Diabetes Deep Dives: Carb Counting (Tips and Tricks)

0:00 foreign0:08 I'm so pleased that you're joining us0:11 today0:12 diabetes deep Dives is a series of0:14 videos designed to dive deeper and0:16 Beyond the surface of different areas of0:18 diabetes management we are exploring0:20 those burning questions that you may0:22 have by featuring Dynamic and engaging0:24 guests with knowledge or lived0:26 experience on the topic our goal is to0:29 share information in ways that will0:30 spark continued interest and learning0:32 and leave you with practical tips and0:35 tools that you can easily use0:37 we'll be dropping a new video every0:39 month so subscribe to our YouTube0:41 channel and click on the notification0:42 Bell to be notified about new content0:44 you can also check us out on social0:47 media to find out when the next one will0:49 be posted to our YouTube channel0:51 just a reminder that the information0:53 shared in these videos in no way0:55 replaces the advice and direction from0:57 your Healthcare team if you have0:59 questions about your care please speak1:01 to your healthcare provider and team to1:03 make sure that you are getting the best1:04 advice1:06 in this episode our guest speaker1:08 Gabrielle Schmid will offer her1:10 practical advice on navigating the1:12 complex world of counting carbs when1:14 enjoying your meals with different1:16 ingredients all mixed together1:18 Gabrielle will walk us through the key1:19 learnings that we hope you will get from1:21 this video1:23 Gabrielle is a registered dietitian1:25 certified educator and pump trainer she1:28 currently works at LMC Healthcare as a1:31 diabetes educator and clinical1:33 coordinator for the diabetes education1:35 program1:36 she has been living with type 1 diabetes1:38 for 25 years and ultimately she is1:40 passionate about driving change in the1:42 healthcare provider approach to help1:44 Empower all people living with diabetes1:49 we hope that you will find this video1:50 informative and that it will support you1:52 in managing your blood sugar while1:54 enjoying your favorite mixed dishes and1:56 now over to GabrielleWelcome1:59 hi everyone and welcome to diabetes2:01 Canada deep Dives today's topic is tips2:03 and tricks on carb counting my name is2:06 Gabrielle Schmid I'm a registered2:07 dietitian and certified diabetes2:10 educator in Ottawa2:11 so let me first start by saying that2:13 curb counting is a very difficult skill2:15 to learn you may have learned this early2:17 on in your diagnosis or maybe you're2:19 learning this for the first time but2:21 when we learn crowd counting we learn2:22 about food labels looking at the grams2:24 of carbs subtracting our fiber for a2:26 total amount of carbs or maybe learning2:29 how to use a food scale but what if our2:31 environment changes right we don't have2:32 access to these food scales and food2:34 labels in a restaurant out with friends2:36 Etc so today I want to help teach you2:39 some tips and tricks to help you learn2:41 more about practical skills so we're2:43 going to learn practical carb counting2:45 methods how fat protein and the glycemic2:47 affects carb Counting hidden sources of2:50 carbs how to make a best guess when carb2:53 counting using technology to help and2:56 Insulin strategiesPractical Methods2:58 so here we're looking at practical3:00 methods so you'll see on the left hand3:02 side actually two in one so we're3:04 looking at both the plate method and3:06 also a visual like using your hand so if3:09 you're looking at the plate method here3:11 you'll see that in the plate you're3:13 divided in three you have your grains3:15 and starches in one quart of the plate3:17 protein in the other quarter of your3:19 plate and half your plate is vegetables3:21 although this might not be new to you3:24 you can actually use this method let's3:26 say in a restaurant right you can order3:27 a dish that might mimic this and it3:29 might help you look at it and understand3:31 more about your3:32 carbohydrate portions3:34 um so looking at your corner of your3:36 plate now maybe the restaurant plate is3:37 much bigger but at least you have a3:39 better understanding of how much3:41 carbohydrate is in your plate versus a3:43 mixed dish or something like that3:45 at the same time you can see the hand so3:48 beside the graves and starches you have3:50 a fist so that once this tier you're3:52 looking about a cup of food so