RDTC TRACKING SHEET •  Record patient information in top right corner

•  When completed, place in RDTC binder at A-pod

Faculty desk

ED provider (i.e. faculty / PA / NP / resident to complete)

Protocol: ________________________________________________________

Date: _____/ _____/ _____ Time: _____ : _____ (military)

Current ED Location _________ (pod and room #)

Name of supervising ED provider: _________________________________________

Name of RDTC Faculty: _________________________________________________

RDTC PA / NP / Faculty to complete

Disposition: Date: _____/ _____/ _____ Time: _____ : _____ (military)

Hospitalized

Discharged

AMA / Elopement

PLEASE PLACE IN BINDER AT COMPLETION OF PATIENT COURSE

Name: _____________________________

MR# _____________________________

Stamp OR write patient information above

Rapid Diagnosis and Treatment Center University Hospital, Center For Emergency Care

ED MD/PA Protocol Checklist and Templates

Required Activities In order to bill for RDTC, we must have Orders, Progress Notes and Discharge Note. The entire completed RDTC Packet must be returned to the HUC at discharge.

! RDTC Binder Sheet (ED Provider begins. RDTC Provider Completes.)

! Dictate ED Summary Note (ED Provider – addendum by attending)

! Sign, Date and Time Order Set (RDTC Attending)

! Dictate RDTC Admission Note including reason for RDTC and the risk Stratification. (RDTC Provider–addendum by attending)

! Any patient seen in the ED before Midnight who then goes into the RDTC after midnight needs a second note dictated at the level 4/5* plus the risk stratification. (RDTC Provider–addendum by attending)

! Document RDTC Progress Notes (RDTC Provider)

! Sign, Date and Time Discharge Order Sheet (RDTC Attending)

! Dictate RDTC Discharge Summary Note (RDTC Provider–addendum by attending)

! Give entire RDTC Packet to HUC (RDTC Provider)

*Level 4 Level 5 4 HPI elements 4 HPI elements 2+ ROS 10+ ROS 3/3 Past, Fam, Social HX 3/3 Past, Fam, Social Hx EXAM 5-7 body areas/organ sx EXAM 8+ organ sx MDM straight forward – mod complexity MDM High complexity

ED MD/PA/NP Protocol Checklist and Templates

Dictation Templates RDTC Attending Summary Template (if no PA/NP/resident to do admit note)

This patient has been risk-stratified based on the available history, physical exam, and related study findings, and admission to observation status for further diagnosis/treatment of ________is warranted. This extended period of observation is specifically required to determine the need for hospitalization. This patient will be treated/monitor with/for_______. We will observe the patient for the following endpoints______. When met, appropriate disposition will be arranged.

PA/NP Admission Summary Template

I'm dictating on behalf of the attending ________. This patient has been risk-stratified based on the available history, physical exam, and related study findings, and admission to observation status for further diagnosis/treatment of ________ is warranted. This extended period of observation is specifically required to determine the need for hospitalization. This patient will be treated/monitored with/for ________. We will observe the patient for the following endpoints ________. When met, appropriate disposition will be arranged.

Discharge Home Stat Disposition Summary Templates

This patient has been cared for according to standard RDTC protocol for ________ (diagnosis). Significant events during the course of observation include (detailed testing, therapy, and response). This extended period of observation was specifically required to determine the need for hospitalization. (Please give evidence for medical necessity of DURATION of observation – i.e. when condition improves sufficiently or when study results became available.) This patient is stable for discharge based on the following diagnostic/therapeutic criteria. Prior to discharge from observation, the final physical examinations reveals________. Total length of observation time was ________ hours. (Detailed discharge instructions and discussions with primary/consulting MDs)

If PA/NP/resident dictating add: I have reviewed the case with Dr. ________ (RDTC Attending.)

Admission Disposition Summary Template This patient has been cared for according to standard RDTC protocol for ___________(diagnosis). Significant events during the course of observation include (detailed testing, therapy, and response). This extended period of observation was specifically required to determine the need for hospitalization. (Please give evidence for medical necessity of DURATION of observation – i.e. when condition improved sufficiently or when study results became available.) It is now clear based on ___________ that this patient will require admission to hospital for ___________. Prior to discharge from observation, the final physical examination reveals ___________. Total length of observation time was ___________hours.

