Carbohydrate counting is one way to estimate the amount of carbohydrates from various foods for diabetics. Thus, management of diabetes will be more appropriate and blood sugar control targets are achieved.
Why is the amount of carbohydrates in foods important to know?
All types of carbohydrates, whether complex or simple, will directly affect blood sugar levels. Consumption of too many carbohydrates at a time can cause blood sugar levels after eating too high.
Meanwhile, consumption of too little carbohydrates can cause energy deficiency and hypoglycemia blood sugar levels are too low. Moreover, if you use insulin or antidiabetic drugs that work to increase insulin expenditure.
That is why the amount of carbohydrates consumed at one time should be noted to keep blood sugar levels on target.
One way to know the amount of carbohydrates you consume is by carbohydrate counting . This method of calculation aims to the amount of carbohydrates consumed from the daily diet is not excessive and in accordance with the dose of insulin or antidiabetic drugs used as therapy.
Reasons for using carbohydrate counting:
- Carbohydrates are the most nutrients that affect blood sugar because it is directly converted into glucose (100%) (Souto, D Lopes. 2010. Use of carb counting in dietary treatment of diabetes mellitus).
- According to the case, the patient feels no abstinence or allergies. In addition, patients can not monitor the food. carbohydrate counting is suitable for such patients because the patient is more flexible and freely chooses the selected foods.
- Balance of carbohydrate intake with insulin and exercise can help keep glucose levels at the desired target. (Dignard.2010)
Steps to use Carbohydrate Counting Generally
- Knowing what foods contain carbohydrates. Knowing the amount of each food with carbohydrate content of 15 grams
- Knowing the calculation of each serving on carbohydrate foods
- Know what foods are deemed “free”. This food is not calculated on total carbohydrates
- Calculates the amount of carbohydrates in the food eaten
- Check blood sugar levels before meals and 2 hours after meals to find out how the effects of these foods in affecting blood sugar
The purpose of carbohydrate counting in general
- Controlling blood glucose levels
- More flexible on the type of food selected and according to the patient’s eating habits
- Can consume the preferred or desired food
Types of Carbohydrate counting
1. Basic Carbohydrate counting
Target: All patients with DM
Control the blood cave by balancing the carbohydrate intake with oral medication and physical activity
1. Choose a variety of foods and balanced
2. Focus on carbohydrates
3. Determine the target amount of carbohydrates to be consumed tailored to the needs of the patient
4. Determining the content of carbohydrates consumed
How to determine step 3 and step 4
a. Analysis of nutrients from the patient’s habits
1. Determining the amount of energy from the food record results
2. Determine the distribution of energy for 24 hours (morning …%, snack …%, noon …%, night%) and FFQ to see which types of carbohydrates are often consumed
3. Analysis of the composition of nutrients (Protein …%, Carbohydrates …%, Fat …%)
4. Calculation of each serving carbohydrate (Morning … gr, snack … gr, noon … gr, night … gr)
b. Calculation of nutrients needed by the patient by a nutritionist
1. Calculating BMI and patient’s energy needs
2. Determine the distribution of energy for a day divided into several meals according to the patient’s habits
3. Determine the calculation of nutrients according to the needs of patients
4. Calculation of the number of carbohydrates per serving (Morning … gr, snack … gr, noon … gr, night … gr) 1 carb serving = 15 grams of carbohydrates
5. Monitoring blood sugar levels
(Canadian Diabetic Association, 2005)
2 Advance Carbohydrate counting
Target: Diabetic Patients
Controlling blood sugar by balancing carbohydrate intake with insulin
1. Identify carbohydrates in foods eg milk, fruit, etc.
2. Calculate the total carbohydrates consumed in a day
3. Calculate the amount of insulin to determine insulin – carbohydrate ratio.
The method used to determine insulin – carbohydrate ratio:
1. Pattern management
The method uses the patient’s record of food, activity, and insulin to see how best to work from insulin itself
2. TDD (total daily dose)
- insulin ratio = 500 / TDD
- example: 500/64 = 7.8 (rounded to 8)
- then 1 unit of insulin requires 8 grams of carbohydrate
3. TDD and basal insulin
- insulin: carb = average Kh consumed daily: insulin requirement
- insulin requirement = (TDD – basal insulin)
- example: average – Kh consumed per day 259 gr
- TDD = 48
- basal insulin = 24
- insulin: carb = 259: (48 – 24)
- 259: 24 = 10.8 (11)
- then insulin: carb = 1: 11
4. Checking blood sugar levels before eating
5. Calculate insulin correction.
If the blood sugar before meals is above the specified target, we can calculate the ISF
(Insulin sensitivity factor) as a correction factor. ISF can determine the amount of blood glucose that is lowered by 1 unit of insulin and can know how much insulin it should be added.
- ISF = 1500 (short acting insulin) or 1800 (long acting insulin): TDD
- insulin: carbo ratio = ISF x 0.33
- To determine the dosage of insulin to match the target of blood sugar achieved
example: Current GD: 264 mg / dl GD target: 100 mg / dl
ISF = 53 mg / dl
then: Blood sugar difference = 264 – 100 = 164 mg / dl
Insulin requirement = 164 mg / dl: 53 mg / dl = 3 units
6. Mentotal requirement of insulin at the time before eating
- TDD = 34 units
- GD before meals: 226 mg / dl GD target: 100 mg / dl
- Carbohydrates consumed 60 grams
- Differences Blood sugar: 226 – 100 = 126 mg / dl
- ISF = 1800: 34 = 52.9 (rounded to 53)
- Insulin requirement: 126: 53 = 2.3 units
- Insulin: carbo -> 500 / TDD
- 500/34 = 14.7 (1 insulin takes 15 grams of carbohydrate)
- Insulin needed to cover 60 grams of carbohydrate = 60: 15 = 4 units
- then premeal insulin = 2.3 + 4 = 6.3 units
7. Activity Adjustment
When performing activity more than usual after a maximum of 2 hours injection, then the dose of insulin can be reduced by 50%. When doing more than usual activity after 2-3 hours of injections, then the dose of insulin can be reduced by 25%.
8. Inject, Eat and Record, Inject insulin, eat, and record on carb counting daily worksheet
9. Check blood glucose levels 2 hours after insulin injections to see the accuracy of carbo ratio insulin and ISF.
(Fraser Health Advance Carbohydrate counting)