As noted, carbohydrate is the main determinant of glycemic rise after eating. Protein and fat have far less impact on the rise of blood glucose levels than carbohydrate (ADA 2008b). Despite the limited impact of protein and fat on blood glucose levels, the amount of these macronutrients consumed by people with diabetes can contribute to both their short- and long-term health. Refer to chapter 10 for more discussion on the impact of protein and fat on blood glucose levels. The ADA encourages practitioners to follow the DRIs for protein of 10–35% of total energy and 20–35% for fat (ADA 2008b; Institute of Medicine 2002).
People who are taught Basic Carbohydrate Counting also need to be provided with some basic guidelines about healthy amounts of foods that contain protein and fat.
Educational points about protein
• Teach the foods (food groups) that provide protein. Teach that foods such as red meats, seafood, eggs, and poultry provide no carbohydrate (unless it is added into a convenience food or in food preparation), but mainly protein and varying amounts of fat. Do note that fat and carbohydrate content of these foods can change based on food preparation. Teach that servings of milk and yogurt provide protein. One cup of milk (any type) provides about the amount of protein as an ounce of meat. Teach that smaller amounts of protein come from non-animal sources, such as grains, cereals, pasta, beans, and vegetables. Use Table 3-3 to do this.
• According to the Dietary Guidelines for Americans (U.S. Department of Health and Human Services et al. 2005), most adults need about two to three 3-ounce servings of cooked meat or meat substitute per day based on calorie needs. Note: this might not be sufficient protein for children, pregnant, or lactating women, or larger than average-size adults.
• Encourage the purchase and consumption of protein foods that are lean and lower in saturated fat and cholesterol.
• Encourage the use of low-fat preparation methods.
• Encourage the use of measuring equipment to ensure serving sizes are in line with the relatively small amounts of meat being encouraged for healthy eating.
Educational points about fat
• Teach the foods (food groups) that provide fat. Teach that fat comes in some foods, such as meats, cheeses, and other dairy foods, such as ice cream. Fat, such as butter, margarine, mayonnaise, and salad dressing, is also added to foods. Because fat is a concentrated source of calories, its calories add up quickly. Limiting fat is an excellent way to limit calories. Use Table 3-3 to do this.
• Provide the number of fat grams or servings (5 grams of fat equals one serving) that is appropriate for the person and define a serving of fat. Refer to Table 3-1 to determine the appropriate grams or servings of fat for various calorie ranges.
• Encourage people to limit saturated fat intake by:
• Encourage people to limit their intake of trans fat by limiting partially hydrogenated fat from commercially prepared foods. Note that decreasing sources of saturated fat will aid in decreasing trans fat.
CHAPTER FOUR
Concepts to Teach—
Counting Carb,
Reading Food Labels, and
Measuring Portions
The concepts and teaching strategies from chapter 3 should provide a person learning carbohydrate counting with a solid foundation on general meal planning and personal nutrition. Once this foundation has been laid, more advanced concepts can be explored. This chapter will explore the last four concepts listed in the Assessment Checklist on page 14.
CONCEPTS TO TEACH
Know how to determine the carbohydrate counts of foods
People need resources to determine the carbohydrate counts of the variety of foods they eat. When initially teaching Basic Carbohydrate Counting, a handout that provides the serving sizes (within food groups) of commonly consumed foods might be sufficient. For example, 1/2 cup of starch, one small piece of fruit, 1 cup of milk, etc. Lists such as these are available in various American Diabetes Association (ADA) meal planning materials for educators, such as Basic Carbohydrate Counting, The First Step in Diabetes Meal Planning, Choose Your Foods: Exchange Lists for Diabetes,and others.
Educate people to pay attention to the carbohydrate count on the Nutrition Facts panel. Most people who eat a wide variety of foods, including restaurant foods, will need and learn to use additional carbohydrate counting resources, as exchanges/choices often don’t match restaurant servings and options. More on the type of information available from restaurants and how to access these carbohydrate counts is available in chapter 10. Also note that Appendix I provides a listing of books, software, and online resources for carbohydrate counts of foods.
Some people who prepare recipes and enjoy cooking and baking may want to know how to obtain the carbohydrate counts of a serving of their favorite recipe. People can do this by using carbohydrate counting resources noted in Appendix I. They can get a carbohydrate count for all the ingredients in the recipe and then divide that total by the number of servings in the recipe. Some nutrient analysis websites listed in the carbohydrate counting resources in Appendix I allow people to perform this function online. Also, let people know that most diabetes-specific magazines and cookbooks provide the carbohydrate counts for their recipes.
If people are willing and able, encourage them to put together a chart or database with their Personal Carbohydrate Counts. Chapter 13 provides a process to teach people to accomplish this.
Know how to use the Nutrition Facts panel
Today, because of federal food and nutrition labeling regulations, nearly all packaged, canned, and prepared foods have a Nutrition Facts panel (Figure 4-1) on the food label (the only foods that generally do not are fresh fruits, vegetables, other fresh produce, and some fresh meat, poultry, and seafood). The total carbohydrate count is required on nearly all foods that have a Nutrition Facts panel. The Food and Drug Administration (FDA) website at www.fda.gov is a great
