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1
Improving Diabetes Control with Accurate Carb
Counting
Gary Scheiner, MS, CDE
j
2
Carbohydrate CountingAdvantages
  • Fewer high BGs
  • Fewer low BGs
  • No off limits foods
  • Flexibility in meal snack quantities


The Frozen Tundra
3
Carbohydrate is the nutrient in food that raises
blood glucose the most and the fastest, by far
4
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
5
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

6
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

7
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

8
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

9
Now meet the lesser known carbs
(discount 100!)
Fiber
(discount 50!)
Sugar Alcohol
Sorbitol / Maltitol / Lactitol/ Mannitol /
Xylitol
Glycerine
(Rare can ignore!)
10
The fate of dietary carbohydrates
 
Simple Carbohydrates (sugars)
? ?
? ?
Blood Glucose
Complex Carbohydrates (starches)
 
11
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)

12
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.

13
Does the Type of Carbohydrate Matter?
14
Ultimately, The Amount of Carbohydrate is More
Important Than the Type
15
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.

16
Methods for Counting Carbs Accurately
  • The Exchange system
  • Food package labels
  • Resource listings
  • Portion estimation
  • Carb factors

17
The Exchange System
  • Foods with common nutrient values are grouped
    together.

18
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

19
Nutrition Facts Label Method
  • Labels are the best resource for carbohydrate
    counting
  • Pay attention to
  • Serving Size
  • Total Carbohydrate
  • Fiber Sugar Alcohol (if any)

20
(No Transcript)
21
Fiber and Carbohydrate Counting
  • Included in total carbohydrate
  • Does not convert to glucose
  • Subtract fiber from the Total Carbohydrate

22
Fiber and Carbohydrate Counting
  • For example
  • 13 g Total Carb
  • - 3 g dietary fiber
  • Count as 10 grams
  • carbohydrate

23
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

24
Carbohydrate Counting Using Books
  • Use for foods without a
  • Nutrition Facts Label
  • Fresh fruits
  • Fresh vegetables
  • Ethnic foods
  • Fresh baked goods
  • Restaurant foods

25
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

26
  • 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

27
Insulin Pump Carb Databases
  • Accu-Chek Spirit Palm Software
  • Animas IR 1200, 1250, 2020
  • Deltec Cozmo 1800
  • OmniPod PDM

28
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

29
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
 
30
Portion Estimation Method
  • Estimate the carbs

20g/cup X 1 ¼ cups ? 25g
 
31
Portion Estimation Method
  • Estimate the carbs

5g / cup X 4 cups ? 20g
 
32
Portion Estimation Method
  • Estimate the carbs
  • 25g / cup
  • X 1 ½ cups
  • 38g
  • 12g / cup
  • X 1 cup
  • 12g
  • Total 50g

 
33
Portion Estimation Method
 
  • Other tricks

 
 
34
Portion Estimation Method
  • Estimate the carbs

30g / hand X 1 1/3 hands ? 40g
 
35
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

36
Carbohydrate Factor Method
Salter 1450
37
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
38
Carbohydrate Factor Method
  • How much carb
  • is in a baked potato
  • weighing exactly 300
  • grams?
  •  
  • 36g
  • 46g
  • 66g
  • 86g

300 x .22g 66g carb
39
Measuring and Weighing Foods
  • You cant accurately count carbohydrate without
    weighing and measuring periodically
  • Weigh at least once a week
  • Practice, practice, practice!
  • Test yourself against the label

40
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

41
Weight Gain and Carbohydrate Counting
  • Your child can gain weight if
  • Count carbohydrate, but ignore fat/calorie
    content of foods
  • No limits placed on portion sizes
  • Frequent snacking

42
Write it down!
  • Blood glucose results
  • Carbohydrate eaten
  • Insulin or other meds
  • Physical activity/exercise

43
Only count the carbs you actually consume!
Jackie Scheiner Age 1
44
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
  • (877) 735-3648
  • www.integrateddiabetes.com
  • Gary_at_integrateddiabetes.com
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