,
n8
6
7
2.1. Level 1 2.1.2. Objectives
  • Objectives of Level 1 of carbohydrate
    counting1,2,3
  • Identify carbohydrate as the primary nutrient
    affecting blood glucose levels
  • Determine what foods contain carbohydrates,
    protein, and fat
  • Estimate accurately portion sizes
  • Define 1 carbohydrate choice as 15 grams
    carbohydrate and as 1 bread, or 1 fruit, or 1
    milk exchange
  • Count carbohydrate in meal plan
  • Determine time and carbohydrate goals for meals
    and snacks

7
8
2.2. Level 22.2.1. Goals
  • Goals of Level 2 of carbohydrate counting1,2,3
  • Improve glycemic control through managing
    patterns of blood glucose as they relate to food
    intake, diabetes medication, and physical
    activity
  • Increase flexibility in clients lifestyle
    through advanced carbohydrate counting skills
  • For type 1 diabetes, introduce the concept of
    insulin adjustment based on changes in usual
    carbohydrate intake

8
9
2.2. Level 22.2.2. Objectives
  • Objectives of Level 2 of carbohydrate
    counting1,2,3
  • Apply concept of pattern management by
  • Identifying patterns of blood glucose levels
  • Determining relationships among food, diabetes
    medication, physical activity, and glucose levels
  • Establishing guidelines for managing these
    variables
  • Identify impact of protein and fat on glucose
  • Count carbohydrates in choices or grams for
  • Add 1 unit of short-acting or rapid-acting
    insulin for each additional 10-15 grams
    carbohydrates

9
10
2.3. Level 32.3.1. Goals
  • Goals of Level 3 of carbohydrate counting1,2,3
  • Improve BG control for people using intensive
    diabetes management by matching the amount of
    insulin with carbohydrate intake
  • To offer greater flexibility in food choices and
    portion sizes

10
11
2.3.Level 32.3.2. Objectives
  • Objectives of Level 3 of carbohydrate
    counting1,2,3
  • Explain insulin action basal and bolus
  • Count carbohydrates using Carbohydrate Gram
    Method or Carbohydrate Choices Method
  • Calculate insulincarbohydrate ratio and ISF
  • Adjust insulin for
  • Correct hypoglycemia and hyperglycemia

11
12
3. Recommended Teaching Aids
3.1. The Exchange Lists 3.2. Carbohydrate
Choices 3.3. Estimating Portion Sizes and
Carbohydrate Choices 3.4. How Much Carbohydrate
is Needed 3.5. Factors Influencing Glycemic
Control 3.6. Carbohydrate Counting for Foods
Containing Sugar Alcohols 3.7. The Actions of
Insulin 3.8. InsulinCarbohydrate Ratio 3.9.
Calculating Carbohydrates in Recipes 3.10.
Exchanges for Alcoholic Beverages 3.11. Treating
Hypoglycemia 3.12. Exercise Guidelines 3.13.
Guidelines for Illness
12
13
3.1. The Exchange Lists1
13
14
3.2. Carbohydrate Choices
14
15
3.3. Estimating Portion Sizes1 and Carbohydrate
Choices2
15
16
3.4. How Much Carbohydrate is Needed1
16
17
3.5. Factors Influencing Glycemic Control1,2
17
18
3.6. Carbohydrate Counting for Foods Containing
Sugar Alcohols (Polyols)1
18
19
3.7. The Actions of Insulins1
19
20
3.8. InsulinCarbohydrate Ratio
  • 3.8.1. Method 1 Food dairy, insulin dose, and
    SMBG
  • information
  • 3.8.2. Method2 The rule of 450 or 5001
  • 3.8.3. Method3 Using the insulin sensitivity
    factor (ISF)

21
3.8.1. Method 1
21
22
3.8.2. Method 2
22
23
3.8.3. Method 3
23
24
3.9. Calculating Carbohydrates in Recipes1
24
25
3.10. Exchanges for Alcoholic Beverages1
25
26
3.12. Treating Hypoglycemia1
26
27
3.13. Exercise Guidelines1
27
28
3.14. Guidelines for Illness1
  • To replace 10 grams of carbohydrates
  • To replace 15 grams of carbohydrates

28
29
4. Case Studies
  • 4.1. Setting Carbohydrate Goals
  • 4.2. Impact of Fiber
  • 4.3. Applying Pattern Management
  • 4.4. Applying InsulinCarbohydrate Ratio
  • 4.5. Determining Premeal Insulin Dose
  • 4.6. Correcting Premeal Hypoglycemia
  • 4.7. Correcting or Supplementing Insulin Dose

29
30
4.1. Setting Carbohydrate Goals1
30
31
4.2. Impact of Fiber1
31
32
4.3. Applying Pattern Management1
32
33
4.4. Applying CarbohydrateInsulin Ratio1
33
34
4.5. Correcting or Supplementing Insulin Dose1
34
35
4.6. Determining Premeal Insulin Dose1
35
36
4.7. Correcting Premeal Hypoglycemia1
36
1. Practical Carbohydrate Counting, American
Diabetes Association, 2001
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