Carbohydrate counting is a meal planning approach used with clients who have diabetes that focuses on carbohydrate as the primary nutrient affecting postprandial glycemic response. The concept of carbohydrate counting has been around since the 1920s, but it received renewed interest after being used as 1 of 4 meal planning approaches in the Diabetes Control and Complications Trial. In the trial, carbohydrate counting was found to be effective in meeting outcome goals and allowed flexibility in food choices. Recent practice pattern surveys have shown an increasing interest in and use of carbohydrate counting for medical nutrition 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 increasing levels of complexity. Level 1, or basic, introduces clients to the concept of carbohydrate counting and focuses on carbohydrate consistency. 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 patterns of blood glucose levels. Level 3, or advanced, is designed to teach clients with type 1 diabetes who are using multiple daily injections or insulin infusion pumps how to match short-acting insulin to carbohydrate using carbohydrate-to-insulin ratios. All 3 levels emphasize portion 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 carbohydrate counting and show the usual progression through each level. Carbohydrate counting as a meal planning approach offers variability of food choices with the potential for improving glycemic control. Research opportunities are available for those interested in comparing carbohydrate counting with other meal planning approaches for clients with diabetes and the effects on clinical outcomes.

Using Carbohydrate Counting in Diabetes Clinical Practice

Hypoglycemic effect of crude exopolysaccharides produced by a medicinal mushroom Phellinus baumii in streptozotocin-induced diabetic rats.

Background Dentists play a major role as part of an allied health team in providing oral care to patients with diabetes. As such, they may detect undiagnosed cases of diabetes and refer patients to physicians for further evaluation. Methods The author describes new concepts in metabolic control for diabetes and the relationship of oral complications to diabetes mellitus. The treatment of acute oral infections and the dentist's role in supporting patients in smoking-cessation programs are approaches that may reduce morbidity from diabetes mellitus. In consultation with the patient's physician, the dentist may need to modify the treatment plan where systemic complications are present. Results Working with the physician, nutritionist and dental hygienist, the dentist can maintain the patient's oral health and possibly improve the patient's metabolic control of diabetes. In consultation with the patient's physician, the dentist can discuss the indications and contraindications of medications for the treatment of oral complications in patients with systemic complications resulting from diabetes. Using a glucometer may avert emergencies related to diabetes. Conclusions The dental team can improve the metabolic control of a patient's diabetes by maintaining optimal oral health. The dentist also can reduce comorbidity factors by supporting patients in tobacco-use cessation programs. Clinical Implications Dentists can reduce the morbidity and mortality associated with diabetes by maintaining their patients' oral health and by referring patients with signs and symptoms of oral complications suggestive of diabetes to physicians for further evaluation.

https://jada.ada.org/article/S0002-8177(14)65196-5/pdf

Dental considerations for the treatment of patients with diabetes mellitus

https://www.jrnjournal.org/article/S1051-2276(04)00135-9/pdf

Adequate protein dietary restriction in diabetic and nondiabetic patients with chronic renal failure.

Diabet. Med. 28, 781–784 (2011)

Abstract
Aims  To explore older patients’ perceived impact of chronic co-morbid conditions on Type 2 diabetes self-management.

Methods  We used purposive sampling to select 32 mentally alert community-dwelling adults, aged 60 years or older, diagnosed with Type 2 diabetes and at least one other chronic health condition to participate in focus groups. We summarized the discussions following each focus group and identified codes to describe the overarching themes.

Results  We conducted eight 90-min focus groups, each consisting of two to six patients. Three themes emerged. (i) Diabetes complications as a motivator: managing co-morbid conditions made health an important focal point in the lives of older patients. Most patients acknowledged the positive effect complications had on their diabetes self-management by motivating them to pay greater attention to their diabetes to diminish the progression of these complications. (ii) Prioritizing health conditions: patients reported prioritizing health conditions and selectively attending to the management of those conditions based on perceived severity or importance. Further, many patients perceived some conditions as more serious than others and admitted to prioritizing another health condition over their diabetes. (iii) Emotional impact of co-morbidity management: patients described feeling frustrated, confused, and overwhelmed in response to conflicting treatment recommendations, particularly for diet, physical activity and medication regimens.

Conclusions  Complications and co-morbidities may have differential impacts on the diabetes self-management of older patients. Addressing the perceived impact of co-morbidity on diabetes self-management may improve patients’ outcomes; however, the most effective method of utilizing this information in clinical practice needs to be examined.

Perceived challenges and priorities in co-morbidity management of older patients with Type 2 diabetes

UNDERSTANDING DIABETES Pathophysiology Complications of Diabetes Mellitus SETTING AND ACHIEVING NUTRITION GOALS Nutrition-Focused Diabetes Care Nutrition Assessment Diabetes Medications/Delivery Methods Exercise and Diabetes Mellitus Monitoring of Comprehensive Diabetes Management Use of Self Blood Glucose Monitoring Achieving Goals through Self-Management Training Nutritional Counseling SELECTING NUTRITIONAL EDUCATION APPROACH Meal Planning for Diabetes: Approaches and Educational Resources The Exchange System Carbohydrate Counting Very Low Calorie Diets Cultural Considerations in Diabetes Nutrition Therapy MACRONUTRIENT INFLUENCE ON BLOOD GLUCOSE AND HEALTH The Role of Carbohydrate in the Diabetes Meal Plan Protein Lipids Calories Low-Calorie Sweeteners and Fat Replacers: The Ingredients, Use in Foods, and Diabetes Management Fiber and the Diabetic Diet MAKING FOOD CHOICES Selected Foods Altering the Basic Meal Plan Glycemic Control and Supplemental Vitamins, Minerals, and Nonfood Substances LIFE STAGES Children and Adolescents Pregnancy and Diabetes Medical Nutrition Therapy for the Older Person with Diabetes NUTRITION AND SPECIFIC CLINICAL CONDITIONS Diabetic Nephropathy Hypertension and Diabetes Eating Disorders in Diabetes Mellitus Surgery and Surgical Nutrition in Diabetes Gastrointestinal Manifestations of Diabetes Mellitus Dental Care of the Person with Diabetes Diabetes in HIV/AIDS MAKING IT WORK Reimbursement for Medical Nutrition Therapy and Diabetes Self-Management Training View from the Mountain

Powers, Margaret A., Rd

Papers

Handbook Of Diabetes Medical Nutrition Therapy

Handbook of diabetes nutritional management

Nutrition guide for professionals : diabetes education and meal planning