IMAM REZA HOSPITAL Z. SAEEDREZAEE-NUTRITIONIST Jun 7, 2012.

Mashhad University of Medical Sciences

 IMAM REZA HOSPITAL

Z. SAEEDREZAEE-NUTRITIONISTJun 7 , 2012

Carbohydrate Counting for Patients With Type 1 Diabetes

What is Carbohydrate Counting?

Estimating the carbohydrate content of food so

that you can adjust your insulin dose to match the amount of

carbohydrate you want to eat.

Advantages of Carbohydrate Counting

Good glycemic controlFreedom to eat when you want toFreedom to eat as little or as much as you wish

( more flexible in the diet & lifestyle)

What is Carbohydrate?

SUGARS

GLUCOSE

CARBOHYDRATE

STARCH FIBER

Blood Stream

Insulin

Cells of body

Food Groups

CHO

CHO

Starchy Vegetables&

CHO

Starchy food Approximately 15 grams of CHO Per serving

CHO :Starchfiber

Fruit GroupApproximately

15 grams of CHO per serving

CHOSugar (Fructose , glucose, sucrose,Sugar alcohol)FiberLow starch

Milk GroupApproximately 12 grams of CHO per serving

CHO :Sugar (lactose)

Other Carbohydrate Group

Approximately 15 grams of CHO per serving

CHO: starch SugarLow fiber

Sugar1)Sugar occurs naturally in some unprocessed food : milk , fruit , vegetables , some grain

2)Added sugars that is added to foods and beverages : Include table sugar, brown sugar, corn syrup, molasses (saccharose , glucose ,fructose ,lactose, maltose , dextrose , maltodextrine , sorbitol)

Artificial sweetenersArtificial sweeteners currently approved by the Food and Drug Administration (FDA) are: Acesulfame potassiumAspartame NeotameSaccharinSucralose

Example:

SUGAR FREE NO CARBOHYDRATE FREE

CHO content from labels

Shredded WheatNutrition FactsServing Size 2 biscuit (1.6 oz.)Servings per container: 10Total Calories: 155 Calories from fat: 9

FatSaturatedTrans Fat

CholesterolSodiumTotal Carbohydrate

Dietary FiberSugars

Protein

1 g0.2 g0g0mg3mg36.2g

5.5g0.4g5.2g

Vitamin A 0% Vitamin C 0% Calcium 2% Iron 6%

Shredded WheatNutrition FactsServing Size 2 biscuit (1.6 oz.)Servings per container: 10Total Calories: 155 Calories from fat: 9

FatSaturatedTrans Fat

CholesterolSodiumTotal Carbohydrate

Dietary FiberSugars

Protein

1 g0.2 g0g0mg3mg36.2g

5.5g0.4g5.2g

Vitamin A 0% Vitamin C 0% Calcium 2% Iron 6%

1. Look at the “Serving size”

2. Look at the “Total Carbohydrate” in grams

Total Carbohydrate: includes grams ofsugar, sugar alcohol, starch, and dietary fiber

3. Subtract fiber and sugar alcohol from the “Total Carbohydrate”

How to adjust insulin for carbohydrate ?

1)Insulin-to-Carb Ratio the amount of rapid acting insulin given for the amount of carbohydrate eaten at a meal or snack

Age (yr) Units Added Per 15 g CHO at meal

0 - 5 0/5

5- 12 0/75

12- 18 1-2

Ref:rence : Alemzade R,Wyatt DT.Diabetes Mellitus in Children.ln:Behrman RE,et al.Nelson,textbook of pediatrics.19 th ed,2010.

2)insulin sensitivity factor A correction (or sensitivity) factor can be used to determine how much extra insulin should be added to the insulin dose which will be given to cover the carb eaten.

Age (yr) Units Added Per 100 mg/dl Above Target

0 - 5 0/5

5- 12 0/75

12- 18 1-2

Ref:rence : Alemzade R,Wyatt DT.Diabetes Mellitus in Children.ln:Behrman RE,et al.Nelson,textbook of pediatrics.19 th ed,2010.

Example (Breakfast)BG befor breakfast : 130Bread 2 slice (60 gr ) 2 U insulinEgg without CHOMilk ( 1 cup) 1 U insulinApple jam( 1 tablespoon) 1 U insulin

4 U insulin Aspart inject After 2 h check BG

Small snack <15 gr CHO – no insulin needed

Larger snack over 15 gr CHO insulin may be required

snacks

Example (lunch)BG before lunch : 300 Cooked rice (1 cup) 3 U insulinCooked lentils (1/2 cup) 1 UMeat ,salad without CHOYogurt (1/2 cup) 0/5 U

4.5 U insulin + 1.5 U insulin After 2 h check BG

Testing timesBefore Breakfast

2 hours after breakfast

Befor lunch

2 hours after lunch

Befor dinner

2 hours after dinner

3 am

Timing of insulin for quick or slow meals

Quick acting: French bread ,mashed potato , cake inject before meal

Slow acting : pasta , whole bread , legums inject after eating

High fat &/or high protein slows up rise in blood sugar : Pizza , fish & chips½ insulin just after eating and the other ½ 30

– 45 minutes later

Disadvantages of CHO countingNeed to skilled in making calculationPossible weight gain if high calorie foods intake is not monitored

Eating for Good HealthLow sugar, avoid sugary drinksLow fat, especially low in saturated fat1 – 2 portions of oily fish per weekGood intake of fruit & vegetables

Thank you