If PA/NP/resident dictating add: I have reviewed the case with Dr. __________(RDTC Attending).

!"#$%&'$"()*+$+&")%&,-."/0.)/&1.)/.-&2)$3.-+$/4&5*+#$/"67&1.)/.-&8*-&90.-(.):4&1"-.

5;<9!=>;19?@A&&

@B1>2C@DB&AB'&'@C15A!=9&1!@,9!@A&&&

A'?@CC@DB&&

@):6E+$*)&1-$/.-$"&(if ALL criteria apply patient is a POTENTIAL RDTC candidate) &

;& B& Clinical picture consistent with hyperglycemia secondary to DM Patient has mild to moderate hyperglycemia (>300 mg/dl)& Anticipated RDTC length-of-stay greater than 8 hours and less than 23 hours Primary physician and / or consultant contacted (if applicable) Order for admission to observation status signed, dated, and timed by attending physician Adequate follow-up and social support anticipated at time of discharge

&9F:6E+$*)&1-$/.-$"&(if ANY criteria apply patient is NOT an RDTC candidate)

&;& B

Unstable vital signs, shock, impending respiratory failure, or severe systemic illness Diabetic Ketoacidosis (pH < 7.35)& New onset DM @8 insulin requiring (i.e. DKA) Possible myocardial infarction or ACS Delirium Co-morbidities or concurrent condition likely to significantly complicate disposition Emergency Physician, Primary Physician, or Consulting Physician chooses hospitalization

&&

'@C<DC@,@DB& '$+#*+$/$*)&1-$/.-$"&&

&;& B& 5*0.&(if ALL criteria apply patient may be discharged to home)&& & Blood Glucose < 250 and stable & & Tolerating PO fluids and medicine & & Stable and normal vital signs & & Follow-up obtained & & Primary physician or consulting physician contacted as appropriate

&;& B& 5*+#$/"6&(if ANY criteria apply patient should be hospitalized)

Unstable / abnormal vital signs, unresolved symptoms, or persistent vomiting New diagnosis requiring hospitalization discovered Does not or will not meet Home Disposition criteria after 23 hours of treatment At the discretion of the ED physician, primary physician, or consultant

RAPID DIAGNOSIS AND TREATMENT CENTER PHYSICIAN ORDER SHEET

All applicable orders have been checked. ORDERS NOT CHECKED ARE NOT TO BE FOLLOWED

Orders are modified according to the medical condition of the patient. All orders are to be dated, timed and signed by a physician. Additional orders may be entered at the end of the order set. If the orders are transcribed in sessions, the transcriber must date, time, and initial in the section marked order noted. PAGE 1 OF 3

ALLERGIES: ! None Known ! Yes, Drug/Reaction:

ORDER NOTED ORDER # " HYPERGLYCEMIA PROTOCOL

RDTC Admission Orders (DATE/TIME) (INITIAL)

1. " Admit to observation status (Please record date / time order noted by nurse)

2. "

• Take off Order to begin observation by recording Date/Time • ED nurse stamp protocol with addressograph • Begin protocol orders unless RDTC bed imminently available • Report to RDTC nurse with completed admission paperwork • Transfer to RDTC

3. " Diagnosis: Hyperglycemia / mild DKA

4. "

Call RDTC MD or PA if: greater than Less than SBP 180 90 DBP 110 50

HR 110 50 RR 25 10

VS: Q 2hour x 2, then Q 4 hours and prn (with pain assessment)

T 100.0° F

5. " Allergies: confirm allergy list and record on designated area pg 1&2

6. " Nursing: Call MD / PA for recurrent vomiting, pain or fever, prn Pulse Oximetry x1 on RDTC Admission if not previously obtained Evaluate for discharge criteria every 4 hours

7. # IVF: NS @ 250 mL/hr until K+ less than or equal to 5 IVF: NS with 20 mEq KCL/liter @ 250 mL/hr if K+ less than 5

8. # KCL 40 mEq PO (liquid or powder) q4 hrs PRN for K+ less than 3.5 if tolerating PO

9. " Continuous Cardiac monitoring for K+ greater than 5 or less than 3.5

10. # Consult Social Services for:________________________________

Medications: Please review allergy list before administration

11. # Metformin 500 mg PO x 1 now unless already received in ED

12. # Metoclopramide 10 – 20 mg IV q6 hrs PRN nausea/vomiting Change to 10 mg PO q6 hrs PRN when tolerating PO fluids

