carbs and t1d jdrf
TRANSCRIPT
ARE ALL CARBS CREATED EQUAL?Cory Eck MCN RD LD Diabetes Educator
Texas Health Presbyterian PlanoJune 6th 2015
2
Cory EckMCN RD LD
Education:
BS Nutritional Sciences, Penn State University Penn State Varsity Track and Field, NCAA Academic
All-American
Masters of Clinical Nutrition, UT Southwestern
Type 1 diabetic, 13 years
@TheEcksfactorProfessional:
Cook Children's Fort Worth, TXPediatric Endocrinology Dietitian, 2.5 years
Texas Health Presbyterian PlanoDiabetes Educator since February 2015
ObjectivesUnderstand the difference between fast and
slow carbsUnderstand the basics of the Glycemic IndexUnderstand effects of fat and fiber on
carbohydrate absorptionUnderstand how to modify insulin injections
for high fat meals, i.e. pizza
Carbohydrates
Simple: Glucose or fructose or Lactose
Complex: Starches and fibers
Fast: Juice, Hard candy, Soda and low-fat sugary desserts
Slow: Breads, starchy vegetables, whole fruits and milk and yogurt
Simple vs. Complex Fast vs. Slow
5
Simple Vs. ComplexChocolate bar
Potato
Banana
Lifesaver
Agave Nectar
Wheat Bread
Milk
Greek Yogurt
Orange Juice
Jello
Brownie
Peanut Butter
PizzaKetchup
White Bread
6
Fast Vs. SlowChocolate bar
Potato
Banana
Lifesaver
Agave Nectar
Wheat Bread
Milk
Greek Yogurt
Orange Juice
Jello
Brownie
Peanut Butter
PizzaKetchup
White Bread
Click icon to add picture
Glycemic IndexMeasurement of how much a
food raises your blood sugar Compared to plain white sugar Scale of 0-100: Low <55, Medium 56-69,
High ≥70 Must also consider amount of carbs or
the glycemic load
Benefits of Low GI foods Less increase in blood sugar Increased fullness due to increased fiber Lower your risk of heart disease
Glycemic IndexWhat lowers a foods GI?
Type of carbohydrate it contains Increases in fiber Less processing The amount of fat the food contains
Are all low GI foods good for me?
Baked Potato Potato Chips Sweet Potato
GI = 76 GI = 54 GI = 61
9
Glycemic IndexGI is affected by cooking method
Frying vs. Baking Hot vs. Cold Acids that are added
Need to consider the glycemic load Rise in BG also depends on the amount of carbs
Are their too many variables to consider?
10
Glycemic IndexFood Type
Low GI (≤55) Choose most often
Medium GI (56-69) Choose more often
High GI (≥70)Choose less often
Breads 100% ground wheat/grainPumpernickel
Whole wheat or rye bread/bagel/tortilla
Pita- white or wheat
White bread/bagel/tortillaKaiser roll
Cereals All-BranTM
Oat BranTM
Oatmeal or quick oatsPuffed wheatGrapenutsTM
Rice KrispiesTM
Corn FlakesBran Flakes
GrainsParboiled or converted riceBarley, bulgur or quinoa
Pasta/noodlesBrown riceBasmati riceCouscous
Short grain rice
OtherLegumes- Lentils, chick peas, kidney, soy, black, bakedPotato Chips
White/red/sweet(yam) potatoSweet or Popped cornWheat thins or rye crackersBean soupsFrench Fries
Baked potatoPretzelsSoda crackersRice cakes
Fruit Whole fresh or frozen fruit
Cantaloupe, pineappleFruit Juice Watermelon
Fat and Fiber
Slows stomach emptying
Slows carbohydrate absorption
Can create temporary insulin resistance
Slows stomach emptying
Improves post meal satiety
Reduces overall rise in blood sugar
Keeps you regular
Fat Fiber
Fat and Fiber
Meal 1 Hour 2 Hour 3 Hour 4 Hour
White Bread
Legumes
French Fries
Insulin
Blo
od
Glu
co
se
Target Blood Sugar
Insulin Onset Peak Duration
Humalog®, Novolog®, Apidra® 10-15 minutes 60-90 minutes 3.5-5 hours
Adjusting Insulin Administration Provide insulin 15-20 minutes early with most meals
If blood sugar <100mg/dL wait till meal time If blood sugar >150mg/dL consider 30 minutes
With Multiple Daily Injections:Provide meal bolus insulin pre- and post- meal:
High fat foods with carbs
Correction and 50% of meal bolus before, remaining 50% of meal bolus 30 minutes-1hr later
Adjusting Insulin Administration
With Insulin Pump Therapy
Calculate all meal and correction boluses utilizing the bolus calculators Use can reduce average BG by 25mg/dL Pumps can provide insulin for ALL carbs!!!
Utilize advanced bolus features High fat foods with carbs, grazing, or at party Combo/Dual Wave or extended/square wave bolus ≥1 advanced bolus per day can produce better blood sugar control
Carbohydrate Counting PizzaIdentify all sources of carbohydrate:
Crust- Thin crust pizzas are usually 5g less per slice Subtract 5-10g carb/crust that doesn’t get eaten
Sauce-
Cheese-
Toppings-
1/8 12” Pizza = 25g, +5g w/ each additional inch
Yes, choose wheat to lower GI
Yes, ½ cup = 10-15g carb; more for BBQ sauce
Yes and No; Yes for fruits, potato's, noodles or sweets
No, but the more you add the more fat their is
Taking Insulin for PizzaMDI:
2 Injection: Correction and 50% 15 minutes early, remaining 50% following meal
The more fat there is the more the delay
Insulin Pumps: Low fat Pizza- 15-20 minutes early High fat Pizza (>10g fat)- Utilize combo/dual wave bolus
50% 15-20 minutes early 50% over the next 2-4 hours
Start with 2 hours and extend longer as needed
ConclusionsIdentify your carbohydrates
Determine the GI of the food Simple vs. complex, fiber, fat and how processed the food is
Count ALL your carbs!
Adjust you insulin administration times Open that Ferrari up on the highway of life