Carbohydrate Counting 101

Transcription

1 Disclosures Carbohydrate Counting 101 Kathryn DeNure, RD/LD, CNSC Clinical Nutrition Manager, CoxHealth Medical Nutrition Therapy Role of the RD Inpatient Outpatient Nutrition Assessment Components Interventions & Goals Client centered Individualized plan of care Follow-up Case Study Insert Details Carbohydrate Macronutrient Function Metabolism Blake, Munoz, Volpe. Nutrition From Science to You

2 History Calorie Points Exchange System DCCT Carboydrate Counting Blake, Munoz, Volpe. Nutrition From Science to You Carbohydrate Consistent Diet Food Keep it Real Client Centered Flexibility Consistent Timing Balance Food Sources 1 serving = 15 grams Carb Breads, crackers, cereals Pasta, rice, grains Starchy vegetables; potatoes, corn, peas Beans, legumes Milk, soy milk, yogurt Fruit Fruit juice Sweets ; cakes, cookies, ice cream, jelly Sugar sweetened beverages So... What s a Serving Household measurements Examples (15 grams carb/serving) 1 slice bread One quarter large sweet potato One third cup cooked rice 1 cup strawberries 1 cup milk 1 Tbsp. table sugar or honey 2

3 Fiber Food Sources Benefits To subtract or not subtract Free Foods Sugar Alcohols Examples Black coffee, unsweet tea Mustard, vinegar, 1 Tbsp. ketchup Sugar-free gelatin, 2 Tbsp. sugar-free syrup Club soda, carbonated or mineral water Food Sources But it was a sugar free ice cream Caution Non-nutritive sweeteners Food Labels Ingredients keep it simple Serving size it matters Total Carbohydrate Fiber Sugars Changes 3

4 Hospital Menu Ticket Example Lunch THU 10/18/2018 Diet: Regul, CarbC GUEST, MENU Baked Pork Chop (3 gm) 5 ounce Mixed Greens & Vinegar (4 gm) 1/2 cup Macaroni and Cheese (26 gm) 6 ounce House Salad (2 gm) 1 cup Fruit Bowl (14 gm) 1/2 cup Italian Dressing Packet (1 gm) 1 pkt Chocolate Ice Cream (17 gm) 1 each Tea, Iced (0 gm) 1 cup Meal Time Insulin Baked Pork Chop (3 gm) 5 ounce 100% Mixed Greens & Vinegar (4 gm) 1/2 cup 100% Macaroni and Cheese (26 gm) 6 ounce 50% House Salad (2 gm) 1 cup 0% Fruit Bowl (14 gm) 1/2 cup 50% Italian Dressing Packet (1 gm) 1 pkt 0% Chocolate Ice Cream (17 gm) 1 each 100% Tea, Iced (0 gm) 1 cup 100% *1:5 insulin to carb ratio *How much insulin? Sample Menu Breakfast 1 egg 1 extra-small banana ¾ cup corn flakes 1 cup milk 1 slice whole wheat toast 1 tsp. butter Lunch 3 ounces turkey breast 1 whole wheat pita 4 carrot sticks, 4 celery sticks, ½ cup sliced cucumber ¾ ounce tortilla chips 1 ounce avocado 1 medium apple Sample Menu Supper 4 ounces roast beef ½ large baked potato 1 Tbsp. sour cream 1 cup cooked Brussel sprouts 2 cups mixed green salad 1 Tbsp. salad dressing 1 Tbsp. sesame seeds 1 cup cubed melon Snack 1 container plain Greek yogurt (5.3 ounces) ½ cup sliced strawberries 1 ounce almonds Case Study Wrap-Up Interventions Goals 4

5 Summary Real Food Multiple Approaches Client Focused Care Team Follow-up References MacLeod, Janice et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Nutrition Intervention Evidence Reviews and Recommendations. Journal of the Academy of Nutrition and Dietetics. 2017;(10): Franz, Marion J. et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: Systematic Review of Evidence for Medical Nutrition Therapy Effectiveness and Recommendations for Integration into the Nutrition Care Process. Journal of the Academy of Nutrition and Dietetics 2017; (10): Davis, Dianne L et al. Carbohydrate counting alternative in glucose control. Journal of the Academy of Nutrition and Dietetics. 1993;(10): Shils, Shike. Modern Nutrition in Health and Disease Blake, Munoz, Volpe. Nutrition From Science to You Biesemeier. Academy of Nutrition and Dietetics, Nutrition Care Manual Academy of Nutrition and Dietetics. Evidence Analysis Library American Diabetes Association, Academy of Nutrition and Dietetics. Choose Your Foods, Exchange Lists for Diabetes Thank you, Questions? 5