if you3:54 have a big plate at the restaurant and3:56 you think you have about two fifths of3:58 food that's approximately two cups so4:00 then you can do the math in terms of4:01 what you think the carb count is4:04 another practical method that I like to4:06 use is actually using a dry measuring4:08 cup to actually serve the food on4:10 someone's plate or my own plate so4:12 instead of using like a ladle or a big4:14 spoon I don't know how much that later4:16 that spoon is actually going to give me4:17 in terms of the amount of food but if I4:20 actually use4:21 um a one cup measuring cup I know that4:23 I'll be serving myself one cup of food4:25 and I can do my curb counting a little4:27 easier that way so using a dry measuring4:29 cup is actually quite useful for4:31 actually serving the food on someone's4:32 plate same thing for liquids if you4:35 actually want to measure the amount of4:38 liquid going into a smoothie for example4:39 maybe pouring it up in a measuring cup4:42 to see how much milk you're getting or4:44 fruit Etc to give you a better sense of4:47 the amount of carbohydrateHand Visuals4:51 here's another document to show you more4:54 visuals so just understanding more4:56 household objects versus your hand but4:59 certainly you may not have access to5:00 these things if you're at a restaurant5:01 but you have your hand right so looking5:04 in at your fist was again one cup the5:07 palm of your hand is about a quart or5:09 half a cup sorry5:11 um the Palm here5:13 is about three ounces a handful another5:17 ounce so looking at different ways to5:18 use your hand to look at you know uh how5:21 much I may be eating in my plate of food5:23 you could even maybe print this off and5:25 have it handy for the first couple of5:26 times just because you may not be sure5:29 um but you'll get used to it so if you5:30 start using this now even at home when5:32 you're in a restaurant or someone else's5:34 house to eat it might get easier over5:36 time5:37 so looking at both household objects and5:39 also your hands could be another5:40 practical tip to help you with your carb5:42 counting a little more accuratelyNon Carbs5:46 so what about non-carbs so we know that5:48 when we eat carbohydrate if we just eat5:50 the carbohydrate alone it's pretty5:52 predictable how it might act in the body5:54 but if I have something that's high fat5:56 and high protein with the carb food it's5:59 actually going to slow down the6:00 absorption of the carb so if I take6:02 insulin for my carb counting and I think6:05 you know when I eat it alone and I think6:07 that it's going to work within two hours6:09 Etc it might not be the same thing when6:12 we're actually adding something like6:13 cheese or something that's deep fried or6:15 something of that sort you may have that6:17 experience yourself when you in6:19 something like pizza or nachos right the6:22 spaghetti or the noodle itself or the6:24 chip itself uh maybe the chip because6:26 it's higher in fat but let's say the6:28 noodle itself is pretty predictable in6:30 terms of how it affects your sugar but6:32 when you add a lot of that cheese or a6:34 lot of that meat sauce it might change6:36 the way that it works so looking at6:38 strategies to help you with that could6:39 be either using the extend bolts feature6:42 if you're using an insulin pump if6:44 you're on injections you might want to6:45 split urine injection in two and of6:48 course discussing this with your6:49 diabetes team to help you learn more6:51 about those features and understanding6:53 how to split your injection6:55 but just understanding the fact that you6:57 know if I have a plate of food and it6:59 seems to be quite high fat high protein7:01 the outcome is going to be different7:02 than if you're just having a7:04 carbohydrate with more predictable food7:05 on the plate like a side salad and a7:08 small piece of fish or something like7:10 thatGlycemic Index7:12 and what about the glycemic index so the7:15 glycemic index is a way to look at how7:17 carbohydrate is going to impact the7:19 sugar just the carbohydrate alone so an7:21 example would be let's say bread if I'm7:24 eating a white uh bread or one slice of7:26 white bread my blood sugar might Spike7:28 fast versus if I have something like7:31 sourdough bread or rye bread7:33 surprisingly even though they are still7:35 white by visually looking at it the way7:38 that it's made and fermented