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Basic Carbohydrate Counting. Fuadiyah Nila K., S.Gz , MPH Leny Budhi Harti , S.Gz Jurusan Gizi FKUB. Diet Diabetes Mellitus. Nutrition Care Process (ADA,2003). Practice Settings. Dietetics Knowledge. Skills & competencies. Code of Ethics. Nutrition assessment obtain/collect timely - PowerPoint PPT Presentation
Citation preview
Basic Carbohydrate
CountingFuadiyah Nila K., S.Gz, MPH
Leny Budhi Harti, S.GzJurusan Gizi FKUB
Diet Diabetes Mellitus
Nutrition Care Process (ADA,2003)
Relationship between
Patients/client/group and
Dietetics Professional
Nutrition assessment • obtain/collect timely and appropriate data• analyze/interpret with evidence-based standards• document
Nutrition diagnosis • identify & label
problem• determine cause/
contributing risk factors
• cluster signs & symptoms/ defining
characteristics• document
Nutrition interventions
• plan nutrition Intervention
- Formulate goals & determine
a plan of action• implement nutrition
intervention- Care is delivered & actions are carried out
• document
Nutriton monitoring & Evaluation • monitor progress• measure outcome indicators• Evaluate outcomes• document
Practice Settings
Social Systems
Econ
om
ics
Healt
h C
are
S
yste
ms
Code
of E
thics Skills &
competencies
Dietetics Knowledge
Communication Collaboration
Cri
tical Th
inkin
g
Evid
en
ce-b
ased
P
racti
ce
XAsuhan Gizi Standard-Sosio Kulture- Ekonomi Keluarga- Kebiasaan
Asuhan Gizi Individual
Nutritional Care Process
XPantang Makanan Pengaturan Diet
Lena has been overweight for a few years. She is 52 years old, and she found out that she has type 2 diabetes 1 year ago. She has been seeing a doctor at her physician’s office for nutrition information, and the doctor has referred her to a registered dietitian (RD) in the outpatient clinic at the nearby hospital.
Kulkarni, KD.Clin. Diabetes 23: 120 - 122
Lena brings her food records to her initial visit with the RD. The RD reviews the records, which consist only of Lena’s food choices with no portion sizes or amounts consumed listed. The RD recommends that Lena consider weighing and measuring her portion sizes andwriting them down along with her food choices. The RD provides Lena with a copy of the American Diabetes Association (ADA) basic carbohydrate counting pamphlet1 and uses food models to demonstrate appropriate portions of the foods Lena might select.
Kulkarni, KD.Clin. Diabetes 23: 120 - 122
Content :
1. Definition of carbohydrate counting
2. Level of carbohydrate counting3. Indication of using carbohydrate
counting4. Why should people with diabetes
use carbohydrate counting????5. Steps to count carbohydrate
counting
Definition of carbohydrate counting
Carbohydrate counting is a meal-planning approach and not a specific diet
It places emphasis on the total amount of carbohydrate consumed, rather than on the source or type of carbohydrate consumed
Kulkarni, KD.Clin. Diabetes 23: 120 - 122
Level of carbohydrate counting
Carbohydrate countingBasic Advance
understanding the relationship among food, physical activity, and blood glucose levels
includes understanding
pattern management and
how to use insulin-to-carbohydrate
ratios
Kulkarni, KD.Clin. Diabetes 23: 120 - 122
introduces patient to the concept of
carbohydrate counting and for
carbohydrate consistency
Level of carbohydrate counting
Carbohydrate counting
Level 1 Level 2 Level 3
Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48
Focuses on the relationships among food,
diabetes medication,
physical activity and blood glucose
level and
Level of carbohydrate counting
Carbohydrate counting
Level 1 Level 2 Level 3
Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48
how to match short-acting insulin to
carbohydrate using
carbohydrate-to- insulinratios.
Level of carbohydrate counting
Carbohydrate counting
Level 1 Level 2 Level 3
Chiesa, G, et al. Acta Biomed 2005; 76; suppl. 3 : 44-48
Level 1 / Basic CarbingGoals
61. Carbohydrate Counting: Getting Started, The American Diabetes Association and The American Dietetic Association, 1995. 2. Practical Carbohydrate Counting, American Diabetes Association, 2001. 3. Using Carbohydrate Counting in Clinical Practice, JADA, 1988, v98, n8
• Regulate blood glucose by balancing carbohydrate intake with the diabetes medication and physical activity
• Achieve and maintain consistency of carbohydrate intake at meals and snacks at similar times each day
• Eating similar amounts of carb foods at each meal or snack helps “even out” the ups-and-downs in your blood glucose level.
Who Can Use Carbing
Carbohydrate counting can be used by anyone with diabetes, not just people taking insulin
Why Should People with Diabetes Use Carbohydarte Counting????
