Hey man some chips Um Sure Jeremy What are you doing What's that I said what are you doing I'm uh I'm counting my carbs With an abacus Yeah man you got some better way to do It Yeah watch the next session Yeah Well um Can I keep my Abacus though If you want Weirdo Hi everyone my name is Adriana Valencia I am a registered dietitian and Certified Diabetes Care and education Specialist today we're going to be Talking about carb counting how to count Carbs in the real world today's talk is More geared towards patients with type 1 And it's going to be kind of taking a Little bit of a deeper dive into carb Counting today So first I want you to think what are Some of your favorite things to do with Your family and friends I bet some of you are thinking movies Going to the beach Um going to a party I bet a lot of these Things that we enjoy doing with family
And friends revolve around food So many times when we're traveling or When we're eating at someone's house or When we're at a restaurant we tend to Eat a lot of different foods than we do When we're at home Now it can get really difficult to Estimate the carbohydrates when we're Eating out or eating at a party as I had Mentioned or eating at someone else's Home so what we're going to do today is Discuss some strategies to help you Estimate the carbohydrates when eating Something that's a little bit different And we're also going to talk about kind Of accounting for fat and protein as Well So I want you to start thinking a little Bit of why is carb counting so hard Well you're not alone in that thinking Even dietitians have a hard time carb Counting there was a study that was Conducted in May of 2018 that found that Is the meal size gets larger the margin Of error for carb counting gets larger As well so basically that means that the Bigger the meal like potatoes or pasta The harder it can be to carb count Especially for things like I mentioned The rice pasta chips or polenta so I'm Sure you all agree with that and already Knew that before I even mentioned that To you So I've always kind of felt that there's
Three layers to carb counting the first Step is really being able to identify What foods contain carbohydrates The second step is being able to Identify the serving size of those Foods Okay for example a bagel has about 55 Grams of carb And the third step of that is accounting For fat and protein content of the meal Now today we're going to focus on number Two and number three we're not going to Do the identification of carbs just to Kind of save some time if you're new to Carb counting you may still be working On number one and that's okay so go Ahead and there's a lot of other videos On the tcoid website that you can review For some kind of starting off carb Counting tips Now um I'm going to go ahead and talk About some applications you can use on Your phones on your smartphones there Are many different applications out There that can help you with carb Counting of course you are welcome to Use whatever you feel works best for you These are the two that I'll be touching On today with you one of them is figwi And the other one is Calorie King these Are the little widgets that you'll find In your app store when you're searching For them The first one we're going to talk about Today is Calorie King so it's a free
Application you can also access it on Your computer so if you're on your Desktop or laptop and you type in Google CalorieKing it will come up the reason I Like this particular app is because it Has a really large database that it uses Also there's no need to create a login So you don't need to put your email and Your name and your goals that's also What I like about it it does have a free Version just so you know when you're Using the free version on your phone or On your computer there are a fair amount Of pop-ups it's fine but I just wanted To make that you aware of that you can Get rid of those if you do a paid Version of that as well Now to show you how CalorieKing works You can type in a food such as the one That you see here in the example is Watermelon And what it does is it pulls up on the Side when you type watermelon it will Show you an average so it has watermelon Raw there you can see it also pulled up A slushie from Sonics so if you're just Going to have regular watermelon you can Click on that And when you click on the food it then Gives you the nutrition label for that Particular food Now the nice thing is you can also Modify the serving size so a lot of them You can do tablespoons or cups so on
This one I think is this for one cup of Watermelon And you can see you can also change to Two cups and it would change the Nutrition label so this is really nice Because it gives you a nutrition label For something that you might not have or Might not know so if you're eating Something like couscous and you don't Really eat that you can look up the Carbs for couscous on here for example Or the calories you can also look at Fast food it has a very large Kind of database for fast food so it has Things like Starbucks and Panda Express And Little Caesars Pizza so it can Really help you keep on track for your Carbohydrate goal or help you with carb Counting when you're eating out as well The second application that I'm going to Touch on today is called figwi as I Mentioned this is the little widget for It when you look in the App Store This is also a free application this one You do need to register you need to put An email in and create a login so this One you put like your name and you have To put your email and you have to log Into it initially The reason why I like this app in Particular is it has a visual component To it which I'll show you on the next Slide this one does also have Restaurants Incorporated in the LA the