13. # Promethazine 12.5 – 25 mg IV q6 hrs PRN nausea/vomiting Change to 25 mg PO q6 hrs PRN when tolerating po fluids

14. # Ondansetron 4 – 8 mg IV q4 hrs PRN nausea/vomiting Change to 8 mg PO q8 hrs PRN when tolerating po fluids

15. # Ketorolac 30 mg IV q6 hrs PRN mild-moderate pain or fever if unable to take PO

16. # Acetaminophen 650mg po/pr q 4 hrs PRN mild pain or fever

17. # Oxycodone/ASAP 5/325mg 1-2 tabs PO q4 hr PRN moderate-severe pain: preferred if tolerating PO fluids, hold for sedation

18. # Morphine Sulfate 2-5 mg IV q2hr PRN, breakthrough pain hold for sedation

White -- Chart Yellow -- Pharmacy Pink -- Floor Copy …………………………………………………………….See Page 2

Please Stamp Here

Orders

RAPID DIAGNOSIS AND TREATMENT CENTER PHYSICIAN ORDER SHEET

All applicable orders have been checked. ORDERS NOT CHECKED ARE NOT TO BE FOLLOWED

Orders are modified according to the medical condition of the patient. All orders are to be dated, timed and signed by a physician. Additional orders may be entered at the end of the order set. If the orders are transcribed in sessions, the transcriber must date, time, and initial in the section marked order noted. PAGE 2 OF 3

ALLERGIES: ! None Known ! Yes, Drug/Reaction:

ORDER NOTED ORDER # " HYPERGLYCEMIA PROTOCOL

RDTC Admission Orders Continued (DATE/TIME) (INITIAL)

19. # BASAL-BOLUS-CORRECTION (B-B-C) SUBCUTANEOUS INSULIN ORDERS SET (See attached order sheet)

20. # Home insulin: Do not give with Sliding Scale Insulin Type: _________ Dose: _____subcutaneously Freq: _______ Type: _________ Dose: _____subcutaneously Freq: _______

Other/Home Medications

21. #

Diet: Advance as tolerated

22. # Diabetic Consistent Carbohydrate 1900-2100 kcal

23. Studies:

Laboratory: FSBG/Glucose greater than 400 notify MD/PA/NP

24. " CBC with differential on admission if not already obtained

25. " Serum Ketone if not already obtained 26. " HbA1c on admission if not already obtained with in the last 30 days

27. " AccuCheck 1 hr after each insulin dose and prn NOTIFY MD WHEN GLUCOSE LESS THAN 250

28. " EP1 q 4 hrs

29. " VBG: on arrival (if not obtained in the ED) and prior to discharge

30. " UA with micro if not already performed in ED

31. # Urine Pregnancy test if female and not already performed

32. # EKG if not already obtained

Imaging:

33. # Chest X-ray PA & Lateral, if not already obtained

Miscellaneous:

34. # White -- Chart Yellow -- Pharmacy Pink -- Floor Copy

Attending MD Signature: Date: Time: (ADMISSION ORDERS ONLY) Developed by: Emergency Medicine Date 02-15-2005 Review Date

Please Stamp Here

Orders

THE UNIVERSITY HOSPITAL PHYSICIAN’S CHECKLIST/

ORDER SHEET

All applicable orders have been checked. ORDERS NOT CHECKED ARE NOT TO BE FOLLOWED. Orders are modified according to the medical condition of the patient. All orders are to be dated, timed and signed by a physician. Additional orders may be entered at the end of the order set. If the orders are transcribed in sessions, the transcriber must date, time, and initial in the section marked order noted. If the entire set of orders is transcribed at one time, make a single slash across the page and enter the date, time, and your initials. PAGE 1 OF 1

UMC-1050, Rev. 5/11

ALLERGIES: ! None Known ! Yes, Drug/Reaction: _______________________________________

BASAL- BOLUS-CORRECTION (B-B-C) SUBCUTANEOUS INSULIN ORDERS Diagnosis: Uncontrolled Diabetes type 1 Uncontrolled Diabetes type 2 Hyperglycemia

Goal Range 110-180 mg/dL

Blood Glucose (BG) Monitoring:

Before meals and bedtime OR Every 6 hours if not eating meals and on continuous tube feeding

! Insulin Glargine cannot be mixed with other insulins Breakfast Lunch Dinner Bedtime

Basal Insulin Orders Give units of:

NPH Glargine (Lantus®)!

