Download Carbohydrate Counting

Nutrition – CARBOHYDRATE COUNTING
SECTION: 16.03
b.
CONSIDERATIONS:
1. Carbohydrate counting is a key part of glycemic
control and a key element in diabetes diet teaching.
2. The carbohydrate counting diet is healthful for all
people, and can be used as a plan for weight control
and for overall balanced eating.
3. People need at least 130 grams of carbohydrate
each day for good health. It is as important to eat
enough carbohydrate as it is to not eat too much.
4. Carbohydrate counting:
a. Aims for about 45 - 60 grams of
carbohydrates/meal; must individualize to
patient
b. Each 15 grams of carbohydrate equals one
serving
c. Most meals should consist of 3 to 4 servings of
carbohydrate
5. There are many benefits to adhering to this diet,
including:
a. Blood sugar and blood lipid control
b. Weight control
c. It allows some patients with diabetes take less
medication or avoid medication if they have
diabetes
d. Helps people to avoid the short-term and longterm complications of diabetes. These
complications can affect the heart, kidneys,
eyes, and nerves
3.
4.
EQUIPMENT:
Nutrition Label Handout:
http://www.diabetes.org/food-and-fitness/food/what-cani-eat/taking-a-closer-look-at-labels.html
Nutrition labels on foods in patient’s kitchen
Measuring cups
Food scale
PROCEDURE:
1. Introduce carbohydrate counting
a. Carbohydrate counting is a meal-planning
approach based on the ideas that:
i. Carbohydrates are the main nutrient
affecting postprandial glycemic response
ii. The total amount of carbohydrates
consumed is more important that the source
of carbohydrates
b. Carbohydrate counting is more flexible than
other meal-planning programs and concepts
c. Sugar is not forbidden. Sugar is just one of
many types of carbohydrate. However, most
carbohydrate should come from nutritious
sources, such as fruits, vegetables, whole
grains, etc.
2. Describe which types of food contain carbohydrate.
These foods are “counted”:
a. Breads, cereals, pasta, and grains
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Beans and certain vegetables, known as
starchy vegetables
c. Fruit and fruit juices
d. Milk and yogurt
e. Sugar-sweetened beverages
f. Candy, bakery items, ice cream, pudding, and
snack foods such as potato chips and pretzels
Explain to the patient that he will be allotted a
certain number of carbohydrate choices for meals
and snacks:
a. Most females get three choices at breakfast and
lunch, three or four at dinner, and two before
bed
b. Most males get four choices at breakfast and
lunch, four or five at dinner, and two before bed
Explain that one carbohydrate choice contains
roughly 15 grams of carbohydrate. One choice is
equal to the following portion sizes:
a. One slice of bread, ½ a hotdog or hamburger
bun, ½ an English muffin, 1/3 cup pasta or rice,
or ¾ cup of unsweetened cereal counts as one
choice
b. 1/3 cup of baked beans, ½ cup of other beans
such as black beans or kidney beans, ½ cup of
peas, ½ cup of corn, or a ½ cup of mashed
potatoes count as one carbohydrate choice.
Fifteen French fries is a carbohydrate choice
(an average small size fast food serving is two
choices). A small baked potato (only three
ounces) is one carbohydrate choice:
i. It is helpful to weigh a potato to show how
many ounces an average potato weighs. If
it’s six ounces, it counts as two choices. If
it’s nine ounces it counts as three choices
ii. Other vegetables are non-starchy
vegetables. One cup of raw vegetables or ½
cup of cooked vegetables only contains five
grams of carbohydrate. This includes
lettuce, green beans, tomatoes, cabbage,
broccoli, cauliflower, summer squash,
carrots, etc.
c. One small orange, apple, or peach is one
carbohydrate choice. A half-cup of canned
unsweetened fruit or unsweetened apple sauce
is one carbohydrate choice. Fifteen grapes or
twelve cherries is one choice. A cup of melon is
one choice. Pears, bananas, grapefruit,
mangoes and papayas count as two choices
each. Two tablespoons of raisins is one choice.
