Carbohydrate counting is a method of meal planning that will help keep blood sugar under control. It is based on the principle of measuring blood glucose before and after meals, determining the food to be consumed accordingly, and calculating the insulin dose needed to reach the target blood glucose. Nutrients; They contain various nutritional elements such as carbohydrates, proteins, fats, vitamins, minerals and water. However, carbohydrates raise blood sugar more than other nutrients such as protein and fat. In other words, blood sugar level and insulin need at the meal are related to the amount of carbohydrate consumed. By keeping a nutrition diary, you can keep a record of the foods eaten during the day, measure blood sugar levels, and monitor the increase in blood sugar with carbohydrates. If blood sugar is kept within the normal range, the person feels better, and complications such as eye, kidney and cardiovascular diseases that may develop due to diabetes can be reduced or prevented.
The ideal blood sugar range should be decided with the doctor. Goals may differ depending on individual characteristics. For example, while a lower blood sugar may be ideal for a pregnant individual, this range may not be ideal for an elderly patient with cardiovascular disease and a high risk of hypoglycemia.
DAFNE study with the carbohydrate counting method; It shows that there is a 1% decrease in HbA1c when the amount of carbohydrate consumed in the meal is calculated and the appropriate insulin dose is determined.
So, is carbohydrate counting suitable for everyone?
Carbohydrate counting method Beginning level It is divided into two: Advanced level and Advanced level. Initial carbohydrate counting is suitable for type I diabetics, type II diabetics, gestational diabetics, those using fast or short-acting insulin analogues, those using insulin pumps, in short, all diabetics. Advanced carbohydrate counting can be done by people with type I diabetes, those using rapid or short-acting insulin analogues or insulin pumps.
Carbohydrate counting techniques
Portion control is important in carbohydrate counting. Exchange lists for portion control, practical kitchen sizes (cups, spoons, bowls, plates of various sizes) ), 57 hand measurements (fist, palm, soft drink can), labels, kitchen scales and books showing the carbohydrate content of foods can be used. While teaching the individual with diabetes how to calculate carbohydrates, it is reinforced by selecting the appropriate tools, applying them and asking the individual with diabetes to calculate them.
Carbohydrates can be counted by three methods. These;
1-Counting grams of carbohydrates
2-Counting carbohydrate options (15 g carbohydrate replacement lists)
3-Counting portions of foods containing carbohydrates.
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Individuals who will count carbohydrates should also gain the habit of reading labels. The diabetic individual should calculate the carbohydrate content of his/her food in accordance with the method used to count carbohydrates (grams, exchange lists, portions). Some packaged foods do not specify the net carbohydrate content. Manufacturers deduct fiber and sugar alcohols from the total carbohydrate content. Sugar alcohols (sorbitol, xylitol, mannitol) contain lower energy than sucrose and starch. These products are also found in diabetic products. It should definitely be taken into account when counting carbohydrates.
Beginning level carbohydrate counting
The amount of carbohydrates a diabetic individual takes according to the portion sizes of the foods he consumes in his daily life and foods containing 15 g of carbohydrates. is explained.
Basic carbohydrate counting can be taught in 7 stages:
Keeping a nutrition diary
Learning the carbohydrate content of foods
Teaching portion control and carbohydrate amounts in memorable ways (pictures, replicas, photographs, etc.)
Checking the carbohydrate calculations of individuals with diabetes
Controlling the amount of carbohydrates in food consumption
Controlling the amount of carbohydrates that should be consumed daily
Evaluation of the postprandial glucose effect of the amount of carbohydrate taken at meals
Example of foods containing 15 g carbohydrate
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1 small piece of fresh fruit
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Concert and or frozen fruit 1/2 cup
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1 slice of bread or 1 tortilla
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Oatmeal 1/2 water cup
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Pasta or rice 1/3 cup or 3 tablespoons
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4-6 crackers
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1/2 cup of starchy vegetables
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¼ of a large cooked potato or small potato
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2/3 cup fat-free yogurt
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2 small cookies
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1/2 cup ice cream
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1 tablespoon jam, jelly, sugar or honey
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6 chicken nuggets
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Stew 1/2 cup
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Soup 1 cup
Advanced carbohydrate counting
When advanced glycemic control is achieved and the basal insulin dose is adjusted, the Carbohydrate/Insulin ratio and insulin sensitivity factor of individuals using an insulin pump or receiving multiple dose insulin therapy are calculated, usage is taught and applications are checked at regular intervals. If there is an increase in body weight, the presence of hypoglycemia or an increase in the frequency of hypoglycemia, it is evaluated and the Carbohydrate/Insulin ratio is recalculated if necessary.
To determine the carbohydrate/insulin ratio;
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Basal and bolus dose and total carbohydrate intake and distribution of carbohydrates into meals should be appropriate to the individual's needs.
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Food consumption during 1 week, the amount of CH consumed at meals and snacks, preprandial and postprandial blood glucose measurement results of the determined meals, and the time and dose of insulin treatment should be recorded regularly and completely.
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When food consumption records are evaluated, the recommended amount of CH should be consumed in main and snack meals.
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Blood glucose measurements before the meal and the 2nd hour after the meal should be at target levels.
Carbohydrate-insulin (K/I) ratio is calculated in two ways:
Amount of carbohydrate consumed in the meal (g) / Insulin dose applied for the meal = K/I ratio
500 / total insulin dose = Carbohydrate (g) / 1 unit insulin
The diabetic individual, whose K/I ratio is determined for each main meal, In conditions where it is necessary to reduce or increase the amount of Carbohydrates it needs to take (such as special occasions, celebrations, illness/loss of appetite), it calculates the short / fast-acting insulin dose by using the K / I ratio according to the amount of Carbohydrates (g) determined for that meal and corrects the insulin dose for that meal. plans.
Insulin Sensitivity (Correction) Factor (IDF)
Insulin Diabetes Factor determines how much 1 unit of short regular or rapid-acting analog insulin increases blood glucose levels.
Insulin sensitivity factor in the use of short regular insulin: 1500/total insulin dose
Insulin sensitivity factor in the use of rapid analog insulin: 1800/total insulin dose
Insulin correction dose calculation: The blood glucose-120 insulin sensitivity factor is calculated and added to the meal.
Insulin Dose Adjustment at Meals in Diabetics Using Basal / Bolus Insulin or Insulin Pump
Insulin Dose Based on Premeal Carbohydrate Ratio = (Calculated Insulin) + (Insulin Correction Calculation Dose)
Protein, fat and fiber
Protein and fat have little effect on blood glucose levels. Excessive consumption of protein and fat causes weight gain. If the amount of fat is taken in excess in the meal patterns, blood sugar regulation is disrupted, causing hypoglycemia in the postprandial period and hyperglycemia later on. Fiber slows down the absorption of nutrients and gives a feeling of satiety. Fiber is effective in reducing post-meal glycemia, insulin and blood lipids. Individuals with diabetes should consume vegetables, fruits, whole wheat, oats, rye, whole grain cereals and legumes, which are rich sources of fiber.
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