Оглавление
Hope S. Warshaw. Practical Carbohydrate Counting
Table of Contents
Introduction
CHAPTER ONE. What, Why, Who, and. How Much? CARBOHYDRATE COUNTING DEFINED
THE CASE FOR CARBOHYDRATE COUNTING
RECOMMENDATIONS FOR. CARBOHYDRATE CONSUMPTION. Total carbohydrate
Amounts and types of carbohydrate
CHAPTER TWO. Assessing. Knowledge. and Skills
ASSESSING A PERSON’S KNOWLEDGE AND SKILLS
Methods for assessment
Ongoing assessment
Assessment Checklist
Progression to Advanced Carbohydrate Counting
CHAPTER THREE. Concepts to Teach— From Basic Nutrition to. Meal Planning
CONCEPTS TO TEACH. Rationale for counting carbohydrate
Identify foods (food groups) that contain carbohydrate
Identify foods (food groups) that do not contain carbohydrate
Understand that many foods that contain. carbohydrate are healthy and offer energy and. an array of vitamins and minerals
Understand that healthy foods that contain. carbohydrate should not be significantly limited. or avoided as a means to achieve glycemic control
Know how much carbohydrate to eat per day
Know how much carbohydrate to eat at meals and snacks
Define a serving of a variety of common foods
Know how to plan meals
Know how to integrate limited amounts of sucrose- containing foods into a healthy eating plan
Have general guidelines for what and. how much protein and fat to eat
Educational points about protein
Educational points about fat
CHAPTER FOUR. Concepts to Teach— Counting Carb, Reading Food Labels, and. Measuring Portions
CONCEPTS TO TEACH. Know how to determine the carbohydrate counts of foods
Know how to use the Nutrition Facts panel
Have and know how to use measuring equipment. and other portion control tools
Additional portion control tips
Continually stress portion control
Know how to interpret postprandial blood glucose levels
CHAPTER FIVE. Basic Carbohydrate. Counting. Case Studies. CASE STUDY #1: BENITA
CASE STUDY #2: MARY
CASE STUDY #3: DAVE
CHAPTER SIX. Concepts to Teach— Advanced. Carbohydrate Counting
ADVANCED CARBOHYDRATE COUNTING CONCEPTS
Insulin action
Insulin regulation for 24-hour blood glucose control
Basal (background) insulin
Bolus (food coverage and correction dose) insulin
Insulin delivery vehicles
Syringes
Insulin pens
Insulin pump
Jet injectors
Calculation of ICR(s)
Hidden Carbs
Method #1: Food diary, insulin bolus dose, and self-monitoring. blood glucose (SMBG) information
Method #2: The Rule of 500
Method #3: Using a formula based on weight and TDD
Method #4: Using the CF to calculate the ICR
Other considerations
Adjusting the ICR
Calculation of CF and correction or. supplemental insulin dose
Correction or supplemental insulin dose
One unit per 50 mg/dl
Sliding scale
The 2000, 1800, 1700, or 1500 Rule
CSII Correction Dosing
Other considerations
Table 6-1. Stages of Life and Life Situations: Insulin Sensitivity and Insulin Resistance
Determination of meal and snack (preprandial) bolus insulin doses
PRACTICAL ADVICE ON BOLUS DOSE TIMING. FOR PEOPLE USING RAPID-ACTING INSULIN
Stay ahead of blood glucose rise (be proactive rather than reactive)
Correct for hyperglycemia prior to food intake
Caveats
Low blood glucose before a meal
Uncertain carbohydrate intake
Longer or larger than usual meals
Covering the carbohydrate in snacks
CHAPTER SEVEN. Advanced Carbohydrate. Counting and Continuous. Subcutaneous. Insulin Infusion
THE NUTS AND BOLTS: BASAL RATES AND BOLUS OPTIONS. Insulin pumps
Is the Patient Ready?
