Question

1. Your patient is admitted with a HgbA1c of 12% and is diagnosed as a new Type 2 Diabetic. They are given a standard Carbohydrate Consistent (60 g per meal) diet order. The patient asks for your help in filling out their menu for the next day, as they do not understand why they are on a carbohydrate restriction. Explain the rationale for a carbohydrate consistent diet to them.

Answer 1

Hemoglobin is the molecule within red blood cells.that carries oxygen to the body’s tissues. A small percentage of the hemoglobin has sugar attached to it, and this type of hemoglobin is known as hemoglobin A1c.. The amount of hemoglobin A1c depends on the level of sugar (glucose) in the blood: the higher the blood sugar the higher is the amount of hemoglobin A1c.

Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%. Here the level is very high (12%).

The consistent (or controlled) carbohydrate diet (CCHO diet) helps people with diabetes keep their carb consumption at a steady level, through every meal and snack. This prevents blood sugar spikes or falls.

How the CCHO diet works

Your body uses carbohydrates from foods for energy. Simple carbs, like pasta and sugar, deliver quick and almost immediate energy. Complex carbs, like whole grains, beans, and vegetables, break down more slowly. Complex carbs don’t cause the sudden spike associated with the “sugar high” of a cookie or slice of cake.

Some people with diabetes take the low-carb approach and strictly limit carb intake. The ketogenic diet, for example, has been shown to dramatically improve blood sugar levels and weight in people with diabetes. But this ultra-low-carb approach only allows 20 to 50 grams of carbohydrates in a day. That may be too strict for most people.

But too many carbs can be a bad thing, too. Carbohydrates increase insulin levels and raise blood sugars. The challenge is balancing carbohydrate intake with medications and exercise to keep blood sugars in a safe range.

Leveling carb intake prevents insulin spikes and dips

The idea behind the CCHO diet is to monitor and program your carbohydrate consumption so you have fewer spikes or dips. In other words, the CCHO diet keeps your carbohydrate intake the same throughout the day, and every day of the week.

Taking medications at the same times each day and exercising at a regular time can help keep things running smoothly.

Replacing carb counting with ‘choices’

Instead of counting carbs, the CCHO diet assigns units of measurements called “choices” to foods. About 15 grams of carbohydrates equals one carb “choice.”

For example, a half cup of rice has about 22 grams of carbohydrates. That would equal 1 1/2 carb “choices” in your daily total. One slice of bread has 12 to 15 grams of carbs, so it would equal one “choice.”

Planning out your menu and limiting your total number of carb choices at a meal helps keep your carb intake and blood sugars more level.

Ultimately, the CCHO diet may be easier than tracking the number of foods from food groups or counting individual carbs to adjust your insulin accordingly at each meal.

Once you know many of the most common exchanges, you can sail through ordering at restaurants or planning your menu for the week as long as portion sizes are consistent.