1 Carb Counting and Insulin Administration Module Georgia Hospital Association Diabetes Special...
-
Upload
garry-mcbride -
Category
Documents
-
view
213 -
download
0
Transcript of 1 Carb Counting and Insulin Administration Module Georgia Hospital Association Diabetes Special...
11
Carb Counting and Insulin Carb Counting and Insulin Administration ModuleAdministration Module
Georgia Hospital Association
Diabetes Special Interest Group
22
Program ObjectivesProgram Objectives
Define basal bolus insulin therapy
Define carbohydrate (CHO)
Identify the carb content of various food groups
33
Program Objectives (cont.)Program Objectives (cont.)
Calculate carb content by reading a food label
Calculate the carb load in a sample meal
Calculate meal insulin dosage using carb/insulin ratio
Calculate initial Total Daily Insulin (TDI)
44
BASAL BOLUS INSULIN THERAPYBASAL BOLUS INSULIN THERAPY
Calculate initial Total Daily Insulin (TDI):
Adjust Pre-Admission TDI considering for change in diet, stress, meds, etc.
OR Calculate Weight (kg) x 0.5 units = TDI for
Type 2 (consider using 0.3 for renal impaired or 0.4 for Type 1)
55
NextNext Give 50% as Glargine or Detemir (This is the
BASAL insulin.)
Give 50% divided in thirds or 17% per meal as rapid-acting insulin analog (This is the MEAL BOLUS insulin to cover the carbs consumed at the meals.)
Give in proportion to CHO consumed at meal if patient is carb counting or give divided equally in thirds for consistent carb meals.
66
Another way to calculate the Another way to calculate the meal bolus insulin is to estimate meal bolus insulin is to estimate
the carb to insulin ratio. the carb to insulin ratio.
77
Calculating the Carb to Insulin RatioCalculating the Carb to Insulin Ratio
If previously on insulin, divide the total daily dose of insulin into 600. This will estimate the CHO ratio or how many grams of CHO 1 unit of rapid acting insulin will cover.
Example:600/60 = 10Therefore, 1 unit will cover about 10 grams of CHO
88
Calculate the Correction Factor “CF”Calculate the Correction Factor “CF”
If BG >140 mg/dL: (BG-100) / CF = units of rapid acting insulin
(This is the Correction Bolus.)
If the Total Daily Insulin is known, then CF = 1700 / Total Daily Insulin OR If the Total Daily Insulin is not known then CF = 3000 / Wt (kg)
Do Not Use Correction (Sliding Scale) Insulin as the Only Diabetes Management Tool
99
Insulin Administration GuidelinesInsulin Administration Guidelines
Test capillary blood glucose before meals, bedtime and when appropriate at 3 AM.
If BG is in target range at meal time give the meal bolus within 15 minutes of the start of the meal
If the BG is above target range at meal time give the meal bolus plus the correction bolus
1010
Guidelines continuedGuidelines continued
The basal insulin is administered whether the patient is eating or not.
Corrections are given whether the patient is eating or not.
The meal bolus is held if the patient is not eating or is adjusted based on the amount of carb consumed at the meal.
1111
Carbohydrate CountingCarbohydrate Counting
Counting just the carbohydrate in the food eaten is one method for meal planning that works well for many people with diabetes
Carbohydrate counting focuses the attention on food choices that most affect blood glucose levels
1212
Fixed or Flexible Meal PlansFixed or Flexible Meal Plans
The carbohydrate at each meal or snack may be consistent from day to day or flexible, depending on the type of carbohydrate counting meal plan used.
Carbohydrate affects blood glucose more than any other nutrient.
1313
Carbohydrate FactsCarbohydrate Facts
One of three major energy sources in foods
Most common carbs are sugars and starches (chains of sugar)
Carbs are primarily found in milk, fruit, starch and starchy vegetables
Carbs are also in honey, molasses, syrup and sugar
1414
Nutrients in FoodNutrients in FoodFood and Blood Glucose VISUAL #2
Nutrients in Food
Nutrient Contains Calories
Carbohydrate
Protein
Fat
Vitamins
Minerals
Water
62
© 2004 American Diabetes Association
CHO has the greatest effecton post meal blood glucose
1515
Nutrients in Food Groups
V I S U A L # 3 D i a b e t e s E x c h a n g e L i s t s
N u t r i e n t s i n F o o d E x c h a n g e G r o u p s
C a r b o h y d r a t e P r o t e i n F a t G r o u p ( g m ) ( g m ) ( g m ) C a l o r i e s
C a r b o h y d r a t e
S t a r c h 1 5 3 1 o r l e s s 8 0
F r u i t 1 5 — — 6 0
M i l k
F a t - f r e e ( s k i m ) 1 2 8 0 – 3 9 0
L o w - f a t ( 1 % ) 1 2 8 5 1 2 0
W h o l e 1 2 8 8 1 5 0
N o n s t a r c h y V e g e t a b l e s 5 2 — 2 5
O t h e r C a r b o h y d r a t e s V a r i e s V a r i e s V a r i e s V a r i e s
M e a t / M e a t S u b s t i t u t e
V e r y l e a n — 7 0 – 1 3 5
L e a n — 7 3 5 5
M e d i u m f a t — 7 5 7 5
H i g h f a t — 7 8 1 0 0
F a t — — 5 4 5
M o n o u n s a t u r a t e d — — 5 4 5
P o l y u n s a t u r a t e d — — 5 4 5
S a t u r a t e d — — 5 4 5
H y d r o g e n a t e d — — 5 4 5
1616
““Diabetes Food Lists”Diabetes Food Lists”
CHO
CHO
CHO
Starchy Vegetables&