actually7:40 it's quite different and so the outcome7:42 or the absorption of the carbohydrate7:44 may look differently than just having7:45 that white bread so if I have to7:48 pre-bull this let's say for my sandwich7:49 with white bread I may not need to7:51 pre-bull this if I'm having something7:53 with sourdough bread or rye bread7:55 because the carb even though the carb7:57 count might be similar it's how the7:58 carbohydrate is actually behaving in my8:00 body once I've eaten it so again it's8:03 not all about carb counting learning the8:05 grams of carbohydrate but understanding8:07 kind of what foods do what and when we8:09 pair it on top of fat and protein again8:11 right understanding of that there might8:13 be a change in the outcome of your sugarHidden Carbs8:18 and what about those hidden sources of8:20 carbohydrate so certainly if you're at a8:22 restaurant right this is my this might8:24 be where you might come to face this8:26 challenge just because if you're at home8:28 you have more control in terms of what8:30 you're putting into your recipes8:32 Etc so if I'm at a restaurant remember8:34 to look at the sauces the salad8:36 dressings the condiments the breaded or8:40 crispy options right those are going to8:41 be more or higher in carbohydrates so if8:45 you're having let's say chicken fingers8:46 right sure the chicken is protein it may8:49 not be counted but if it's breaded then8:52 you'll look at not only maybe higher fat8:54 but also looking at carbohydrate because8:56 of that breading8:58 milk Alternatives so not all milk is9:01 created equally so one cup of cow's milk9:03 for example is not the same thing as one9:05 cup of oat milk or if you're looking at9:08 almond milk so looking at the food label9:10 because that's often um available to you9:12 when you are purchasing the milk9:13 Alternatives but be mindful of that as9:17 well9:17 and some nuts and seeds so usually when9:20 we learn about carb counting we say you9:22 know don't count your nuts and seeds but9:24 that's not true not all nuts are created9:26 equally so looking at cashews for9:28 example those are actually kind of high9:31 in carbohydrate depending on the amount9:32 that you're having but I would actually9:34 count that towards your carb amount if9:36 you are eating let's say about a third9:38 of a cup of cashews compared to if9:41 you're eating peanuts or almonds9:43 so here are some examples right so9:46 ketchup for example a quarter of a cup9:48 of ketchup often very common when we're9:50 eating especially during the summer time9:52 right that can add about 15 grams of9:54 carbohydrate to your meal but often we9:57 might forget about it because it doesn't9:58 visually look like a carbohydrate that10:00 we might usually count for like the10:02 bread or a fruit example as exampleTechnology10:07 so technology so we're lucky today that10:10 we live in a world where you know we10:12 have access to lots of things that are10:13 fingertips in terms of information and10:15 that includes carb counting not only10:18 just carbohydrate but all nutrition and10:20 nutrients found in our Foods so I often10:23 tell my patients you know start Maybe by10:25 Googling it so if you don't have access10:26 to a food label or a food scale or10:28 really you're just looking at a plate of10:30 food and you're not sure but you have10:31 access to it to your phone you could10:33 Google it you go in your search bar and10:35 you just type in something like I don't10:36 know um strawberries right and then you10:39 can actually choose the amount of10:40 strawberries that you're going to be10:41 eating and it will come up with the carb10:43 count for that amount of food all as10:46 well as the fiber and all the other10:48 nutrition for that food10:50 the other thing I like to teach my10:52 patients is the fast foods restaurants10:54 nutrition information so if you actually10:56 go on Google and do a quick search I can10:59 actually do a live demonstration here to11:01 show you how easy it is so let me just11:03 stop sharing my screen11:06 if I go to Google and let's say I'm11:08 going to Subway for lunch11:11 okay and then I'm going to click on11:14 subway11:24 let's see if I can find it somewhere11:26 else here11:28 um11:31 okay11:34 so nutrition11:39 I go down to nutrition data tables11:41 it's a PDF so you can actually print11:43 this if you're often going to Subway uh11:46 you can print this