Practical Carbohydrate Counting. Hope S. Warshaw

in this skill. In addition, people may be interested in online meal and menu planning.

      Know how to integrate limited amounts of sucrose-

      containing foods into a healthy eating plan

      The current ADA (2008b) nutrition recommendation about the inclusion of sucrose and sucrose-containing foods reads as follows:

      Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake.

      This recommendation is based on the scientific evidence that dietary sucrose does not increase glycemia more than the same amounts of starch. Sucrose-containing foods do not need to be limited because of a concern about exacerbating hyperglycemia (ADA 2008b). However, it is common for sucrose-containing foods to contain fat, saturated fat, and cholesterol as well as excess calories.

      With these recommendations in hand, it is reasonable to teach people with diabetes that sugary foods and sweets have not been forbidden since the publication of the 1994 ADA nutrition recommendations. However, to maintain a healthy eating plan and achieve their diabetes and nutrition goals, sugary foods and sweets usually need to be limited. This recommendation is in sync with the Dietary Guidelines for Americans (U.S. Department of Health and Human Services et al. 2005).

      In providing individual guidance about sweets, the educator should consider the person’s food habits and preferences along with their weight, glycemic, and lipid status. It is reasonable to assume that most people will want to include some sucrose-containing foods in their eating plan and it is important to help them learn how to do this within the context of achieving their nutrition and diabetes goals.

      These tips can help people eat fewer and smaller portions of sweets:

      • Choose a few favorite desserts and decide how often to eat them based on personal diabetes and nutrition goals.

      • Take note of the calories, total fat, saturated fat, and cholesterol of preferred desserts. Make healthier choices.

      • Recognize that smaller portions can satisfy the sweet tooth just as much as large portions. For this reason, split desserts when eating out. Take advantage of smaller portions when they are available, such as in ice cream shops, when you can choose the kiddie, junior, single, or regular scoop.

      • Use the Nutrition Facts on the food label to learn the grams of carbohydrate per serving. Then use this information to appropriately swap a sucrose-containing food for another carbohydrate-containing food.

      • Learn the impact of sucrose-containing foods on blood glucose. Check blood glucose 1 to 2 hours after eating to see the effect. People may find that sucrose-containing foods with more fat raise blood glucose more slowly.

      • Explore palatable sugar-free options that are sweetened with no-calorie sweeteners.

      Have general guidelines for what and

      how much protein and fat to eat

      As noted, carbohydrate is the main determinant of glycemic rise after eating. Protein and fat have far less impact on the rise of blood glucose levels than carbohydrate (ADA 2008b). Despite the limited impact of protein and fat on blood glucose levels, the amount of these macronutrients consumed by people with diabetes can contribute to both their short- and long-term health. Refer to chapter 10 for more discussion on the impact of protein and fat on blood glucose levels. The ADA encourages practitioners to follow the DRIs for protein of 10–35% of total energy and 20–35% for fat (ADA 2008b; Institute of Medicine 2002).

      People who are taught Basic Carbohydrate Counting also need to be provided with some basic guidelines about healthy amounts of foods that contain protein and fat.

      Educational points about protein

      • Teach the foods (food groups) that provide protein. Teach that foods such as red meats, seafood, eggs, and poultry provide no carbohydrate (unless it is added into a convenience food or in food preparation), but mainly protein and varying amounts of fat. Do note that fat and carbohydrate content of these foods can change based on food preparation. Teach that servings of milk and yogurt provide protein. One cup of milk (any type) provides about the amount of protein as an ounce of meat. Teach that smaller amounts of protein come from non-animal sources, such as grains, cereals, pasta, beans, and vegetables. Use Table 3-3 to do this.

      • According to the Dietary Guidelines for Americans (U.S. Department of Health and Human Services et al. 2005), most adults need about two to three 3-ounce servings of cooked meat or meat substitute per day based on calorie needs. Note: this might not be sufficient protein for children, pregnant, or lactating women, or larger than average-size adults.

      • Encourage the purchase and consumption of protein foods that are lean and lower in saturated fat and cholesterol.

      • Encourage the use of low-fat preparation methods.

      • Encourage the use of measuring equipment to ensure serving sizes are in line with the relatively small amounts of meat being encouraged for healthy eating.

      Educational points about fat

      • Teach the foods (food groups) that provide fat. Teach that fat comes in some foods, such as meats, cheeses, and other dairy foods, such as ice cream. Fat, such as butter, margarine, mayonnaise, and salad dressing, is also added to foods. Because fat is a concentrated source of calories, its calories add up quickly. Limiting fat is an excellent way to limit calories. Use Table 3-3 to do this.

      • Provide the number of fat grams or servings (5 grams of fat equals one serving) that is appropriate for the person and define a serving of fat. Refer to Table 3-1 to determine the appropriate grams or servings of fat for various calorie ranges.

      • Encourage people to limit saturated fat intake by:

      

choosing lower-fat cheeses,

      

drinking fat-free milk and using fat-free yogurt and other dairy foods,

      

choosing lean red meats,

      

eating small servings of red meats,

      

using more fish than red meat.

      • Encourage people to limit their intake of trans fat by limiting partially hydrogenated fat from commercially prepared foods. Note that decreasing sources of saturated fat will aid in decreasing trans fat.

      CHAPTER FOUR

      Concepts to Teach—

      Counting Carb,

      Reading Food Labels, and

      Measuring Portions

      The concepts and teaching strategies from chapter 3 should provide a person learning carbohydrate counting with a solid foundation on general meal planning and personal nutrition. Once this foundation has been laid, more advanced concepts can be explored. This chapter will explore the last four concepts listed in the Assessment Checklist on page 14.

      CONCEPTS TO TEACH

      Know how to determine the carbohydrate counts of foods

      People