Practical Carbohydrate Counting. Hope S. Warshaw

      Assessment Checklist

      Below is a list of knowledge and skills a person using Basic Carbohydrate Counting should obtain. Some of the skills may be present from the beginning; most will probably be acquired through carbohydrate counting education. Use this checklist as an ongoing assessment tool. Strategies for teaching this knowledge and these skills are addressed in chapters 3 and 4.

      Covered in Chapter 3. Concepts to Teach—From Basic Nutrition to Meal Planning:

      

Understand the rationale behind why carbohydrate counting can effectively achieve glycemic control

      

Identify the foods (food groups) that contain carbohydrate

      

Identify the foods (food groups) that do not contain carbohydrate

      

Understand that foods that contain carbohydrate are healthy and offer energy and an array of vitamins and minerals

      

Understand that healthy foods that contain carbohydrate should not be significantly limited or avoided as a means to achieve glycemic control (if a person is not achieving glycemic goals, other methods, such as blood glucose—lowering medication, should be utilized, constituting a progression of therapy)

      

Know how much carbohydrate to eat per day

      

Know how much carbohydrate to eat at meals and snacks

      

Define a serving of a variety of common foods

      

Know how to plan meals

      

Know how to integrate limited amounts of sucrose-containing foods into a healthy eating plan

      

Have general personal guidelines for what and how much protein and fat to eat

      

Know how to take, record, and track blood glucose levels

      Covered in Chapter 4. Concepts to Teach—Counting Carb, Reading Food Labels, and Measuring Portions:

      

Know how to determine the carbohydrate counts of foods

      

Know how to use the Nutrition Facts panel

      

Have and know how to use measuring equipment and portion control tools and tips

      

Know how to interpret postprandial blood glucose levels

      Progression to Advanced Carbohydrate Counting

      A person who is ready to progress to learning and using Advanced Carbohydrate Counting should be able to perform all the tasks listed above in the Assessment Checklist. However, not all diabetes self-management regimens are suited to Advanced Carbohydrate Counting. The mastery of Basic Carbohydrate Counting—with the simple goal of eating a consistent amount of carbohydrate throughout the day—can be an endpoint for some people with diabetes. For others, the mastery of Basic Carbohydrate Counting skills and knowledge will serve as a base upon which they can progress to acquire and master Advanced Carbohydrate Counting skills.

      A person who has type 2 diabetes and follows a healthy eating plan integrated with regular physical activity and no blood glucose—lowering medications has no need to progress to Advanced Carbohydrate Counting with their current regimen. They may need to progress as their diabetes management plan becomes more complex, often with the addition of oral or injectable medications and/or insulin that can be adjusted based on blood glucose levels and/or carbohydrate intake. Until that time (or if that complexity never becomes necessary), Basic Carbohydrate Counting will usually suffice.

      In other cases, there is no intermediary period between Basic and Advanced Carbohydrate Counting. The person with type 1 diabetes who seeks a more flexible insulin regimen and eating plan may want or need to progress beyond Basic Carbohydrate Counting immediately. Chapter 6 provides a more in-depth discussion of determining a person’s readiness to progress.

      CHAPTER THREE

      Concepts to Teach—

      From Basic Nutrition to

      Meal Planning

      Regardless of the initial knowledge level or ultimate goals of the person learning carbohydrate counting as a meal planning approach, all will begin with Basic Carbohydrate Counting. In chapter 2 we discussed assessing carbohydrate counting skills and presented an Assessment Checklist (see page 14) that summarized the necessary skills involved with Basic Carbohydrate Counting. In this chapter, we’ll discuss many of those concepts and some strategies for teaching those concepts.

      CONCEPTS TO TEACH

      Rationale for counting carbohydrate

      It is important that a person understands the rationale for counting carbohydrate. Give a brief explanation that calories are provided from three macronutrients—carbohydrate, protein, and fat. Next explain that foods are made up of combinations, or “packages” of varying amounts of carbohydrate, protein, and fat.

      Concrete examples work best, so provide examples in terms of real foods. The following examples often work well:

      • A slice of bread (white or whole wheat) contains mainly carbohydrate and a small amount of protein.

      • A piece of grilled chicken contains mainly protein and a small amount of fat.

      • A piece of fruit contains mainly carbohydrate.

      • A glass of milk (8 ounces) contains mainly carbohydrate, but is also a source of protein and may contain some fat, depending on the type of milk.

      After you’ve established carbohydrate as a constituent of food and given some general examples of carbohydrate-containing foods, move on to the role carbohydrate plays in diabetes self-management. Some concepts to explain:

      • It is the carbohydrate in foods that is the main contributor to the rise of blood glucose after eating. Carbohydrate counting as a meal planning approach focuses on counting the amount of the nutrient (carbohydrate) that causes the greatest rise in blood glucose levels.

      • Equivalent amounts of carbohydrate from a variety of carbohydrate-containing foods raise blood