CARBOHYDRATE COUNTING. Podder Guide to Carbohydrate Counting
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1 CARBOHYDRATE COUNTING Podder Guide to Carbohydrate Counting
2 WHY CARBOHYDRATES MATTER 1,2 WHAT ARE CARBOHYDRATES? 3 STARCHES Carbohydrates are important because they provide energy and essential vitamins and minerals. Proteins and fats also contain calories, vitamins and minerals but do not contain carbohydrates unless the food is a mixed dish like a casserole. Proteins and fats take longer to digest and are slower to affect blood glucose. Higher consumption of protein or fat at meals can delay glucose absorption, and create higher blood glucose levels later. Carbohydrates are the primary foods that affect glucose levels. Nearly 100% of digestible starches and sugars become glucose soon after eating. Glucose is then released into the blood stream to provide immediate energy needs, or stored in the muscle and liver as glycogen. Excess glucose is converted to fat for storage. 2 Starchy vegetables like potatoes, corn and peas, dried beans and lentils, grains like oats, barley, rice and items made from wheat flour. SUGARS Naturally occur in milk and fruit, or added during cooking or processing. Common names for sugar are table sugar, brown sugar, molasses, honey, cane sugar, maple syrup, high fructose corn syrup and agave nectar. FIBER Can be found in fruits, vegetables, whole grains, nuts and legumes. Most dietary fiber is not digestible. Fiber contributes to digestive health, keeps you regular and helps make you feel full and satisfied after eating. 3
3 KNOW YOUR CARBOHYDRATES 3,4 COMPLEX CARBOHYDRATES include starchy foods and foods with fiber like whole grain pasta, beans, brown rice, or whole wheat bread. Choosing less processed, whole grain products like these are not only more nutritious, but the fiber can have a favorable effect on your blood glucose and digestive health. SIMPLE CARBOHYDRATES include table sugar, honey, syrups, regular soda, fruit juice, jellies and candies. These foods are digested easier and absorbed into your blood stream faster than complex carbohydrates. SUGAR ALCOHOLS include erythritol, glycerol, sorbitol, mannitol, and xylitol among others. They usually end with tol. These sweeteners provide fewer calories than sugar and have less of an effect on blood glucose. CARBOHYDRATES, INSULIN & BLOOD GLUCOSE LOW-CALORIE SWEETENERS include Nutrasweet, Equal, Sweet N Low, Splenda and Stevia. These sweeteners do not provide carbohydrates or calories to your food or beverages. WHAT IS BASAL/BOLUS INSULIN THERAPY? In order to understand insulin-to-carbohydrate ratios, it is important to fi rst understand basal insulin and bolus doses. 62 WHY COUNT CARBOHYDRATES? Carbohydrate counting is a great technique to use to help you plan your meals and manage your insulin dosing. Some people count carbohydrates for better portion control and balanced meals. When you have diabetes, it can be benefi cial to count carbohydrates so that you may dose meal time insulin based on your carbohydrate intake. This method uses an insulin-tocarbohydrate ratio or "IC Ratio" that is provided to you by your healthcare provider. 5 BASAL INSULIN Your body needs a small amount of insulin constantly working in the background. If you currently take insulin using Multiple Daily Injections (MDI), you likely use long-acting insulin to address this. If you are using an insulin pump, you get your basal insulin from a constant infusion of rapid-acting insulin called a basal rate. BOLUS DOSES On top of basal insulin, additional insulin is needed in anticipation of foods that are likely to raise your BGs, like carbohydrates, and/or to correct an elevated blood glucose (BG) value. This additional dose of insulin is called a bolus dose. Whether you are using MDI or an insulin pump, rapid-acting insulin is most commonly used for bolus doses. 4 5
