Using Carbohydrate Counting in Diabetes Clinical Practice
Section snippets
Historical Background
Carbohydrate counting is not a new concept. Soon after the discovery of insulin in 1921, references appeared in the literature (6), (7), (8) that indicate that carbohydrate counting was used in meal planning for persons with diabetes in the United States and in Europe. Joslin et al (6), (7) reported tests in which they administered similar amounts of different carbohydrate-containing foods to compare dextrose to starches. No statistical differences were found in glycosuria or blood glucose
Practice Patterns and Meal Planning Approaches
Practice patterns of dietitians in the United States are changing as a variety of meal planning approaches for persons with diabetes are available and are being used (9). During the past decade, several surveys of dietitians who provide medical nutrition therapy for persons with diabetes have been conducted to determine current practice patterns as well as to assess the needs of dietitians (11), (12), (13). These surveys identified the need for a variety of meal planning approaches to be used
Why Count Carbohydrates?
Carbohydrate counting is based on 2 tenets. First, scientific evidence gathered using modern research methods (2), (3), (4), (5) and clinical observations have shown that carbohydrate is the main factor affecting postprandial blood glucose excursions and, thus, insulin requirements. Second, carbohydrate is converted to glucose within the first 2 hours after eating (3), (4) and appears in the systemic circulation within the first 15 minutes (4). The 1994 American Diabetes Association nutrition
Levels of Carbohydrate Counting
Three levels of carbohydrate counting have been identified: level 1, or basic; level 2, or intermediate; and level 3, or advanced. Level 1 introduces the concept of carbohydrate counting and encourages inclusion of consistent amounts of carbohydrate at meals and snacks. Level 2 focuses on relationships among food, medication, activity, and blood glucose level and introduces the concept of how to make adjustments based on blood glucose patterns. Level 3 is designed to teach clients who use
Summary and Future Directions
Carbohydrate counting is a meal planning approach that is being used more frequently for persons with diabetes. The graduated approach that includes 3 levels with progressive complexity has been helpful to clients and health care providers. A variety of content areas need to be covered at all levels and multiple visits by the client are highly useful (Table 1). Progress is being made nationally to secure third-party reimbursement for medical nutrition therapy, which should help with coverage
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Carbohydrate CountingGetting Started
Carbohydrate CountingMoving On
Carbohydrate CountingUsing Carbohydrate/Insulin Ratios
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