Summary NUTR 453 Exam 2 Study Guide.

Summary NUTR 453 Exam 2 Study Guide. Carb Counting ● List the ADA and AND recommendations for determining CHO choices from grams. ○ CHO counting is based on the concept that after eating, the CHO in foods predicts the post-prandial Blood Glucose levels ○ 2 ways to CHO count: ■ Counting CHO choices ● Teach patient how to do CHO counting ■ Counting all CHO consumed ● Determines # of choices allowed ○ 15 g CHO = 1 CHO choice ○ NOTE: 8 ounces of milk = 1 CHO choice ■ Even though it only contains 12 g CHO How to count different foods: ○ Non-starchy vegetables: ■ 1 serving = 5 g CHO ● FREE ■ 2 servings consumed in the same eating episode ● 10 g CHO ○ ½ CHO choice ■ 3 servings consumed in the same eating episode ● 15 g CHO ○ 1 CHO choice ○ ADA and AND recommend the following: ■ 0 - 5 g CHO ● FREE → do NOT count ■ 6 - 10 g CHO consumed in a single eating episode ● ½ CHO choice ■ 11 - 20 g CHO consumed in a single eating episode ● 1 CHO choice ■ 21 - 25 g CHO consumed in a single eating episode NUTR 453 Exam 2 Study Guide ● 1.5 CHO choice ■ 26 - 35 g CHO consumed in a single eating episode ● 2 CHO choices ○ CHO counting guidelines: ■ Count all CHO consumed per eating occasion from all food sources ● Milk ● Fruit ● Non-starchy vegetables ● Other CHOs ● Starches ○ Translating grams consumed to CHO choices ■ Remember: 1 CHO choice = 15 g of CHO (*note milk) ■ Example of translating total CHO intake to CHO choices: ● Consume 210 g CHO daily over 4 eating occasions ● 210 g CHO / 15 g CHO per choice = 14 CHO choices ● Distribute the 14 choices over 4 eating occasions based on the # of CHO choices he/she should have per occasion ○ # of choices per occasion may be different at each occasion based on blood glucose profile ● Calculate the insulin:CHO ratio ○ 5 steps to identify insulin : CHO ratio 1. Keep and study 3-day food records and glucose records 2. If CHO varies between days → eat consistent amount for 3 additional days with records 3. Study the records → identify some meals when pre- and post-meal glucose were within ADA Goals ○ Pre: 90 - 130 mg/dl ○ Post: 180 mg/dl ■ 2 hours from start of meal 4. Determine insulin : CHO ratio ○ Divide CHO (g) by units of pre-meal insulin ■ Example: ● 45 g (3 servings) CHO / 3 U insulin = 15 g CHO/U ○ Ratio = 1 U insulin for every 15 g CHO 5. Fine tune the ratio ○ Each meal may be different, activity varies, etc. ● Calculate the ISF, knowing when to use the 1800 rule and when to use the 1500 rule ○ “ISF” = correction factor = supplemental factor ○ Reduction in blood glucose (mg/dl) caused by 1 U of rapid- or short-acting insulin ○ Goal is to get pre-meal glucose in desired range ○ 1800 rule: ■ For RAPID acting and/or insulin SENSITIVE ○ 1500 rule: ■ For SHORT acting and/or insulin RESISTANT Calculate ISF: ○ Determine total daily insulin dose (TDD) ○ ISF = 1800/ TDD ■ or 1500/ TDD for short acting ○ Example: ■ 3 pre-meal rapid acting bolus doses totaling 15 U + 1 U long acting dose of 22 U ● TDD=15+22 ○ TDD=37U ● ISF = 1800 / TDD ○ ISF = 1800 / 37 ■ ISF = 48.6 → ~50 ○ ISF = 50 ● 1 U of rapid acting insulin will lower your BG by ~50 mg/dl ● Explain how the ISF is used ○ Use ISF to correct elevated Blood Glucose between meals ■ Wait at least 3 hours post meals ○ Example: ■ 3.5 hr post- prandial BG is 252 mg/dl ■ Target is 140 ■ 252 - 140 = 112 over goal ■ If ISF = 50 . . . ● 112/50=2.24→2.2→2 ○ Show to the nearest 10th, AND nearest whole number ■ Need correction dose of 2 (or 2.2) U of insulin.