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

Gary Scheiner, MS, CDEGary Scheiner, MS, CDE

Improving Diabetes Control with Accurate

Carb Counting

Carbohydrate CountingAdvantages

– Fewer high BGs– Fewer low BGs– No “off limits” foods– Flexibility in meal & snack

quantities

“The Frozen Tundra”

Meal 1 Hr 2 Hrs 3 Hrs 4 Hrs 5 Hrs 6 Hrs 7 Hrs 8 Hrs

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%)

Timed Effect on Blood Sugar Levels

* In absence of dietary carbs ** may cause insulin resistance in large qty

MEET THE CARBS!

Glucose Fructose (fruit sugar) Galactose Dextrose Lactose (milk sugar) Sucrose (table sugar)

“flavored” simple sugars:

• Maltose• High-Fructose Corn Syrup• Molasses• Brown Sugar• Honey

MEET THE CARBS!

Fruit Fruit Juice Candy Regular Soda Punch Wine

Muffins Milk Ice Cream Yogurt Sport Drinks Table Sugar

Chocolate Cookies & Cakes Pies & Pastries Raisins/Dried Fruit Syrup Jelly

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

“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

MEET THE CARBS!

• Potatoes• Rice• Noodles/Pasta• Cereal• Oatmeal• Bread

• Tortillas• Pancakes• Waffles• Crackers• Bagels• Pizza

• Beans• Corn• Pretzels• Chips• Popcorn• Beer

Now meet the lesser known carbs

(discount 100%!)

(discount 50%!)

Sorbitol / Maltitol / Lactitol/ Mannitol / Xylitol

(Rare… can ignore!)

The “fate” of dietary carbohydrates

Simple Carbohydrates (sugars)

Complex Carbohydrates (starches)

BloodGlucose

Does the Type of Carbohydrate Matter?

Glycemic IndexGlycemic Index

• All carbs (except fiber) convert to All carbs (except fiber) convert to blood glucose eventuallyblood glucose eventually

• G.I. Reflects the magnitude of blood G.I. Reflects the magnitude of blood glucose rise for the first 2 hours glucose rise for the first 2 hours following ingestionfollowing ingestion

• G.I. Number is % or rise relative to G.I. Number is % or rise relative to pure glucose (100% of glucose is in pure glucose (100% of glucose is in bloodstream within 2 hours)bloodstream within 2 hours)

Does the Type of Carbohydrate Matter?

Glycemic Index (contd.)Glycemic Index (contd.)Example:Example:

SpaghettiSpaghettiGI = 37GI = 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?

Slow Stuff Average Stuff

Fast Stuff

PastaLegumes

Salad VeggiesDairy

Chocolate

FruitJuicePizzaSoupCake

Breads/CrackersSalty Snacks

PotatoesRice

CerealsSugary Candies

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

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.

Methods for Counting Carbs Accurately

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

The “Exchange” System

• Foods with common nutrient values are grouped together.

1 Fat

1 Meat

1 Vegetable

1 Milk

1 Fruit

1 Starch

0 5 10 15

Practice Counting Carbs Using the Exchange system

Breakfast Exchange/# 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

Nutrition Facts Label Method

• Labels are the best resource for carbohydrate counting

• Pay attention to:– Serving Size– Total Carbohydrate– Fiber & Sugar Alcohol (if

any)

Fiber and Carbohydrate Counting

• Included in total carbohydrate• Does not convert to glucose• Subtract fiber from the Total

Carbohydrate

Fiber and Carbohydrate Counting

• For example:13 g Total Carb- 3 g dietary fiber

Count as 10 grams carbohydrate

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

Carbohydrate Counting Using Books

• Use for foods without a

Nutrition Facts Label– Fresh fruits – Fresh vegetables– Ethnic foods– Fresh baked goods– Restaurant foods

Carbohydrate Counting Using Websites

• USDA Food Composition– www.nal.usda.gov/fnic/foodcomp/sear

ch/

• Calorie King– www.calorieking.com

• Fast food companies’ or food manufacturers’ websites

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

Insulin Pump Carb Databases

• Accu-Chek Spirit Palm Software

• Animas IR 1200, 1250, 2020

• Deltec Cozmo 1800

• OmniPod PDM

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

Portion Estimation Method• Examples of 1-cup Carb Estimates:

Potato: 40g

Pasta: 40g

Rice: 50g

Rolls: 25g

Cereal: 25g

Fruit: 20g

Cooked Veggies: 10g

Salad Veggies: 5g

Corn: 30g

Peas: 30g

Beans: 40g

Pretzels: 25g

Chips: 15g

Popcorn: 5g

Ice Cream: 35g

Cake: 45g

Portion Estimation Method

•Estimate the carbs:

20g/cup

X 1 ¼ cups

25g

Portion Estimation Method

•Estimate the carbs:

5g / cup

X 3 cups

15g

Portion Estimation Method

•Estimate the carbs:25g / cup

X 1 ½ cups 38g

12g / cup

X 1 cup

= 12g

Total = 50g

Portion Estimation Method• Other “tricks”:

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

•Estimate the carbs:

30g / hand

X 1 1/3 hands

40g

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

Carbohydrate Factor Method

Salter 1450

Carbohydrate Factor Method

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

Carbohydrate Factor Method

How much carb

is in a baked potato

weighing exactly 300

grams?

A. 36g

B. 46g

C. 66g

D. 86g

300 x .22g = 66g carb

Measuring and Weighing Foods

• To be an accurate carb counter, weigh/measure at least once a week

• Practice, practice, practice!

• Test yourself against the label

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

Weight Gain and Carbohydrate Counting

Your can gain weight if:

• Count carbohydrate, but ignore fat/calorie content of foods

• No limits placed on portion sizes

• Frequent snacking

Write it down!

• Blood glucose results • Carbohydrate eaten• Insulin or other meds• Physical

activity/exercise

Only count the carbs you actually consume!

Jackie Scheiner

Age 1

The Ultimate Guide to Accurate Carb Counting

Gary Scheiner MS, CDE

Integrated Diabetes ServicesIn-Office, Phone & Online

Consults333 E. Lancaster Ave., Suite 204Wynnewood, PA 19096USA (877) 735-3648www.integrateddiabetes.comGary@integrateddiabetes.com