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Fuadiyah Nila K., S.Gz , MPH Leny Budhi Harti , S.Gz Jurusan Gizi FKUB

Basic Carbohydrate Counting. Fuadiyah Nila K., S.Gz , MPH Leny Budhi Harti , S.Gz Jurusan Gizi FKUB. Diet Diabetes Mellitus. Nutrition Care Process (ADA,2003). Practice Settings. Dietetics Knowledge. Skills & competencies. Code of Ethics. Nutrition assessment obtain/collect timely

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Fuadiyah Nila K., S.Gz , MPH Leny Budhi Harti , S.Gz Jurusan Gizi FKUB

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  1. Basic Carbohydrate Counting FuadiyahNila K., S.Gz, MPH LenyBudhiHarti, S.Gz JurusanGizi FKUB

  2. Diet Diabetes Mellitus

  3. Nutrition Care Process (ADA,2003) Practice Settings Dietetics Knowledge Skills & competencies Code of Ethics • Nutrition assessment • obtain/collect timely • and appropriate data • analyze/interpret with • evidence-based • standards • document • Nutrition diagnosis • identify & label problem • determine cause/ • contributing risk factors • cluster signs & • symptoms/ defining • characteristics • document Relationship between Patients/client/group and Dietetics Professional Economics Health Care Systems • Nutriton monitoring & • Evaluation • monitor progress • measure outcome • indicators • Evaluate outcomes • document • Nutrition interventions • plan nutrition • Intervention • Formulate goals & determine • a plan of action • implement nutrition • intervention • Care is delivered & • actions are carried out • document Evidence-based Practice Critical Thinking Communication Collaboration Social Systems

  4. Nutritional Care Process X AsuhanGizi Standard AsuhanGizi Individual • SosioKulture • EkonomiKeluarga • Kebiasaan X Pengaturan Diet PantangMakanan

  5. Lena has been overweight for afew years. She is 52 years old,and she found out that she hastype 2 diabetes 1 year ago. She has beenseeing a doctor at her physician’s officefor nutrition information, and the doctor has referred her to a registered dietitian(RD) in the outpatient clinic at the nearby hospital. Kulkarni, KD.Clin. Diabetes 23: 120 - 122

  6. Lena brings her food records to herinitial visit with the RD. The RD reviewsthe records, which consist only of Lena’sfood choices with no portion sizes oramounts consumed listed. The RD recommends that Lena consider weighing and measuring her portion sizes and writing them down along with her foodchoices. The RD provides Lena with acopy of the American Diabetes Association (ADA) basic carbohydrate countingpamphlet1 and uses food models todemonstrate appropriate portions of the foods Lena might select. Kulkarni, KD.Clin. Diabetes 23: 120 - 122

  7. Content : • Definition of carbohydrate counting • Level of carbohydrate counting • Indication of using carbohydrate counting • Why should people with diabetes use carbohydratecounting???? • Steps to count carbohydrate counting

  8. Definition of carbohydrate counting • Carbohydrate counting is a meal-planningapproach and not a specific diet • It places emphasis on the total amount ofcarbohydrate consumed, rather than onthe source or type of carbohydrate consumed Kulkarni, KD.Clin. Diabetes 23: 120 - 122

  9. Level of carbohydrate counting understanding the relationship among food, physical activity, and blood glucose levels includes understanding pattern management and how to use insulin-to-carbohydrate ratios Kulkarni, KD.Clin. Diabetes 23: 120 - 122

  10. Level of carbohydrate counting introduces patient to the concept of carbohydrate counting and for carbohydrate consistency Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48

  11. Level of carbohydrate counting Focuses on the relationships among food, diabetes medication,physical activity and blood glucose level and Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48

  12. Level of carbohydrate counting how to match short-acting insulin to carbohydrate using carbohydrate-to- insulin ratios. Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48

