Glucometers and Carbohydrate Counting in Schools

1. Glucometers and Carbohydrate Counting in Schools Katie Goldsworthy R.D.

2. CHO (carbohydrate counting) Fulcrum of balancing diet and medicine Essential to good diabetes management Health professionals role is dependent on age and competency of diabetic Works by using a CHO to insulin ratio

3. CHO Food Groups • Fruits = to 15 CHO • Fruit size of tennis ball, ½ c. canned 1c. cut. Fresh fruit • Watch for fruit canned in syrup • Look to see amount in juices • Some dairy (milk, yogurt) = to 15 CHO • 1 c. milk • ½ c. chocolate milk • 1 container sugar-free yogurt • Starch (mostly breads, but also starchy vegetables) = to 15 CHO • One piece bread, ½ bagel, 1/3 c. rice, ½ c. pasta • Sugars

4. The Past and Now • Old method “exchange method” • Counted every food group including meats and vegetables • Sugars were considered “no-no’s”. • Had to eat certain amounts of carbs, meats, and fats at certain times during the day

5. The Past and Now • New method “carb counting” • Uses insulin to CHO ratio • Allows extreme flexibility to eat when and what diabetic wants • Less strict = more compliance • Only counts CHO food groups

6. CHO usually group in groups of 15 CHO • Count how many “carbs choices” there are • Use book to count “carb choices” or count each carb individually • Then divide by insulin/carb to get ratio

7. Let’s Practice! • Carton milk = 15 CHO or 1 CHO choice • Green beans = don’t need to count • Burrito = 45 CHO or 3 carb choices • Cookie = 15 CHO or 1 carb choice • Canned Fruit (1/2 c. light) = 15 CHO or 1 carb choice

8. Let’s Practice! • Carton chocolate milk = • Ham sandwich = • Apple = • 4 Oreos = • Carrot sticks = • 1 small bag of chips = 15 CHO, 1 carb

9. Let’s Practice! • Child has a CHO/ insulin ratio of 15 CHO/1.0 unit of insulin = how much insulin???

10. Quick note • Best to buy CHO counting booklet at store, or you can call Mimimed pump co, they can mail you one, or call a local meter rep. • 1800-minimed • Novo Nordisk 1-1800-727-6500 • You can also find on internet • Best to find a very complete book—go to local book store

11. Quick note • Try to kindly involve parents • Encourage them to get school lunch menu early to count carbs with child • Suggest fun ideas • Flash cards • Separate baggies for snacks (pre-labeled) • Special decorated tray in nurses station or classroom • Resource: NovoNordisk www.carbcards.com

12. CHO (carbohydrate counting) Usually a rapid-acting insulin for boluses --Lispro (Humalog), Aspart (Novolog), Glulisine (Apidra) Possibly using short acting insulins --Regular (Humalin R. Novolin R) If using vial and syringe method, most likely using fast-acting insulin bolus with intermediate or long acting insulin. More and more children using insulin pumps --only using rapid acting insulin alone

13. Quick notes • Sugar is not a “no-no” with carb counting, if done properly. • We want to encourage diabetic to comply with diet, not discourage • Don’t ask “are you supposed to be eating that?” ask “did you give yourself insulin for the carbs in that?” • They’re bound to get candy at school • Check with parents on sugar and CHO counting philosophy

14. Glucometers • Kid-friendly glucometers • Precision Sof-Tact • Freestyle meters • One Touch FastTake • Relatively fast meters, can use alternate testing sites (forearm, thumb, thigh), and use less blood

15. Other kid-friendly devices • Pens • EZ shot • Bolus wizards on insulin pumps

16. Blood glucose ranges • Blood glucose ranges very general for children due to huge swings in blood glucose • Suggested ranges for BG goals pre and post-prandial are: -- 80-200mg/dl; A1C 7.5%-9.3% <5 yrs --70-180 mg/dl; A1C <8.5% 5-11yrs --70-150 mg/dl; A1C 7.8% >12 yrs *Test before PE and lunch

17. Let’s test! • Clean area, wash with warm water • Hold hand at side, then briefly shake it • Prick the finger with firm pressure • Site rotation is recommended to as many sites as possible, sides of fingertips may be more comfortable d/t fewer nerve endings

18. Alternate Site Testing • Seem to be discrepancies in readings between alternate sites and fingertips • If blood glucose changes suddenly, use fingertip • Rapid B.G. changes typically occur during exercise, illness or after eating.

19. Quick notes • Good to have back-up meter in office • Glucometer sales reps will most likely donate meter • Should using glucometer testing solution

20. Quick notes • * Remember: for child to be in good control does not meal BG readings alone. Assess: • 1.) How does the child feel? • 2.) Is the child going to school? • 3.) Participating in school activities? • 4.) Is the child growing normally • 5.) Insulin skipping in adolescents?

21. Local Support Groups/Meetings Keiki Ohana Konnection (Youth) Aloha Pumpers –Tom Wellman 454-1850 Military support group TAMC/CWD Ages 0-18yrs –Hope Cooper-Oliver 433-2565 Local ADA Chapter 1-808-947-5979 For diabetes info: www.diabetes.org or 1800-342-2383

22. Thank You!! • Good luck to you in this next school year! • Feel free to call me with any questions 375-4271

23. Q & A