Diabetes CHO counting (Diabetes Week 9)

Question 1

What are the healthy portions for women and men with diabetes?

Answer 1

Question 2

What are “free foods”?

Answer 2

Free foods: can be used at all meals and/or snacks
* “Free Vegetables” can be used as needed and are those high in water and fibre typically containing 0.5-1 g PRO and <4 gm CHO (should have little effect of blood glucose)
* Caution: once hitting about 2 cups of free veggies may become CHO choice
* “Other Free Foods” may need a caution
* Caution with higher salt options
* Free foods may contain a little protein and CHO

Question 3

Criteria for defining a CHO choice

Answer 3

1 CHO choice/serving contains
* 12-18 g/CHO (average=15 g/serving)
* < 5 g of FAT
* < 6 g of Protein.

• If these foods contain more CHO, then they are potentially a combination foods which contain both a CHO choice and potentially either a FAT choice and/or a protein choice and/or simply more than one serving of a CHO
• TYPICALLY ONE CHO choice=15 GM of CHO, but varying amts of protein and fat

Question 4

What are the categories of CHO choices?

Answer 4

• Sweet vegetables and fruits (should try to have 7 or more per day). Usually contain 1-2 g protein/ 1 CHO choice or serving.
• Grain (Starch Foods): should try to have 6 servings per day. Usually contain 1-3 g protein/1 CHO choices or serving
• Milk and Alternatives (should have at least 2-3 per day; may need lower fat versions). May contain up to 4-6 gm of protein.
• Sweet Foods and Snacks (these are OTHER foods).

Question 5

Examples of CHO choices

Answer 5

Question 6

What is important to be aware of with CHO choices?

Answer 6

ARE NOT PROTEIN OR FAT CHOICES
* Be careful about making decisions about the types of foods especially with foods that have a substantial amount of CHO such as cheese.
* CHO Choices have varying amounts of protein/fat in them.
* CHO choices serving sizes may NOT be the same as in Canada’s Food Guide to Healthy Eating. The size is contingent upon the effects on glycemic effects.

Question 7

Cows milk considerations

Answer 7

Typically contains 4-6 g protein/serving, 15 g CHO, but has varying amounts of fat.
* Skim milk has 0 gm fat
* 1% 1 gm of fat per serving
* 2% has 2 gm of fat per serving etc.

Question 8

Considerations for fibre in CHO

Answer 8

Need to consider the available CHO in a food
* Fiber is present in foods, but does NOT contribute to glycemic control.
* Fiber content (if fiber content is > 5 gm or more per 1 serving) should be subtracted off the total CHO amount to determine the ‘amount of available’ CHO.
* You should also subtract off polydextrose (g amounts) or 50% of sugar alcohols off from the total CHO

Question 9

Fat choices

Answer 9

One choice contains 5 gms of fat
* Consider healthier fat choices; Olive oil, canola.
* choose liquid fats
* choose more often may lower cholesterol
* choose less often may elevate cholesterol

Question 10

What happens with a CHO choice that has ≥ 5gms fat?

Answer 10

High fat yogurt with fruit flavor (1/2 cup)
* If this 1/2 cup yogurt contained 5.5 g protein, 16 g CHO and 8 g fat; you would say this is 1 CHO choice (that contains 16 g CHO, 5.5 g protein and 8 4.9 g fat) +3.1g fat extra (1 fat choice = 5 gm of fat). Therefore this food item is 1 CHO choices + 0.5 fat choice.

Question 11

What are the protein choices?

Answer 11

Typically contain 7 grams protein and 3 grams of fat.

There are HIGH FAT protein choices; which are usually considered 1 PROTEIN + one fat choice.

Question 12

Describe high fat protein choices

Answer 12

One High fat protein choice contains more than 8 grams of fat, and may NOT provide 7 grams of protein
* bologna, wieners, sausage, 1oz (30 g)
* cheese, regular, 1oz (30 g) (more than 20% M.F. and higher)
* peanut butter, reduced fat: 2 Tbsp (30 mL)
* if using reg PB , 2 tbsp = 1 PRO and 2 fat choices

Question 13

What about legumes?

Answer 13

These count as 1 PRO (7 g protein, 3 g fat) + 1 CHO (15 g CHO, 1-5 g protein)
* hummus
* legumes: kidney beans, lentils, pinto beans

Question 14

What about whole milk?

Answer 14

• High protein milk: 8 g protein /serving; 12 g
  CHO/serving; 8 gm of fat/serving, this would be considered 1 CHO, 0.5 fat choice.
  But what about the protein; max is 6 g protein/CHO serving; so there is an extra 2 g protein; 2/7 or 0.25 protein/serving.1 CHO, 0.5 fat, 0.25 protein serving.

Question 15

Calculate carb, protein and fat choices in the meal

Answer 15

• 4 CHO choices which contains 60 g CHO, 9 g protein.
• 2 Protein choices containing 14 g protein, 6 g fat.
• 2 fat choices containing 10 g fat. How many kcal?

= 60 x 4 + 23 x 4 +16 x 9 = 476 kcal

Question 16

How does CHO counting compare to CFG?

Answer 16

• More free veggies like mushrooms, broccoli, celery, less carbs with other F/V
• That may contain a higher CHO load (such as carrots, peas).

Question 17

How to calculate carb protein and fat choices in mixed foods

Answer 17

2 approaches
* CHO choices
* looking a the recipe

Question 18

CHO choicses approach for mixed foods

Answer 18

lasagna mixed foods

Question 19

Looking at the recipe approach for mixed foods

Answer 19

lasagna

Question 20

What needs to be considered when menu planning?

Answer 20

• energy requirements for patients taking into consideration their body habitus, activity levels etc
• Distribution of Meals

Question 21

What about snacks?

Answer 21

• Needed if meals are more than 4 hours apart; particularly for those patients on insulin therapy (will discuss later in course).
• Choose a carbohydrate containing snack
• Night snack can include a protein to slow down absorption and helps with glucose control

Question 22

Steps for CHO counting

Answer 22

1. Calculate energy requirements
2. Decide the number of CHO choices for breakfast, lunch and dinner
3. Review what patient eats for breakfast/ lunch/ dinner
   * determine energy density
   * Identify concerns
   * Make changes