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Important notice

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


Carbohydrate counting

Carbohydrate Counting


What is carbohydrate counting

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.


Advantages of carbohydrate counting

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


What is carbohydrate

What is Carbohydrate?


Important notice

CARBOHYDRATE

STARCHY FOODS

SUGARS

GLUCOSE

Blood Stream

Insulin

Cells of body


Carbohydrate foods

Carbohydrate Foods

STARCHY FOODSSUGARS

Breadsugar

Potatoglucose

Ricesugary drinks

Pastasweets, chocolate

Breakfast cerealssweet puddings

Biscuits and other fruit

flour productsmilk

yoghurt


Quick or slow acting carbohydrate

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


Rise in blood sugar is influenced by

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


Estimating cho

Estimating CHO

  • Weighing food

  • Measuring using cups & spoons

  • Food labels

  • Recipes that list CHO content

  • CHO Counting tables/books


Cho content from labels

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


Calculating cho per portion from labels

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


Important notice

Basal insulin

Lantus

or

Levemir


Adjusting your basal insulin

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


How do i adjust my quick acting insulin

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


Testing times

Testing Times:


How do i check my ratio

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


Is my ratio correct

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


Is my ratio correct1

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


Small snack 15gms cho no insulin needed larger snack over 15gms cho insulin may be required

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


Adjusting your insulin

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


Reactively adjusting insulin why not

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


A vicious circle

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

  • ????????????????


Hypoglycaemia

Hunger

Hypoglycaemia

Sweating

Palpitations

Trembling

Dizziness

Blood glucose – below 4


Treating a hypo fast acting sugar

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)


Alcohol

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


Driving

Driving

  • Test before long journeys

  • Ensure you have snacks available

  • Regular testing often advisable

  • DVLA / Insurance


The effects of exercise

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


Timing of insulin for quick or slow meals

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


Important notice

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


Disadvantages of carb counting

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


Eating for good health

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


Want more information

Want more information?

  • The Hugely Better Carbohydrate Counter – Essentials –by Carolyn Humphries £4.99

    or

  • The Fat, Fibre & Carbohydrate Counter

    £3.99


Important notice

HELP

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


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