Food contains many nutrients such as
1. Macronutrients : carbohydrate, protein, and fat
2. Micronutrients : vitamins and minerals
Why Should People with Diabetes Use Carbohydarte Counting????
In fact, 90-100 % of the carb you eat appears in your bloodstream as blood glucose within a few hours after you have eaten.
Protein and fat have much less effect on your blood glucose
Why Should People with Diabetes Use Carbohydarte Counting????
Bolderman, K.M, 2007. Educational Information From BD Medical Diabetes Care
Steps to Count Carbohydrate Counting
1. Step 1 : Make healthy food choices
2. Step 2 : Focus on carbohydrate
3. Step 3 : Set carbohydrate goals
4. Step 4 : Determine carbohydrate content
5. Step 5 : Monitor effect on blood glucose level
Canadian Diabetic Association, 2005
Step 1 Make healthy food choices Enjoy a variety of
vegetables, fruits, whole grains,
Use added fats in small amounts.
Choose portion sizes
Canadian Diabetic Association, 2005
Steps to Count Carbohydrate Counting
1. Step 1 : Make healthy food choices
2. Step 2 : Focus on carbohydrate
3. Step 3 : Set carbohydrate goals
4. Step 4 : Determine carbohydrate content
5. Step 5 : Monitor effect on blood glucose level
Canadian Diabetic Association, 2005
Step 2 Focus on Carbohydrate
Step 2 Focus on Carbohydrate
Steps to Count Carbohydrate Counting
1. Step 1 : Make healthy food choices
2. Step 2 : Focus on carbohydrate
3. Step 3 : Set carbohydrate goals
4. Step 4 : Determine carbohydrate content
5. Step 5 : Monitor effect on blood glucose level
Canadian Diabetic Association, 2005
Step 3 : Set Carbohydrate Goals
dietitian will help to set a goal for grams of carbohydrate at each meal and snack
This may be the same from day to day or may be flexible, depending on patient needs
Canadian Diabetic Association, 2005
Step 3 : Set Carbohydrate Goals
Pilih obat yang diperlukan sesuai jumlah karbohidrat
Jumlah energi
Distribusi energi
selama 24 jam
Analisis terhadap komposisi
zat gizi
Perhitungan KH setiap
sajian
Step 3 : Set Carbohydrate Goals
Analisis zat gizi dari kebiasaan makan pasien
Food record
Food Record
Food Record
Food Record
Food Record
Energi dari hasil record : ....... Kkal
Distribusi energi :- pagi : .....%- snack : .....%- siang : .....%- malam : .....%
Komposisi zat gizi :- protein : ....%- KH : ....%- Lemak : ....%
Serving KH per sajian
Perhitungn zat gizi yang diperlukan pasien
Energi
Distribusikan dalam 24
jam
Komposisi zat gizi sesuai dengan
kebiasaan
Perhitungan jumlah
karbohidrat per sajian
Perhitungn zat gizi yang diperlukan pasien
Perhitungn zat gizi yang diperlukan pasien
Status Gizi IMT IMT = BB (kg)/ {TB (m)}² Berikut ini pembagian IMT berdasar
standard Asia menurut IOTF, WHO (2000) :
<18,5 = Underweight18,5-22,9 = Normal23-24,9 = At risk25-29,9 = Obese I>=30 = Obese II
Perhitungan Kalori
BMI Normal : 25 – 30 cal/kg BW Kurus : > 40 cal/kg BW Overweight : < 20 cal/kg BW (BMI
requiring and /obese 130 g/day of CHO)
Perhitungn zat gizi yang diperlukan pasien
Energi Distribusikan dalam 24
jam
Komposisi zat gizi sesuai dengan
kebiasaan
Perhitungan jumlah
karbohidrat per sajian
Perhitungn zat gizi yang diperlukan pasien
Distriusi kalori dalam 24 jam disesuaikan dengan kebiasaan
makan pasien
Perhitungn zat gizi yang diperlukan pasien
Energi Distribusikan dalam 24
jam
Komposisi zat gizi sesuai dengan
kebiasaan
Perhitungan jumlah
karbohidrat per sajian
Perhitungn zat gizi yang diperlukan pasien
Karbohidrat sebesar 45-65% total asupan energi.
Protein sebesar 10 – 20% total asupan energi.
Asupan lemak sekitar 20-25% kebutuhan kalori.