  13. Level 1 / Basic CarbingGoals • Regulate blood glucose by balancing carbohydrate intake with the diabetes medication and physical activity • Achieve and maintain consistency of carbohydrate intake at meals and snacks at similar times each day • Eating similar amounts of carbfoods at each meal or snack helps “even out” the ups-and-downs in your blood glucose level. • 1. Carbohydrate Counting: Getting Started, The American Diabetes Association and The American Dietetic Association, 1995. • 2. Practical Carbohydrate Counting, American Diabetes Association, 2001. • 3. Using Carbohydrate Counting in Clinical Practice, JADA, 1988, v98, n8 6

  14. Who Can Use Carbing • Carbohydrate counting can be used by anyone with diabetes, not just people taking insulin

  15. Why Should People with Diabetes Use Carbohydarte Counting???? Food contains many nutrients such as • Macronutrients : carbohydrate,protein, and fat • Micronutrients : vitamins and minerals

  16. Why Should People with Diabetes Use Carbohydarte Counting????

  17. Why Should People with Diabetes Use Carbohydarte Counting???? • In fact, 90-100 %of the carb you eatappears in your bloodstream as bloodglucose within a few hours after you haveeaten. • Protein and fat have much lesseffect on your blood glucose Bolderman, K.M, 2007. Educational Information From BD Medical Diabetes Care

  18. Steps to Count Carbohydrate Counting • Step 1 : Make healthy food choices • Step 2 : Focus on carbohydrate • Step 3 : Set carbohydrate goals • Step 4 : Determine carbohydrate content • Step 5 : Monitor effect on blood glucose level Canadian Diabetic Association, 2005

  19. Step 1 Make healthy food choices • Enjoy a variety of vegetables, fruits, whole grains, • Use added fats in small amounts. • Choose portion sizes Canadian Diabetic Association, 2005

  20. Steps to Count Carbohydrate Counting • Step 1 : Make healthy food choices • Step 2 : Focus on carbohydrate • Step 3 : Set carbohydrate goals • Step 4 : Determine carbohydrate content • Step 5 : Monitor effect on blood glucose level Canadian Diabetic Association, 2005

  21. Step 2 Focus on Carbohydrate

  22. Step 2 Focus on Carbohydrate

  23. Steps to Count Carbohydrate Counting • Step 1 : Make healthy food choices • Step 2 : Focus on carbohydrate • Step 3 : Set carbohydrate goals • Step 4 : Determine carbohydrate content • Step 5 : Monitor effect on blood glucose level Canadian Diabetic Association, 2005

  24. Step 3 : Set CarbohydrateGoals • dietitian will help to set a goal for grams of carbohydrate at each meal and snack • This may be the same from day to day or may be flexible, depending on patient needs Canadian Diabetic Association, 2005

  25. Step 3 : Set CarbohydrateGoals Pilih obat yang diperlukan sesuai jumlah karbohidrat

  26. Step 3 : Set CarbohydrateGoals • Jumlah energi • Distribusi energi selama 24 jam • Analisis terhadap komposisi zat gizi • Perhitungan KH setiap sajian • Analisis zat gizi dari kebiasaan makan pasien Food record

  27. Food Record

  28. Food Record

  29. Food Record

  30. Food Record • Energi dari hasil record : ....... Kkal • Distribusi energi : - pagi : .....% - snack : .....% - siang : .....% - malam : .....% • Komposisi zat gizi : - protein : ....% - KH : ....% - Lemak : ....% • Serving KH per sajian

  31. Perhitungn zat gizi yang diperlukan pasien • Perhitungn zat gizi yang diperlukan pasien • Energi • Distribusikan dalam 24 jam • Komposisi zat gizi sesuai dengan kebiasaan • Perhitungan jumlah karbohidrat per sajian

  32. Perhitungn zat gizi yang diperlukan pasien • Status Gizi  IMT • IMT = BB (kg)/ {TB (m)}² • Berikut ini pembagian IMT berdasar standard Asia menurut IOTF, WHO (2000) :<18,5 = Underweight 18,5-22,9 = Normal 23-24,9 = At risk 25-29,9 = Obese I >=30 = Obese II

  33. PerhitunganKalori • BMI • Normal : 25 – 30 cal/kg BW • Kurus : > 40 cal/kg BW • Overweight : < 20 cal/kg BW (BMI requiring and /obese 130 g/day of CHO)

