Читать книгу Practical Carbohydrate Counting - Hope S. Warshaw - Страница 8

CHAPTER TWO
Assessing
Knowledge
and Skills

The choice to use carbohydrate counting as a meal planning approach should be based on several factors about each individual, including but not limited to

• Existing knowledge of meal planning and diabetes management self-management

• Willingness and ability to learn and use the necessary skills

• Diabetes management needs and desires

These same factors will indicate whether a person should progress from Basic to Advanced Carbohydrate Counting (see chapter 6).

ASSESSING A PERSON’S KNOWLEDGE AND SKILLS

Before beginning carbohydrate counting education, it is essential to determine a person’s base knowledge. When working with a person with newly diagnosed diabetes or new to carbohydrate counting, assess the following:

• Knowledge of the goals for healthy eating in general

• Knowledge of the goals for healthy eating with diabetes

• Preconceived notions of what a person with diabetes should or should not eat, as well as understanding about the timing of meals and snacks

• Understanding of basic nutrition concepts, such as:

The three macronutrients—carbohydrate, protein, and fat

Foods that provide the three main macronutrients

• Understanding of blood glucose—lowering medication(s)—onset, action, duration, and mechanism(s) of action(s)

People with diabetes are referred for medical nutrition therapy (MNT) at varying points in their life and management of diabetes. For this reason, it is important to realize that just because a person has had diabetes for many years or claims to have learned or used carbohydrate counting, doesn’t mean that they have and/or are able to apply the above knowledge and/or that this knowledge is up to date as diabetes nutrition recommendations have evolved.

Methods for assessment

Since many diabetes educators teach Basic Carbohydrate Counting in a group setting, it is important to develop methods that assess each person’s knowledge and learning needs within the group. Consider using one or more of these assessment options:

• Develop a few written questions that allow you to quickly assess whether people know the foods (as food groups) that do and do not contain carbohydrate (see box Questions to Ask).

• Ask people to complete a one-to-three day food record and have them circle the foods that contain carbohydrate. Ask them to include the amount of food and, if possible, the amount of carbohydrate each food provides. If people haven’t determined the carbohydrate counts of these foods, they can demonstrate their ability to do this using a variety of carbohydrate counting resources and tools provided by the educator in class (see box Tools and Resources Every Educator Needs). Finally, have them provide a total carbohydrate count for meals and for the day.

• To assess a person’s measuring skills, consider having a box of dry cereal, nuts, or dried fruit (foods that can be reused and aren’t perishable), and ask them to measure out a specific amount or one serving of the food.

• Provide people with different Nutrition Facts panels from common packaged foods. Create a brief questionnaire that can demonstrate their knowledge of where to find the serving size and total grams of carbohydrate. Determine if they can calculate the total grams in a serving if the serving is different from the serving size on the Nutrition Facts panel.

• Use food models to ask people to estimate the carbohydrate count of a variety of foods, including commonly eaten mixed dishes.

• Develop a brief questionnaire with which to assess a person’s ability to find and determine a total for the grams of carbohydrate in a fast food meal. Use the nutrition facts for fast food restaurants (see Appendix I).

Ongoing assessment

In addition to assessing initial carbohydrate counting skills, it is important to be able to assess the progression of a person’s knowledge and skills as well. Educators can use many of the same questions and tools suggested above for this purpose.

Assessment Checklist

Below is a list of knowledge and skills a person using Basic Carbohydrate Counting should obtain. Some of the skills may be present from the beginning; most will probably be acquired through carbohydrate counting education. Use this checklist as an ongoing assessment tool. Strategies for teaching this knowledge and these skills are addressed in chapters 3 and 4.

Covered in Chapter 3. Concepts to Teach—From Basic Nutrition to Meal Planning:

Understand the rationale behind why carbohydrate counting can effectively achieve glycemic control

Identify the foods (food groups) that contain carbohydrate

Identify the foods (food groups) that do not contain carbohydrate

Understand that 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 (if a person is not achieving glycemic goals, other methods, such as blood glucose—lowering medication, should be utilized, constituting a progression of therapy)

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 personal guidelines for what and how much protein and fat to eat

Know how to take, record, and track blood glucose levels

Covered in Chapter 4. Concepts to Teach—Counting Carb, Reading Food Labels, and Measuring Portions:

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 portion control tools and tips

Know how to interpret postprandial blood glucose levels

Progression to Advanced Carbohydrate Counting

A person who is ready to progress to learning and using Advanced Carbohydrate Counting should be able to perform all the tasks listed above in the Assessment Checklist. However, not all diabetes self-management regimens are suited to Advanced Carbohydrate Counting. The mastery of Basic Carbohydrate Counting—with the simple goal of eating a consistent amount of carbohydrate throughout the day—can be an endpoint for some people with diabetes. For others, the mastery of Basic Carbohydrate Counting skills and knowledge will serve as a base upon which they can progress to acquire and master Advanced Carbohydrate Counting skills.

A person who has type 2 diabetes and follows a healthy eating plan integrated with regular physical activity and no blood glucose—lowering medications has no need to progress to Advanced Carbohydrate Counting with their current regimen. They may need to progress as their diabetes management plan becomes more complex, often with the addition of oral or injectable medications and/or insulin that can be adjusted based on blood glucose levels and/or carbohydrate intake. Until that time (or if that complexity never becomes necessary), Basic Carbohydrate Counting will usually suffice.

In other cases, there is no intermediary period between Basic and Advanced Carbohydrate Counting. The person with type 1 diabetes who seeks a more flexible insulin regimen and eating plan may want or need to progress beyond Basic Carbohydrate Counting immediately. Chapter 6 provides a more in-depth discussion of determining a person’s readiness to progress.