1. UNIT THREE LESSON 8 Carbohydrate Counting

2. Objectives At the end of the lesson, participants should be able to: 1. Describe carbohydrate counting 2. Explain the role of counting carbohydrates in the management of diabetes 3. Name foods high and low in carbohydrates 4. Choose to set or revise goals that relate to carbohydrate counting 5. Describe feelings and experiences of eating with diabetes 6. Identify ways to modify everyday recipes to fit into the diabetes meal plan

3. L-esson

4. Meal Planning Planning your food intake is the first step in controlling your blood glucose and diabetes When you eat healthy, you feel better Your family will also eat better and learn good eating habits for life

5. Meal Planning Before you begin counting carbohydrates, you should meet with a registered dietitian to develop a meal plan that is right for you

6. Carbohydrate Counting Carbohydrate counting is a way of keeping track of the amount of carbohydrates you get from the foods you eat This is done to manage your blood glucose level

7. Carbohydrate Counting Carbohydrates are found in the following foods: Fruit and juice Starchy foods: bread, pasta, cereal, rice, crackers Starchy vegetables: corn, potatoes, squash, yams Dried beans and peas Milk and yogurt Sweets and snack foods: cake, cookies, candy, soda

8. Carbohydrate Counting Foods are a combination of protein, fat, and carbohydrate Foods that contain carbohydrate (sugars and starches) have the greatest effect on blood glucose

9. Carbohydrate Counting When carbohydrate foods are eaten, they are changed almost completely to glucose after about 90 minutes Fats and protein do not raise blood glucose, but a person with diabetes should limit his or her intake of fats

10. Benefits of Carbohydrate Counting Allows you to spread carbohydrate intake across the day Can help you manage your weight Eating too many carbs can lead to weight gain Keeps blood glucose level within the target range

11. Steps in Carbohydrate Counting 1. Know the foods that contain carbohydrates Breads, crackers, cereals, biscuits, pasta Grains, rice, corn, wheat, oats, couscous Starchy vegetables—potatoes, corn, peas, winter squash, pumpkin Fruits (fresh, canned, dried) and fruit juices Milk, yogurt Sweets, desserts

12. Steps in Carbohydrate Counting 2. Know what counts as a serving size Check serving size with measuring cups and spoons or a food scale Read the Nutrition Facts on food labels to find out how many grams or carbohydrate are in the foods you eat

13. Serving Sizes of Carbohydrate Foods Breads and grains Pasta (cooked): 1/3 cup Bagel: ¼ of a large (1 ounce) Biscuit: 1 whole Bread: 1 slice Cereal (cooked): ½ cup Cereal (ready-to-eat): ¼ cup Crackers (saltines): 6 Rice: 1/3 cup Hamburger bun: ½ bun Taco shells: 2 (6-inch) Tortillas: 1 (6-inch) Starchy Vegetables Peas: ½ cup Pinto or kidney beans: ½ cup Corn: ½ cup Potato, mashed: ½ cup Sweet potato: ½ cup

14. Serving Sizes of Carbohydrate Foods Fruit Apple: 1 small (4 ounces) Banana: 1 small (4 ounces) Peach: 1 medium (4 ounces) Orange juice: ½ cup Fruit, canned: ½ cup Milk Milk: 1 cup Yogurt: 2/3 cup plain, fat-free or sweetened with sugar substitutes Dessert Cake (unfrosted): 2 inch Cookies: 2 small Ice cream (light): ½ cup Snack Popcorn: 3 cups popped Potato chips: ¾ ounce (15-20 chips) Pretzels: ¾ ounce Others Sugar: 1 tablespoon Jelly or jam: 1 tablespoon

15. Examples of Portion Sizes Food GroupPortionEstimate Meat, fish, poultry, meat substitutes 3 ouncesThe area of palm of the hand (not including the fingers) and the thickness of the little finger Grains and starchy vegetables 1 cup (2 servings) Closed fist Fruit1 servingClosed fist Vegetables (non- starchy) 1 servingBoth hands cupped together Milk8 ounces8 ounce glass or mini soda can Cheese1 ounceThumb Mayonnaise or Margarine 1 teaspoonThumb tip

16. Steps in Carbohydrate Counting 3. Know that one serving of carbohydrate food equals 15 grams

17. Steps in Carbohydrate Counting 4. Know the foods that are considered “free” Foods that contain non calorie sweeteners or sugar substitutes: Sugar-free soft drinks Unsweetened tea or coffee (no milk added) Gelatin Broth Foods that contain: less than 20 calories per serving or 5 grams of carbohydrates

18. Steps in Carbohydrate Counting Foods that are considered “free” Raw vegetables: count up to 1 cup of raw cooked non- starchy vegetables or ½ cup cooked non-starchy vegetables as “free” foods However, three or more servings of non-starchy vegetables at one meal counts as one carbohydrate serving For example, 1 ½ cups cooked carrots at one meals counts as one carbohydrate serving

19. Steps in Carbohydrate Counting 5. One serving of combination foods such as pizza, casseroles, and soups should be counted as two carbohydrate servings

20. Carbohydrate Measurements Carbohydrates are measured in grams One carbohydrate serving = 15 grams of carbohydrates Check the nutrition fact panel of food labels to see the grams of carbohydrate in food

21. Using Food Labels The two most important areas of the food labels in terms of carbohydrate counting are: Serving Size Total Carbohydrate

22. Let’s Practice If you had one large bagel for breakfast, how many carbohydrate servings did you have?

23. Let’s Practice If you had one hamburger for lunch, how many carbohydrate servings did you have?

24. Let’s Practice If you had 1 cup of mashed potatoes for dinner, how many carbohydrate servings did you have?

25. Let’s Practice If you had three cups of popcorn as a snack, how many carbohydrate servings did you have?

26. Serving Size Serving size tells you what is considered a serving for a particular food. If you are eating twice or three times the amount of the serving size on the food package, then you have to double or triple the amount of total carbohydrates and other information on the label.

