Nutrition Guideline Implementation Committee

1 Nutrition GuidelinesImplementation CommitteeMaking Carbohydrates Count:A Hands-On ApproachBarbara Allan RD, CDE, Anne Garrett, RD, Arcudi , CDE, Kerry Schubert-Mackey RD, CDEO bjectives use the new CDA Nutrition tool: Basic carbohydrate counting for Diabetes Management understand the steps involved in teaching clients how to carbohydrate countAt the end of the session participants should be able 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 carbohydratecount? It is a simple and flexible way to plan meals. It focuses on the nutrient with the greatest impact on blood glucose levels.

2 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 andknow how to use measuring cups, spoons and scales keep accurate and detailed recordsThe Facts TableNutrition 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 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.

3 *AADE 2001. A Core Curriculum for Diabetes Education, 4thEd.**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 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 postprandialwill be instructive. See Professionals Only sectionof the CDA Alcohols Nutritive sweeteners commonly used in dietetic and sugar-free foods. They produce a lower glycemic response due to reduced absorption.

4 Potential for gastrointestinal upset Alcohols and PolydextroseNo data50-60%0%50-75% 50% 50%50-79%% Value(Kcal/g)Sugar alcoholCanadian 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 Polydextroseis 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) Alcohol Recommendations An intake of 10 grams of sugar alcohols daily should not adversely affect metabolic control in adults with diabetes.(Grade D) The riskof GI side effects is low with an intakeof less than 10 grams but increases as intake increases.

5 (Grade B, level 2)Armit E and the NNC, CDA. Report from the NNC. Diabetes Quarterly. 2003 (1):14 Sugar AlcoholsCarbohydrate counting ChecklistFor additional info For copies of the toolLiterature Coordinator, Fax: To contact the SubcommitteeE-mail or call SharonZeiler, x 473 Case Study1. List the tools/resources for teaching New toolBasic carbohydrate counting for Diabetes Management Just the Basics: Healthy Eating for Diabetes Management and Prevention Canada s Food Guide to Healthy Eatingor Diabetes Food Guide Food models Measuring cups & food weigh scale1. 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 toolBasic carbohydrate counting for Diabetes Management-What did you eat or drink?

6 FoodRecords2. 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 s Lunch October 2ndCarb gFood, PortionLight Crunch barPear, medium8 Mini carrots, 10 Baked beans, 1cupSoda crackers Premium whole wheat, 1023 Tomato soup with milk., 8oz0 Mustard, 1tsp0 Beef, 2oz31 Pita, whole wheat inchdia(60 g wt)Guy s Lunch October 2nd11 Light Crunch bar150 Total available carbohydrateCarb gFood, Portion21 Pear, medium8 Mini carrots, 1034 Baked beans, 1cup22 Soda crackers Premium , 1023 Tomato soup with milk, 8 , 1tsp0 Beef, 2oz31 Pita, whole wheat inchdia(60 g wt)Light Crunch BarSimplifiedTotal 30 13 /2= 10 g3b How would you go about determining Guy s lunch Carbgoal?

7 Review calculations. Discuss variation in his 3 lunch meals (80g vs 74g vs 150g). Together determine a goal for consistent carbgram. Consider your perception of health needs and Guy s What do you say to Guy about diet candy bars? Cautionhim againsttaking 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 polyolsby dividing grams by 2 or by using the chart for more exact Your thoughts are important!! Give your surveys to speakers or drop off at the CDA booth. Completed surveys will be entered into a draw.