Nutrition GuidelinesImplementation Committee

Making Carbohydrates Count:

A Hands-On Approach

Barbara Allan RD, CDE, Anne Garrett, RD, MEd.

Kathryn Arcudi P.Dt, CDE, Kerry Schubert-Mackey RD, CDE

Objectives

• use the new CDA nutrition tool: “Basic Carbohydrate Counting for Diabetes Management”

• understand the steps involved in teaching clients how to carbohydrate count

At the end of the session participants should be able to:

Objectives…and participants should be able to:

• identify carbohydrates on food labels

• recognize the glycemic impact of various carbohydrate sources

• use food labels and other resources tocalculate the carbohydrate content of meals

“Basic Carbohydrate Counting for Diabetes Management”

Why carbohydrate count?• It is a simple and flexible way to plan

meals.

• It focuses on the nutrient with the greatest impact on blood glucose levels.

• It helps clients manage their blood glucose levels.

“Basic Carbohydrate Counting for Diabetes Management”

For basic carbohydrate counting, a person must have the ability to:

• do simple mathematics• use nutrient analysis information • have and know how to use measuring

cups, spoons and scales• keep accurate and detailed records

The tool…

Nutrition Facts Table

Nutrition Facts Table

• The total amount of carbohydrate in grams is listed first.

• This number includes starch, sugars and fibre. (Sugars and fibre may also be listed separately.)

• Clients must note the given serving size with care.

Dietary Fibre

• Fibre does not raise blood glucose levels.

• Subtract fibre from the total carbohydrate if 5 grams or more per food.*

• For advanced carbohydrate counting, subtract fibre from total carbohydrate if 3 grams** or more per food.

*AADE 2001. A Core Curriculum for Diabetes Education, 4th Ed.

**Building Competencies in Diabetes Education:The Essentials 2001

Other Considerations

• Glycemic Index

• Sugar Alcohols (polyols)

Glycemic Index

• The Glycemic Index is a ranking system for carbohydrate-rich foods.

• It describes the extent that blood glucose rises after a “test” carbohydrate food in comparison with a “reference” carbohydrate food, usually glucose or white bread.

GI in Practice

• For the same number of carbohydrate grams, low or medium GI foods may raise blood glucose less than high GI foods.

• Glucose determinations at 1-2 hours postprandial will be instructive.

• See “Professionals Only” sectionof the CDA website.

Sugar Alcohols

• Nutritive sweeteners commonly used in ‘dietetic’ and ‘sugar-free’ foods.

• They produce a lower glycemic response due to reduced absorption.

• Potential for gastrointestinal upset andhypoglycemia.

Sugar Alcohols and Polydextrose

No data

50-60%

0%

50-75%

≅50%

≅50%

50-79%

% Absorbed

1.0Polydextrose

2.0Isomalt

2.0Lactitol

3.0Maltitol

3.0Xylitol

1.6Mannitol

2.6Sorbitol

Energy Value(Kcal/g)Sugar alcohol

Canadian Journal of Diabetes: Volume 26 Number 4; pp 356-362

Sugar Alcohols

• For basic carbohydrate counting you would count only half (50%) of the carbohydrate coming from sugar alcohols

• Polydextrose is not a sugar alcohol. Subtract it from the total carbohydrate.*

*National Nutrition Committee, Canadian Diabetes Association. Guidelines for Assigning Food Choice Values and Symbols Beta Release 1993: 17 (3) p.11-15

Sugar Alcohol Recommendations

• An intake of 10 grams of sugar alcohols daily should not adversely affect metabolic control in adults with diabetes. (Grade D)

• The risk of GI side effects is low with an intake of less than 10 grams but increases as intake increases. (Grade B, level 2)

Armit E and the NNC, CDA. Report from the NNC. Diabetes Quarterly. 2003 (1):14

Sugar Alcohols

Carbohydrate Counting Checklist

For additional info

• For copies of the toolLiterature Coordinator, Fax: 416-363-7465www.diabetes.ca

• To contact the SubcommitteeE-mail or call Sharon Zeiler, zeiler@diabetes.ca1-800-BANTING x 473

Case Study

1. List the tools/resources for teaching

• New tool Basic Carbohydrate Counting for Diabetes Management

• Just the Basics: Healthy Eating for Diabetes Management and Prevention

• Canada’s Food Guide to Healthy Eating or Diabetes Food Guide

• Food models• Measuring cups & food weigh scale

1. List the tools/resources for teaching

• Good Health Eating Guide Resource• Sources of nutrient content of foods such

as books, websites, fast food flyers, food packages.

• New tool Basic Carbohydrate Counting for Diabetes Management- What did you eat or drink?

Food Records

2. What are the steps in teaching?

• Step 1: Make healthy choices.• Step 2: Focus on carbohydrate.• Step 3: Set carbohydrate goals.• Step 4: Determine carbohydrate content.• Step 5: Monitor effect on blood glucose.

Guy’s Lunch October 2ndCarb gFood, Portion

Light Crunch bar

Pear, medium

8Mini carrots, 10

Baked beans, 1cup

Soda crackers Premium whole wheat, 10

23Tomato soup with milk., 8oz

0Mustard, 1tsp

0Beef, 2oz

31Pita, whole wheat 6.5 inch dia (60 g wt)

Guy’s Lunch October 2nd

11Light Crunch bar

150Total available carbohydrate

Carb gFood, Portion

21Pear, medium

8Mini carrots, 10

34Baked beans, 1cup

22Soda crackers Premium W.W, 10

23Tomato soup with milk, 8 oz.

0Mustard, 1tsp

0Beef, 2oz

31Pita, whole wheat 6.5 inch dia (60 g wt)

Light Crunch BarSimplified

Total carbohydrate…………………….=30 g

- fibre……- 0g……………………….…= 30 g

- polydextrose……- 17g………………= 13 g

- polyols…….5.7g /2=3……………….= 10 g

3b How would you go about determining Guy’s lunch Carb goal?

• Review calculations.

• Discuss variation in his 3 lunch meals (80g vs 74g vs 150g).

• Together determine a goal for consistent carb gram. Consider your perception of health needs and Guy’s preferences.

4. What do you say to Guy about diet candy bars?

• Caution him against taking more than 10g polyolsdaily as more than this can cause GI upset and impact on metabolic control.

• Caution him against habitual use of diet candies because of their low nutritional value and potentially high saturated fat content.

• Calculate carbohydrate from polyols by dividing grams by 2 or by using the chart for more exact calculations.

Participant Survey

• Your thoughts are important!!

• Give your surveys to speakers or drop off at the CDA booth.

• Completed surveys will be entered into a draw.