INTERMEDIATE CARBOHYDRATE COUNTING

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Improving Diabetes Control with Accurate Carb
Counting
Gary Scheiner, MS, CDE
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Carbohydrate CountingAdvantages

• Fewer high BGs
• Fewer low BGs
• No off limits foods
• Flexibility in meal snack quantities

The Frozen Tundra
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Carbohydrate is the nutrient in food that raises
blood glucose the most and the fastest, by far
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Timed Effect on Blood Sugar Levels
Carbohydrate. rapid digestion, total
absorption/conversion to glucose (100)   Sugar
Alcohols.. moderate digestion, partial
absorption as glucose (50)   Protein slow
digestion, partial conversion to glucose (40)
  Fat. slow digestion, little conversion
to glucose (lt20)
In absence of dietary carbs may cause
insulin resistance in large qty
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MEET THE CARBS!
Sugars (aka "simple" carbohydrates)

• Glucose
• Fructose (fruit sugar)
• Galactose
• Dextrose
• Lactose (milk sugar)
• Sucrose (table sugar)

• flavored simple sugars
• Maltose
• High-Fructose Corn Syrup
• Molasses
• Brown Sugar
• Honey

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MEET THE CARBS!
Sugars (aka "simple" carbohydrates)

• Fruit
• Fruit Juice
• Candy
• Regular Soda
• Punch
• Wine

• Muffins
• Milk
• Ice Cream
• Yogurt
• Sport Drinks
• Table Sugar

• Chocolate
• Cookies Cakes
• Pies Pastries
• Raisins/Dried Fruit
• Syrup
• Jelly

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MEET THE CARBS!
Starches (aka "complex" carbohydrates)
straight chain G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G-G
-G-G-G-G-G-G

• branched chain
• G G G G G - G G G
• / \ /
• G G G G G G
  G G G
• \ /
  \ /
• G G G G G G G G G G
  G G
• \
  \
• G G G
  G G G G G

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MEET THE CARBS!
Starches (aka "complex" carbohydrates)

• Potatoes
• Rice
• Noodles/Pasta
• Cereal
• Oatmeal
• Bread

• Tortillas
• Pancakes
• Waffles
• Crackers
• Bagels
• Pizza

• Beans
• Corn
• Pretzels
• Chips
• Popcorn
• Beer

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Now meet the lesser known carbs
(discount 100!)
Fiber
(discount 50!)
Sugar Alcohol
Sorbitol / Maltitol / Lactitol/ Mannitol /
Xylitol
Glycerine
(Rare can ignore!)
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The fate of dietary carbohydrates
 
Simple Carbohydrates (sugars)
? ?
? ?
Blood Glucose
Complex Carbohydrates (starches)
 
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Does the Type of Carbohydrate Matter?
Glycemic Index

• All carbs (except fiber) convert to blood glucose
  eventually
• G.I. Reflects the magnitude of blood glucose rise
  for the first 2 hours following ingestion
• G.I. Number is or rise relative to pure glucose
  (100 of glucose is in bloodstream within 2
  hours)

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Does the Type of Carbohydrate Matter?
Glycemic Index (contd.)

• Example
• Spaghetti
• GI 37
• Only 37 of spaghettis carbs turn into blood
  glucose in the first 2 hours.
• The rest will convert to blood glucose over the
  next several hours.

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Does the Type of Carbohydrate Matter?
Slow Stuff Average Stuff Fast Stuff
Pasta Legumes Salad Veggies Dairy Chocolate Fruit Juice Pizza Soup Cake Breads/Crackers Salty Snacks Potatoes Rice Cereals Sugary Candies
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Ultimately, The Amount of Carbohydrate is More
Important Than the Type
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CARB BASICS QUIZ True or False

• Equal amounts of sugar and starch will raise
  blood glucose the same amount.
• Fiber will raise blood glucose levels a little
  bit.
• Sugar-Free chocolate (made with sugar alcohol)
  will not raise blood glucose levels.

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Methods for Counting Carbs Accurately

• The Exchange system
• Food package labels
• Resource listings
• Portion estimation
• Carb factors

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The Exchange System

• Foods with common nutrient values are grouped
  together.

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Practice Counting Carbs Using the Exchange system

• Breakfast Exchange/ Grams
• 1 large bagel (4 oz) starch (4) x 15 60g
• 1 tsp. margarine fat (1)x0 0g
• 1/2 cup orange juice fruit (1) 15g
• 6 oz skim milk milk (3/4) x 12 9g
• Total Carbs 84g

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Nutrition Facts Label Method

• Labels are the best resource for carbohydrate
  counting
• Pay attention to
• Serving Size
• Total Carbohydrate
• Fiber Sugar Alcohol (if any)

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(No Transcript)
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Fiber and Carbohydrate Counting

• Included in total carbohydrate
• Does not convert to glucose
• Subtract fiber from the Total Carbohydrate

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Fiber and Carbohydrate Counting

• For example
• 13 g Total Carb
• - 3 g dietary fiber
• Count as 10 grams
• carbohydrate

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Sugar Alcohols and Carbohydrate Counting

• Artificial Sweeteners
• Found in chewing gum, mints, yogurt, ice cream,
  cookies and candy
• Digest slowly and partially (? 50)
• Can cause diarrhea