keep this handy ready11:47 to go you can actually find this in your11:49 phone as well okay so PDF comes up and11:52 in the PDF I'll make this a bit bigger11:54 here you see here the carbohydrate and11:57 the dietary fiber11:58 so you can do the math12:00 okay so if I'm looking at perhaps12:05 the turkey12:06 43 minus five so I'm looking at about 3812:10 grams of carbs first my six inch12:13 sandwich okay so you can literally like12:15 I said like I said print this off have12:17 it handy uh take a picture with your12:20 phone uh but again keeping track of the12:22 things that you're often ordering can be12:24 very helpful and maybe it's once or12:25 twice a need to look it up and then12:27 after that you'll know it by heart so12:29 that's just an information how easy it12:31 is to find nutrition information your12:33 carb counting online12:36 so let me just reshare my screen12:44 okay perfect the other thing that we can12:46 do as well is if you again look online12:48 are Canadian nutrient file has a huge12:51 array of different foods that we've come12:53 up with over the years in terms of the12:54 nutrition available to us so again just12:57 looking up a certain food you'll find12:59 all the nutrients related to that food13:01 including the carb count13:04 another thing that we all use these days13:05 for multiple reasons are apps on our13:08 phone so for example carbs and cows carb13:11 manager MyFitnessPal Calorie King these13:14 are examples of carb counting apps so13:16 you might be already using a diabetes13:18 app or um not for anything right so13:21 downloading another app on your phone to13:23 help with this it's not that you need to13:25 use it every time that you need to card13:26 count I mean you can but it could be for13:29 those things that you're just really not13:30 sure about there's often big databases13:32 of different types of foods ethnicities13:34 all types of foods available to you13:36 different restaurants even if you travel13:39 to a different country you'd be13:40 surprised what you can see there or13:42 different chains so again using these13:44 apps uh when you want can really help13:46 and like I said if you often visit these13:49 restaurants or have these meals over and13:52 over again you might need to look it up13:53 once or twice a few times and then13:56 you'll know it off by heart after after13:58 a few times of looking it up14:00 so these are some of many apps available14:02 to you these are the most popular that I14:04 see but certainly looking on your phone14:06 and looking either in your app store to14:09 see what's available to you when you14:10 type in carbohydrate counting you'd be14:12 surprised what you can see there so take14:14 a lookStrategies14:17 so of course when we're carb counting14:19 we're often doing that to take our14:20 insulin with our carb ratio or perhaps14:23 just looking at learning more about14:24 carbohydrates so we can come up with the14:26 carb ratio for you so here are some14:29 strategies to help you with your insulin14:31 but also to help your insulin work14:33 better especially when there's a14:34 situation where you're not sure about14:35 the carb count14:36 so consider taking your correction if14:38 you're a little high before eating so at14:41 least get some insulin circulating in14:43 your system if you're really not sure if14:45 you can't pre-bull this for your meal14:46 making sure that you have at least a14:48 correction going in so that you can be14:50 maybe less above Target when you're14:53 eating your food again if you can and14:55 you can remember14:57 if you're at a restaurant don't pre-bull14:59 this at a restaurant you don't know15:00 what's happening in the kitchen there15:02 might be a fire there someone might be15:04 delayed whatever it is so really make15:06 sure that you're only bullisting when15:08 your plate of food arrives at your table15:09 then you can take a look at it do some15:11 calculation maybe looking at your hands15:14 to see if it mimics the plate method or15:15 whatever it is and then bolus when you15:18 have a better understanding of your card15:19 count and again when it's in front of15:21 you15:22 use your extend Bulls feature on your15:24 pump like we talked about in terms of15:26 high fat high protein certainly a15:28 situation that would happen more often15:29 in a restaurant and if there's something15:31 that you're often eating in a restaurant15:33 