Basal rates
Examples of basal rates (in units per hour)
Bolus doses. Standard bolus doses
Bolus options: Extended (square wave) and combination (dual wave)
Pramlintide and CSII
Examples of Bolus Doses (Extended and Combination)
Bolus considerations
CORRECTION DOSES AND CSII. Multiple CFs
Multiple Correction Doses Based on Level of Hyperglycemia
Correction bolus doses
Duration of insulin action and remaining bolus insulin
USEFUL PUMP FEATURES
CHAPTER EIGHT. Pattern Management. for Glycemic Control
PATTERN MANAGEMENT: THE KEY TO FINE-TUNING CONTROL
What to record
Identify trends
Once a pattern emerges
ADJUSTING THE ICR
Food diary, insulin bolus dose, and SMBG information
Making adjustments
USING FEWER CORRECTION BOLUSES
Data interpretation
Pramlintide and Exenatide: Making Adjustments
CHAPTER NINE. Advanced. Carbohydrate. Counting Case Studies. CASE STUDY #1: DAVE
Regimen:
Action Plan
Dave’s Goals
Follow-Up
Dietitian’s Action Plan
The Next Appointment
Follow-Up
Dave’s Action Plan
Follow-Up
CASE STUDY #2: BARBARA. History
Data
Regimen
Other medical conditions
Food habits/daily schedule
Situation
Dietitian’s Action Plan
Barbara’s Goals
Follow-Up
CASE STUDY #3: BILL. History
Data
Food Habits and Daily Schedule
Regimen
Situation
Dietitian’s Action Plan
Follow-Up
Bill’s Goals
Action Plan
Follow-Up
Follow-Up
CHAPTER TEN. Impact on Glycemia of. Dietary Components. Beyond Carbohydrate
SOURCES OF PROTEIN AND FAT
Fat and protein impact on insulin therapy
GLYCEMIC INDEX AND LOAD
Table 10-1. Factors That Affect Postprandial Blood Glucose
ADJUSTING FOR DIETARY FIBER INTAKE
Subtracting fiber from carbohydrate counts
TREATING HYPOGLYCEMIA
WEIGHT MANAGEMENT
RESTAURANT FOODS AND MEALS
FOODS THAT CONTAIN POLYOLS (SUGAR ALCOHOLS)
ALCOHOL
CONCLUSION
CHAPTER ELEVEN. Impact on Glycemia. of Non-Dietary Factors
PHYSICAL ACTIVITY AND EXERCISE
ILLNESS, SICK DAY MANAGEMENT, AND SURGERY
Sick day guidelines
STRESS
CHANGES IN ROUTINE AND DELAYED MEALS
TRAVEL
Time zone changes
GASTROPARESIS
MENSES AND HORMONAL CHANGES
CONCLUSION
CHAPTER TWELVE. Blood Glucose— Lowering and. Related Medications. UNDERSTANDING NORMAL INSULIN RESPONSE
INSULIN REGIMENS
Basal-bolus insulin therapy
Basal insulin
Bolus insulin
INSULIN PHARMACOKINETICS AND PHARMACODYNAMICS
About Pre-Mixed Insulin
EXAMPLES OF INSULIN REGIMENS
About insulin concentrations
OTHER INJECTABLE MEDICATIONS
Amylinomimetics
Incretin mimetics
ORAL DIABETES MEDICATIONS
CONCLUSION
CHAPTER THIRTEEN. Process to Develop. and Maintain Personal. Carbohydrate Counts
PERSONAL CARBOHYDRATE COUNTS
INTEGRATION OF PERSONAL CARBOHYDRATE COUNTS WITH INSULIN PUMPS
CONCLUSION
APPENDIX I. Resources for. Carbohydrate Counting. and Insulin Pump Therapy
BOOKS THAT TEACH CARBOHYDRATE COUNTING
BOOKS AND PRINT MATERIAL WITH CARBOHYDRATE COUNTS
SOFTWARE AND ONLINE RESOURCES FOR CARBOHYDRATE COUNTS
Websites
Online restaurant information
Advanced software and websites
CONTINUOUS SUBCUTANEOUS INSULIN. INFUSION (CSII) RESOURCES
Books for health care providers
Books for people with diabetes
Consumer magazine publications for people with diabetes
Useful articles
Website
APPENDIX II. Blood Glucose— Lowering Medications. ORAL BLOOD GLUCOSE LOWERING MEDICATIONS. Category: Sulfonylureas*
Category: Meglinitinides
Category: Biguanides
Category: Thiazolidinediones (TZDs)
Category: Alpha-Glucosidase inhibitors
Category: Dipeptidyl peptidase-4 inhibitors (DPP-4)
Combination meds
INJECTABLE BLOOD GLUCOSE LOWERING MEDICATIONS. Category: Incretin mimetics
Category: Amylin analog
Category: Insulin
Notes on insulin
Appendix III. Sample Record. Keeping for Basic. and Advanced. Carbohydrate. Counting
Reference List
Index