Food GroupsFood Groups
1717
Approximately 15 grams of CHO per serving
Reference: Life with Diabetes Third Edition, American Diabetes Association
Starch GroupStarch Group
1818
Approximately 15 grams of CHO per serving
Reference: Life with Diabetes Third Edition, American Diabetes Association
Fruit GroupFruit Group
1919
Approximately 12 grams of CHO per serving
Reference: Life with Diabetes Third Edition, American Diabetes Association
Milk GroupMilk Group
2020
Approximately 15 grams of CHO per serving
Reference: Life with Diabetes Third Edition, American Diabetes Association
Other Carbohydrate GroupOther Carbohydrate Group
2121
Approximately 5 grams of CHO
per serving
Reference: Life with Diabetes Third Edition, American Diabetes Association
Vegetable GroupVegetable Group
2222
Sample Meal Plan 1800 CaloriesSample Meal Plan 1800 CaloriesBreakfast (60 grams CHO) 4 CHO x 15 g = 60 g 2 Starches 1 Fruit 1 Milk• Protein (1 ounce) 1 Fat Free Foods or Beverages totaling less than 20 calories
Lunch (60 g of CHO) 4 CHO x 15g = 60 g 3 Starches 1 Fruit 2 servings of Vegetables• Protein (3 ounces) 1 Fat Free foods or beverages totaling less than 20 calories
Dinner (60 g of CHO) 4 CHO x 15 g =45 g 2 Starches 1 Fruit 3 Vegetables x 5 grams per serving = 15 g Protein (3 ounces) 1 Fat Free food or beverage totaling
less than 20 calories
Bedtime Snack (15 g of CHO)• 1 CHO = 15 g 1 Starch, fruit or milk Protein (1 ounce) Free food or beverage totaling
less than 20 calories
2323
““Carbohydrate Counting”Carbohydrate Counting”1. Look at the “Serving size”
2. Look at the “Total Carbohydrate” in grams
3. Subtract half the fiber (if greater than 5 grams) and half the sugar alcohol (if any listed) from the “Total Carbohydrate”
4. This is the amount you will Cover with insulin
Shredded WheatNutrition FactsServing Size 2 biscuit (1.6 oz.)Servings per container: 10Total Calories: 155 Calories from fat: 9
FatSaturatedTrans Fat
CholesterolSodiumTotal Carbohydrate
Dietary FiberSugars
Protein
1 g0.2 g0g0mg3mg36.2g
5.5g0.4g5.2g
Vitamin A 0% Vitamin C 0% Calcium 2% Iron 6%
Shredded WheatNutrition FactsServing Size 2 biscuit (1.6 oz.)Servings per container: 10Total Calories: 155 Calories from fat: 9
FatSaturatedTrans Fat
CholesterolSodiumTotal Carbohydrate
Dietary FiberSugars
Protein
1 g0.2 g0g0mg3mg36.2g
5.5g0.4g5.2g
Vitamin A 0% Vitamin C 0% Calcium 2% Iron 6%
2424
Count the CHO in ThisCount the CHO in ThisSample Meal PlanSample Meal Plan
2/3 cup pasta 1 oz. slice garlic bread Meat tomato sauce 1 small salad ½ cup cooked broccoli, cauliflower 1 cup unsweetened tea 1 packet of low cal dressing (3 grams of CHO) 1 packet of sweetener (1 gram of CHO) ½ cup lite fruit
2525
AnswerAnswer
This meal is approximately 60 grams of CHO: 2/3 cup pasta = 30 grams of CHO 1 oz. slice of bread = 15 grams of CHO ½ cup lite fruit = 15 grams of CHO
We count the CHO in the fruit, milk and starch groups.
We do not count the vegetables unless there are at least three servings.
2626
Practice Carb/Insulin RatioPractice Carb/Insulin Ratio
If patient weighs less than 150 lbs: Total CHO in grams divided by 15 = number of
units of insulin for meal bolus Example: 60 grams = 4 units of insulin 15 If patient weighs 150 lbs or more divide total
CHO in grams by 10 to find the units of insulin for meal bolus
Example: 60 grams = 6 units of insulin 10
2727
Estimating Meal Insulin DoseEstimating Meal Insulin Dose If patient is on 1800 calorie diet he/she usually
receives about 60 grams (4 carbs) at each meal at a hospital.
If the patient plans to eat all of the meal, give the meal bolus as ordered by physician.
If the patient eats half the meal or more exactly half the carb, give half the meal bolus
If the patient skips the meal, do not give the meal bolus, but do give the correction bolus if BG is above target and you have orders for correction insulin.
2828
Nursing JudgmentNursing Judgment
The nurse may give the meal bolus within 15 minutes of the start of the meal if the patient is not a reliable eater.
If the patient is a reliable eater the nurse should give the meal bolus with the meal.
If the meal bolus has been given and the patient failed to eat adequate CHO load consider substituting liquid CHO for the solid CHO that was not consumed.
Example: 1/2 cup apple juice = 15 grams of CHO This should be done as soon as possible to prevent
hypoglycemia.
2929
SummarySummary
Up to 100% of the carbohydrate can be changed into BG in your body
You can estimate the carb load for your patient’s meal by adding the grams of carb found in fruit, milk, and starch on the tray
You can also use the food label to find out how much carb is in a serving size by reading the total carb and subtracting half the fiber and half the sugar alcohol.
3030
Summary (continued)Summary (continued)
There are three components to subcutaneous insulin therapy: Basal insulin to control blood glucose
between meals Meal or prandial insulin to cover the CHO load
at the meal Correction insulin to bring a high blood
glucose into target range.