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Gary Scheiner, MS, CDE

Improving Diabetes Control with Accurate Carb Counting. Gary Scheiner, MS, CDE. j. Carbohydrate Counting Advantages. Fewer high BGs Fewer low BGs No “off limits” foods Flexibility in meal & snack quantities. “The Frozen Tundra”. Carbohydrate is the nutrient

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Gary Scheiner, MS, CDE

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  1. Improving Diabetes Control with Accurate Carb Counting Gary Scheiner, MS, CDE j

  2. Carbohydrate CountingAdvantages • Fewer high BGs • Fewer low BGs • No “off limits” foods • Flexibility in meal & snack quantities “The Frozen Tundra”

  3. Carbohydrate is the nutrient in food that raises blood glucose the most and the fastest, by far

  4. Timed Effect on Blood Sugar Levels 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

  5. MEET THE CARBS! • Glucose • Fructose (fruit sugar) • Galactose • Dextrose • Lactose (milk sugar) • Sucrose (table sugar) Sugars (aka "simple" carbohydrates) • “flavored” simple sugars: • Maltose • High-Fructose Corn Syrup • Molasses • Brown Sugar • Honey

  6. MEET THE CARBS! • Fruit • Fruit Juice • Candy • Regular Soda • Punch • Wine Sugars (aka "simple" carbohydrates) • Muffins • Milk • Ice Cream • Yogurt • Sport Drinks • Table Sugar • Chocolate • Cookies & Cakes • Pies & Pastries • Raisins/Dried Fruit • Syrup • Jelly

  7. MEET THE CARBS! “branched chain” G – G – G – G – G - G G – G / \ / G – G G G – G – G G – G – G \ / \ / G – G – G – G – G – G G – G – G – G – G – G \ \ G – G – G G – G – G – G – G Starches (aka "complex" carbohydrates) “straight chain” G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G

  8. MEET THE CARBS! Starches (aka "complex" carbohydrates) • Potatoes • Rice • Noodles/Pasta • Cereal • Oatmeal • Bread • Tortillas • Pancakes • Waffles • Crackers • Bagels • Pizza • Beans • Corn • Pretzels • Chips • Popcorn • Beer

  9. Now meet the lesser known carbs (discount 100%!) Fiber (discount 50%!) Sugar Alcohol Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol Glycerine (Rare… can ignore!)

  10. The “fate” of dietary carbohydrates Simple Carbohydrates (sugars)     Blood Glucose Complex Carbohydrates (starches)

  11. Does the Type of Carbohydrate Matter? • 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) Glycemic Index

  12. 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. Does the Type of Carbohydrate Matter? Glycemic Index (contd.)

  13. Does the Type of Carbohydrate Matter?

  14. Ultimately, The Amount of Carbohydrate is More Important Than the Type

  15. CARB BASICS QUIZ – True or False • Equal amounts of sugar and starch will raise blood glucose the same amount. • Fiber will raise blood glucose levels a little bit. • “Sugar-Free” chocolate (made with sugar alcohol) will not raise blood glucose levels.

  16. Methods for Counting Carbs Accurately • The “Exchange” system • Food package labels • Resource listings • Portion estimation • Carb factors

  17. The “Exchange” System • Foods with common nutrient values are grouped together.

  18. Practice Counting Carbs Using the Exchange system BreakfastExchange/#Grams 1 large bagel (4 oz) starch (4) x 15 60g 1 tsp. margarine fat (1)x0 0g 1/2 cup orange juice fruit (1) 15g 6 oz skim milk milk (3/4) x 12 9g Total Carbs: 84g

  19. Nutrition Facts Label Method • Labels are the best resource for carbohydrate counting • Pay attention to: • Serving Size • Total Carbohydrate • Fiber & Sugar Alcohol (if any)

  20. Fiber and Carbohydrate Counting • Included in total carbohydrate • Does not convert to glucose • Subtract fiber from the Total Carbohydrate

  21. Fiber and Carbohydrate Counting • For example: 13 g Total Carb - 3 g dietary fiber Count as 10 grams carbohydrate

  22. Sugar Alcohols and Carbohydrate Counting • Artificial Sweeteners • Found in chewing gum, mints, yogurt, ice cream, cookies and candy • Digest slowly and partially ( 50%) • Can cause diarrhea