4 BALANCING INSULIN WITH CARBOHYDRATES Your BGs after a meal rely heavily on the balance of insulin to carbohydrates. Accurately counting the amount of carbohydrates in your meal is a key step to achieving this balance. KNOW YOUR BLOOD GLUCOSE LEVELS When you begin carbohydrate counting, it is helpful to know what your pre- and post-meal targets should be. Targeted American Diabetes Association Recommended Range7 A1C Less than 7.0% Pre-meal Blood Glucose mg/dl Post-meal Blood Glucose Less than 180 mg/dl (1-2 hours after start of meal) WHAT IS AN IC RATIO? Omnipod Insulin-to-Carbohydrate Ratios are used to determine your meal bolus dose. This ratio helps you calculate how many units of rapid-acting insulin are needed for the amount of carbohydrates (in grams) you plan on eating. Example: IC Ratio of 1U :10g 10g carbohydrates 60g carbohydrates 6 needs 1U rapid-acting insulin 10 = 6 unit bolus As you can see, with this method, the amount of insulin you take for your meals is better customized to what you are going to eat. If you eat more carbohydrates, you take more insulin. If you eat less carbohydrates, you take less insulin. The Omnipod Insulin Management System may help you with this calculation. After providing the Omnipod System a current BG and carbohydrate amount, the Omnipod System can suggest a bolus amount for you. 7
5 THREE STEPS OF CARBOHYDRATE COUNTING IDENTIFY THE CARBOHYDRATES. ESTIMATE THE PORTION. 8 After you have identifi ed the carbohydrates in your meal, it s time to estimate how much you plan to eat. There are several ways you can do this: Measuring cups Initially, you will fi nd it helpful to use measuring cups to get an understanding of how much of a certain food looks like. Before you know it, you will be able to eye-ball a portion and be fairly accurate! Nutritional food scales Some fi nd scales helpful as this is the most accurate way to determine carbohydrate grams. This method tends to be a little more complicated and not widely used. Estimate by comparison You may fi nd these comparisons helpful when estimating portions. STEP ONE Foods we eat are categorized into the following: Carbohydrates: Starches, starchy vegetables, legumes, fruit, fruit juice, dairy products (not cheese), and sweets. Proteins: Meat, fi sh, eggs, tofu, cheese, and nuts. Fats: Cooking oils, butter, margarine, cream, avocado, cheese, and nuts. Free foods: Non-starchy vegetables, artifi cial sweeteners, condiments like mustard or low-calorie dressing. For example, if you have a meal of grilled chicken, mashed potatoes, green beans, corn and a fruit cup, you would focus on just the potatoes, corn, and fruit for your carbohydrate count! IDENTIFY THE CARBOHYDRATES ESTIMATE THE PORTION = CALCULATE THE GRAMS 30g carbs total STEP THREE STEP TWO 1 teaspoon of margarine is the size of one dice. 3 ounces of meat is the size of a deck of cards. CALCULATE THE GRAMS. of pasta is the size of a baseball. Once you know the portion size of the carbohydrates in your meal, it s time to count the grams of carbohydrates using the nutrition label or food lists! 1½ ounces of cheese is the size of four stacked dice. ½ cup of fresh fruit is the size of a tennis ball. 8 9
6 NUTRITION FACTS LABEL 9 If you have this available on your food product, here is some advice on where to look. The two key pieces of information on the nutrition facts label for carbohydrate counting are the serving size and total carbohydrates. Nutritional facts are calculated based on this portion. TOTAL CARBOHYDRATES Includes grams of sugar, sugar alcohol, starch, and dietary fiber. FIBER If there are more than five grams of fiber in a serving, subtract half of the grams of fiber from the total carbs, and use the adjusted number as the food s total carb count. HOW MANY CARBOHYDRATES PER MEAL IS IDEAL? 1,5 ADULT MEN Maintain Current Weight Lose Weight Meals grams grams Snacks grams 15 grams Maintain Current Weight Lose Weight Meals grams grams Snacks 15 grams 0 grams ADULT WOMEN ADDED SUGARS Sugars that are either added during processing or packaging
