Practical Methods Of Carb Counting K.Yzquierdo

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Diabetes Management of the School-Aged ChildProvided by Texas Children’s HospitalProvider #18-267764-AFebruary 2nd, 2019 The Woodlands, TX 8:00-5:00 pmCONTINUING NURSING EDUCATIONTexas Children's Hospital is an approved provider with commendation of continuing nursing education by the Texas Nurses Association - Approver, an accreditedapprover with distinction, by the American Nurses Credentialing Center’s Commission on Accreditation.REQUIREMENTS FOR SUCCESSFUL COMPLETIONTo receive contact hours for this continuing education activity, the participant must: Attend activity the entire activity Sign the attendance sheet Complete post survey evaluation onlineOnce successful completion has been verified, a “Certificate of Successful Completion” will be awarded for 4.8 contact hour(s). For web link issues, emailcne@texaschildrens.orgLEARNING OUTCOME: At the conclusion of this course, the nurse will be able to provide improved care for the school age child as a result of increased knowledge aboutdiabetes, ways to treat them, and the appropriate management of identified barriers.CONFLICTS OF INTERESTExplanation: A conflict of interest occurs when an individual has an opportunity to affect or impact educational content with which he or she may have a commercialinterest or a potentially biasing relationship of a financial nature. All planners and presenters/authors/content reviewers must disclose the presence or absence of aconflict of interest relative to this activity. All potential conflicts are resolved prior to the planning, implementation, or evaluation of the continuing nursing educationactivity. All activity planning committee members and presenters/authors/content reviewers have submitted Conflict of Interest Disclosure forms.The activity’s Nurse Planner has determined that the following presenter, Dr. Siripoom McKay, have a conflict of interest. Those conflicts of interest have beenappropriately resolved. No other planning committee member, presenter, or content reviewer has a conflict of interest.JOINT PROVIDER STATEMENTThis CME/CNE activity has been jointly provided by Texas Children’s Hospital collaboratively with Baylor College of Medicine.

OBJECTIVES Learn how to carb count for meals andsnacks Understand label reading and othermethods to calculate carb counts Apply carb counting to manage bloodglucose levels Learn how to prepare the student forphysical activity/sportsCLINICAL NUTRITION

EATING HEALTHY WITH DIABETES Follow age appropriate meal planand portion sizes (MyPlate) Make your carbs count by choosingwhole grains, fruit and vegetables Eat less saturated fat and focus onhealthy fat sources Limit foods high in added sugar.CLINICAL 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 ARE CARBOHYDRATES? Starches Made from grains: pasta, bread, rice, corn,potatoes, beans Sugars Fruit, sweets, dairy Fiber Fruits, vegetables, whole grainsCLINICAL NUTRITION

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

SUGAR Simple or “fast-acting” carbohydrate. There are two main types of sugar: naturally occurring sugars - milk (lactose) or fruit (fructose) added sugars - added in processing such as fruit canned in heavy syrupor sugar added to make a cookie (sucrose) Examples of common names are table sugar, brown sugar, molasses, honey, beetsugar, 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 Fruits, vegetables, whole grains, nutsand legumes. Beneficial for digestive health,management of cholesterol levels,and aids in satietyCLINICAL NUTRITION

WHAT IS GLUCOSE?Glucose type of sugar your bodies form of energy!Glucose ENERGY The carbohydrates we eat are turned into glucose by the body. Glucose provides energy for: Cells Brain Every function in the body!CLINICAL NUTRITION


WHAT IS INSULIN?Insulin Hormone made by the pancreas Insulin is the key that unlocks the celland allows glucose be used as energy! We need to pair glucose (or carbs) withinsulin in order to get energy from thefoods we eat!CLINICAL NUTRITIONglucose

WHY IS CARB COUNTING IMPORTANT? Eating consistent amounts of carbohydrates at meals andsnacks keeps your blood glucose in a healthy range The goal is consistency: Too many carbs make blood glucose (hyperglycemia) Too little carbs make blood glucose (hypoglycemia)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: THE BASICS A carbohydrate prescription will give you a goalamount of carbs to eat at each meal or snack time7:00am10:00am12:00pm45 g0-15 g60 g3:00pm0-15 g5:30pm8:00pm60 g0-15 g 1 serving of carbohydrates 15gA dietitian can help determine a carb prescription that is appropriate for the age and activity levelof the childCLINICAL 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 calculatesautomatically.CLINICAL NUTRITION

CARB COUNTING: THE BASICS Methods of Carb Counting:1.Based on serving size (Food ListHandout)2.Reading food labels3.Utilizing restaurant or foodcompany 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 pt to refer to list whenstruggling 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” Carb count non-starchy vegetables onlywhen eating 3 cups raw or 1.5 cupscooked at a time Limit fat intake; choose low-fat whenpossibleCLINICAL NUTRITION


LETS PRACTICE How many servings in this product? What is the serving size of this product?2 servings1 cup How many grams of carbohydrates inthis product?31g (2 servings carbs) How many grams would be in 2 cups ofthis product?62g (4 servings carbs)CLINICAL NUTRITION

USEFUL TOOLS Apps My Fitness Pal Calorie King ShopWell Websites 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






PREPARING FOR ACTIVITY Regular physical activity is important for overall health and wellness Its important to balance insulin doses with the food you eat andactivity you do (even if just house or yard work) Planning ahead and knowing your body’s typical blood glucoseresponse to exercise can help you keep your blood glucose fromgoing too low or too high. If blood glucose is less than 100 mg/dL or greater than 300 mg/dL,no strenuous exercise until blood glucose levels are within range.CLINICAL NUTRITION

PREPARING FOR ACTIVITY Your blood glucose response to exercise will vary dependingon: your blood glucose level before starting activity, the intensity of the activity, the length of time you are active, and changes you’ve made to insulin doses.CLINICAL NUTRITION

HYPOGLYCEMIA Sometimes people experience a drop in blood glucoseduring or after exercise, so it is very important to monitoryour blood glucose, take proper precautions, and be prepared to treathypoglycemia (low blood glucose). To learn how different types of activity affect you, you should frequentlycheck your blood glucose before, during, and after an exercise session Physical activity can lower your blood glucose up to 24 hours or moreafter your workout by making your body more sensitive to insulin.CLINICAL NUTRITION

HYPERGLYCEMIA Blood glucose can also run high temporarily during orafter exercise, especially with high-intensityexercise that increases stress hormone (i.e., glucose-raisinghormone) levels. If your blood glucose is high before starting exercise, check yourblood or urine for ketones. If you test positive for ketones, avoidvigorous activity. If you do not have ketones in your blood or urine and you feel well,it should be fine to exercise.CLINICAL NUTRITION

PRIOR TO ACTIVITYFOLLOW THE 15-15 RULE:1. Check your blood glucose.2. If your reading is 100 mg/dL or lower, have 15-20 grams ofcarbohydrate to raise your blood glucose.3. Check your blood glucose again after 15 minutes. If it is still below100 mg/dL, have another serving of 15 grams of carbohydrate.4. Repeat these steps every 15 minutes until your blood glucose is atleast 100 mg/dL.CLINICAL NUTRITION




1. Pt is prescribed a carb consistent diet or ICR 2. Pt calculates the amount of carbohydrate in their meal 3. Carb count is used to ensure compliance with carb consistent diet ORto determine amount of insulin needed with ICR ORis entered into an insulin pump which calculates automatically. UTILIZING THE CARB COUNT

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