Post on 23-Feb-2016
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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 Group Approximately 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