Glucometers and Carbohydrate Counting in Schools

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Glucometers and Carbohydrate Counting in Schools

• Katie Goldsworthy R.D.

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CHO (carbohydrate counting)

• Fulcrum of balancing diet and medicine
• Essential to good diabetes management
• Health professionals role is dependent on age
  and competency of diabetic
• Works by using a CHO to insulin ratio

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CHO Food Groups

• Fruits to 15 CHO
• Fruit size of tennis ball, ½ c. canned 1c. cut.
  Fresh fruit
• Watch for fruit canned in syrup
• Look to see amount in juices
• Some dairy (milk, yogurt) to 15 CHO
• 1 c. milk
• ½ c. chocolate milk
• 1 container sugar-free yogurt
• Starch (mostly breads, but also starchy
  vegetables) to 15 CHO
• One piece bread, ½ bagel, 1/3 c. rice, ½ c. pasta
• Sugars

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The Past and Now

• Old method exchange method
• Counted every food group including meats and
  vegetables
• Sugars were considered no-nos.
• Had to eat certain amounts of carbs, meats, and
  fats at certain times during the day

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The Past and Now

• New method carb counting
• Uses insulin to CHO ratio
• Allows extreme flexibility to eat when and what
  diabetic wants
• Less strict more compliance
• Only counts CHO food groups

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• CHO usually group in groups of 15 CHO
• Count how many carbs choices there are
• Use book to count carb choices or count each
  carb individually
• Then divide by insulin/carb to get ratio

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Lets Practice!

• Carton milk 15 CHO or 1 CHO choice
• Green beans dont need to count
• Burrito 45 CHO or 3 carb choices
• Cookie 15 CHO or 1 carb choice
• Canned Fruit (1/2 c. light) 15 CHO or 1 carb
  choice

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Lets Practice!

• Carton chocolate milk
• Ham sandwich
• Apple
• 4 Oreos
• Carrot sticks
• 1 small bag of chips 15 CHO, 1 carb

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Lets Practice!

• Child has a CHO/ insulin ratio of 15 CHO/1.0 unit
  of insulin how much insulin???

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Quick note

• Best to buy CHO counting booklet at store, or you
  can call Mimimed pump co, they can mail you one,
  or call a local meter rep.
• 1800-minimed
• Novo Nordisk 1-1800-727-6500
• You can also find on internet
• Best to find a very complete bookgo to local
  book store

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Quick note

• Try to kindly involve parents
• Encourage them to get school lunch menu early to
  count carbs with child
• Suggest fun ideas
• Flash cards
• Separate baggies for snacks (pre-labeled)
• Special decorated tray in nurses station or
  classroom
• Resource NovoNordisk www.carbcards.com

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CHO (carbohydrate counting)

• Usually a rapid-acting insulin for boluses
• --Lispro (Humalog), Aspart (Novolog), Glulisine
  (Apidra)
• Possibly using short acting insulins
• --Regular (Humalin R. Novolin R)
• If using vial and syringe method, most likely
  using fast-acting insulin bolus with intermediate
  or long acting insulin.
• More and more children using insulin pumps
• --only using rapid acting insulin alone

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Quick notes

• Sugar is not a no-no with carb counting, if
  done properly.
• We want to encourage diabetic to comply with
  diet, not discourage
• Dont ask are you supposed to be eating that?
  ask did you give yourself insulin for the carbs
  in that?
• Theyre bound to get candy at school
• Check with parents on sugar and CHO counting
  philosophy

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Glucometers

• Kid-friendly glucometers
• Precision Sof-Tact
• Freestyle meters
• One Touch FastTake
• Relatively fast meters, can use alternate testing
  sites (forearm, thumb, thigh), and use less blood

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Other kid-friendly devices

• Pens
• EZ shot
• Bolus wizards on insulin pumps

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Blood glucose ranges

• Blood glucose ranges very general for children
  due to huge swings in blood glucose
• Suggested ranges for BG goals pre and
  post-prandial are
• -- 80-200mg/dl A1C 7.5-9.3
• --70-180 mg/dl A1C
• --70-150 mg/dl A1C 7.8 12 yrs
• Test before PE and lunch

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Lets test!

• Clean area, wash with warm water
• Hold hand at side, then briefly shake it
• Prick the finger with firm pressure
• Site rotation is recommended to as many sites as
  possible, sides of fingertips may be more
  comfortable d/t fewer nerve endings

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Alternate Site Testing

• Seem to be discrepancies in readings between
  alternate sites and fingertips
• If blood glucose changes suddenly, use fingertip
• Rapid B.G. changes typically occur during
  exercise, illness or after eating.

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Quick notes

• Good to have back-up meter in office
• Glucometer sales reps will most likely donate
  meter
• Should using glucometer testing solution

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Quick notes

• Remember for child to be in good control does
  not meal BG readings alone. Assess
• 1.) How does the child feel?
• 2.) Is the child going to school?
• 3.) Participating in school activities?
• 4.) Is the child growing normally
• 5.) Insulin skipping in adolescents?

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Local Support Groups/Meetings

• Keiki Ohana Konnection (Youth)
• Aloha Pumpers Tom Wellman 454-1850
• Military support group TAMC/CWD Ages 0-18yrs
  Hope Cooper-Oliver 433-2565
• Local ADA Chapter 1-808-947-5979
• For diabetes info www.diabetes.org or
  1800-342-2383

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Thank You!!

• Good luck to you in this next school year!
• Feel free to call me with any questions 375-4271

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