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

The University of Georgia Cooperative The University of Georgia Cooperative Extension ServiceExtension Service

Improving Diabetes Control with

Carbohydrate Counting

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

Carbohydrate CountingAdvantages

• Easier - you only count carbohydrate

• Allows you more flexibility in food choices– Virtually any food can be worked

into your meal plan

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)

Why Count Carbohydrate?

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

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

Nutrients in Foods

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

What are Carbohydrates?

bread, rice, cereal, potatoes, pasta, corn, peas, butter beans

fruit, milk, regular sodas, candy, juices

Combination Foods That Contain Carbohydrate

•Pizza•Spaghetti•Sandwiches

•Casseroles•Soups•Stews

Which Contain Carbohydrate?

• Brunswick stew• Brussels

sprouts• Sugar-free jello• Skim milk• Fat-free frozen

yogurt

• Baked chicken

• Rice• Orange juice• Diet soda• Oreos

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

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

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)

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

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

2 Ways to Count Carbohydrate

•Carbohydrate Choices Food Exchanges or Servings

•Carbohydrate Grams Specific number of grams of

carbohydrate per meal or snack

Carbohydrate Choices(servings)

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

• One carbohydrate choice = 15 grams carbohydrate

Carbohydrate Choices

•Lunch:Exchanges Carbohydrate Choices2 starch = 2 carb choices1 fruit = 1 carb choice1 milk = 1 carb choice3 meat = 0 carb choices2 fat = 0 carb choices

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

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

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

Resources for Counting Carbohydrate

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

Nutrition Facts Label

• Best resource for carbohydrate

counting• Pay attention to:

–Serving Size–Total Carbohydrate

Nutrition FactsServing Size 1 cup (228 g)Servings per Container 8Calories 170 Calories from fat 18Total Fat 2 gSaturated Fat 0 gCholesterol 0 gSodium 330 mgTotal Carbohydrate 32 gDietary Fiber 8 gSugars 5 gProtein 6 gVit A 35% Vit C 4%Calcium 10% Iron 20%

Food Label (Example 1)

• Your meal plan: 2 carb choices (30 grams carb)• Food label (ice-cream):

Serving size = 1/2 cupTotal carbohydrate = 15 grams

How much ice-cream should you have?

Food Label (Example 2)

If your meal plan at breakfast is: 45 grams carbohydrate

Food label: Cereal MilkServing size: 1/2 cup 1 cupTotal Carb: 15 grams 12

gramsHow much cereal and milk should

you have?

Carbohydrate Counting Books

• Use for foods without a Nutrition Facts Label

– Fresh fruits – Fresh vegetables– Breads from a bakery or farmer’s

market– Restaurant foods

Food Exchange Booklet

• Gives average carbohydrate values for many foods

• Pocket Guide available

Practice Counting Carbs #1

Breakfast Choices Grams

1 large bagel (4 oz)1 tsp. margarine 1/2 cup orange juice

1 cup skim milk

Practice Counting Carbs #2

Dinner Choices GramsSpaghetti noodles

1 cups

Spaghetti sauce, cup

Tossed salad with lettuce,

tomato

Garlic bread, 2 slices (2 oz)

Diet Coke

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 15:1 means that 1 unit of

insulin needed for every 15 grams carbohydrate

• Insulin dose depends on planned carbohydrate intake at meal

Write down:

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

What Else Affects Your Blood Glucose?

•Portions sizes– Large portions of carbohydrate increase blood glucose

What Else Affects Your Blood Glucose?

•Timing of food intake– Space food throughout day– Eat at regular times– Don’t skip meals

Measuring and Weighing Foods

• You can’t accurately count carbohydrate without weighing and measuring

• Weigh at least once a week

• Practice, practice, practice!

What to Weigh and Measure

•Weigh: Bread, rolls, bagels,

some fruits, baked potatoes

•Measure: mashed potatoes, popcorn, pasta, rice, vegetables,

fruit juice

Mixed Foods Containing Carbohydrate

• Macaroni & Cheese

• Soups• Casseroles• Lasagna

• Subs• Beef Stew• Spaghetti and

Meatballs

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

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

Fast Food Restaurants #1

Subway® Carb ExchangesClassic Italian 43 g 2 1/2 starch

2 meat,1 veg,1 fat

Tuna - 6” 42 g 2 1/2 starch1 meat, 1 veg 5

fat

Fast Food Restaurants #2

McDonalds® CarbExchanges

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 fatmedium

Other Factors to Consider

•Fat– Slows down time your stomach

takes to empty– Delays rise in blood glucose– High in calories

Other Factors to Consider

•Protein– Very little effect on blood

glucose– Usually combined with fat

Weight Gain and Carbohydrate Counting

You can gain weight if you: • Count carbohydrate, but ignore

fat content of foods• Eat more high-calorie foods

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

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

So, enjoy the increased variety and flexibility with Carb Counting...

..but watch the fat and calories!

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