  34. Perhitungn zat gizi yang diperlukan pasien • Perhitungn zat gizi yang diperlukan pasien • Energi • Distribusikan dalam 24 jam • Komposisi zat gizi sesuai dengan kebiasaan • Perhitungan jumlah karbohidrat per sajian Distriusi kalori dalam 24 jam  disesuaikan dengan kebiasaan makan pasien

  35. Perhitungn zat gizi yang diperlukan pasien • Perhitungn zat gizi yang diperlukan pasien • Energi • Distribusikan dalam 24 jam • Komposisi zat gizi sesuai dengan kebiasaan • Perhitungan jumlah karbohidrat per sajian

  36. Perhitungn zat gizi yang diperlukan pasien • Karbohidratsebesar 45-65% total asupanenergi. • Proteinsebesar 10 – 20% total asupanenergi. • Asupan lemak sekitar 20-25% kebutuhan kalori. Perkeni, 2006

  37. Perhitungn zat gizi yang diperlukan pasien • Perhitungn zat gizi yang diperlukan pasien • Energi • Distribusikan dalam 24 jam • Komposisi zat gizi sesuai dengan kebiasaan • Perhitungan jumlah karbohidrat per sajian

  38. Perhitungn zat gizi yang diperlukan pasien Karbohidratsebesar 45-65% total asupanenergi Dibagi dalam beberapa kali makan KH per sajian snack snack Pagi .....% = ...g Malam .....% = ...g Siang .....% = ...g Sesuai dengan kebiasaan makan pasien

  39. Perhitungn zat gizi yang diperlukan pasien Perhitungan jumlah karbohidrat per sajian Carbohydrate serving/ choice (carb serving/ choise) Carb grams

  40. Carb Seving/ Carb Choise • 1 carb serving/ choie = 15 g karbohidrat Kulkarni, KD.Clin. Diabetes 23: 120 - 122

  41. Carb Seving/ Carb Choise Ex : untuk makan pagi, Tn. H membutuhkan 45 g karbohidrat g KH = 3 carb serving ↓ 2 slice of bread + ½ cup of fruit juice

  42. How Can I Use Nutrition Facts on Food Labels?

  43. Case Study • Tn. Han, usia 37 tahun. Penderita DM type 2. TB 155 cm, BB 75 kg. Bekerja sebagai pegawai yang sebagaian besar aktifitasnya dilakukan dengan duduk. Pulang dan pergi kerja diantar oleh sopir. Pemeriksaan gula darah puasa/dl, DG 2 JPP 310 mg/dl

  44. Food pattern (Hasil Food Frequency Questionnaire/FFQ) • CHO yang paling sering: nasi, mie, roti • Protein hewaniayam, daging, telur • Protein nabatitempedantahu • Sayurjaranghanya 1x/hari • Buahfrekuensijarang, konsumsidalambentuk jus • Snack dalambentukmakanantinggikalori

  45. Stage 1 • Nutritional Assessment • Antropometri : BB = 75 kg, TB= 155 cm • BBI = (155-100) x 90% = 49.5 cm • IMT = 75/1.5 2 = 31 (0bese)

  46. Record Hari 1

  47. Hasil Record

  48. Stage 3 • Nutrition Intervention • Perhitungankebutuhan • 20 Kal x 75 = 1500 Kalori • KH 55% = 55/100 x 1500 = 825Kalori= 206.3gram • Lemak25% = 25/100 x 1500 = 375Kalori = 41.6 gr • Protein 20%= 20/100x1500= 300Kalori= 75gr

  49. Stage 4 • Meal planning (KH) sesuaidengankebiasaanmakan • Energi = 3346 Kalori, CHO= 382.7 g yang terbagidalam : Sarapan (%) = Snack (%) Makansiang (%) Snack (%) Makanmalam (%)

  50. Distribusikonsumsi KH dalamgrdan serving unit Kebiasaanmkn = 382.7 g CHO Kebutuhan = 206.3g CHO

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