INTERMEDIATE CARBOHYDRATE COUNTING

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Improving Diabetes Control with Carbohydrate
Counting
The University of Georgia Cooperative Extension
Service
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Carbohydrate CountingAdvantages

• Helps improve blood glucose
• A1C goal Less than 7
• Blood glucose goals (plasma)
• Before meals 90-130
• After meals less than 180
• Bedtime 110-150

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Carbohydrate CountingAdvantages

• Easier - you only count carbohydrate
• Allows you more flexibility in food choices
• Virtually any food can be worked into your meal
  plan

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What is Carbohydrate Counting?

• Keeping track of the amount of carbohydrate eaten
  at meals and snacks
• Keeping carbohydrate intake consistent at meals
  from day to day
• Matching insulin injections to
• carbohydrate intake (for some)

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Why Count Carbohydrate?
Carbohydrate is the nutrient in food that raises
blood glucose the most
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Why Count Carbohydrate?

• Amount of carbohydrate eaten determines how high
  blood glucose will rise after a meal
• Carbohydrate begins to raise blood glucose within
  15 minutes of eating

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Who Should Count Carbohydrate?

• People wanting to improve diabetes control who
  manage their diabetes with
• Balanced food intake and
• regular physical activity or...
• Diabetes pills or...
• Insulin injections

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Nutrients in Foods

• Carbohydrate
• Protein
• Fat
• (Vitamins, minerals, water)

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What are Carbohydrates?

• bread, rice, cereal, potatoes, pasta, corn,
  peas, butter beans
• fruit, milk, regular sodas, candy, juices

Starches
Sugars
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Combination Foods That Contain Carbohydrate

• Pizza
• Spaghetti
• Sandwiches

• Casseroles
• Soups
• Stews

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Which Contain Carbohydrate?

• Brunswick stew
• Brussels sprouts
• Sugar-free jello
• Skim milk
• Fat-free frozen yogurt

• Baked chicken
• Rice
• Orange juice
• Diet soda
• Oreos

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Carbohydrate is Healthy

• Most foods containing carbohydrate are among the
  healthiest foods to eat
• grains, fruits, vegetables, low-fat milk and
  yogurt
• Carbohydrates are the foundation of a healthy
  eating plan
• contain many essential vitamins, minerals, and
  fiber

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Does the Type of Carbohydrate Matter?

• Various carbohydrates have slightly different
  effects on blood glucose
• processing, cooking, fiber, mixed meals with with
  fat or protein affect glucose response

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The Amount of Carbohydrate is More Important
Than the Type

• 1 frosted brownie 2 slices bread
• 1 cup ice-cream 1 cup cereal
• (30 grams carbohydrate)

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Use of Sugar in the Meal Plan

• Can be used in moderation
• share desserts in restaurants
• ask for child-sized portions of ice-cream
• keep large portions of sweets out of the house
• Substitute for other carbohydrate in the same
  meal
• Check effect on your
• blood glucose

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Use of Sugar in the Meal Plan

• Many high-sugar foods
• are also high in fat
• provide very little nutritional value (empty
  calories)
• may replace more healthful foods

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2 Ways to Count Carbohydrate

• Carbohydrate Choices
• Food Exchanges or Servings
• Carbohydrate Grams
• Specific number of grams of carbohydrate per
  meal or snack

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Carbohydrate Choices(servings)

• Each food in fruit, starch, milk group contains
  about 15 grams carbohydrate
• One carbohydrate choice 15 grams carbohydrate

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Carbohydrate Choices

• Lunch
• Exchanges Carbohydrate Choices
• 2 starch 2 carb choices
• 1 fruit 1 carb choice
• 1 milk 1 carb choice
• 3 meat 0 carb choices
• 2 fat 0 carb choices

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Each Carbohydrate Choice 15 grams
Carbohydrate

• Example
• Breakfast 3 carb choices 45 grams
• Lunch 2 carb choices 30 grams
• Snack 1 carb choice 15 grams
• Dinner 3 carb choices 45 grams
• Evening
• Snack 1 carb choice 15 grams

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How Much Carbohydrate Should You Have?

• Depends on your
• calorie needs
• height
• weight
• physical activity
• level of fat in your blood (triglycerides)
• usual food habits and schedule

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Carbohydrate Needs (Example)

• 1500 Calories 188 grams/day
• 3 carb choices at breakfast
• 4 carb choices at lunch
• 4 carb choices at dinner
• 1 carb choice at bedtime

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Resources for Counting Carbohydrate

• Food package labels
• Carbohydrate counting books
• Food Exchange booklets

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Nutrition Facts Label

• Best resource for
• carbohydrate counting
• Pay attention to
• Serving Size
• Total Carbohydrate

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Food Label (Example 1)

• Your meal plan 2 carb choices
• (30 grams carb)
• Food label (ice-cream)
• Serving size 1/2 cup
• Total carbohydrate 15 grams
• How much ice-cream should you have?