Perhitungn zat gizi yang diperlukan pasien
Perkeni, 2006
Perhitungn zat gizi yang diperlukan pasien
Perhitungn zat gizi yang diperlukan pasien
Energi Distribusikan dalam 24
jam
Komposisi zat gizi sesuai dengan
kebiasaan
Perhitungan jumlah
karbohidrat per sajian
Karbohidrat sebesar 45-65% total asupan energi
Perhitungn zat gizi yang diperlukan pasien
Dibagi dalam
beberapa kali makan
Pagi.....% = ...g Siang
.....% = ...g
Malam.....% = ...g
snack
snack
Sesuai dengan kebiasaan makan pasien
KH per sajian
Perhitungan jumlah karbohidrat per sajian
Perhitungn zat gizi yang diperlukan pasien
Carbohydrate serving/
choice (carb serving/ choise)
Carb grams
Carb Seving/ Carb Choise
1 carb serving/ choie = 15 g karbohidrat
Kulkarni, KD.Clin. Diabetes 23: 120 - 122
Ex : untuk makan pagi, Tn. H membutuhkan 45 g karbohidrat
45g KH = 3 carb serving↓
2 slice of bread + ½ cup of fruit juice
Carb Seving/ Carb Choise
How Can I Use Nutrition Facts on Food Labels?
Case Study
Tn. Han, usia 37 tahun. Penderita DM type 2. TB 155 cm, BB 75 kg. Bekerja sebagai pegawai yang sebagaian besar aktifitasnya dilakukan dengan duduk. Pulang dan pergi kerja diantar oleh sopir. Pemeriksaan gula darah puasa/dl, DG 2 JPP 310 mg/dl
Food pattern (Hasil Food Frequency Questionnaire/FFQ)
CHO yang paling sering: nasi, mie, roti
Protein hewani ayam, daging, telur Protein nabati tempe dan tahu Sayur jarang hanya 1x/hari Buah frekuensi jarang, konsumsi
dalam bentuk jus Snack dalam bentuk makanan tinggi
kalori
Stage 1
Nutritional Assessment Antropometri : BB = 75 kg, TB= 155 cm BBI = (155-100) x 90% = 49.5 cm IMT = 75/1.5 2 = 31 (0bese)
Record Hari 1
Waktu Makan
MenuBahan
Makanan
Portion SizeJml
karbohidrat
URT Gram GramServin
g
Sarapan
Nasi putihAyam grg
Tempe grg
Pecel
Teh manis
Nasi Ayam MinyakTempeMinyakBayamTaoge Kcang tnhGula pasir
1 gls1 ptg sdg
½ sdm2 ptg sdg
½ sdm½ gls¼ gls2 sdm2 sdm
130505
505
50252020
60--8-5-8
20
6 ½ --½---½1
102 g (…..%)
6.5 serv.
Makan siang Tot Carb
Makan malam Tot
Carb
Hasil Record
Hari E P (gr) F (gr) CHO (gr)
Hari 1 3310.6 76.2 148.8 417.9
Hari 2 3657.3 128.7 179.3 386
Hari 3 3071.2 106.1 138.8 343.8
Rata-rata intake
3346 103.6 155.6 387.2
Stage 3
Nutrition Intervention Perhitungan kebutuhan 20 Kal x 75 = 1500 Kalori KH 55% = 55/100 x 1500 = 825 Kalori=
206.3 gram Lemak 25% = 25/100 x 1500 = 375
Kalori = 41.6 gr Protein 20%= 20/100x1500= 300
Kalori= 75 gr
Stage 4 Meal planning (KH) sesuai dengan
kebiasaan makan Energi = 3346 Kalori, CHO= 382.7 g
yang terbagi dalam :
Sarapan (%) = Snack (%)Makan siang (%)Snack (%)Makan malam (%)
Distribusi konsumsi KH dalam gr dan serving unit
Waktu makan
gram CHO
Unit serving
CHO
Sarapan
100.6 (26%)
6.5
Snack 65.5 (17%) 4
Siang 111.0 (29%)
7.5
Snack 15.4 (4%) 1
Malam 90.2 (24%) 6
Total 382.7 25
gram CHO
Unit serving
CHO
54(26%) 3.5
35 (17%) 2
60 (29%) 4
8 (4%) 1
49 (24%) 3
206 13.5
Kebiasaan mkn = 382.7 g CHO
Kebutuhan = 206.3 g CHO
Steps to Count Carbohydrate Counting
1. Step 1 : Make healthy food choices
2. Step 2 : Focus on carbohydrate
3. Step 3 : Set carbohydrate goals
4. Step 4 : Determine carbohydrate content
5. Step 5 : Monitor effect on blood glucose level
Step 4 : Determine carbohydrate content
1. Write down what you eat and drink throughout the day
2. Be sure to note the portion sizes3. Record the grams of carbohydrate
in these foods and drinks.
Steps to Count Carbohydrate Counting
1. Step 1 : Make healthy food choices
2. Step 2 : Focus on carbohydrate
3. Step 3 : Set carbohydrate goals
4. Step 4 : Determine carbohydrate content
5. Step 5 : Monitor effect on blood glucose level
Step 5 : Monitor effect on blood glucose level
Work with your health care team to correct blood glucose levels that are too high or too low
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