Download Make carbohydrate counting add up

CLI N IC AL QU ER I ES
Make carbohydrate counting add up
One of my patients newly diagnosed with diabetes doesn’t understand carbohydrate counting.
What suggestions could help
him?—R.M., TEX.
Connie M. Beck, BSN, RN, replies:
Carbohydrate counting is a way for
people with diabetes to estimate the
amount of carbohydrates in a meal
and use this information to adjust
their insulin dosage. Made of starches
and sugars, carbohydrates are found
in many foods made from flours,
sugars, starches, grains (whole or
processed), and some vegetables.
Examples include breads and other
baked goods, cereals, crackers, pasta,
and starchy vegetables such as corn,
peas, and potatoes. They’re also
found in dairy products; fruits; nonstarchy vegetables such as lettuce,
broccoli, and carrots; and desserts
and other sweets.1
Lists can be found online and in
most nutrition books. (See Resources
for patients.) Carbohydrates are also
listed on food labels in grams.
National fast food restaurants list
them in their nutritional information.
Generally, one serving of carbohydrates is equal to 15 g of carbohydrates, or the amount of carbohydrates
in a slice of white bread. Other
examples of portions that are equivalent to one serving of carbohydrates
are a 5-cm (2-in) diameter apple, half
a banana, or 1/2 cup of pasta.
Resources for patients
• American Diabetes Association.
http://www.diabetes.org.
• American Diabetes Association, American Dietetic Association. The Diabetic
Exchange List. http://glycemic.com/
DiabeticExchange/The%20Diabetic
%20Exchange%20List.pdf.
64 l Nursing2014 l September
Teaching patients with diabetes to
keep track of their carbohydrate intake along with pre/post-self-monitoring of blood glucose (SMBG) can
help them identify patterns and better manage food intake and maintain
glycemic control.2 “Carb counting”
increases meal planning options and
reduces the risk of hypoglycemia.
With the help of a diabetes educator
or dietitian, motivated patients can
learn to use a personalized insulin-tocarbohydrate ratio to help determine
the correct insulin dosage needed to
control their blood glucose levels.3
Multiple daily insulin injections,
which include basal and bolus insulin,
can be adjusted up or down depending
on the blood glucose/carbohydrate
count. With the guidance of their
primary care provider or diabetes
educator, some patients control their
blood glucose well enough to reduce
the amount of medications needed.
The easiest way to learn how to do
carb counting is to remember that
one serving equals 15 g of carbohydrates. A general guideline to use for
carb intake per meal is 45 to 60 g of
carbs for women and 60 to 75 g for
men, with 15 g for snacks.1
Serving size matters too. Remind
patients that a package may contain
more than one serving. (Many patients don’t always check to see what
a serving size really is.) The total carbohydrate grams are what matters.
Many patients incorrectly check only
the grams of sugar. Reading nutritional labels for not just the grams of
carbohydrates but for serving size too
will help patients determine how
much they can eat while maintaining
glycemic control and the recommended carb count for the day.4
Patients with diabetes who wish to
use carb counting should also be aware
of its drawbacks. This method requires
that patients be motivated to perform
SMBG more frequently, calculate carbs
to be consumed before and after each
meal, and account for “hidden” carbs
in foods and drinks, such as artificial
creamers used in coffee or tea and
condiments like ketchup and mustard.
Because not all patients want or need to
do math with their meals, matching
dietary approach and patient motivation
is crucial to successful diabetes control.3
All patients with diabetes, not just
those who choose carb counting to
control their diabetes, need to be educated on how an increase or decrease
in physical activity and any illness or
surgery can affect blood glucose. These
changes may require that patients,
with the guidance of their provider,
have their calories, carbohydrate, and/
or insulin adjusted for better control
during these stressful times.5
With the right information, patients with diabetes can successfully
use carb counting to help maintain
glycemic control and live a healthy,
active life. ■
REFERENCES
1. Geil PB. Choose your foods: exchange lists for
diabetes: the 2008 revision of exchange lists for
meal planning. Diabetes Spectr. 2008;21(4):281-283.
2. Watts SA, Anselmo JM, Kern E. Validating the
AdultCarbQuiz: a test of carbohydrate-counting
knowledge for adults with diabetes. Diabetes Spectr.
2011;24(3):154-160.
3. Henske JA, Griffith ML, Fowler MJ. Initiating
and titrating insulin in patients with type 2 diabetes. Clin Diabetes. 2009;27(2):72-76.
4. Hunt M, Hooley I, Hartley L, West Suffolk Hospital, Bury St. Edmunds. Carbohydrate counting—the
West Suffolk way. J Diabetes Nurs. 2011;15(5):199.
5. Childs BP, Grothe JM, Greenleaf PJ. Strategies
to limit the effect of hypoglycemia on the diabetes
control: identifying and reducing the risks. Clin
Diabetes. 2012;30(1):28-33.
Connie M. Beck is a staff RN II at Unity Health System,
Parkridge Hospital, in Rochester, N.Y.
The author has disclosed that she has no financial
relationships related to this article.
DOI-10.1097/01.NURSE.0000453008.25395.31
www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.