USING CARBOHYDRATE COUNTING IN DIABETES CLINICAL-PRACTICE

Carbohydrate counting is a meal planning approach used with clients wh o have diabetes that focuses on carbohydrate as the primary nutrient a ffecting postprandial glycemic response. The concept of carbohydrate c ounting has been around since the 1920s, but it received renewed inter est after being used as 1 of 4 meal planning approaches in the Diabete s Control and Complications Trial. In the trial, carbohydrate counting was found to be effective in meeting outcome goals and allowed flexib ility in food choices. Recent practice pattern surveys have shown an i ncreasing interest in and use of carbohydrate counting for medical nut rition therapy for persons with diabetes. Carbohydrate counting can be used by clients with type 1, type 2, and gestational diabetes. Three levels of carbohydrate counting have been identified based on increasi ng levels of complexity. Level 1, or basic, introduces clients to the concept of carbohydrate counting and focuses on carbohydrate consisten cy. Level 2, or intermediate, focuses on the relationships among food, diabetes medications, physical activity, and blood glucose level and introduces the steps needed to manage these variables based on pattern s of blood glucose levels. Level 3, or advanced, is designed to teach clients with type 1 diabetes who are using multiple daily injections o r insulin infusion pumps how to match short-acting insulin to carbohyd rate using carbohydrate-to-insulin ratios. AU 3 levels emphasize porti on control and offer opportunities for using creative teaching methods , such as ''food labs,'' and use of a variety of carbohydrate resource tools and publications. In this article, glycemic effects of protein, fat, and fiber intake are discussed for persons with type 1 and type 2 diabetes. Decision trees are introduced for each level of carbohydra te counting and show the usual progression through each level. Carbohy drate counting as a meal planning approach offers variability of food choices with the potential for improving glycemic control. Research op portunities are available for those interested in comparing carbohydra te counting with other meal planning approaches for clients with diabe tes and the effects on clinical outcomes.