ARE ALL CARBS CREATED EQUAL?Cory Eck MCN RD LD Diabetes Educator

Texas Health Presbyterian PlanoJune 6th 2015

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Cory EckMCN RD LD

Education:

BS Nutritional Sciences, Penn State University Penn State Varsity Track and Field, NCAA Academic

All-American

Masters of Clinical Nutrition, UT Southwestern

Type 1 diabetic, 13 years

@TheEcksfactorProfessional:

Cook Children's Fort Worth, TXPediatric Endocrinology Dietitian, 2.5 years

Texas Health Presbyterian PlanoDiabetes Educator since February 2015

ObjectivesUnderstand the difference between fast and

slow carbsUnderstand the basics of the Glycemic IndexUnderstand effects of fat and fiber on

carbohydrate absorptionUnderstand how to modify insulin injections

for high fat meals, i.e. pizza

Carbohydrates

Simple: Glucose or fructose or Lactose

Complex: Starches and fibers

Fast: Juice, Hard candy, Soda and low-fat sugary desserts

Slow: Breads, starchy vegetables, whole fruits and milk and yogurt

Simple vs. Complex Fast vs. Slow

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Simple Vs. ComplexChocolate bar

Potato

Banana

Lifesaver

Agave Nectar

Wheat Bread

Milk

Greek Yogurt

Orange Juice

Jello

Brownie

Peanut Butter

PizzaKetchup

White Bread

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Fast Vs. SlowChocolate bar

Potato

Banana

Lifesaver

Agave Nectar

Wheat Bread

Milk

Greek Yogurt

Orange Juice

Jello

Brownie

Peanut Butter

PizzaKetchup

White Bread

Click icon to add picture

Glycemic IndexMeasurement of how much a

food raises your blood sugar Compared to plain white sugar Scale of 0-100: Low <55, Medium 56-69,

High ≥70 Must also consider amount of carbs or

the glycemic load

Benefits of Low GI foods Less increase in blood sugar Increased fullness due to increased fiber Lower your risk of heart disease

Glycemic IndexWhat lowers a foods GI?

Type of carbohydrate it contains Increases in fiber Less processing The amount of fat the food contains

Are all low GI foods good for me?

Baked Potato Potato Chips Sweet Potato

GI = 76 GI = 54 GI = 61

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Glycemic IndexGI is affected by cooking method

Frying vs. Baking Hot vs. Cold Acids that are added

Need to consider the glycemic load Rise in BG also depends on the amount of carbs

Are their too many variables to consider?

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Glycemic IndexFood Type

Low GI (≤55) Choose most often

Medium GI (56-69) Choose more often

High GI (≥70)Choose less often

Breads 100% ground wheat/grainPumpernickel

Whole wheat or rye bread/bagel/tortilla

Pita- white or wheat

White bread/bagel/tortillaKaiser roll

Cereals All-BranTM

Oat BranTM

Oatmeal or quick oatsPuffed wheatGrapenutsTM

Rice KrispiesTM

Corn FlakesBran Flakes

GrainsParboiled or converted riceBarley, bulgur or quinoa

Pasta/noodlesBrown riceBasmati riceCouscous

Short grain rice

OtherLegumes- Lentils, chick peas, kidney, soy, black, bakedPotato Chips

White/red/sweet(yam) potatoSweet or Popped cornWheat thins or rye crackersBean soupsFrench Fries

Baked potatoPretzelsSoda crackersRice cakes

Fruit Whole fresh or frozen fruit

Cantaloupe, pineappleFruit Juice Watermelon

Fat and Fiber

Slows stomach emptying

Slows carbohydrate absorption

Can create temporary insulin resistance

Slows stomach emptying

Improves post meal satiety

Reduces overall rise in blood sugar

Keeps you regular

Fat Fiber

Fat and Fiber

Meal 1 Hour 2 Hour 3 Hour 4 Hour

White Bread

Legumes

French Fries

Insulin

Blo

od

Glu

co

se

Target Blood Sugar

Insulin Onset Peak Duration

Humalog®, Novolog®, Apidra® 10-15 minutes 60-90 minutes 3.5-5 hours

Adjusting Insulin Administration Provide insulin 15-20 minutes early with most meals

If blood sugar <100mg/dL wait till meal time If blood sugar >150mg/dL consider 30 minutes

With Multiple Daily Injections:Provide meal bolus insulin pre- and post- meal:

High fat foods with carbs

Correction and 50% of meal bolus before, remaining 50% of meal bolus 30 minutes-1hr later

Adjusting Insulin Administration

With Insulin Pump Therapy

Calculate all meal and correction boluses utilizing the bolus calculators Use can reduce average BG by 25mg/dL Pumps can provide insulin for ALL carbs!!!

Utilize advanced bolus features High fat foods with carbs, grazing, or at party Combo/Dual Wave or extended/square wave bolus ≥1 advanced bolus per day can produce better blood sugar control

Carbohydrate Counting PizzaIdentify all sources of carbohydrate:

Crust- Thin crust pizzas are usually 5g less per slice Subtract 5-10g carb/crust that doesn’t get eaten

Sauce-

Cheese-

Toppings-

1/8 12” Pizza = 25g, +5g w/ each additional inch

Yes, choose wheat to lower GI

Yes, ½ cup = 10-15g carb; more for BBQ sauce

Yes and No; Yes for fruits, potato's, noodles or sweets

No, but the more you add the more fat their is

Taking Insulin for PizzaMDI:

2 Injection: Correction and 50% 15 minutes early, remaining 50% following meal

The more fat there is the more the delay

Insulin Pumps: Low fat Pizza- 15-20 minutes early High fat Pizza (>10g fat)- Utilize combo/dual wave bolus

50% 15-20 minutes early 50% over the next 2-4 hours

Start with 2 hours and extend longer as needed

ConclusionsIdentify your carbohydrates

Determine the GI of the food Simple vs. complex, fiber, fat and how processed the food is

Count ALL your carbs!

Adjust you insulin administration times Open that Ferrari up on the highway of life

Questions?