Title: Carbohydrate Counting at Different Levels: USA Management Guidelines Suha Khoury, RD
1Carbohydrate Counting at Different Levels USA
Management Guidelines
Suha Khoury, RD
2Purpose of Presentation
- To explain the carbohydrate counting approach and
to demonstrate ways for applying it in diabetes
nutrition management
1
3Topics 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
4Definition 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
52. 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.
62.1. 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
72.1. 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
82.2. 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
92.2. 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
102.3. 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
112.3.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
123. 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
133.1. The Exchange Lists1
13
143.2. Carbohydrate Choices
14
153.3. Estimating Portion Sizes1 and Carbohydrate
Choices2
15
163.4. How Much Carbohydrate is Needed1
16
173.5. Factors Influencing Glycemic Control1,2
17
183.6. Carbohydrate Counting for Foods Containing
Sugar Alcohols (Polyols)1
18
193.7. The Actions of Insulins1
19
203.8. 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)
213.8.1. Method 1
21
223.8.2. Method 2
22
233.8.3. Method 3
23
243.9. Calculating Carbohydrates in Recipes1
24
253.10. Exchanges for Alcoholic Beverages1
25
263.12. Treating Hypoglycemia1
26
273.13. Exercise Guidelines1
27
283.14. Guidelines for Illness1
- To replace 10 grams of carbohydrates
- To replace 15 grams of carbohydrates
28
294. 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
304.1. Setting Carbohydrate Goals1
30
314.2. Impact of Fiber1
31
324.3. Applying Pattern Management1
32
334.4. Applying CarbohydrateInsulin Ratio1
33
344.5. Correcting or Supplementing Insulin Dose1
34
354.6. Determining Premeal Insulin Dose1
35
364.7. Correcting Premeal Hypoglycemia1
36
1. Practical Carbohydrate Counting, American
Diabetes Association, 2001