Give units of:

NPH

Give units of:

NPH Glargine (Lantus®)!

Bolus Insulin (Prandial or Food) Give units of:

Lispro (Humalog®) U-100 Regular

Give units of:

Lispro (Humalog®) U-100 Regular

Give units of:

Lispro (Humalog®) U-100 Regular

Continuous Give units of: U-100 Regular every 6 hours Tube-Feeding insulin *If tube-feeding held or discontinued, do not give this dose of insulin Bolus Give units of: Lispro (Humalog®) with each tube feeding bolus OR

U-100 Regular with each tube feeding bolus Suggested Lag Times for Prandial Insulin: Aspart/Lispro: 0-15 minutes before eating Regular: 30 minutes before eating

DIET: (For patients requiring enteral tube feeding or diets not listed write separate order) Clear liquid, diabetic diet Diabetic Consistent Carbohydrate 1500 - 1800 kcal diet Diabetic Consistent Carbohydrate 1900 - 2100 kcal diet Diabetic Consistent Carbohydrate 1900 - 2100 kcal, 4 gram Sodium diet Diabetic Consistent Carbohydrate 2200 – 2500 kcal diet

Treatment of Hypoglycemia (Blood glucose less than 70 mg/dL) (A) If patient can take PO, and the blood glucose is between 50 and 70 mg/dL, give 15 grams of fast acting carbohydrate (4 oz fruit

juice/non diet soda.) If the blood glucose is below 50 mg/dL give 30 grams of fast acting carbohydrate on the first attempt to correct the hypoglycemia. If further attempts are necessary, revert to 15 grams of carbohydrate.

(B) If patient cannot take PO; Awake: D50W – 25 ml (1/2 amp) IV push. If not awake (i.e. sedated): D50W –50 ml (1 amp) IV push (C) Check finger stick glucose every 15 minutes and repeat above until blood glucose is greater than 70 mg/dL. Note: Individual insulin doses vary widely and adjustments should be made based on the bedside and laboratory glucose levels. Correction algorithms for Hyperglycemia: These algorithms are intended to supplement bolus and basal insulin. Please indicate if patient is to receive correction insulin for preprandial hyperglycemia and bedtime hyperglycemia by checking the boxes below: Premeal Correction Bedtime Correction IF CORRECTION INSULIN IS GIVEN AT BEDTIME, BG MUST BE CHECKED AT 0200-0300 Insulin type for correction dose (will automatically default to Bolus insulin if not chosen)

Lispro (Humalog®) U-100 Regular (Must specify LOW, MEDIUM, HIGH or INDIVIDUALIZED below) PREMEAL

Blood Glucose mg/dL 100-149 150-199 200-249 250-299 300-349 >349 Low Dose (requiring less than 40 units/day) None 1 unit 2 units 3 units 4 units 5 units Medium Dose (requiring 40 – 80 units/day) None 1 unit 3 units 5 units 7 units 8 units High Dose (requiring greater than 80 units/day) None 2 units 4 units 7 units 10 units 12 units Correction Only (For patients not on Basal/Bolus doses) None 1 unit 2 units 3 units 4 units 5 units Individualized For postprandial or random BG measurements use half of the dose indicated for PREMEAL CORRECTION For patients that are NPO or on continuous tube-feeding, give correction dose every 6 hours with bolus dose

BEDTIME Low Dose (requiring less than 40 units/day) None None 1 unit 2 units 3 units 4 units Medium Dose (requiring 40 – 80 units/day) None None 2 units 3 units 5 units 7 units High Dose (requiring greater than 80 units/day) None None 2 units 5 units 7 units 10 units Correction Only (For patients not on Basal/Bolus doses) None None 1 unit 2 units 3 units 4 units Individualized

White--Chart Yellow—Pharmacy Physician Signature/Credentials ___________________________ Date _______ Time ______ Developed by: IDEA Team 4/06 Nurse Signature/Credentials ______________________________ Date _______Time ______

Rapid Diagnosis and Treatment Center University Hospital, Center for Emergency Care

HYPERGLYCEMIA

RDTC MD/PA Protocol Continuation Checklist

! PA notes/Dictations must include current RDTC attending name ! Progress Notes documented every 6 hours during RDTC

admission. If stay is less than 6 hours, there must be at least one progress note.