  23. Carbohydrate Counting Using Books • Use for foods without a Nutrition Facts Label • Fresh fruits • Fresh vegetables • Ethnic foods • Fresh baked goods • Restaurant foods

  24. Carbohydrate Counting Using Websites • USDA Food Composition • www.nal.usda.gov/fnic/foodcomp/search/ • Calorie King • www.calorieking.com • Fast food companies’ or food manufacturers’ websites

  25. Arby’s: www.arbys.com/nutrition/ Boston Market: www.bostonmarket.com/restaurant Burger King:www.bk.com/Food/Nutrition/NutritionWizard/index.aspx Dairy Queen: www.dairyqueen.com/en-US/Menus+and+Nutrition/Nutrition+Charts/default.htm Denny’s: www.dennys.com/en/cms/Nutrition/Allergens/23.html Dunkin’ Donuts: www.dunkindonuts.com/aboutus/nutrition/ KFC: www.kfc.com/kitchen/nutrition.htm McDonald’s: www.mcdonalds.com/usa/eat/nutrition_info.html Old Country/Hometown Buffet: www.buffet.com/nutritioncontent.htm Pizza Hut: www.pizzahut.com/menu/nutritioninfo.asp Starbuck’s: www.starbucks.com/retail/nutrition_info.asp Subway: www.subway.com/applications/NutritionInfo/index.aspx Taco Bell: www.tacobell.com/ Wendy’s: www.wendys.com/food/NutritionLanding.jsp

  26. Insulin Pump Carb Databases • Accu-Chek Spirit Palm Software • Animas IR 1200, 1250, 2020 • Deltec Cozmo 1800 • OmniPod PDM

  27. Portion Estimation Method • Use common, everyday objects to measure the portion size of food • Soda can (12 fl.oz.) = 1 ½ cups • Baseball or adult’s fist = 1 cup • Child’s fist = ½ cup • Adult’s spread hand = 8” diameter • Adult’s palm = 4” diameter

  28. Portion Estimation Method • Examples of 1-cup Carb Estimates: Corn: 30g Peas: 30g Beans: 40g Pretzels: 25g Chips: 15g Popcorn: 5g Ice Cream: 35g Cake: 45g Potato: 40g Pasta: 40g Rice: 50g Rolls: 25g Cereal: 25g Fruit: 20g Cooked Veggies: 10g Salad Veggies: 5g

  29. Portion Estimation Method • Estimate the carbs: 20g/cup X 1 ¼ cups  25g

  30. Portion Estimation Method • Estimate the carbs: 5g / cup X 4 cups  20g

  31. Portion Estimation Method • Estimate the carbs: • 25g / cup • X 1 ½ cups • 38g 12g / cup X 1 cup = 12g Total = 50g

  32. Long Sandwiches 8g per inch Pizza 30g per adult hand-sized piece (fingers together) Cookies 20g per adult-sized palm Breaded meat/veg/cheese 4g small (“thumb/nugget sized”) 10g large (“patty/palm-sized”) Portion Estimation Method • Other “tricks”:

  33. Portion Estimation Method • Estimate the carbs: 30g / hand X 1 1/3 hands  40g

  34. Carbohydrate Factor Method • 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

  35. Carbohydrate Factor Method Salter 1450

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

  37. Carbohydrate Factor Method • How much carb • is in a baked potato • weighing exactly 300 • grams? • 36g • 46g • 66g • 86g 300 x .22g = 66g carb

  38. Measuring and Weighing Foods • You can’t accurately count carbohydrate without weighing and measuring periodically • Weigh at least once a week • Practice, practice, practice! • Test yourself against the label

  39. Other Factors to Consider • 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

  40. Weight Gain and Carbohydrate Counting Your child can gain weight if: • Count carbohydrate, but ignore fat/calorie content of foods • No limits placed on portion sizes • Frequent snacking

  41. Write it down! • Blood glucose results • Carbohydrate eaten • Insulin or other meds • Physical activity/exercise

  42. Only count the carbs you actually consume! Jackie Scheiner Age 1

  43. The Ultimate Guide to Accurate Carb Counting Gary Scheiner MS, CDE Integrated Diabetes Services In-Office, Phone & Online Consults 333 E. Lancaster Ave., Suite 204 Wynnewood, PA 19096 (877) 735-3648 www.integrateddiabetes.com Gary@integrateddiabetes.com

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