27. Total Carbohydrates on the Food Label

28. Rules for Carbohydrate Counting Number of gramsNumber of servings 0 – 5 gramsDo not count 6 – 10 grams½ carbohydrate serving or ½ starch, fruit, or milk serving 11 – 20 grams1 carbohydrate serving or 1 starch, fruit, or milk serving 21 – 25 grams1 ½ carbohydrate servings or 1 ½ starch, fruit, or milk servings 26 – 35 grams2 carbohydrate servings or 2 starch, fruit, or milk servings

29. Other Parts of the Food Label to Consider Individuals with diabetes are more likely to develop heart disease Look out for saturated fat and trans fat Choose foods that are low in saturated and trans fats to lower your risk for heart disease

30. Other Parts of the Food Label to Consider Individuals with diabetes are more likely to develop high blood pressure Look out for sodium Choose foods that are low in sodium

31. When Counting Carbohydrates Keep a record of the food you eat and your blood glucose levels This can help you understand which foods are more likely to cause your blood glucose level to rise quickly Check your blood glucose level regularly This can tell you if you need to adjust the timing of your meals

32. Meal Planning Tips The number of servings of carbohydrates you should eat varies depending on: Weight Level of physical activity Diabetes medication Goals set by your doctor for blood glucose control

33. Meal Planning Tips The American Dietetic Association suggests for many adults: Three to five servings of carbohydrate foods at each meal and One or two carbohydrate servings for each snack

34. Meal Planning Tips Most people will plan to eat three to five carbohydrate servings at each meal Women generally need about three to four carbohydrate servings at each meal Men generally need four to five carbohydrate servings at each meal Allow one to two servings for each snack

35. Meal Planning Tips Use mostly whole-grain products, such as whole wheat bread, oatmeal, brown rice, and whole-grain cereals Eat four to six ounces of lean meat or other protein foods each day Use healthy fats, such as olive oil and canola oil, in salad dressings and for cooking Eat as little trans fat as possible and keep saturated fat low

36. Sample Menu Breakfast One small orange (one carbohydrate serving) ½ cup shredded wheat cereal (one carbohydrate serving) One cup fat-free or low-fat milk (one carbohydrate serving) ½ English muffin with 1 teaspoon soft margarine (one carbohydrate serving)

37. Sample Menu Lunch Sandwich Two slices of whole-wheat bread (two carbohydrate servings) Two ounces of lean meat Vegetables: Three to four carrot sticks, three to four celery sticks, two lettuce leaves One cup fat-free or low-fat milk (one carbohydrate serving) Snack 1/2 cup canned fruit in its own juice (one carbohydrate serving) 3/4 ounce unsalted mini-pretzels (one carbohydrate serving)

38. Sample Menu Dinner Three ounces grilled chicken breast 1/3 cup cooked pasta (one carbohydrate serving) ½ cup green beans One small whole wheat dinner roll (one carbohydrate serving) One cup melon balls (one carbohydrate serving) Ice tea sweetened with sugar-free sweetener Snack Six ounces of low-fat, fruited yogurt with sugar-free sweetener (one carbohydrate serving) Two tablespoons unsalted nuts

39. E-mpowerment Diabetes Education Series: Carbohydrate Counting

40. Diabetes Education Series Describe your experiences of eating related to diabetes. What was most difficult for you? What are ways that you could overcome some of these difficulties?

41. A-ction Did you accomplish the goal you set last week? Set a goal to practice carbohydrate counting

42. R-eal-Life Problem Solving Duncan’s Story

44. Questions about Duncan’s Story What is Duncan’s problem? What suggestions do you have for Duncan in the area of carbohydrate counting? What is the best advice you can give to Duncan in this situation and why? What would you do if you were in Duncan’s situation?

45. Questions about Duncan’s Story Please find the Real-Life Problem Solving handout for this lesson in your folder These questions will help with your understanding of Duncan’s story

46. Nutrition Menu Baked Chicken Red Potato Salad All Season Refresher

47. See you next week! Keep moving on! Topic for the next week: Think Your Plate

48. Date: References: Margaret E. Cook-Newell, Ph.D., R.D., L.D., CDE Irene Hong-McAtee, MD, MCR Adrienne Glodt, B.S., Graduate Student Laura Hieronymus, MSEd, APRN, BC-ADM, CDE Cheryl Case, M.S., Harrison County Ann Hollon, M.A., Wolfe County Hazel Forsythe, Ph.D., R.D., L.D., CFCS Stephen D. Perry, M.S., R.D., L.D. Pam Sigler, M.S. Lynn Blankenship, M.S., Metcalfe County Theresa Scott, M.A., Floyd County Tamara Thomas, M.S., Franklin County Rusty Manseau, B.A., Graphic Artist Author: Ingrid Adams, Ph.D., Assistant Professor, Nutrition and Food Science, University of Kentucky Other Contributors