Diabetes educators and dietitians Hope Warshaw, MMSc, RD, CDE, BC-ADM, and Karen Bolderman, RD, LDN, CDE, present the essentials of teaching carbohydrate counting in this revised and much expanded edition. This resource provides clear and practical approaches that will allow you to help your patients achieve glycemic control with Basic or Advanced Carbohydrate Counting. This new edition includes:
Reasons for teaching carbohydrate counting, which type, and to whom
Complete information on both Basic and Advanced Carbohydrate Counting
Skills and readiness checklists for patients considering carbohydrate counting
Expanded sections on using carbohydrate counting in conjunction with insulin pump therapy
Methods for calculating insulin-to-carbohydrate ratios, correction factors, and other formulas
Details on fine-tuning and pattern management
Expanded case studies
Useful charts, record-keeping forms, and resource sections
Written for all clinicians working in diabetes care and education, this second edition of Practical Carbohydrate Counting will be your go-to tool when patients want to improve their glucose control with medical nutrition therapy.
Introduction
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Published:2008
"Introduction", Practical Carbohydrate Counting: A How-to-Teach Guidefor Health Professionals, Hope S. Warshaw, MMSc, RD, CDE, BC-ADM, Karen M. Bolderman, RD, LDN, CDE
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According to the American Diabetes Association (ADA), Medical Nutrition Therapy (MNT) is an integral component of diabetes management and diabetes self-management training (DSMT) (ADA 2008b). MNT has been shown, through clinical trials and outcome studies, to demonstrate decreases in A1C of approximately 1% in type 1 diabetes and 1–2% in type 2 diabetes (Pastors et al. 2002; Pastors, Franz, et al. 2003). By helping patients choose foods and plan meals to monitor their carbohydrate intake and achieve their MNT and diabetes care goals, carbohydrate counting is an attractive meal-planning approach (ADA 2008b).
The following MNT goals for diabetes management (ADA 2008b) are to:
Achieve and maintain (refer to Table I-1 for these goals):
Blood glucose levels in the normal range or as close to normal as is safely possible.
A lipid and lipoprotein profile that reduces the risk for vascular disease.
Blood pressure levels in the normal range or as close to normal as is safely possible.
Prevent, or at least slow, the rate of development of the chronic complications of diabetes by modifying nutrient intake and lifestyle.
Address individual nutrition needs, taking into account personal and cultural preferences and willingness to change.
Maintain the pleasure of eating by limiting food choices only when indicated by scientific evidence.
Target Glycemic Goals for Adults with Diabetes
| A1C | <7.0%* |
| Preprandial capillary plasma glucose | 70–130 mg/dl (3.9–7.2 mmol/l) |
| Peak postprandial capillary plasma glucose† | <180 mg/dl (<10.0 mmol/l) |
Key concepts in setting glycemic goals:
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| A1C | <7.0%* |
| Preprandial capillary plasma glucose | 70–130 mg/dl (3.9–7.2 mmol/l) |
| Peak postprandial capillary plasma glucose† | <180 mg/dl (<10.0 mmol/l) |
Key concepts in setting glycemic goals:
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Referenced to a nondiabetic range of 4.0–6.0% using a DCCT-based assay.
Postprandial glucose measurements should be made 1–2 h after the beginning of the meal, generally peak levels in patients with diabetes.
Source: Reprinted by permission from American Diabetes Association: Clinical Practice Recommendations 2008 (American Diabetes Association, 2008), S18, table 8
Regarding glycemic goals for infants, children, and adolescents, the ADA position statement Care of Children and Adolescents with Type 1 Diabetes states that near-normalization of blood glucose levels in children and adolescents is generally the same as that for adults (ADA 2005). However, the position statement details a number of caveats that discuss the greater risks of hypoglycemia and the difficulty of achieving tight glycemic control in this age population. The position statement specifies A1C goals that differ from the adult A1C goal for three age groups as follows:
Children <6 years old: 7.5–8.5%
Children 6–12 years old: < 8%
Adolescents: 7.5%
Making the necessary lifestyle changes to eat healthy with diabetes, in addition to acquiring and utilizing the knowledge to both prospectively and retrospectively manage glycemic control acutely and chronically, is one of the most challenging aspects of diabetes care. Helping people with diabetes achieve these goals is also challenging for their providers. Many factors contribute to the challenge of glycemic control, including those listed in Table I-2. Yet, it has been shown that people at varying levels of ability and motivation, as well as people implementing various diabetes therapies, can use carbohydrate counting to achieve short- and long-term glycemic and health goals (Anderson et al. 1993; DAFNE Study Group 2002).
Interrelated Factors That Determine Plasma Glucose Concentration
Numerous interrelated factors determine plasma glucose concentration in people with diabetes*, including:
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Numerous interrelated factors determine plasma glucose concentration in people with diabetes*, including:
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This list constitutes a lengthy, yet incomplete, list of interrelated factors that affect plasma glucose. Several were listed in reference (Schade and Valentine 2006).
To help facilitate these established health outcomes, Practical Carbohydrate Counting: A How-to-Teach Guide for Health Professionals is designed to:
Provide educators with the concepts to cover when teaching Basic and Advanced Carbohydrate Counting
Help educators learn how to assess preexisting knowledge and abilities and determine if and when a person is ready to progress their level of carbohydrate counting
Discuss related dietary and nondietary factors, beyond the carbohydrate content of foods, that affect blood glucose control
Utilize case studies for Basic and Advanced Carbohydrate Counting that illustrate the use of this meal planning approach
Offer educators a variety of carbohydrate counting resources