that you really want to get correct in15:35 terms of bolusing maybe discussing this15:37 with your diabetes team taking notes so15:40 maybe the first time you're not actually15:42 using extendable list you just take a15:43 you take your insulin as you usually15:45 would and see what happens to your sugar15:47 and then maybe you'll see that maybe in15:49 four hours or six hours you need more15:51 insulin well we can use the extend Bulls15:53 feature to help you with that15:56 be careful it's better to underestimate15:59 than to overestimate when we're looking16:00 at our carb count I would say if you're16:02 really not sure give it a guess but try16:05 to guess a little lower than maybe what16:07 you think is actually in your plate16:09 um so better to do that than to overdo16:11 it and then have too much insulin on16:12 board and cause a low16:15 if you're really not sure bullets for16:17 some right or half if you think of an16:19 idea of how much it is Monitor and16:22 adjust as needed we can always give16:24 Corrections later on but certainly you16:26 want to give it enough time you don't16:27 want to give a correction half an hour16:29 after eating you want to at least wait16:31 two three four hours to give your16:33 correction16:34 um so just keep that in mind just give16:36 some before if you can16:39 um and if you have no idea you can eat16:42 your plate of food think of how much you16:44 ate and go from there right some insulin16:46 is better than no insulinSummary16:50 so I hope that today we learned about a16:53 few things ultimately we know carb16:55 counting is hard work we never expect16:56 Perfection you shouldn't as well right16:59 that is a lot of work to just do that17:01 um so be mindful of that skill use your17:04 hands or visuals to help you understand17:06 your portions like we talked about those17:08 household items if you have them around17:09 but certainly using your hand is good17:11 enough17:12 model the plate method at a restaurant17:14 when possible so if you're at a17:16 restaurant and you want to order17:18 something if you can see if it fits more17:20 into that plate method versus a mixed17:22 dish certainly you know it might17:24 increase your chances of getting a more17:26 accurate carb counting but don't make17:27 that your deciding factor for what17:29 you're going to order but it could be a17:31 helpful strategy for sure17:33 look out for those hidden sources of17:35 carbohydrate like we said in those17:37 sauces and the condiments pay attention17:39 to how high fat and high protein meals17:42 affect your sugars and discuss with your17:44 team so maybe you won't use the extended17:46 bolus or give insulin a different way17:48 you'll just see how your sugar reacts to17:50 a certain food take note of that and see17:52 what happens and you can discuss that17:54 with your diabetes team17:56 a best guess is better than no guests17:58 and use technology to help with your18:00 carb Counting18:02 I hope today's presentation helped you a18:04 little more with your curb counting18:05 skills and like I said please reach out18:07 to your diabetes team if you need more18:09 uh review or skills or practical18:11 knowledge on learning how to carb count18:13 thank you so muchOutro18:16 thank you so much for joining us to dive18:18 deeper into how card counting can help18:20 support your diabetes management please18:22 take the opportunity to let us know what18:24 you learned what you liked and how we18:26 can do better18:27 you can do that by posting a comment in18:29 the comments section below or by18:31 clicking the link to the feedback survey18:33 in the description box18:35 if you have ideas for other topics you'd18:37 like to learn more about you can include18:39 that in the comments or feedback survey18:41 as well18:43 you can also find the website linked to18:45 the Canadian nutrient file mentioned in18:47 the video in the description box as well18:49 as some additional helpful resources on18:52 this topic from diabetes Canada18:54 if you are looking for more resources18:56 about diabetes management please visit18:58 our website at diabetes.ca you can also19:01 email us at info diabetes.ca or call our19:05 info line at 1-800banting that's19:10 1-800-226-8464 and speak to one of our19:12 information and support Specialists who19:14 can address your needs thanks again for19:17 joining us and see you next time19:19 foreign19:21 [Music]