! Add additional orders to NEW order form, NOT to original order set ! Complete Patient Tracking Form by A-pod desk at shift change

Please Stamp Here

DATE TIME Please sign, date, and time all notes

NOT for admission/discharge notes (these should be STAT dictated) All PA notes should document attending name

Attending Observation Admission Addendum Progress Note(s) Attending Observation Discharge Addendum

RAPID DIAGNOSIS AND TREATMENT CENTER PHYSICIAN ORDER SHEET

All applicable orders have been checked. ORDERS NOT CHECKED ARE NOT TO BE FOLLOWED

Orders are modified according to the medical condition of the patient. All orders are to be dated, timed and signed by a physician. Additional orders may be entered at the end of the order set. If the orders are transcribed in sessions, the transcriber must date, time, and initial in the section marked order noted. PAGE 3 OF 3

ALLERGIES: ! None Known ! Yes, Drug/Reaction:

ORDER NOTED ORDER # " HYPERGLYCEMIA PROTOCOL

RDTC Discharge Orders (DATE/TIME) (INITIAL)

1. # DISCHARGE ORDERS (Please record date / time order noted by nurse)

A. Ensure completion of: ! ED Summary Form ! RDTC Disposition Summary Form B. Ensure completion of : ! ED Protocol Initiation Checklist ! RDTC Protocol Initiation Checklist ! RDTC Protocol Disposition Checklist ! Nurse Protocol Checklist C. Place completed Summary Forms and Protocol Checklists in Quality

Assurance Folder (See A & B above) D. Complete entry for Patient RDTC Log E. Discontinue IV F. Provide copy of Discharge Information Sheet G. Review Discharge Instruction Sheet with patient and discharge to home H. Discharge Diagnosis: 1._________________________________ 2._________________________________

2. # HOSPITAL ADMISSION ORDERS (Please record date / time order noted by nurse)

A. Ensure completion of: ! ED Summary Form ! RDTC Disposition Summary Form B. Ensure completion of : ! ED Protocol Initiation Checklist ! RDTC Protocol Initiation Checklist ! RDTC Protocol Disposition Checklist ! Nurse Protocol Checklist C. Place completed Summary Forms and Protocol Checklists in Quality

Assurance Folder (See A & B above) D. Complete entry for Patient RDTC Log E. Convert patient to transitional status unless transferred back to ED for

unstable medical condition F. Admit to hospital G. Admitting Service:_______________________ H. Admitting attending/resident:________________/________________ I. Bed type or floor:________________________ J. Hospital Admission Diagnosis: 1._____________ _______________

2.____________________________

White -- Chart Yellow -- Pharmacy Pink -- Floor Copy

Attending MD Signature: Date: Time:

(DISCHARGE ORDERS ONLY)

Developed by: Emergency Medicine Date 02/15/2005 Review Date

Please Stamp Here

Orders

You have been treated in the Rapid Diagnosis and Treatment Center (RDTC) for hyperglycemia. Hyperglycemia refers to a blood sugar level that is too high and is usually caused by diabetes. Diabetes is a disease where the body does not produce enough insulin and/or is unable to use insulin properly. Insulin is a hormone that helps convert blood sugar into energy used for daily life.

Hyperglycemia can hurt your organs and blood vessels. Kidney disease, heart attacks, and strokes are a particular concern. Although diabetes is not curable once it occurs, you can control your blood sugar by working with your primary care provider. Some people can control their blood sugar by eating a healthy, low-sugar diet, exercising regularly, and losing weight. Others need to take pills or even inject themselves with insulin to control their blood sugar. Sometimes, even if following your primary care providers directions you may develop hyperglycemia because your medications need to be adjusted or you have a new illness which is making it even harder for your body to use glucose appropriately.

Because diabetes makes you at high risk for blood vessel problems, you should be very careful to avoid other causes of blood vessel damage. For example, if you have high blood pressure or high cholesterol you should work closely with your primary care provider and if you smoke it is very important that you stop.

