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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 507 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 508 Last Update 9/12