7 DRIED BEANS, PEAS, LENTIL CARBS COMMON CARBOHYDRATE 10 S Black beans cooked Pinto beans cooked Peas cooked Chickpeas cooked Lentils cooked 18g 12g 16g BREADS MILK AND MILK PRODUCTS CARBS CARBS White or wheat bread Hotdog or hamburger bun Bagel 2 slices (2 oz) 1 whole (2 oz) 1 whole (3-4 oz) 25-30g 25g 52g Milk (low fat, fat-free, 2%, whole) Plain low-fat yogurt Plain, low-fat, greek yogurt (8 oz) (8 oz) (8 oz) 12g 16g 8g Corn bread Biscuit Dinner roll (whole wheat) Saltine crackers Flour tortilla Corn tortilla Pita bread 1 muffin (2 oz) 1 biscuit (2 oz) 1 roll (1 oz) 5 crackers 1 tortilla (8" diameter) 1 tortilla (6" diameter) 1 pita (6.5" diameter) 28g 27g 15g 11g 25g 13g 33g FRUIT AND FRUIT JUICES Apple Banana Watermelon Strawberries Blueberries 1 small (4 oz) 1 small (6") halves CARBS 17g 23g 12g 12g 21g CEREALS / GRAINS / PASTA Pineapple 21g CARBS Grapes 27g Rice cooked (white or brown) 2/3 cup 30g Canned fruits (in juice) 28g Pasta cooked 38g Apple, orange, grapefruit, or pineapple juice (4 oz) 15g Dry cereal (Plain Cheerios ) Cranberry, grape, or prune juice (4 oz) Instant oatmeal (regular cooked with water) Grits cooked with water Couscous cooked Quinoa cooked 1 packet 32g 37g 40g SWEETS, DESSERTS AND SNACKS Regular soda Vanilla ice cream (regular) 1 can (12 oz) CARBS 38g 15- STARCHY VEGETABLES Vanilla wafers 8 cookies 22g CARBS Chocolate chip cookie 1 cookie (1 oz) Corn 35g Graham crackers 8 crackers (1 oz) 27g Mashed potatoes 35g Frozen yogurt 18g Baked potato 3-4" diameter 1 large (10 oz) 64g Popcorn (regular, microwave) popped 5g Mixed vegetables 15g Pretzels 1 oz 23g Butternut squash 21g Potato chips (plain, lightly-salted) 1 oz (15 chips) 15g 12 13
8 MY PERSONALIZED LIST SAMPLE DIARY SIZE CARBOHYDRATE (g) LOG Date: Breakfast Glucose Level Food Carbs (g) Before Meal: After Meal: Medication(s): Other Notes: Lunch Glucose Level Food Carbs (g) Before Meal: After Meal: Medication(s): Other Notes: Dinner Glucose Level Food Carbs (g) Before Meal: After Meal: Medication(s): Other Notes: Snack(s) Glucose Level Food Carbs (g) Before Meal: After Meal: Medication(s): Other Notes: 14 15
9 CARB COUNTING RESOURCES Online Carbohydrate Food Lists: Calorie King USDA RESOURCES 1. Making Healthy Food Choices. American Diabetes Association Website. food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/. Updated August 26, Accessed April 27, Beaser RS. Joslin s Diabetes Deskbook: A guide for primary care providers. 3rd ed. Boston, MA: Joslin Diabetes Center; Nutrition and Carb-Counting Books: American Diabetes Association 0r 800-ADA-ORDER ( ) American Association of Diabetes Educators Recipes: dlife Other Helpful Sites: Find a Registered Dietitian More Diabetes Information Find a Certified Diabetes Educator DiabetesEducation/Find.html Resources for the Omnipod System: MyOmnipod.com Customer Care (available 24/7) Types of Carbohydrates. American Diabetes Association Website. food/what-can-i-eat/understanding-carbohydrates/types-of-carbohydrates.html. Updated March 9, Accessed April 27, Low Calorie Sweeteners. American Diabetes Association Website. Updated December 16, Accessed April 27, Carbohydrate Counting. American Diabetes Association Website. food/what-can-i-eat/understanding-carbohydrates/carbohydrate-counting.html. Updated March 11, Accessed April 27, How Do Insulin Pumps Work? American Diabetes Association Website. Updated March 9, Accessed April 27, American Diabetes Association. Standards of Medical Care in Diabetes Diabetes Care. 2016; 39 (Suppl. 1): S43 8. Serving Size vs. Portion Size: Is There a Difference? Academy of Nutrition and Dietetics Website. Updated March 20, Accessed April 27, U.S. Food and Drug Administration Website. LabelingNutrition/default.htm. Updated June 30, Accessed September 23, USDA Food Composition Database Website. Accessed September 1, 2016 For additional information download the free My Omnipod mobile app! 16 17
10 2017 Insulet Corporation. Omnipod, the Omnipod logo and Podder are trademarks or registered trademarks of Insulet Corporation. All rights reserved. All other trademarks are the property of their respective owners. The use of third party trademarks does not constitute an endorsement or imply a relationship or other affi liation A-AW R3 01/17
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