EmergencyKT: HYPERGLYCEMIA

Following discharge from the Rapid Diagnostic and Treatment Center you should: 1. Take medications as noted on your discharge sheet 2. Drink plenty of fluids 3. Eat a low sugar, low fat, and low salt diet and exercise regularly 4. See your primary care provider regularly 5. Stop smoking if you currently smoke 6. Other: ____________________________________________________________

___________________________________________________________________________

Notify Your Primary Care Provider or Return to the Emergency Department if you have: * very high blood sugar when you check at home * frequent urination or you are very thirsty * chest pain, fever, difficulty breathing, vomiting or any other concerns

Follow Up A visit to the emergency department cannot substitute for having a primary care provider. You should plan to see your regular primary care provider.

Please review your Discharge Instructions Sheet for specific instructions regarding your follow-up and medications.

University Hospital Services 1. Pharmacy Locations 1A Central Pharmacy – Basement

( (Main Hospital) 1B Outpatient Pharmacy – First Floor ( (Outpatient Building) 2. X-ray Services 3. Emergency Department 584-4571 Outpatient Information 584-4001 Outpatient Business Office 584-5061

For questions regarding discharge instructions or follow up call: University Hospital Emergency Department Nurse Clinician at (513)584-2026

Hyperglycemia (High Blood Sugar) is caused from too much sugar (glucose) in your blood. High blood sugar is dangerous because it can cause organ damage and other dangerous conditions, even death. Causes of High Blood Sugar:

• Eating or drinking too much food that is high in sugar, (carbohydrates) • Not taking your medication • Being sick or under increased stress • Being over weight • Not getting enough exercise

Warning Signs of Hyperglycemia: You may not always feel sick with high blood sugars but if you do you may notice:

• Increased thirst, increased hunger and a frequent need to urinate • Feeling tired or weak • Nausea and/or Vomiting • Blurry vision • Fast breathing • Weakness or feeling faint • Wounds that don’t heal or heal slowly

What You Should Do If your Blood Sugar Is High: • Keep checking your blood sugar and keep taking your medication • Drink lots of clear liquids with out sugar (carbohydrates), water is best • Don’t drink or eat foods high is sugar (carbohydrates) • Call your healthcare provider if your blood sugar does not return to its target range • Return to the emergency department for severe vomiting and if you cant keep down vlliquids or your medication

Preventing High Blood Sugar: • Follow up regularly with your primary care provider • Follow the nutritional guidelines set up with your primary care provider, diabetes care pprovider or nutritionist • Take your medications as directed by you healthcare team and test your blood sugar plregularly

Other Things You Should Do: • Carry a medical ID card or wear a medical alert bracelet that tells others that you are a dldiabetic. • Talk with your family, friends, and coworkers and let them know what to do if your blood dlsugar becomes to high or to low and you pass out of become confused and can’t help dlyourself

EmergencyKT: HYPERGLYCEMIA

Symptoms of High Blood Sugar

Nutrition Guidelines for Diabetes• It is important for you to eat a healthy variety of foods each day. Choose fresh fruits, vegetables, whole grain breads and cereals, lean meats, and low-fat milk and dairy products.• The carbohydrate foods in your diet have the biggest e!ect on your blood sugar.• Carbohydrates are found in breads, cereals, pasta, rice, starchy vegetables like corn, peas and potatoes, fruit, milk and sugar.• Try to eat the same amount of carbohydrate from day to day to help improve your blood sugar and keep the meal times about the same each day.• Say “NO” to second helpings!• Most women with diabetes should have 3 - 4 servings (45 - 60 grams) ofcarbohydrate at each meal. Men should usually have 4 - 5 servings (60 - 75 grams) of carbohydrate at each meal.• Do not skip meals or snacks! You should eat your meals about 4 - 5 hours apart.• Try to eat less fat by limiting fried foods, removing skin from poultry, and trimming visible fat from meats. Many snack foods like chips, cookies and pastries are also high in fat.• Try to eat less sugar by avoiding regular soft drinks, desserts and candy.• With your physician’s approval, try to exercise everyday.• Limit your alcohol intake.• Eat protein in moderation. A portion should be about the size of the palm of your hand. Proteins include " sh, skinless poultry, lean meats, lowfat cheeses, peanut butter and nuts.• Schedule an appointment with an outpatient registered dietitian as soon as possible to receive your personal meal plan. Please call: 513-584-4542

6/11 (1 of 2)

What is one serving of a carbohydrate? Each serving contains 15 grams carbohydrate.