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Carbohydrate Counting Using Books

• Use for foods without a
• Nutrition Facts Label
• Fresh fruits
• Fresh vegetables
• Ethnic foods
• Fresh baked goods
• Restaurant foods

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Carbohydrate Counting Using Websites

• USDA Food Composition
• www.nal.usda.gov/fnic/foodcomp/search/
• Calorie King
• www.calorieking.com
• Fast food companies or food manufacturers
  websites

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• Arbys www.arbys.com/nutrition/
• Boston Market www.bostonmarket.com/restaurant
• Burger Kingwww.bk.com/Food/Nutrition/NutritionWiz
  ard/index.aspx
• Dairy Queen www.dairyqueen.com/en-US/MenusandN
  utrition/NutritionCharts/default.htm
• Dennys www.dennys.com/en/cms/Nutrition/Allergen
  s/23.html
• Dunkin Donuts www.dunkindonuts.com/aboutus/nutr
  ition/
• KFC www.kfc.com/kitchen/nutrition.htm
• McDonalds www.mcdonalds.com/usa/eat/nutrition_i
  nfo.html
• Old Country/Hometown Buffet www.buffet.com/nutri
  tioncontent.htm
• Pizza Hut www.pizzahut.com/menu/nutritioninfo.as
  p
• Starbucks www.starbucks.com/retail/nutrition_in
  fo.asp
• Subway www.subway.com/applications/NutritionInfo
  /index.aspx
• Taco Bell www.tacobell.com/
• Wendys www.wendys.com/food/NutritionLanding.jsp
  

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Insulin Pump Carb Databases

• Accu-Chek Spirit Palm Software
• Animas IR 1200, 1250, 2020
• Deltec Cozmo 1800
• OmniPod PDM

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Portion Estimation Method

• Use common, everyday objects to measure the
  portion size of food
• Soda can (12 fl.oz.) 1 ½ cups
• Baseball or adults fist 1 cup
• Childs fist ½ cup
• Adults spread hand 8 diameter
• Adults palm 4 diameter

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Portion Estimation Method

• Examples of 1-cup Carb Estimates

Corn 30g Peas 30g Beans 40g Pretzels
25g Chips 15g Popcorn 5g Ice Cream
35g Cake 45g
Potato 40g Pasta 40g Rice 50g Rolls
25g Cereal 25g Fruit 20g Cooked Veggies
10g Salad Veggies 5g
 
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Portion Estimation Method

• Estimate the carbs

20g/cup X 1 ¼ cups ? 25g
 
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Portion Estimation Method

• Estimate the carbs

5g / cup X 3 cups ? 15g
 
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Portion Estimation Method

• Estimate the carbs

• 25g / cup
• X 1 ½ cups
• 38g
• 12g / cup
• X 1 cup
• 12g
• Total 50g

 
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Portion Estimation Method
 

• Other tricks

 
 
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Portion Estimation Method

• Estimate the carbs

30g / hand X 1 1/3 hands ? 40g
 
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Carbohydrate Factor Method

• Weigh a portion of food
• Multiply the weight by its carb factor
• Get total carb count
• A carb factor is the percentage of the foods
  weight that is carbohydrate. The rest is water,
  protein, fat, minerals

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Carbohydrate Factor Method
Salter 1450
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Carbohydrate Factor Method
Carb Factor Examples Apple .13 Apple Pie
.32 Bagel .51 Carrot (raw) .06 Chocolate
Cake .51 Cornbread .45 Pancake .28
Pizza (cheese) .32 Potato, baked .22 Potato
Salad .09 Rice .27 Spaghetti .26 Vanilla
Ice Cream .23 Watermelon .06
For carb factors for more than 6000 foods (in
Excel spreadsheet format), go to
www.friendswithdiabetes.org/files/Carb factor.xls
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Carbohydrate Factor Method

• How much carb
• is in a baked potato
• weighing exactly 300
• grams?
•  
• 36g
• 46g
• 66g
• 86g

300 x .22g 66g carb
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Measuring and Weighing Foods

• To be an accurate carb counter, weigh/measure at
  least once a week
• Practice, practice, practice!
• Test yourself against the label

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Other Factors to Consider

• Fat
• Lengthens time your stomach takes to empty
• Delays rise in blood glucose
• May cause temporary insulin resistance

• Protein
• Very little effect on blood glucose (unless ??
  carb diet)
• Usually combined with fat

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Weight Gain and Carbohydrate Counting

• Your can gain weight if
• Count carbohydrate, but ignore fat/calorie
  content of foods
• No limits placed on portion sizes
• Frequent snacking

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Write it down!

• Blood glucose results
• Carbohydrate eaten
• Insulin or other meds
• Physical activity/exercise

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Only count the carbs you actually consume!
Jackie Scheiner Age 1
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The Ultimate Guide to Accurate Carb Counting

• Gary Scheiner MS, CDE
• Integrated Diabetes Services
• In-Office, Phone Online Consults
• 333 E. Lancaster Ave., Suite 204
• Wynnewood, PA 19096
• USA [phone]
• www.integrateddiabetes.com
• Gary_at_integrateddiabetes.com