Introduction

According to the Centers for Disease Control and Prevention (or CDC) National Diabetes Statistics Report for 2020 (1) there are approximately 34.2 million Americans who currently have diabetes, which translates to about 1 in 10 people. While new cases diagnosed in adults between 2008 and 2018 declined, cases have increased in specific sub-populations. These include youth, especially in racial and ethnic minorities. Cases increased among non-Hispanic blacks, and people of Hispanic origin. The percentage of already existing cases was highest among American Indians and Alaska Natives. Concomitant risk factors included overweight or obese in 89% of adults diagnosed with diabetes, 38% who were physically inactive, and 15% who were smokers. About 37% had chronic kidney disease, of which 25% with moderate to severe kidney disease who were not aware of their condition.

 

Some of the complications include kidney disease, cardiovascular disease, hypertension, liver disease, sleep apnea, and others. In a 2016 study (2), it was suggested that nearly 98% of adults with type 2 diabetes have at least one comorbid chronic disease and almost 90% have at least two comorbid diseases.

Costs of care and treatment for diabetes are definitely a concern, and are a factor when considering the importance of effective disease management. The total estimated direct and indirect costs of diagnosed diabetes (remember that many with diabetes do not have a formal diagnosis) was $327 billion in 2017. Direct costs increased from $188 billion in 2012 to $237 billion in 2017 (using 2017 dollars). Indirect costs increased from $73 billion to $90 Billion over this period of time. Per person excess medical costs increased from $8,417 to $9,601 per person (in 2017 dollars).

More people are paying attention to the possibility of the issue of prediabetes. While most are unaware of their condition, it is estimated that 88 million Americans have prediabetes, translating to 1 in 3 people! Diagnosing prediabetes is very important because with adequate treatment strategies, progression to diabetes may be slowed or prevented. And, because diabetes tends to be a progressive disease, maintaining control of blood glucose levels may help to slow that process--and many of the complications that accompany diabetes and diabetes progression. In our discussion today, we will assume that you have a basic knowledge of diabetes.

About 1 in 10 Americans have diabetes -Significant increase in incidence among youth -Racial and ethnic minorities at higher rates -Overweight/obesity was a common finding -Growing older population contributes to increases -Complications and co-morbidities are fairly common About 1 in 3 Americans have prediabetes  (Most are unaware)

 

Carbohydrate Counting

There are many strategies to prevent and slow the progression of diabetes and reduce the risks for related complications. Typically, these include medications, diet, exercise, and attention to the care and treatment of risk factors for comorbidities. For our purposes today, we will limit our discussion to the dietary strategy of carbohydrate counting. Note that we recommend that a prediabetes or diabetes patient should spend some time with a Registered Dietitian/Nutritionist with the credentials “RDN” or a Certified Diabetic Educator with the credentials “CDE” to tailor this information to the actual patient.

 

Carbohydrate counting is a strategy for dietary control of blood sugar levels for people with type 1 or type 2 diabetes, but can also be used to reduce risk for progression of prediabetes. This method makes it easier for patients with prediabetes or diabetes to plan a meal in advance, or sit down to pretty much any meal and figure out the approximate amount of carbohydrate that the meal, snack, or beverage will deliver.

The premise of this strategy is that if a person can distribute carbohydrates throughout the day, then the amount of carbohydrates consumed at one time will be lower than if the carbohydrates are concentrated in a single meal. Carbohydrate counting allows the patient to estimate their carbohydrate intake per meal, snack, or beverage with an easy system.

 

Uses for this strategy include keeping blood sugars in normal (or closer to normal) range throughout the day. It may also help to plan for reducing the risk for hypoglycemia, especially when taking anti-diabetic medications. This may help to prevent hyperglycemia and match medication doses and even minimize the need for some medications.

 

During this course we will discuss these concepts and how they work. We will also provide some additional tips for optimizing carbohydrate counting to expand the flexibility of food and beverage choices while still maintaining control of blood glucose. We will dig a bit deeper to cover diet strategies to complement, and even improve, the use of carbohydrate counting. Finally, we will look at some examples for using carbohydrate counting with diabetes medications to improve outcomes.

 

Definitions: dietary strategy to control blood glucose levels Premise: carbohydrate quantity and distribution   Uses: Diet control of blood sugar: hyperglycemia, hypoglycemia Matching for medication control of blood sugar Advanced concepts to improve the impact of carbohydrate counting Recommended referral: RDN or CDE (sometimes both!)

 

The Basics of Carbohydrate Counting

In the short-term, keeping glucose within an acceptable range can improve one’s day-to-day quality of life. This includes having more energy, better physical performance, improved mental focus, and more stable moods.

Dose Carbohydrate “servings”: 15 g carbs per carb serving How many per day?: Divide calories by 4 and then again by 15 Distribution How many per meal?: ≤4-5 per meal Distribute somewhat evenly with time between