Bread/Starch/Grains1 slice of bread 3/4 oz. pretzels, tortilla chips, or snack crackers*6 saltines1/2 cup of peas, corn, or potatoes 1/2 of an English mu# n, small bagel, or bun1 small tortilla (6 inch) 1/2 cup of hot cereal or rice cereal1 small baked potato (3 oz.) 1/3 cup of cooked rice or pasta1/3 cup cooked legumes (dried beans, peas, pinto, navy)3/4 cup of unsweetened dry cereal3 cups light popcorn1 cup soup, broth based or creamed, made with water

Milk1 cup of milk (skim or 1%)1 cup of plain or light yogurt

Fruits1 small piece of fresh fruit 1/2 cup of unsweetened canned fruit1/2 cup of unsweetened fruit juice 2 tablespoons of raisins1/2 banana (4 inches) 1 cup melon or berries15 grapes

Others(for occasional use only)*1/2 cup of low fat ice cream1 mu#n2 small cookies* Some carbohydrates such as desserts, sweets and snack foods are also high in fat and may lead to weight gain. Eating a large amount of these carbohydrates may make it di!cult for you to control your blood sugar levels.

6/11 (2 of 2)

Time: ______ Breakfast - 4 carbohydrate servings (60 grams) 1 scrambled egg or 1/4 cup egg substitute or 1 - 2 oz. lean meat (protein) 1-1/2 cups of Cheerios (2 carbohydrates) 1/2 banana (about 4 inches) (1 carbohydrate) 1 cup of 1% milk (1 carbohydrate)

Time: ______ Lunch - 4 carbohydrate servings (60 grams) 3 ounces of turkey (protein) 2 slices of bread (2 carbohydrates) 1 slice of lettuce and tomato (free) 1 teaspoon of mayonnaise (fat) 1 cup of light yogurt (1 carbohydrate) 1 cup of iced tea (free) 1 small apple (1 carbohydrate)

Time: ______ Snack Optional 1 - 2 carbohydrate servings (15-30 grams)

Time: ______ Dinner - 4 carbohydrate servings (60 grams) 1 grilled chicken breast (protein) 1/2 cup of potatoes (1 carbohydrate) 1/2 cup of green beans (free) Tossed salad (free) 1 tablespoon of salad dressing (fat) 1/2 cup of pineapple (1 carbohydrate) 1 slice of bread (1 carbohydrate) 1 cup co!ee (free) 1/2 cup low fat ice cream (1 carbohydrate)

Time: ______ Snack Optional 1 - 2 carbohydrate servings (15-30 grams) Snack Suggestions 1) 1 oz. lean meat, 1 slice of bread (1 carbohydrate, protein) 2) 1 oz. cheese, 6 saltine squares (1 carbohydrate, protein) 3) 1 tablespoon peanut butter, 3 Graham cracker squares (1 carbohydrate, protein)

Label Reading for CarbohydratesWhen reading nutrition labels, look at the serving size and total grams of carbohydrates (see example to the right). One serving of carbohydrate equals 15 grams. Therefore, a meal that contains three carbohydrate servings will provide approximately 45 grams of carbohydrates.On this example, the serving size is 1 cup. Since there are 31 grams of carbohydrates per serving, each cup is 2 carbohydrate servings.**Do not look at the sugars when reading the labels. Sugar is already added in the grams of total carbohydrates. This number does not need to be included in your meal plan.

Graphic adapted from National Food Processors Association, 1993.

15 grams of carbohydrates = 1 serving carbohydrate. (1 slice of bread or 1 small piece of fruit or 1 cup of milk)

Nutrition FactsServing Size 1 cup (228g)Servings Per Container 2

Amount Per ServingCalories 260 Calories from Fat 120

% Daily Value*Total Fat 13g 20% Saturated Fat 5g 25%Cholesterol 30mg 10%Sodium 660mg 28%Total Carbohydrate 31g 10% Dietry Fiber 0g 0% Sugars 5gProtein 5gVitamin A 4% Vitamin C 2%Calcium 15% Iron 4%* Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs: Calories 2,000 2,500Total Fat Less than 65g 80g Sat Fat Less than 20g 25gCholesterol Less than 300mg 300mgSodium Less than 2,400mg 2,400mgTotal Carbohydrate 300g 375g Dietary Fiber 25g 30gCalories per gram:Fat 9 Carbohydrates 4 Protein 4

= 2 carbo-hydrate servings