Carbohydrate counting is a meal planning approach for managing blood sugar levels in diabetes. It is based on counting the total amount of carbohydrates consumed rather than specific food sources. The amount of carbohydrates has the largest effect on post-meal blood sugar levels. Carbohydrate counting provides flexibility in meal planning and eating when desired without feeling restricted. It requires understanding how different foods affect blood sugar and investing time to accurately estimate portion sizes and carbohydrate amounts in foods.

1. DR. LOUAY LABBAN DEPARTMENT OF NUTRITION UNIVERSITY OF KALAMOON

2. Carbohydrate Counting is a meal planning approach based on the following ideas : Carbohydrates is the main nutrient affecting post-prandial glycemic response Total amount of carbohydrates is more important than source of carbohydrates

3. Carb counting began receiving attention in 1990 as method of controlling blood sugar

4. 1994 ADA used science behind carb counting to make nutrition recommendations

5. Getting the best of from your insulin regimen Good glycemic control Freedom to eat when you want to Freedom to eat as little or as much as you wish Freedom to eat traditionally ‘forbidden’ food without feeling guilty

6. Not difficult but you need to invest time & effort in getting it right It is possible that you may gain weight if : You eat the high calorie foods you previously avoided Have larger portions because you can give extra insulin Concentrate on only CHO and forget about other aspects of a healthy diet

7. • Understand how foods affect your blood sugar • Carbohydrates have largest effect on blood sugar • Allows flexibility in meal planning • No “good” foods or “bad” foods

8. Carbohydrate…. rapid digestion, total absorption/conversion to glucose (100%) Sugar Alcohols.. moderate digestion, partial absorption as glucose (50%) Protein…………… slow digestion, partial conversion to glucose* (~40%) Fat…………………. slow digestion, little conversion to glucose** (<20%) * In absence of dietary carbs ** may cause insulin resistance in large qty

10. Glucose Fructose (fruit sugar) Galactose Dextrose Lactose (milk sugar) Sucrose (table sugar) Sugars (aka &quot;simple&quot; carbohydrates) “ flavored” simple sugars: Maltose High-Fructose Corn Syrup Molasses Brown Sugar Honey

11. Fruit Fruit Juice Candy Regular Soda Punch Sugars (aka &quot;simple&quot; carbohydrates) Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly

12. Starches (aka &quot;complex&quot; carbohydrates) Potatoes Rice Noodles/Pasta Cereal Oatmeal Bread Tortillas Pancakes Waffles Crackers Bagels Pizza Beans Corn Pretzels Chips Popcorn Sweet potatoes

13. Fiber Glycerine Sugar Alcohol (disount 100%!) (discount 50%!) Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol (Rare… can ignore!)

14. Simple Carbohydrates (sugars) Complex Carbohydrates (starches)     Blood Glucose

15. All carbs (except fiber) convert to blood glucose eventually G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours)

16. Example: Spaghetti GI = 37 Only 37% of spaghetti’s carbs turn into blood glucose in the first 2 hours. The rest will convert to blood glucose over the next several hours. Glycemic Index (contd.)

17. Slow Stuff Average Stuff Fast Stuff Pasta Legumes Salad Veggies Dairy Fruit Juice Pizza Soup Cake Breads/Crackers Salty Snacks Potatoes Rice Cereals Sugary Candies

18. = = =

19. The “Exchange” system Food package labels Resource listings Portion estimation Carb factors

20. Foods with common nutrient values are grouped together.

21. Groups/ Lists Carb. Protein Fat Calories Carbohydrate Group Starch 15 3 1 or less 80 Fruit 15 ___ ___ 60 Milk Skim Low-fat Whole 12 12 12 8 8 8 0-3 5 8 90 120 150 Other carbohydrates 15 varies varies varies Vegetables 5 2 ___ 25 Meat and Substitute Group Very lean Lean Medium-fat High-fat ___ ___ ___ ___ 7 7 7 7 0-1 3 5 8 35 55 75 100 Fat Group ___ ___ 5 45

22. Labels are the best resource for carbohydrate counting Pay attention to: Serving Size Total Carbohydrate Fiber & Sugar Alcohol (if any)

23. Labels are the best resource for carbohydrate counting Pay attention to: Serving Size Total Carbohydrate Fiber & Sugar Alcohol (if any)

25. Included in total carbohydrate Does not convert to glucose Subtract fiber from the Total Carbohydrate

26. For example: 13 g Total Carb - 3 g dietary fiber Count as 10 grams carbohydrate

27. Artificial Sweeteners Found in chewing gum, mints, yogurt, ice cream, cookies and candy Digest slowly and partially (  50%) Can cause diarrhea

28. Fat Lengthens time your stomach takes to empty Delays rise in blood glucose May cause temporary insulin resistance Protein Very little effect on blood glucose (unless  carb diet) Usually combined with fat

31. 1 ounce of cheese is about the size of your thumb A teaspoon of margarine is about the size of your thumb tip

32. 1 cup of milk, yogurt or chopped fresh greens is about the size of a small hand holding a tennis ball

33. 1 oz nuts or small candies: About one handful

34. 1 cup: About the size of a man's fist

35. One piece fruit or potato: About the size of a regular (60 watt) light bulb One-half cup of vegetables is the size of a light bulb

36. One cup of pasta is the size of a tennis ball 3/4 cup: About the size of a tennis ball 1 fruit serving = ½ cup canned or 1 medium fruit is about the size of a tennis ball

37. Is the weight of serving of a particular food divided by its content of carbohydrates

38. Weigh a portion of food Multiply the weight by its carb factor* Get total carb count *A carb factor is the percentage of the food’s weight that is carbohydrate. The rest is water, protein, fat, minerals

39. Carb Factor Examples: Apple: .13 Apple Pie: .32 Bagel: .51 Carrot (raw): .06 Chocolate Cake: .51 Cornbread: .45 Pancake: .28 For carb factors for more than 6000 foods (in Excel spreadsheet format), go to: www.friendswithdiabetes.org/files/Carb factor.xls Pizza (cheese): .32 Potato, baked: .22 Potato Salad: .09 Rice: .27 Spaghetti: .26 Vanilla Ice Cream: .23 Watermelon: .06