Patients who have diabetes or who are overweight are advised to do carbohydrate counting. The most challenging part of the treatment plan for these cases is determining what to eat. There is no “One size fits all” eating pattern
BY DERLYN B. CLACIO, RND
Currently, the best practice to maintain and sustain the quality of life of a person with diabetes is to undergo Diabetes Self Management Education (DSME). Considered as patient-centered, DSME is cost-efficient and responsive to individual’s preferences, needs and values. One such method is Carbohydrate Counting.
Monitoring and having a consistent pattern of carbohydrate intake with respect to time and amount can result in improved glycemic control and a reduced risk of hypoglycemia (blood glucose level <70mg/dL).
Why Count Carbohydrates?
Carbohydrates are the body’s main source of fuel and are necessary to maintain proper cellular function. After you eat any type of carbohydrates, it breaks down into glucose and enters the bloodstream. This is why blood glucose rises after eating carbs. As to protein and fat, they do not have as big of an impact on blood sugar as carbohydrates, so carbs are what we look at.
The hormone insulin, which comes from the pancreas, helps cells throughout your body absorb glucose and use it for energy. With diabetes, glucose is unable to travel to the cells due to a lack of insulin or insulin resistance. You may also need to take diabetes medicines or have insulin shots to control your blood glucose levels.
If you’re living with diabetes, and take insulin, you’ll need to take that into account when eating carbs.
How Should Carbohydrate Counting be done?
Finding the right amount of carbohydrate depends on many factors such as: Height, Weight, Age, Activity level, medication and weight loss goals.
Carbohydrate counting can be used by anyone with diabetes, not just by people taking insulin. Carbohydrate counting is a method of calculating grams of carbohydrate consumed at meals and snacks. It is a way of planning your meals to help you manage your blood sugar.
Carbohydrate counting does not have to be confusing and complicated. It can be counted by two ways: by grams or by carb choices. Your Registered Nutritionist- Dietitian (RND) or Certified Diabetes Educator (CDE) will let you choose, which method you prefer.
First step is to have a meal plan; it will help you figure out how much carbohydrate, protein and fat to eat at meals each day. If you do not have a meal plan meet with a Registered Nutritionist-Dietitian.
Step two; learn to identify which foods contain carbohydrate. Most people know that starchy foods, such as bread, pasta and cereal contain carbohydrates, but other foods such as fruit, milk and desserts have carbs too. You could ask for a food choice list from your Registered Nutritionist-Dietitian and learn also how to read Nutrition Facts Label.
You can find out how many grams of carbohydrate are in the foods you eat by checking the nutrition labels on food packages. Following is an example of a nutrition label
Nutrition labels tell you the total grams of carbohydrate per serving, along with other nutrition information:
• the food’s serving size––such as one slice or 1/2 cup
• the total grams of carbohydrate per serving
• other nutrition information, including calories and the amount of protein and fat per serving
Reading food label is a great way to know how much carbohydrate is in a food. Serving size is important because all the values on the nutrition label are based on 1 serving, not the entire package. Multiply the number of servings you will eat by the total grams of carbohydrate and you will know how many carbs you are eating.
If the serving size is 1 cup, measure one cup to be sure that’s how much you are eating. If the portion you eat is more or less than the serving size on the label, you need to figure out how many grams of carbohydrate you actually consumed. It’s a good idea to measure or weigh your food so you could get a good sense of serving size. For foods that do not have a label, you have to estimate how much carbohydrate is in it. Keeping general serving size in mind will help you estimate how much carbohydrate you are eating.
To make things easy, you can begin carbohydrate counting by rounding the carb values of milk up to 15 grams, so 1 serving of milk contains 15 grams ( 12 grams in Food Exchange List,FNRI/DOST), 3 serving of vegetable also contains 15grams, 1-2 serving of vegetable do not need to be counted.
Counting is based on the principle that 15 g of carbohydrate equal one carbohydrate serving (or one carb choice). Each meal and snack will contain a total number of grams of carbohydrates. Add up the number of grams of carbohydrate for each meal and snack and write the total. It is important to know your carbohydrate allowance for each meal and snack than it is to know your total for the day.
Exchange Lists for Diabetes
Carbohydrate Foods, Serving Sizes, and Carbohydrate Grams Per Servings
Here is an example; let’s say your Breakfast meal plan contains 4 carbohydrate servings or 60 grams of carbohydrate. The label on a breakfast cereal says it contains 30grams of carbohydrates. Instead of calculating how many exchanges that converts to, just figure out how many grams of carbohydrate you need to meet your 60grams of carbohydrate. Add about 30 grams of carbohydrate (one serving of fruit and one serving of milk, for example) and voila you have almost matched your total.
As part of counseling for advanced carbohydrate counting, RNDs teach clients to match their rapid-acting mealtime insulin dose (or bolus) with their carbohydrate consumption based on an insulin-to-carbohydrate ratio (ICR) and to adjust the bolus according to the grams of carbohydrate eaten. Dietitians work with clients to help them develop an understanding of the principles of the basal-bolus insulin concept to achieve optimal blood glucose levels.
A normal-functioning pancreas constantly secretes insulin in two ways: basal and bolus. Basal insulin is secreted to counteract rises in blood glucose due to gluconeogenesis (formation of glucose in the liver) or hormone fluctuations caused by stressors, activity, or metabolic changes. Bolus insulin is secreted to counteract rises in blood glucose following meals.
Injected insulin is designed to mimic normal pancreatic function. Basal insulin given by injection is long-acting insulin taken once or twice per day. Some examples include NPH (Humulin N, Novolin N, Novolin NPH), glargine (Lantus), and detemir (Levemir). This type of insulin works to counteract rises in blood glucose that occur independent of meal ingestion.
Bolus insulin is given by injection in relation to meals and counteracts the rise in blood glucose from food. Rapid-acting insulin aspart (NovoLog), lispro (Humalog), and glulisine (Apidra) are examples of bolus insulin. They begin working within 10 to 20 minutes of injection, peak within 40 to 50 minutes, and have duration of action of three to five hours. Regular insulin (Humulin R) also is used as a bolus insulin, although it has a different mechanism of action, beginning to work in 30 minutes, peaking in 80 to 120 minutes, with duration of action of six to eight hours.
Matching bolus insulin to carbohydrate intake using an ICR is optimal for postmeal blood glucose management. Once an ICR is established, patients can adjust their mealtime bolus based on their carbohydrate intake.
For Carbohydrate Counting to be effective in blood glucose control you have to keep good glucose records and food diaries. After a while, you’ll get a sense of how certain foods affect your blood glucose levels so you can anticipate and avoid highs and lows.
Once you learn how to count carbs, it can become second nature. Many people find carb counting to be much easier than using a more traditional exchange meal plan. Lastly, it allows you to decide how much you want to eat at a meal, rather than having to eat a certain amount of carbohydrate, even if you do not want to. The flexibility of food choices makes carb counting very appealing; you can take control of your diabetes with every bite.
“For Carbohydrate Counting to be effective in blood glucose control you have to keep good glucose records and food diaries. After a while, you’ll get a sense of how certain foods affect your blood glucose levels so you can anticipate and avoid highs and lows”
September 2017 Health and Lifestyle