Presentation

1. KEEPING COUNT
By:
Marissa Prieto, RD, LD & Sarah Ruiz RD, LD

2. OBJECTIVES
Defining carbohydrates (CHO)
How to apply basic & advanced CHO
counting to diabetes nutrition management.
Demonstrate CHO counting using the
nutrition facts label for the patient with
diabetes.
Illustrate factors the patient with diabetes
should consider when adjusting CHO for
physical activity.

3. DEFINITIONS
 Carbohydrate Counting is a method of calculating the
number of grams of CHO consumed at meals and
snacks. It is not a specific diet, but a meal planning
approach to promote glycemic control.

4. GOALS OF
CARBOHYDRATE COUNTING
 Maintain consistency of carbohydrate intake at
meals and snacks.
 Increase flexibility in the patient’s diet using CHO
counting skills.
 Manage blood glucose as they relate to food
intake, diabetes medication, and physical activity.

5. WHAT ARE
CARBOHYDRATES?
 Carbohydrates is a macronutrient vital for
metabolic functioning.
 The digestive system breaks down CHO into
simple sugars, known as glucose, which is then
absorbed into the bloodstream.

6. WHAT FOODS CONTAIN
CARBOHYDRATE?
 STARCH – pasta, rice, cereals, bread, tortilla,
grains, crackers
 FRUITS & FRUIT JUICE– all fresh, frozen dry, or
canned fruits
 VEGETABLES – corn, potato, beans, peas
 DAIRY –cows milk, soy milk, yogurt
 DESSERTS – candy, cookies, ice cream, sweetened
beverages, cake

7. WHAT FOODS HAVE LITTLE OR NO
CARBOHYDRATES?
 Non-starchy vegetables
 Dark leafy greens, tomato, broccoli, cauliflower,
cabbage
 Fats: slows glucose absorption, delaying peak glycemic
response when CHO are ingested.
 Nuts, oils, butters, avocado
 Protein: minimal effect on raising blood glucose
 Beef, poultry, seafood
 Eggs, cheese, tofu

8. STEPS TO LEARNING BASIC
CARBOHYDRATE COUNTING
Step 1: Identify foods containing CHO,
protein, and fat.
Step 2: Define 1 carbohydrate choice as 15
grams carbohydrate.
Step 3: Count total carbohydrates in the
meal.

9. WHAT IS ONE SERVING OF
CARBOHYDRATE?
 15 grams of carbohydrate = 1 choice of
carbohydrate
 Examples:
- 1/2 cup of cooked beans, corn, or peas
- 1/3 cup cooked rice, pasta
- 1 corn tortilla, 1 slice of bread
- 8 oz milk, ½ cup ice cream
- 1 small apple (4 oz), ½ cup fruit cocktail, ½ large
banana

10. GENERAL GUIDELINES:
CARBS PER MEAL
Women Men
To lose weight: 30-45 grams To lose weight: 45-60 grams
To maintain weight: 45-60 grams To maintain weight: 60-75 grams
Snacks: 15 - 30 grams Snacks: 15 - 30 grams

11. ADVANCED CARBOHYDRATE
COUNTING
 Match fast-acting insulin doses to grams of CHO
intake based on CHO-to-insulin ratios and correction
factors.
 Willingness/ability to keep food, physical activity,
and BG logs.
 Multiple visits and ongoing support from a Diabetes
Management team is recommended.

12. HOW TO DETERMINE INSULIN TO CARB RATIO
 The insulin : CHO ratio formula
 This can be calculated using the Rule of “500.”
500 ÷ Total Daily Insulin Dose (TDD)
= 1 unit of insulin to cover X amount of grams of carbohydrate
Example:
TDD = 40 units
500 ÷ TDD (40 units) = 12.5 (round up to 13)
= 1:13 g CHO
1 unit is needed per 13 grams of CHO

13. OTHER METHODS TO MEASURE YOUR
CARBS
 Plate Method:
Introduced in 2010 when the Dietary
Guidelines for Americans was
updated.
 Portion Measuring Tools:
Use hands and household items to
measure out portion sizes.
 Reading Food Labels:
Provide guidelines to make healthy
food purchases for both meals and
snacks.
 Mobile/Computer Apps:
Input amounts of daily physical
activity and intake of carbohydrates.

14. IS MY PLATE BALANCED? (EX 1)

15. GRAMS OF CARBOHYDRATE
BREAKDOWN
Food Group/ Type Serving Size Approximate Grams of
Carbohydrate
Watermelon 1 cup 12grams
Corn Tortillas 2 30grams
Pinto Beans (no oil) ½ cup 15grams
Raw Vegetables: romaine
lettuce
tomatoes
cucumbers
lime
1 cup
3 slices
3 slices
1 wedge
5grams or less
TOTAL MEAL
CARBOHYDRATES:
62 grams

16. IS MY PLATE BALANCED? (EX 2)

17. GRAMS OF CARBOHYDRATE
BREAKDOWN
Food Group/ Type Serving Size Approximate Grams of
Carbohydrates
Grapes 8 small 7.5 grams
Tacos (only ground beef) 2 30 grams
Mexican Brown Rice 1/3 cup 15 grams
Unsweetened Sweet Tea 8 fl oz 0 grams
Raw Vegetables:
romaine lettuce
red onions
tomatoes
1 cup
9 slices
4 slices
5 grams or less
TOTAL MEAL
CARBOHYDRATES
57.5 grams

