Carbohydrate Counting


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Medical nutrition therapy for diabetes mellitus, including slides on alcohol intake, exercise, and hypoglycemia.

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  • These interventions should be implemented as soon as the diagnosis of diabetes is made.If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight. The more you vary from your food plan, the Mayo Clinic informs, the more your blood glucose will fluctuate.
  • Eating at regular intervals will help to prevent your blood sugar level from going either too high or too low
  • A general recommendation is to:
  • Meat & Meat Alternatives = nuts, eggs, tofu, etc.Amount determined by patient’s healthcare professional
  • Consume healthy fats in moderation7% of calories from saturated fats = 14 grams on a 1800 calorie/day diet
  • Insoluble fiber increases the movement of materials through your digestive system.Soluble fiber is more important for diabetics. It dissolves in water to form a gel-like material and can help lower cholesterol levels.However, it is unknown if regularly consuming that much fiber each day is realistic for most people.
  • Follow-ups with an RD can provide problem-solving techniques, encouragement, and support that lifestyle changes require.
  • Certain foods do not tend to raise blood sugar levels and can be used to help “fill in” your meal plan with little worry about their blood sugar affects. Have few carbohydrates and calories, count as “0” carb choicesPORTION CONTROL IS KEYLimit to 3 choices a day
  • -Controlled diabetes when A1c is less than 7%Moderate consumption = 1 drink/day for women, 2/day for menAlcohol consumption (in excess) can lead to problems with weight control
  • Dizziness, confusion, blurred vision all symptoms of hypoglycemia as well as intoxicationSome alcoholic beverages can raise your blood sugar because of their high carbohydrate content. To prevent your blood sugar from going to high, avoid sweet wines, liqueurs, and sweetened drinks like daiquiris, margaritas, pina coladas, etc. and choose lower-carb drinks.
  • These five benefits have a DIRECT bearing on how successfully you manage your diabetes. Exercise also has other general health benefits - you sleep better, your mental state improves, etc.
  • If it is more than 1 hr to next meal, test again 1 hr after treatment to see if additional carbohydrates are needed.
  • If you adhere to your meal plan for portion sizes and eating times you should eat the same mix of carbohydrates, proteins and fats each day. Your blood sugar control will be ideal, as will your weight.
  • Carbohydrate Counting