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Food Label (Example 2)

• If your meal plan at breakfast is
• 45 grams carbohydrate
• Food label Cereal Milk
• Serving size 1/2 cup 1 cup
• Total Carb 15 grams 12 grams
• How much cereal and milk should you have?

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Carbohydrate Counting Books

• Use for foods without a
• Nutrition Facts Label
• Fresh fruits
• Fresh vegetables
• Breads from a bakery or farmers market
• Restaurant foods

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Food Exchange Booklet

• Gives average carbohydrate values for many foods
• Pocket Guide available

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Practice Counting Carbs 1

• Breakfast Choices Grams
• 1 large bagel (4 oz)
• 1 tsp. margarine
• 1/2 cup orange juice
• 1 cup skim milk

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Practice Counting Carbs 2

• Dinner Choices Grams
• Spaghetti noodles
• 1? cups
• Spaghetti sauce, ? cup
• Tossed salad with lettuce,
• tomato
• Garlic bread, 2 slices (2 oz)
• Diet Coke

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Matching Insulin to Carbohydrate Intake

• Useful for people taking at least 3-4 insulin
  injections per day or on insulin pump
• Carbohydrate to insulin ratio is determined
• Example Ratio of 151 means that 1 unit of
  insulin needed for every 15 grams carbohydrate
• Insulin dose depends on planned carbohydrate
  intake at meal

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Write down

• Carbohydrate eaten
• Times of meals
• Blood glucose results
• Diabetes pills or insulin
• Physical activity/exercise

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What Else Affects Your Blood Glucose?

• Portions sizes
• Large portions of carbohydrate
• increase blood glucose

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What Else Affects Your Blood Glucose?

• Timing of food intake
• Space food throughout day
• Eat at regular times
• Dont skip meals

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Measuring and Weighing Foods

• You cant accurately count carbohydrate without
  weighing and measuring
• Weigh at least once a week
• Practice, practice, practice!

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What to Weigh and Measure

• Weigh Bread, rolls, bagels,
• some fruits, baked potatoes
• Measure mashed potatoes, popcorn, pasta, rice,
  vegetables,
• fruit juice

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Mixed Foods Containing Carbohydrate

• Macaroni Cheese
• Soups
• Casseroles
• Lasagna

• Subs
• Beef Stew
• Spaghetti and Meatballs

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RestaurantDining

• Dining Out in Restaurants
• Use books on restaurant eating
• Estimate carbohydrate content
• Check blood glucose 2 hours after meal
• Take-out (Example Chinese)
• Measure food at home to determine carbohydrate
  content

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Fast Foods

• Get carbohydrate information from
• Web site or toll-free number for chain
  restaurants
• i.e. www.mcdonalds.com
• Extension web site for fast foods
• Carbohydrate counting books

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Fast Food Restaurants 1

• Subway Carb Exchanges
• Classic Italian 43 g 2 1/2 starch
• 2 meat,1 veg,
• 1 fat
• Tuna - 6 42 g 2 1/2 starch
• 1 meat, 1 veg 5 fat

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Fast Food Restaurants 2

• McDonalds Carb Exchanges
• Hamburger 34 g 2 starch, 1 meat, 1/2 fat
• 6-pc Chicken 15 g 1 starch, 2 meat,
  McNuggets 1 1/2 fat
• French Fries 57 g 4 starch, 3 fat
• medium

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Other Factors to Consider

• Fat
• Slows down time your stomach takes to empty
• Delays rise in blood glucose
• High in calories

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Other Factors to Consider

• Protein
• Very little effect on blood glucose
• Usually combined with fat

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Weight Gain and Carbohydrate Counting

• You can gain weight if you
• Count carbohydrate, but ignore fat content of
  foods
• Eat more high-calorie foods

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Fiber and Carbohydrate Counting

• Included in total carbohydrate
• Does not convert to glucose
• For more than 5 grams insoluble fiber per
  serving subtract amount of fiber from the Total
  Carbohydrate

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Fiber and Carbohydrate Counting

• For example
• 1 cup cereal 30 gm Total Carbohydrate
• - 7 grams insoluble dietary
  fiber
• 23 grams
• Count as 23 grams carbohydrate

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So, enjoy the increased variety and flexibility
with Carb Counting...
..but watch the fat and calories!
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Activity