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IMPORTANT NOTICE

IMPORTANT NOTICE.

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IMPORTANT NOTICE

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  1. IMPORTANT NOTICE This PowerPoint presentation is usually given to patients in person as part of a discussion or consultation. Accordingly you should always speak to one of our clinical personnel, or your diabetes clinic nurse to verify anything which you are not certain about before you change your diet or medication regime

  2. Carbohydrate Counting

  3. What is Carbohydrate Counting? • Estimating the carbohydrate content of food so that you can adjust your insulin dose to match the amount of carbohydrate you want to eat.

  4. Advantages of Carbohydrate Counting • Getting the best of from your insulin regimen • Good glycaemic control • Freedom to eat when you want to • Freedom to eat as little or as much as you wish • Freedom to eat traditionally ‘forbidden’ food without feeling guilty

  5. What is Carbohydrate?

  6. CARBOHYDRATE STARCHY FOODS SUGARS GLUCOSE Blood Stream Insulin Cells of body

  7. Carbohydrate Foods STARCHY FOODS SUGARS Bread sugar Potato glucose Rice sugary drinks Pasta sweets, chocolate Breakfast cereals sweet puddings Biscuits and other fruit flour products milk yoghurt

  8. SLOW (Low GI) Granary & ‘bitty’ bread Basmati & quick cook rice Boiled potatoes Sweet potatoes Porridge No added sugar Muesli Fruit and Fibre Pasta Noodles Fruit Milk & Yoghurt QUICK (High GI) White & Wholemeal bread Other rice Mashed potato Jacket potato Cornflakes Rice krispies Quick or Slow Acting Carbohydrate

  9. Rise in blood sugar is influenced by: • The biggest effect is from the amount of CHO eaten • Speed of digestion & absorption of CHO you eat

  10. Estimating CHO • Weighing food • Measuring using cups & spoons • Food labels • Recipes that list CHO content • CHO Counting tables/books

  11. CHO content from labels • Look at the total CHO figure • Ignore ‘of which are sugars’ figure • Always the total CHO amount per 100gms • Maybe the amount per portion

  12. Calculating CHO per portion from labels • Estimate using the CHO value per portion if available • If only a CHO value per 100gms: • e.g 13gms CHO /100gms • Pack size 400gms • You eat it all = 52gms CHO • You eat half = 26gms

  13. Basal insulin Lantus or Levemir

  14. Adjusting your basal Insulin • 1st priority is to get basal level right This is your blood sugar first thing in the morning before you eat breakfast This test governed by Lantus/Levemir • Adjust dose by 2 units every 2-3 days until fasting level around 7mmol

  15. How do I adjust my quick acting insulin? • Find out your insulin : CHO ratio • Individual - each person from 1-7 units per 10g CHO • Look at BLOOD GLUCOSE levels 2 hours after meals to correct • Can differ during the day • Remember to consider other factors i.e exercise / stress • Set specific amounts of CHO for each meal

  16. Testing Times:

  17. How do I check my Ratio? • If you checked your Pre breakfast sugar e.g. 7mmols • Had 30 gm CHO at breakfast • And had 6u insulin • 2 hour post meal blood sugar was 6.2 mmols • Ratio = 2 units insulin per 10gms CHO

  18. Is my Ratio correct • If your Pre meal BLOOD GLUCOSE was7 mmols • & you ate 30gm CHO • & had 6u Insulin • & 2hour Post meal BLOOD GLUCOSE 12 mmols • Ratio not high enough - try 3u insulin per 10g CHO

  19. Is my Ratio correct • If your Pre meal BLOOD GLUCOSE was 7 mmols • & you ate 30gm CHO • & had 6u Insulin • 2 hour Post meal BLOOD GLUCOSE 2.3 mmols • Ratio too high - try 1u insulin per 10g CHO

  20. Small snack <15gms CHO – no insulin neededLarger snack over 15gms CHO insulin may be required

  21. Adjusting your Insulin • Do not react to one off high/low sugar readings - you may have estimated the CHO wrongly • Look for trends and adjust pre meal insulin accordingly

  22. Reactively Adjusting InsulinWhy Not? • A blood sugar is what it is because of things in the past • Insulin is coping with what is coming • Must look in both directions

  23. A vicious circle • Low reading - eat more → High reading – give more insulin → BS goes low → eat more →BS goes high → give more insulin • STOP think why • ????????????????

  24. Hunger Hypoglycaemia Sweating Palpitations Trembling Dizziness Blood glucose – below 4

  25. Treating a ‘Hypo’Fast Acting Sugar • Chocolate slow acting compared to Dextrose tablets / Lucozade • 4-5 Dextrose tablets repeated in 5-10 minutes if no improvement OR • 80 - 100 mls Lucozade ALWAYS Followed by long acting CHO snack (without insulin- unless it is immediately before a meal is due) 4-5 Glucose Tablets 3 teaspoons sugar Half a glass of lucozade Half a carton of Ribena Half a can of Coke (160mls)

  26. ALCOHOL • Try to keep to the safe limits • Women – less than 2 units / day (max 14u / week) • Men – less than 3 units / day (max 21u / week) • 1 Unit = ½ pint ordinary strength beer, lager or cider 1 small glass wine or sherry 1 pub single spirits REMEMBER Not to drink on an empty stomach not to drink and drive alcohol is high in calories! DO NOT COUNT CHO ! Alcohol increases BS short term but LOWERS BS for several hours after drinking

  27. Driving • Test before long journeys • Ensure you have snacks available • Regular testing often advisable • DVLA / Insurance

  28. The effects of exercise • If you are exercising you may need to : • Reduce your insulin dose pre exercise by up to 25% • Reduce your insulin dose post exercise by up to 25% • If it is high intensity then you will need to take extra CHO before or during and after exercise

  29. Timing of insulin for quick or slow meals • Quick acting e.g. French bread, • mashed potato - inject before meal • Slow acting e.g.porridge, pasta, - inject after eating • Not sure how much your going to get or want to eat – consider having dose during meal

  30. Cont….. • High fat &/or high protein slows up rise in blood sugar so for meals such as Pizza, curry, fish & chips, Large Steak & Chips • Try – • ½ insulin just after eating and the other ½ 30 – 45 minutes later

  31. Disadvantages of Carb Counting • Not difficult but you need to invest time & effort in getting it right • It is possible that you may gain weight if : • You eat the high calorie foods you previously avoided • Have larger portions because you can give extra insulin • Concentrate on only CHO and forget about other aspects of a healthy diet

  32. Eating for Good Health • Low sugar, avoid sugary drinks • Low fat, especially low in saturated fat • 1 – 2 portions of oily fish per week • Good intake of fruit & vegetables • Base meals around starchy CHO

  33. Want more information? • The Hugely Better Carbohydrate Counter – Essentials –by Carolyn Humphries £4.99 or • The Fat, Fibre & Carbohydrate Counter £3.99

  34. HELP • If you need more help please contact the diabetes centre for a one to one appointment

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