Nutrition, Carbohydrate Counting, and Physical Activity

Nutrition

Healthy nutrition and regular physical activity are the cornerstones of diabetes care. The body needs the right amount of food at the right time, and consistent physical activity to keep blood sugar levels in a healthy range. Let’s look at each of these in more detail.

There are 3 main nutrients in the foods we eat:

• Carbohydrate
• Protein
• Fat

Carbohydrate

Carbohydrate breaks down into glucose (sugar). People with diabetes need to monitor the amount of carbohydrate they eat throughout the day to keep their blood sugars in good control.

Protein and Fat

Protein and Fat do not affect the blood sugar. It is important to have healthy amounts of these foods as well, but they do not need to be counted like carbohydrates.

Examples of foods that contain carbohydrates include:

• Starchy vegetables – corn, peas, potatoes, squash
• Grains – bread, buns, rice, pasta, and cereal
• Beans – kidney, garbanzo, baked (not green or yellow beans)
• Fruit and fruit juice
• Milk and yogurt
• Sweets – cake, cookies, pie, ice cream
• Crackers
• Chips
• Combination foods – pizza, tacos, soups, subs, casserole/hot dish

Examples of foods that contain protein and fat include: (these foods do not contain carbohydrate)

• Meat – chicken, beef, pork, lamb
• Fish and shellfish
• Cheese
• Cottage cheese
• Nuts and seeds
• Peanut butter
• Eggs
• Butter or margarine
• Mayonnaise
• Gravy

Carbohydrate Counting

Many people with diabetes use carbohydrate counting to help manage their diabetes. The goal is to eat a moderate amount of carbohydrate spread throughout the day. This provides a steady source of energy for the body. Carbohydrates are counted in grams (or choices). 1 carbohydrate serving (or choice) = 15 grams.

Examples of 1 carbohydrate serving/choice:

• 1 slice bread
• 1 small piece of fruit (apple, orange, pear, peach)
• 1/3 cup cooked pasta or rice
• 1/2 cup mashed potatoes
• 1 cup milk

Remember only count the carbohydrate grams the person actually ate, at the end of the meal. Do not count the carbohydrates at the beginning of the meal because a person may not eat everything on their plate or what they are served.

Each person with diabetes is different, so each person’s carbohydrate needs may also be different. In general, the number of carbohydrate grams (or choices) recommended to be eaten each day is:

• Women and children: 3-4 servings/choices or 45-60 grams at each meal
• Men: 4-5 servings/choices or 60-75 grams at each meal
• Snacks: 2-3 times per day, with 1-2 servings/choices or 15-30 grams per snack

"Eyeballing" portions is not accurate and may lead to glucose fluctuations. If measuring cups are not available, you can estimate portion sizes using these guidelines:

• 1 cup = size of a fist or computer mouse
• 1 teaspoon = tip of the thumb
• 1 tablespoon = length of the thumb

Label reading is helpful when counting carbohydrates.
There are 2 main things to look at on a food label:

1. Portion size
2. Total carbohydrate – It is not necessary to look at the grams of sugar, as that is included in the total carbohydrate grams on the label.

Remember… only count the carbohydrates the person ate! Depending on the portion size the person eats, you may need to change the number of carbohydrates counted.

Practice

Practice using the label shown,

• If John eats ½ cup, you need to change the Total Carbohydrate to be equal to the Serving Size he actually ate. You will divide the Total Carbohydrate in ½; so the total amount of carbohydrate he ate was 5 grams.

Watch the video for more examples and information on counting carbohydrates

Other Resources

• A Registered Dietician (RD) is a valuable resource in teaching about carbohydrate counting and nutrition. Consult with your delegating RN to identify if a RD is available. If so, the RD may be able to help the student/patient develop an individualized meal plan and learn more about nutrition and counting carbohydrates.
  
• There are several excellent resources for carbohydrate counting including:
  • Choose Your Foods: Exchange Lists for Diabetes (2008 Edition) by Anne Daly (Contributor), Alison Evert (Contributor), Marion J. Franz (Contributor) ISBN-13: 978-0880913775 ISBN-10: 0880913770; available at the www.eatright.org, www.diabetes.org, or other book stores, such as www.Amazon.com.
  • Calorie King: You can find more information on how to obtain the book, the smart phone, tablet, or computer app at: www.calorieking.com.

Physical Activity

Regular physical activity helps with heart health, overall fitness and diabetes control. Exercise and activity usually lower blood glucose levels. For this reason, it is important to have low blood sugar treatment options available for people that have diabetes when exercising or engaged in physical activity. Discuss with your delegating RN the treatment options that should be kept available, such as: ½ cup juice, 1 cup milk, glucose tablets or glucose gel.
**More information on how to respond to a low blood sugar is also included in the Hypoglycemia training.

Remember

• The goal for people with diabetes is to be as active as possible.
• For students in the school setting, refer to their Diabetes Medical Management Plan (DMMP) or physician orders to determine safe exercise guidelines.
• For residents or patients in other settings, discuss activity guidelines and/or restrictions with your delegating RN.
• Check the person’s blood glucose (sugar) level before and after exercise, or as directed by the DMMP or physician orders.
• If a person’s blood glucose is low, consult with your delegating RN to determine if a snack is necessary before exercise.
• If a person with type 1 diabetes has high blood glucose (and/or ketones are present) exercise is not safe!
• Monitor the person with diabetes carefully during exercise and document all extra activity in the glucose log and according to your agency policy (ask the delegating RN about documentation).