Carbohydrate Counting For Insulin Administration

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CARBOHYDRATE COUNTING FORINSULIN ADMINISTRATION IN THESCHOOL SETTINGKatelyn Yzquierdo, MS, RD, CSP, LDCLINICAL NUTRITION

OBJECTIVES Learn how to carb count for meals and snacks Understand label reading and other methods tocalculate carb counts Apply carb counting to manage blood glucoselevels Learn how to prepare the student for physicalactivity/sportsCLINICAL NUTRITION

THE IMPORTANCE OF CARB COUNTING Studies show that people with better carb counting skills have better BGcontrol. Counting carbs is the best way of keeping blood sugars under controlbetter than limiting sugars, counting calories or using an exchange system. Inaccurate carb counting can lead to low bloodsugars or hyperglycemia by wrongly estimating insulin before meals. Inaccurate carb counting is also associated with higher blood sugars aftermeals. Adolescents with the most accurate carb counting skills (less than10g off) had better BG control and a lower A1C.CLINICAL NUTRITION

WHY COUNT CARBOHYDRATES? Food is made up of many differentnutrients: Carbohydrate Our bodies need a little bit of eachof these nutrients but someonewith diabetes needs to pay closeattention to the amount ofcarbohydrate they consume. Carbohydrate is the nutrient thatbreaks down to sugar (glucose) inour bodies as we digest it Protein Fat Vitamins & Minerals Water FiberCLINICAL NUTRITION

ARE CARBOHYDRATES BAD? No! Individuals with diabetes must be mindfulof how many carbs they eat, they don't needto avoid it altogether. Carbs are the body'smain source of fuel and are necessary to maintain proper function. The type of carb and portion size are what matter most. Think of your carb intake like rain: We don’t want a drought or a flood but a nice even sprinklingthroughout the day!CLINICAL NUTRITION

WHAT IS GLUCOSE? Our bodies use carbohydrate for energy by turning it intoglucose.Glucose energy Glucose provides energy for: Cells Brain Every function in the body!CLINICAL NUTRITION

WHAT IS INSULIN?Insulin Hormone made by the pancreas In order to use energy from glucose, insulinmust be available to carry glucose into thecells. Because people with diabetes have impairedinsulin production, sugar can build up in theirblood causing hyperglycemia. Our goal: matching carbohydrate intake toinsulin needs!CLINICAL NUTRITIONglucose

HEALTHY EATING GUIDELINES Make ½ your plate fruits andvegetables Choose whole grains Choose low-fat or fat-free dairy Vary your proteins (think lean!) Eat and drink less sodium,saturated fat, and added sugarsCLINICAL NUTRITION

CARB, PROTEIN OR FAT? Carbohydrates: Grains Beans, starchyvegetables Protein Beef, pork,poultry, fish Eggs Fruit Cheese Milk, yogurt Nuts, tofu Dessert foodsCLINICAL NUTRITION Fat Butter, margarine Oils, lard, saladdressings Sour cream,mayonnaise

TYPES OF CARBOHYDRATESCLINICAL NUTRITION

STARCH Foods high in starch include: Grains like wheat, oats, barley and rice Crackers, tortillas, breads, pasta Starchy vegetables: corn, green peas, potatoes, beats Dried beans, lentils and peas pinto beans, kidney beans, black eyed peas and split peasCLINICAL NUTRITION

SUGAR Naturally occurring sugars - milk(lactose) or fruit (fructose) Added sugars (sucrose) Common names: table sugar, brownsugar, molasses, honey, beet sugar,cane sugar, confectioner's sugar,powdered sugar, raw sugar, turbinado,maple syrup, high-fructose corn syrup,agave nectar and sugar cane syrup.CLINICAL NUTRITION

FIBER A complex carbohydrate Fruits Vegetables Whole grains Nuts Legumes Beneficial for digestive health, managementof cholesterol levels, and aids in satietyCLINICAL NUTRITION

CARB COUNTING BASICS The portion size and carb count of all carb containing foods ina meal or snack must be evaluated and added up to providetotal carbohydrates.CLINICAL NUTRITION

CARB COUNTING BASICS The average 2000 calorie diet may eat 45-60g carbs per meal Carb consistent diets are usually used at first diagnosis Pts may then transition to insulin-to-carb ratio (ICR) for insulininjections or use with an insulin pump (ex. 1:10)CLINICAL NUTRITION