Database is not as large as something Like CalorieKing is but like I mentioned It does have that really nice visual Aspect as well So this is an example of what figwe Looks like You can see that this is a plate of hash Browns so there's a a search bar that You put in something like apple or hash Browns or fruit Fruit Loops and it will Show you a bowl or a plate and you can See that on one side the serving of the Hash browns is a little bit smaller Compared to the one on the other side Now when you you can see that there's a Small like golden little arrow on the Side of the plate as you move that Arrow Along the plate it changes the serving Of the food that's on there in this Example the potatoes and it also Modifies the nutrition label there So it's just a really nice guide for if You're like I mentioned you're eating Out or at someone's home Maybe you don't have you're not you're Not eating something you're familiar With you can help search it on here to Give you a good estimation of the carb Counts so this one I really like for the Visual like I mentioned there's a lot of Other apps these two are the ones that I Usually recommend kind of using because Of the large database the reliability And this one for the visual component in
Particular Now also if you're eating out or at Someone's house it's important to kind Of remember well what does one cup look Like you can say I know one cup of pasta Is 45 grams of carb but when you're Looking at your plate you might not know What that actually looks like So you can visualize one cup is about The same as a baseball so about a fist Size we always say Quarter cup is about the size of an egg And two tablespoons is the size of a Golf ball now this can really help you When you are not sure of the serving Size of something when you're at home And you're kind of first starting carb Counting I always recommend to patients To take out your measuring cups and not Use them necessarily every time but when You're first starting to visually assess What one cup looks like on a plate it's Very helpful so that you can start Realizing like oh yeah this is what one Cups of beans looks like or a pasta Looks like on my plate or my bowl Okay now I have to say that we're going To start treading into some murky Waters Here a lot of the first part of the Presentation is probably things that You've heard before are you familiar With the information now we're kind of Going to take a step a deep dive into Step three of the carb Counting
Okay as I'd kind of mentioned earlier so I had to sort through a lot of Information to kind of get these Recommendations Um the studies that I found I will say Were more focused on patients with type 1 diabetes okay not type 2. And the studies that were conducted were Usually with people people who had a Sensor and also have an insulin pump Now just because most of the studies Were conducted on patients with pumps Doesn't mean that this doesn't carry on To you if you use syringes or pens at Home I just wanted to let you know that When we're going through these this Information that that was primarily the Group that was being looked at was type 1 patients with sensors and Insulin Pumps So published in American Diabetes Association Journal there's something Called Diabetes Care now it's a journal That assists Healthcare Providers and Staying up to date with the latest Research and recommendations in January Of 2020 there was an article published In this journal that was titled that's Titled insulin dosing for fat and Protein is it time So this article reviewed some of the Research that has been conducted on how Fat and protein affect blood sugars So we're gonna keep this these next
Couple slides very simple Um just for time's sake so as you know Carbohydrates Go into our bloodstream and affect our Blood glucose levels we knew that one Protein can also affect blood glucose Levels as shown above and as I mentioned The cycle is much more complicated I'm Just trying to keep it simple for our Understanding there are a lot of Different hormones and Cycles involved Here but to keep it simple we're going To say proteins convert to amino acids Which then can affect our blood glucose Levels Now fat is even more complicated than Protein is so like I said I kept it Simple so fat gets converted to free Fatty acids and glycerol which in turn Can affect your blood sugar level now Fat also affects how fast quick how Quickly food empties from our stomach Okay so essentially if you're eating a Meal that is higher in fat it tends to Slow out the M slow down the emptying Into your digestive system which also Slows down the effect of The blood glucose level effect of that Particular food we'll talk a little bit More about this as well So you might think okay Adriana what Does all of this complicated information Mean to me So I did my very best like I mentioned
To comb through the Publications and the Recommendations Um I will say that the recommendations Vary from person to person Okay the recommendations I'm going to Review with you in the next slide are Just a good place to start make sure That before you make any changes to your Regimen or the way that you cover for Your meals you always discuss this with Your Diabetes Care team to make sure That this is something that they feel is Safe for you to try Okay so good news I'll say is that there Doesn't seem to be a difference in blood Sugar changes based on the type of fat That you are eating So if you're eating a meal that has a Lot of basically like animal fat versus A lot of peanut butter it doesn't matter In terms of where the fat is coming from The biggest difference is more the Actual amount of fat versus the type of Fat so that's good news makes it a Little bit less complicated So as I mentioned like many Recommendations this depends on the Person Um Some studies found that for a high fat Meal like pizza the amount of insulin Required ranged from 75 to 120 percent More than usual intake now I show you This information just to show you that
