1. CARBOHYDRATE COUNTING – BASICS & BEYOND Francesca Annan RD

2. Carb counting basics  Most of the glucose in the blood comes from digestion of carbohydrate foods.  Excess glucose is stored as glycogen in muscles and liver  Stored as adipose tissue – fat  Fat and protein are not converted directly to glucose.........

3. What else influences BG after eating?  Previous activity levels  Previous insulin bolus & Duration Insulin Action  Adequacy of basal/background insulin  Meal composition and GI  Environment  Other physical factors

4. Carbohydrate counting – what should it involve  Estimation or calculation amount of carbohydrate in food  Calculation of an insulin dose based on amount of carbohydrate, blood glucose levels, activity  Not just about carbohydrate in food

5. Start with.......  Accuracy of information and experience!  Food labels are not always accurate  The same food from a different food producer may not have the same nutritional composition  If you compare information from different sources you will get different information

6. Nutritional information  Composition of Foods This is where dietitians get information. Basis of information in books like Carbs&Cals or calorie counters

7. Resources  Books – Carbs & Cals, food pictures, calorie counters,  Apps – pictures and nutritional information  Websites – for restaurant/fast food info, supermarkets to access food labels and find info about foods

8. How accurate do you need to be?  Within 10g  Within 5g  Within 1g How accurate an insulin dose can you deliver? Nearest 0.1 unit, 0.5unit or 1 unit?

9. WORKING OUT CARBOHYDRATE USING WEIGHING SCALES

10. When to Use??  Useful for?  RICE  PASTA  CEREALS  OVEN CHIPS  POTATOES (mash/boiled/baked)  RECIPES

11. Step 1: Weigh your carbohydrate food Remember to zero the scales or turn on after putting plate/bowl on the scales. Put your normal portion of food e.g. pasta/rice/cereal onto plate/bowl Consider using digital scales accuracy

12. Step 2: Look at the food label  Find TOTAL CARBOHYDRATE on the food label  Use per 100g column unless you are having the average portion size or the whole serving

13. Make the maths as easy as possible! Use the amount of carbohydrate per 100g to work out how much is in 1g of the food Amount of carbohydrate on the label divided by 100 Multiply this number by the weight of your food This gives you the amount of carbohydrate in your portion

14. Example: Breakfast cereal Your portion of cereal weighs 60g The label tells you that 100g cereal contains 88g carbohydrate If 100g of the cereal contains 88g carbohydrate then 1g will contain (88 ÷ 100 ) 0.88g. Your portion will contain (0.88g x 60g) 53g carbohydrate

15. Example: Breakfast cereal Typical valuesTypical value per 100g 30g with 125ml milk Energy326 kcal157kcal Protein310g7g Carbohydrate88g28g Of which sugars22g13g Of which starch45g13g 100g portion serving

16. Dried wieghts versus cooked weights Foods like pasta, rice and baked potatoes absorb or lose water through cooking. This changes the nutritional composition

17. Pasta Dry pasta 75g water Cook exactly as stated on the instructions 75g dried pasta gives cooked pasta 170g Dry pasta + water = cooked pasta Uncooked to cooked weight more than doubles

18. Pasta Food Label A 75g serving once cooked weighs 170g Typical valuesPer 100g (dry weight)Per 75g serving (dry weight) Energy346 kcal262 kcal Protein12g9g Carbohydrate70g63g Of which sugars4g3.6g Of which starches66g59.4g

19. Rice Rice (uncooked) 40g water Cooked following instructions Cooked rice 100g Rice + Water = cooked rice Uncooked to cooked = increases in weight 2.5 times

20. Rice Food Label A 40g serving once cooked weighs 100g Typical valuesPer 100g (dry weight)Per 40g serving (dry weight) Energy316 kcal126 kcal Protein7.0g2.8g Total Carbohydrate75.0g30g Of which sugars0.2g0.1g Of which starch69.8g27.9g

21. Using labels for rice and pasta difficult? Cooking for one you could weigh out dried pasta before cooking, (if you cook exactly as it says on the label?) Use information about cooked pasta and rice examples Carbs&Cals Information from nutritional composition tables Or use the food label to work out how much 1g cooked rice or pasta will contain and then calculate your portion size from its’ weight.

22. Potatoes Baked potato – remember that carbohydrate value increases if skin is eaten too Does this matter? What happens when you have baked potatoes? Experience counts! Use the following table as a useful tool

23. Baked potato Per 100gKcalProteinCARB Baked, flesh & skin 1363.932 Baked, flesh only 772.218 Boiled 721.817 Mashed 1041.816

24. Baked potato Could you use the weight of the uncooked potato? Compare the uncooked and cooked potatoes & the carb values What do you think? If you use carbs &cals the values in the book are based on flesh only.

25. Handy Measures – literally!  Very useful tool, you can use your hand as a guide to portion sizes.  Once portion sizes have been weighed, look at portion in a bowl/cup/measuring spoon of product  So you don’t have to re-weigh every time – use these handy measures

26. HOW TO WORK OUT CARBOHYDRATE USING FOOD LABELS

27. When To Use??  When eating the WHOLE serving size or suggested portion size  Useful for snacks and packaged foods  E.g.  Cereal bar  Chocolate Bar  Crisps  Yoghurt  Sliced bread

28. How?  Look at TOTAL CARBOHYDRATE PER SERVING/PORTION

29. different portion size? Look at TOTAL CARBOHYDRATE Read label per 100g Weigh your portion size e.g. 125g Work out how much carbohydrate there will be in 1g Use this to calculate the amount of carbohydrate in your portion 100g contains 8g carbohydrate so 1g contains 8 ÷ 100 = 0.08g 125g will contain 0.08 x 125 = 10g

30. Fat, protein, GI and glycaemic load its not just amount of carbohydrate that matters!

31. What are the challenges?  Amount of carbohydrate predicts 66% glucose response  Glycaemic load predicts 88% glycaemic response  Fat & protein content of foods alter digestion and absorption and therefore blood glucose response

32. GI

33.  Regardless of GI pre meal insulin more effective

34. How many foods are pure carbohydrate?  Cooked pasta  30g carbohydrate  5g protein  1g fat

35. Meals are mixed  The amount of protein and fat in a meal will alter the blood glucose response  But we need more research and practical studies to produce better practical guidelines

36. What do we know  Data to be published from a study in Australia demonstrates that high protein and fat meals have prolonged raised post meal glucose curve  But insulin requirements are not as high as previously published by European  Work on food insulin index in non diabetics shows that protein and fat ingestion does not stimulate pancreatic insulin production

37. Calculating insulin doses for food  Amount of carbohydrate  Fat & protein  GI/GL  Last insulin bolus  Activity  Blood glucose levels FoodPlus

38. Calculating insulin doses for food  Maths  Ratios per g carb  Or units per 10g carb  Can you calculate active insulin  Duration of action  Bolus advisors on BG meters, insulin pumps  Diabetes Apps  InsulinCalc  Insulin Pro Manual calculationAutomated calculations