Mashhad University of Medical Sciences

2. Mashhad University of Medical Sciences IMAM REZA HOSPITAL Z. SAEEDREZAEE-NUTRITIONIST Jun 7 , 2012

3. Carbohydrate Counting for Patients With Type 1 Diabetes

4. 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.

5. Advantages of Carbohydrate Counting Good glycemic control Freedom to eat when you want to Freedom to eat as little or as much as you wish ( more flexible in the diet & lifestyle)

6. What is Carbohydrate?

7. CARBOHYDRATE STARCH SUGARS FIBER GLUCOSE Blood Stream Insulin Cells of body

8. Food Groups Starchy Vegetables & CHO CHO CHO

9. Approximately 15 grams of CHO Per serving Starchy food • CHO : • Starch • fiber

10. Approximately 15 grams of CHO per serving Fruit Group • CHO • Sugar (Fructose , glucose, sucrose, • Sugar alcohol) • Fiber • Low starch

11. Approximately 12 grams of CHO per serving Milk Group CHO : Sugar (lactose)

12. Approximately 15 grams of CHO per serving Other Carbohydrate Group • CHO: • starch • Sugar • Low fiber

13. Sugar 1)Sugar occurs naturally in some unprocessed food : milk , fruit , vegetables , some grain 2)Added sugars that is added to foods and beverages : Include table sugar, brown sugar, corn syrup, molasses (saccharose , glucose ,fructose ,lactose, maltose , dextrose , maltodextrine , sorbitol)

14. Artificial sweeteners • Artificial sweeteners currently approved by the Food and Drug Administration (FDA) are: • Acesulfame potassium • Aspartame • Neotame • Saccharin • Sucralose

15. Example: SUGAR FREE NO CARBOHYDRATE FREE

16. CHO content from labels 1. Look at the “Serving size” 2. Look at the “Total Carbohydrate” in grams Total Carbohydrate: includes grams of sugar, sugar alcohol, starch, and dietary fiber 3. Subtract fiber and sugar alcohol from the “Total Carbohydrate”

17. How to adjust insulin for carbohydrate ?

18. 1)Insulin-to-Carb Ratio the amount of rapid acting insulin given for the amount of carbohydrate eaten at a meal or snack Ref:rence : AlemzadeR,WyattDT.Diabetes Mellitus in Children.ln:BehrmanRE,etal.Nelson,textbook of pediatrics.19 th ed,2010.

19. 2)insulin sensitivity factor A correction (or sensitivity) factor can be used to determine how much extra insulin should be added to the insulin dose which will be given to cover the carb eaten. Ref:rence : AlemzadeR,WyattDT.Diabetes Mellitus in Children.ln:BehrmanRE,etal.Nelson,textbook of pediatrics.19 th ed,2010.

20. Example (Breakfast) BG befor breakfast : 130 Bread 2 slice (60 gr ) 2 U insulin Egg without CHO Milk ( 1 cup) 1 U insulin Apple jam( 1 tablespoon) 1 U insulin 4 U insulin Aspartinject After 2 h check BG

21. snacks Small snack <15 gr CHO – no insulin needed Larger snack over 15 gr CHO insulin may be required

22. Example (lunch) BG before lunch : 300 Cooked rice (1 cup) 3 U insulin Cooked lentils (1/2 cup) 1 U Meat ,salad without CHO Yogurt (1/2 cup) 0/5 U 4.5 U insulin + 1.5 U insulin After 2 h check BG

23. Testing times

24. Timing of insulin for quick or slow meals Quick acting: French bread ,mashed potato , cake inject before meal Slow acting : pasta , whole bread , legums inject after eating High fat &/or high protein slows up rise in blood sugar : Pizza , fish & chips ½ insulin just after eating and the other ½ 30 – 45 minutes later

25. Disadvantages of CHO counting Need to skilled in making calculation Possible weight gain if high calorie foods intake is not monitored

26. 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

27. Thank you