A half-cup of orange, apple, or grapefruit juice is
one choice. Only a third of a cup of grape juice
or cranberry juice is one choice
d. One cup of milk, ½ cup of chocolate milk, or
one container of light yogurt counts as one
carbohydrate choice
Last Update 9/12
Nutrition – CARBOHYDRATE COUNTING
SECTION: 16.03
AFTER CARE:
1. Document what was taught, who was taught and
response to teaching.
2. Teach:
a. Use the teach-back method and return
demonstration method to assure learning
b. Ask patient to plan several meals, explaining
amounts
c. Evaluate learning over several visits by
reviewing recent meals
3. Communicate with caregivers who will assist patient
with buying, preparing and serving food.
e.
5.
6.
7.
8.
One small cookie, ½ cup of ice cream, ½ cup of
sugar-free pudding, two fig newton cookies, or a
small handful of potato chips or pretzels counts
as one choice. One frosted cupcake or slice of
pumpkin or custard pie (with only a bottom
crust) counts as two choices
Specify that some foods do not contain enough
carbohydrate to count. It is recommended that lean
or low-fat varieties are chosen for heart-health,
when possible. Foods that are not counted include:
a. Plain meat, fish, or poultry
b. Cheese, including cottage cheese and cream
cheese
c. Nuts and nut butters
d. Seeds
e. Tofu
f. Sugar-free gelatin
g. Butter, oil, margarine, mayonnaise, sour cream,
and most salad dressings
Teach that sugar-free foods are not free foods. They
usually count, and often count as much as the
original version. It is important to look at grams of
total carbohydrate on all food labels. However,
some sugar free foods don’t count, such as diet
soda or sugar-free gelatin. Others, such as sugarfree popsicles or puddings allow you to eat more for
the same amount of carbohydrate:
a. Nutrition Facts labels combine natural sugars
and added sugars
b. If you only look at sugar on the Nutrition Facts,
instead of carbohydrate, you could avoid
healthful foods such as fruit and milk, which
contain natural sugars. Alternatively, some high
carbohydrate foods such as pasta or cereals
have no natural or added sugar, but still need to
be eaten in moderation
Fiber is very important for people with diabetes. It
helps the carbohydrates in food absorb more
gradually so that blood glucose levels remain
steady. One slice of whole wheat bread or one slice
of white bread count as one choice each, but the
whole wheat bread will help to keep your glucose
levels more regulated:
a. The Dietary Guidelines for Americans 2010
recommend that adults consume 14 grams of
fiber per 1000 calories
b. This comes out to be 21 - 25 grams of fiber/day
for many women and 30 - 38 grams/day for
many men
Assure patient can read carbohydrates on food
labels, practicing on several foods in home.
REFERENCE:
Joslin Diabetes Center (2012). Carbohydrate Counting
101. Retrieved May 19, 2012 from:
www.joslin.org/info/Carbohydrate_Counting_101.
html
Taking a Closer Look at Food Labels. Retrieved May 19,
2012 from: http://www.diabetes.org/food-andfitness/food/what-can-i-eat/taking-a-closer-lookat-labels.html
MORE INFORMATION & PATIENT HANDOUTS:
Carbohydrate counting Q & A. Retrieved on May 19, 2012
from:
http://nutrition411.com/diabetes_center/article.ph
p?ID=D-0507
Diabetes Meal Planning: Easy As 1, 2, 3. Retrieved on
May 19, 2012 from:
http://nutrition411.com/diabetes_center/article.ph
p?ID=65pat
Fiber Up for Diabetes. Retrieved on May 19, 2012 from:
http://nutrition411.com/diabetes_center/article.ph
p?ID=7pat
Non-starchy vegetables. Available from:
http://www.diabetes.org/food-andfitness/food/what-can-i-eat/non-starchyvegetables.html
Resources for Teaching Patient. Carbohydrate Counting
For Patients with Diabetes, etc. Retrieved May
19, 2012 from:
http://nutrition411.com/diabetes_center/template
_fhp.htm Hold cursor over link on left to bring up
many downloadable powerpoints for teaching the
patient.
Q & A: Answers to Commonly Asked Questions.
Retrieved on May 19, 2012 from:
http://nutrition411.com/diabetes_center/article.p
hp?ID=D-0563
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Last Update 9/12