    1. 1. Carbohydrate Counting Emily Todhunter
    2. 2. Goals of MNTMaintain blood glucose levels as near to normal aspossible by balancing food intake with medicationand activity level Glucose control to prevent or reduce risk of complicationsImprove cholesterol and triglyceride levelsControl blood pressureManage weight
    3. 3. Goals of MNTPrevent and treat chronic complications throughlifestyle changes in addition to MNT (watch proteinintake related to kidney function)Feel betterImprove overall health
    4. 4. Guidelines for Meal PlanningCoordinate meals with insulin/medicationsPay attention to total energy intakeAccording to the Mayo Clinic, your daily intake ofcalories should consist of: Carbohydrates 45% to 65% Proteins 15% to 20% Fats 20% to 35%Watch sodium intakeBalance meals with exercise
    5. 5. Meal SpacingEvenly spacing out your meals and snacks throughoutthe day will help keep your blood sugar levels stable.General guidelines say to wait at least 2 hours (but nomore than 5 hours) between meals and snacks duringthe day.
    6. 6. Carbohydrate IntakeEat about 2-3 carbohydrate servings (30-45 grams) ateach meal for women and 3-4 carbohydrate servings(45-60 grams) at each meal for men.Both men and women should limit carbohydrates atsnacks to 1-2 carbohydrate servings (15-30 grams).
    7. 7. Protein IntakeConsider adding a little lean protein to every meal andsnack.Small portions of protein do not raise BG levelsProtein may help slow down the rate at whichcarbohydrates are digested, and typically help individualfeel full longer.
    8. 8. Fat IntakeThose with diabetes are at increased risk of heartdisease and stroke because diabetes can acceleratethe development of clogged and hardened arteries.<7% of calories from saturated fatsAvoid trans fatsChose monounsaturated (such as olive and canolaoils) and/or polyunsaturated (found in nuts andseeds).<300 mg cholesterol
    9. 9. Fiber IntakeEating fiber-rich foods can help keep BG stabilized becauseit slows the rate at which carbohydrates are digested.Insoluble fiber (found in whole-wheat flour, wheat bran,nuts and many vegetables)Soluble fiber (found in oats, peas, beans, apples, citrusfruits, carrots, barley and psyllium)Ingestion of large amounts of soluble fiber (approx. 50g)appears to improve BG levels.25-35 g/day
    10. 10. Patient EducationTeaching which foods are carbohydrates (fruits,grains, starchy vegetables, milk, sweets)Average portion sizesHow many servings to select at mealsFrequent follow-ups with RD
    11. 11. Carbohydrate CountingCalculate the total grams of carbohydrate (regardlessof source)Advantages: Places emphasis on carbs Nutrition fact labels make any food ok More flexibility in menu planning
    12. 12. Carbohydrate Counting
    13. 13. Carbohydrate Counting1 carbohydrate choice = 15 grams carbohydrateExchange list: Starch = 15 g carbs Fruit = 15 g carbs Milk = 12 g carbs Vegetables = 15 g carbs (3 servings)
    14. 14. “Free Foods”<5 g carbs, <20 calories/servingNon-starchy vegetables Leafy Greens Cruciferous vegetables Allium vegetables “Fruits” – cucumbers, squash, peppers, tomatoesArtificially-sweetened coffee and tea, diet soda,sugar-free gelatin, seasonings, condiments, sugarsubstitutes and non-dairy creamer
    15. 15. Sample Meal Plan Carbohydrate Breakfast Count 1 scrambled egg 02 slices whole-grain toast 2.0 (30 grams) 1 tsp margarine 0 1/2 cup orange juice 1.0 (15 grams) Breakfast Total: 3.0 (45 grams) Carbohydrate Snack 1 Count 1 medium orange 1.0 (15 grams) Snack Total: 1.0 (15 grams)
    16. 16. Sample Meal Plan Lunch Carbohydrate Count 1 cup skim milk 1.0 (15 grams) 2 slices bread 2.0 (30 grams) Low-fat mayo 0 3 oz. turkey 0Lettuce and tomato 0 Lunch Total: 3 (45 grams) Snack 2 Carbohydrate Count 6 oz. light yogurt 1.0 (15 grams) Snack Total: 1.0 (15 grams)
    17. 17. Sample Meal Plan Dinner Carbohydrate Count 1 medium sweet potato 2.0 (30 grams) 1 tsp margarine 0 1 cup skim milk 1.0 (15 grams)4 oz. baked chicken breast 0 1/2 cup cooked broccoli 0 1 cup salad 0 2 Tbsp low-fat dressing 0 Dinner Total: 3 (45 grams) Snack 3 Carbohydrate Count 1 small apple, sliced 1.0 (15 grams) 2 Tbsp peanut butter 0 Snack Total 1.0 (15 grams)
    18. 18. Net CarbsGrams of fiber may be subtracted from totalcarbohydrate if food contains 5g or morefiber/servings.IE: All-Bran Multi-Grain Crackers18 crackers = 19 g carbs, 5 g fiberSo would count as 14 g of carbohydrate
    19. 19. Example: Blackberries
    20. 20. AlcoholInclude only when BG in goodcontrolAlcohol lowers BG Research has shown that acute consumption increases insulin secretion, causing low blood sugar, and can also impair the hormonal response that would normally rectify the low blood sugar. Drinking as little as 2 ounces of alcohol on an empty stomach can lead to very low blood sugar levels
    21. 21. Alcohol Beverage Serving Size Calories Carbohydrates Beer, regular 12 oz 150 13 g Beer, light 12 oz 100 5gBeer, non-alcoholic 12 oz 75 16 g Distilled spirits* 1.5 oz 100 trace Martini 5 oz 310 4g Wine, red 4 oz 80 2g Wine, white 4 oz 80 1g
    22. 22. ExerciseHelps keep weight downHelps keep blood pressure downCan help raise HDL cholesterol, lowerLDL cholesterolHelps body use insulin moreeffectivelyCan lower BG levels(May need to adjust carbohydrateintake/insulin dose to avoidhypoglycemia)
    23. 23. MNT for Hypoglycemia Immediate treatment with carbohydrates is essential If the BG falls below 70 mg/dL, treat with 15g of carbohydrates: 3 glucose tablets Fruit juice or regular soft drinks, ½ cup 6 saltine crackers 1 tablespoon syrup or honey
    24. 24. MNT for HypoglycemiaWait 15 minutes and retest. If the BG level remains<70 mg/dL, treat with another 15g carbohydratesRepeat testing and treatment until the BG levelreturns to within normal rangeEvaluate the time to next meal or snack to determineneed for additional food
    25. 25. SummaryType II Diabetes affects millions of adults & children inthe US1st priority is to adopt lifestyle interventions thatimprove abnormalities of glycemia, dyslipidemia, andhypertension.Consistent & regular meal patterns & mealcompositionsPatient education is key!