18. IS MY PLATE BALANCED? (EX 3)

19. GRAMS OF CARBOHYDRATES
BREAKDOWN
Food Group/Type Serving Size Approximate Grams of
Carbohydrates
Apple (small) 4 oz 15grams
Brown Rice 1/3 cup 15 grams
Tilapia Fillet 3 oz 0 grams
Milk 1% 1 cup 12 grams
Mixed Vegetables: (cooked)
carrots
zucchini squash
celery
onion
1 cup total 10grams
TOTAL MEAL
CARBOHYDRATES
52 grams

20. TOOLS FOR PORTION CONTROL

21. HOW TO READ A FOOD LABEL
The total grams of
carbohydrate includes the
carbohydrate in fiber, sugars,
and sugar alcohols.
Sugar alcohol is INCOMPLETELY absorbed. Estimate that only half of the sugar in
sugar alcohol will be absorbed and impact your blood sugar.
Ex: 18g Cho/ 2= 9grams of CHO
TOTAL CARBOHYDRATE PER SERVING is
29 grams CHO minus 9 grams CHO for the sugar alcohol= 20 grams CHO

22. FOOD LABELS CONTINUED….
Fiber has to be subtracted
from the Total Carbohydrate
Total CHO (10g)
-Fiber 5g (half) (5g/ 2= 2.5g)
=7.5 grams of CHO
The total carbohydrate tells
how many grams of
carbohydrate are in 1 serving

23. MOBILE AND COMPUTER APPS
 MyFitnessPal: Allows easy and
up to date tracking of daily
intake and physical activity.
 CarbsControl: Keeps a
carbohydrate diary, has a large
nutrition database, and set
daily goals.
 Track3: Tracks high and low
blood glucose levels, records
workout sessions, and
produces email log to self or
diabetes management team.

24. TYPE 2 DIABETES AND EXERCISE
 Individuals with Type 2
diabetes can decrease
insulin resistance through
exercise.
 Studies have shown that
exercise regimens can lower
A1c and glucose levels.
 When combined with
proper nutrition an
individual can lower
medication needs

25. TYPE 1 DIABETES AND EXERCISE
 Moderate Intensity: After 20-30 minutes Type 1 diabetics
have a higher disposition to hypoglycemia.
Ex: walking briskly or general gardening
 Endurance Activities: They are also more likely to experience
hypoglycemia following these types of activities.
Ex: swimming pool laps or jogging
 Short and High Intensity: Immediately following a quick and
intense type of exercise Type 1 diabetics have a greater
chance of hyperglycemia.
Ex: kickboxing or running

26. RULE OF 15
1.) Check blood glucose and
proceed if below 70.
2.) Eat or drink 15 grams of
carbohydrates.
3.) Wait 15 minutes re-check if still
below 70 repeat step 2.
4.) If next meal is more than 1 hour
away eat one carbohydrate choice.
Ex: granola bar (15grams)
5.) Always carry something on your
person to treat hypoglycemia.

27. 15 GRAM CARBOHYDRATE EXAMPLES FOR
TREATMENT
3-4 glucose tablets
1 tube of glucose gel
4 ounces fruit juice
4 ounces sugar
sweetened soda
5 life savers

28. Types of Physical
Activity
Glucose Ranges Grams of
carbohydrates
Examples
Short Duration -80-99mg/dl
- 100mg/dl or above
-10 to 15 grams
-not required
1 fruit or
granola bar
Moderate Intensity -80-99mg/dl or less
-100-179mg/dl
-180-299mg/dl
-300mg/dl or greater
-25 to 50 grams pre-
workout then 10 to
15grams/hr if
needed
-10 to 15 grams
-not required
-Don’t exercise
½ turkey
sandwich
with 1 fruit or
milk
2 graham
crackers
-------------
-------------
Strenuous Activity -80-100mg/dl
-180-299mg/dl
-300mg/dl or greater
-50 grams
-10 to 15 grams
-Don’t exercise
1 ham
sandwich
with milk
1 fruit
-------------

29. THINGS TO REMEMBER
 Discuss the role and types of macronutrients there are
with patients.
 Pick the carbohydrate counting method that will be suit
each individual’s needs.
 Encourage individuals to track their carbohydrate intake
and physical activity level to achieve glucose goals.

30. RESOURCES
 Carbohydrate Counting: A Practical Meal-Planning Option for People with
Diabetes, Clinical Diabetes, 2005, v23, n3.
 Dietary Carbohydrate (Amount and Type) in the Prevention and
Management of Diabetes, The American Diabetes Association, 2004.
 Carbohydrate Counting for People with Type 2 Diabetes, Diabetes
Spectrum, 2008, v13, n8.
 Carbohydrate Counting and Meal Planning, Novo Nordisk, 2013.
 Practical Carbohydrate Counting, The American Diabetes Association, 2001.
 Exchange Lists for Meal Planning, The American Diabetes Association, The
American Dietetic Association, 1995.
 Andrews, R C., Cooper A. R., Montgomery, A.A., Norcross, A. J., Peters, T. J.,
et al. (2011). Diet or diet plus physical activity versus usual care in patients
with newly diagnosed type 2 diabetes. The Lancet. V378: 129-139

31. QUESTIONS????