CARB COUNTING APPLICATION Carb consistent diets are usually used at first diagnosisDfDf7:00am10:00am12:00pm45 g0-15 g60 g3:00pm0-15 g5:30pm8:00pm60 g0-15 gDf Pts may then transition to insulin-to-carb ratio (ICR) for insulininjections or use with an insulin pump (ex. 1:10)A dietitian can help determine a carb prescription that is appropriate for the age and activity level of thechildCLINICAL NUTRITION

SAMPLE CARB CONSISTENT DIETSGirls/Ages(years)Grams CAL NUTRITION

UTILIZING THE CARB COUNT1. Pt is prescribed a carb consistent diet or ICR2. Pt calculates the amount of carbohydrate in their meal3. Carb count is used to ensure compliance with carb consistentdietOR to determine amount of insulin needed with ICROR is entered into an insulin pump which calculates insulindose automatically.CLINICAL NUTRITION

CARB COUNTING METHODS1. Measuring portion sizes2. Reading food labels3. Utilizing websites and/or smartphone apps4. “Guesstimating”CLINICAL NUTRITION

CARB FOODS LIST Use as general guide to learn foodgroups and portion sizes Not always as accurate as food label Encourage students to refer to listwhen struggling to carb count Take a picture of the list and keep it inyour phone for quick referenceCLINICAL NUTRITION

NON-CARB FOODS LIST AKA “free foods” Fill up on non-starchy vegetables and leanproteins Choose healthy unsaturated fatsCLINICAL NUTRITION

READING FOOD LABELSCLINICAL NUTRITION

LETS PRACTICE How many servings in this product? What is the serving size of this product?8 servings2/3 cup How many grams of carbohydrates inthis product?37g How many grams would be in 2servings of this product?74gCLINICAL NUTRITION

USEFUL TOOLS Apps Websites My Fitness Pal https://www.myfitnesspal.com Calorie King http://www.lillydiabetes.com Carb Counting with Lenny Book Calorie King 2020!CLINICAL NUTRITION

SWEETS & SNACKSCLINICAL NUTRITION

CARB COUNTING FOR TREATS AND SWEETS Mini cupcake (15g CHO) vs regular (35-40g) Lofthouse cookie ( 25g) vs mini Lofthouse cookie ( 10) Small slice of birthday cake ( 40g)CLINICAL NUTRITION

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PREPARING FOR ACTIVITYCLINICAL NUTRITION

PREPARING FOR ACTIVITY Regular physical activity is important for overall health andwellness Its important to balance insulin doses with carb intake(meals/snacks) and activity level If blood glucose is less than 100 mg/dL or greater than 300mg/dL, no strenuous exercise until blood glucose levels arewithin range.CLINICAL NUTRITION

CHALLENGES & CONSIDERATIONS OF BGMANAGEMENT WITH EXERCISE Every athlete has a unique BG response before, during,after exercise Type and amount of CHO in diet, intensity, duration,temperature/altitude, performance anxiety/excitement Daytime and nocturnal hypoglycemia are commonduring and after exercise Adjusting basal and/or long acting insulin may benecessary before exerciseCLINICAL NUTRITION

PREVENTING HYPOGLYCEMIAPrior to ExerciseAfter Exercise A BG value of 120-180 mg/dL is a good startingpoint for activity Check BG before exercise; if BG 250 mg/dL, check for ketones (ketones, NO exercise) *BEFORE Boluses/basal rate may need to bereduced before exercise (especially long lastingexercise) to prevent hypoglycemia.During Exercise Measure BG every 30 minutes during exercise *DURING A CHO snack 30 min into exercising maybe necessaryCLINICAL NUTRITION Measure BG immediately after and 2-4 hours postexercise.*AFTER exercise, the greatest concern is lateonset hypoglycemia, which may occur due to lowglycogen levels. Prevention strategies includeconsuming additional CHO (via bedtime snack)and/or reducing basal rate or long-acting insulinafter HIIT or an extended practice.Emphasize proper recovery. Replenish muscleglycogen right after exercise (within 30-60minutes) by taking in adequate carbohydrate,you’ll be less likely to get as low later on.

MANAGING EXERCISECLINICAL NUTRITION

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COMMENTS/QUESTIONS?CLINICAL NUTRITION

CLINICAL NUTRITION Studies show that people with better carb counting skills have better BG control. Counting carbs is the best way of keeping blood sugars under control- better than limiting sugars, counting calories or using an exchange system. Inaccurate carb counting can lead tolow blood sugars or

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