Download Nutrition Guideline Implementation Committee

Nutrition Guidelines
Implementation Committee
Making Carbohydrates
Count:
A Hands-On Approach
Barbara Allan RD, CDE, Anne Garrett, RD, MEd.
Kathryn Arcudi P.Dt, CDE, Kerry Schubert-Mackey RD, CDE
Objectives
At the end of the session participants
should be able to:
•
use the new CDA nutrition tool:
“Basic Carbohydrate Counting for
Diabetes Management”
•
understand the steps involved in
teaching clients how to carbohydrate
count
Objectives
…and participants should be able to:
•
•
•
identify carbohydrates on food labels
recognize the glycemic impact of various
carbohydrate sources
use food labels and other resources to
calculate the carbohydrate content of
meals
“Basic Carbohydrate Counting for
Diabetes Management”
Why carbohydrate count?
• It is a simple and flexible way to plan
meals.
•
It focuses on the nutrient with the greatest
impact on blood glucose levels.
•
It helps clients manage their blood glucose
levels.
“Basic Carbohydrate Counting for
Diabetes Management”
For basic carbohydrate counting,
a person must have the ability to:
do simple mathematics
• use nutrient analysis information
• have and know how to use measuring
cups, spoons and scales
• keep accurate and detailed records
•
The tool…
Nutrition Facts Table
Nutrition Facts Table
The total amount of carbohydrate in
grams is listed first.
• This number includes starch, sugars and
fibre.
(Sugars and fibre may also be listed
separately.)
• Clients must note the given serving size
with care.
•
Dietary Fibre
•
Fibre does not raise blood glucose levels.
•
Subtract fibre from the total carbohydrate
if 5 grams or more per food.*
*AADE 2001. A Core Curriculum for Diabetes Education, 4th Ed.
•
For advanced carbohydrate counting,
subtract fibre from total carbohydrate if 3
grams** or more per food.
**Building Competencies in Diabetes Education:The Essentials 2001
Other Considerations
•
Glycemic Index
•
Sugar Alcohols (polyols)
Glycemic Index
•
The Glycemic Index is a ranking system for
carbohydrate-rich foods.
•
It describes the extent that blood glucose
rises after a “test” carbohydrate food in
comparison with a “reference” carbohydrate
food, usually glucose or white bread.
GI in Practice
•
For the same number of carbohydrate
grams, low or medium GI foods may raise
blood glucose less than high GI foods.
•
Glucose determinations at 1-2 hours
postprandial will be instructive.
•
See “Professionals Only” section
of the CDA website.
Sugar Alcohols
•
Nutritive sweeteners commonly used in
‘dietetic’ and ‘sugar-free’ foods.
•
They produce a lower glycemic
response due to reduced absorption.
•
Potential for gastrointestinal upset and
hypoglycemia.
Sugar Alcohols and Polydextrose
Sugar alcohol
% Absorbed
Energy Value(Kcal/g)
Sorbitol
50-79%
2.6
Mannitol
≅50%
1.6
Xylitol
≅50%
3.0
Maltitol
50-75%
3.0
Lactitol
0%
2.0
Isomalt
50-60%
2.0
Polydextrose
No data
1.0
Canadian Journal of Diabetes: Volume 26 Number 4; pp 356-362
Sugar Alcohols
•
For basic carbohydrate counting you would
count only half (50%) of the carbohydrate
coming from sugar alcohols
•
Polydextrose is not a sugar alcohol. Subtract
it from the total carbohydrate.*
*National Nutrition Committee, Canadian Diabetes Association.
Guidelines for Assigning Food Choice Values and Symbols
Beta Release 1993: 17 (3) p.11-15
Sugar Alcohol
Recommendations
•
An intake of 10 grams of sugar alcohols
daily should not adversely affect metabolic
control in adults with diabetes. (Grade D)
•
The risk of GI side effects is low with an
intake of less than 10 grams but increases
as intake increases. (Grade B, level 2)
Armit E and the NNC, CDA. Report from
the NNC. Diabetes Quarterly. 2003 (1):14
Sugar Alcohols
Carbohydrate
Counting Checklist
For additional info
•
For copies of the tool
Literature Coordinator, Fax: 416-363-7465
www.diabetes.ca
•
To contact the Subcommittee
E-mail or call Sharon Zeiler,
[email protected]
1-800-BANTING x 473
Case Study
1. List the tools/resources
for teaching
•
•
•
•
•
New tool Basic Carbohydrate Counting
for Diabetes Management
Just the Basics: Healthy Eating for
Diabetes Management and Prevention
Canada’s Food Guide to Healthy Eating or
Diabetes Food Guide
Food models
Measuring cups & food weigh scale
1. List the tools/resources
for teaching
Good Health Eating Guide Resource
• Sources of nutrient content of foods such
as books, websites, fast food flyers, food
packages.
• New tool Basic Carbohydrate Counting
for Diabetes Management- What did you
eat or drink?
•
Food Records
2. What are the steps in
teaching?
•
•
•
•
•
Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
Make healthy choices.
Focus on carbohydrate.
Set carbohydrate goals.
Determine carbohydrate content.
Monitor effect on blood glucose.
Guy’s Lunch October 2nd
Food, Portion
Carb g
Pita, whole wheat 6.5 inch dia (60 g wt)
31
Beef, 2oz
0
Mustard, 1tsp
0
Tomato soup with milk., 8oz
23
Soda crackers Premium whole wheat, 10
Baked beans, 1cup
Mini carrots, 10
Pear, medium
Light Crunch bar
8
Guy’s Lunch October 2nd
Food, Portion
Carb g
Pita, whole wheat 6.5 inch dia (60 g wt)
31
Beef, 2oz
0
Mustard, 1tsp
0
Tomato soup with milk, 8 oz.
23
Soda crackers Premium W.W, 10
22
Baked beans, 1cup
34
Mini carrots, 10
8
Pear, medium
21
Light Crunch bar
11
Total available carbohydrate
150
Light Crunch Bar
Simplified
Total carbohydrate…………………….=30 g
- fibre……- 0g……………………….…= 30 g
- polydextrose……- 17g………………= 13 g
- polyols…….5.7g /2=3……………….= 10 g
3b
How would you go about determining Guy’s
lunch Carb goal?
•
Review calculations.
•
Discuss variation in his 3 lunch meals
(80g vs 74g vs 150g).
•
Together determine a goal for consistent
carb gram. Consider your perception of
health needs and Guy’s preferences.
4. What do you say to Guy
about diet candy bars?
•
Caution him against taking more than 10g polyols
daily as more than this can cause GI upset and
impact on metabolic control.
•
Caution him against habitual use of diet candies
because of their low nutritional value and potentially
high saturated fat content.
•
Calculate carbohydrate from polyols by dividing
grams by 2 or by using the chart for more exact
calculations.
Participant Survey
•
Your thoughts are important!!
•
Give your surveys to speakers or drop
off at the CDA booth.
•
Completed surveys will be entered into
a draw.