It's hard to give a blanket Recommendation for everybody okay so What we're going to talk about like I Mentioned is just a kind of a safe good Place to start but as you can see you're Going to have to see what works best for Your body and how your blood sugars Respond to these to these adjusting for Fat and protein So a good place to start would be to Calculate the amount of carbs from a Meal and add about 20 to 30 percent more For high fat meals And a high fat meal is defined as 40 Grams of fat or more we'll give you I'll Give you some examples of that in a Minute now if you have a pump I mentioned these studies were done on Patients with sensors and pumps Primarily if you have a pump you can Start off by using a dual or split wave Which basically splits the coverage for The meal half they recommend starting in Half Sorry 50 now and 50 two hours later is Typically a good place to start Um depending on the food or your body You may adjust that to be 60 40. it just Kind of depends so as I mentioned Multiple times there's a lot of Variation for person to person this is a Conservative place to start based on the Recommendations that I've read And you'll start to see what works for
Your body so consider for high fat meals 40 grams of fat or more adding 20 to 30 Percent more for the carbohydrate count Oh and the other thing that I have to Mention is if you're eating a very low Carb meal but it's very high in protein Such as if you're having like Um steak and salad for example you may Notice a blood sugar Spike much later The recommendations for dosing with With higher protein meals Um aren't as Are a little bit harder to to kind of Define Um so I would say like I mentioned Starting off with this 20 to 30 percent Is a good place to start So let's do an example this is a picture Of a loco mocher Moko Burger which you Might eat on vacation or at a you know At a restaurant so this particular Burger well it's not a burger it's more Like a plate I should say is about 60 Grams of carb and 48 grams of fat so 48 Grams of fat is more than the 40 grams Of fat that I had discussed earlier Which would Define this as a high fat Meal okay there's gravy in here right We're not surprised So using the conservative Recommendations Instead of dosing just for 60 grams of Carbohydrate you would actually be Dosing for 72 grams of carbs so what you
Would do is you would take the 60 grams Of carb multiply that by 20 which would Be 0.20 and that gives us 12. you go Back and add that to the 60 plus the 12 And that's 72 grams of carb instead of The 60. the reason why you're doing this Is because this is a high fat meal and We know that's because it is very high In fat some of that fat and protein will End up getting converted into Essentially carbohydrates which will Affect your blood sugar okay so that's Why we're recommending this additional Added on for this particular example So you might be thinking well what are Some other foods that are high in fat I Don't I don't eat anything like that Plate earlier so these are some other Pictures of some foods that would fall Under the 40 grams of fat or more Category so this would be when you would Add on extra for the fat and protein Dosing so there's an in and out double Double right and I'm sure we've all had Something like that before Pizza a very High fat meal right because of the Cheese and the meat that usually is There Um there's a hash brown Scramble burrito from Chick-fil-A there There's a sausage egg McMuffin McGriddle From McDonald's and then the bottom Picture shows Panda Express there's Beijing beef orange chicken and fried
Rice so these would all be good Um This would all be good examples of when You would be doing a little bit of extra Dosing for the protein and fat and you Can also look up the carbohydrates of These Foods in your Calorie King or Figweed or whatever other application You like using So I know that this is a lot of Information that we reviewed So let's just talk about briefly kind of Just keeping General healthy eating Habits when we're eating out so think About sharing an entree with somebody Ordering a non-starchy veggie to keep Full that would be things like a side Salad chopped up veggie celery sticks Anything like that watching the amount Of chips or bread that's brought to the Table or that you have Kind of picking between having a dessert Or appetizer can really also help reduce Calories and carbohydrates overall Also in your meal if you know that you Wanted to have to share a piece of Cheesecake with your family and you're Ordering a plate with salmon and rice And broccoli you can say you know no Rice I'll just do the broccoli you know You're gonna end up eating a lot of Carbohydrates and cheesecake later so Don't forget that it's okay to ask for Substitutions also looking up the menu
Ahead of time is a good idea like I Mentioned earlier using one of those Applications can really help that way You can feel comfortable with your carb Count your carbohydrate counting for These meals now These tips are really just for anybody In general for healthier eating not Necessarily for somebody who has Type 1 Right I would tell somebody the same Thing consider sharing an entree order a Non-starchy veggie so these are things To just keep kind of in mind when we're Eating out because that's when there Tends to be a lot more calories and and Carbohydrates in our meals overall So to summarize remember that you can Always use your phone app to help you Look up carbs of meals and also that you Can see the fat intake in there as well If you're unsure if it falls in this High fat food category Consider for high fat meals of 40 grams Or more adding 20 to 30 percent more Insulin coverage for those meals because Of the conversion we had talked about Um remember that before making any Changes to your dosing your insulin Regimen you want to make sure that you Talk to your diabetic Diabetes Care team Make sure everybody's on board And remember to always check your blood Sugars of course if you do make any Changes to your to your dosing habits or
Your pump settings so I know this was a Lot of different information today I Hope you found it helpful and I hope That next time you go out to eat with Your family or you go to a some kind of Party you enjoy that meal and that you Remember the recommendations that we Went through for the high fat dosing Here's a list of the references that I Use in case you wanted to do more of a Deep dive into some of the studies that I reviewed thank you so much for Listening today I know it was a lot of Information and I hope that you took Away some helpful tips thank you