A pharmacist's first thought inchronic diseases is usually onmedication therapy. We initiallyjump to think of appropriate drugselection, correct dosing, adverseeffects, and drug interactions to consider.But for our diabetes patients,pharmacists have a unique opportunityto provide them with education onthe therapeutic lifestyle changes thatare an integral part of their diseasemanagement. Therapeutic lifestylechanges include exercise, weight loss,and especially a healthy dietary plan.While the majority of diabetespatients do need to see a nutritionistfor comprehensive dietary assessmentand planning, community pharmacistscan talk with patients about someof the basic choices that they have formeal planning. Although all componentsof a healthy diet are important,such as limiting saturated fats andincreasing fiber, this article will focuson appropriate carbohydrate intake.
Often when I see newly diagnoseddiabetic patients, they come to mewith the assumption that they willhave to completely eliminate all carbohydratesand sugar from their diets. Itypically see a sigh of relief when Ibegin to explain that this is not thecase at all. Patients need to understandthat carbohydrates, although convertedto sugar in the body, are a necessarycomponent of their diet. Carbohydratesare the body's main source ofenergy for all cells, including braincells. Many diabetic patients are stillunder the assumption that the onlyingredient they need to focus on whenlooking at a food label is the grams ofsugar present. While it is commonlybelieved that sucrose and other sugarslead to a more rapid and exaggeratedresponse in blood glucose, research hasnow shown that sucrose does not havea greater impact on blood glucose levelsthan other carbohydrates. Manyfactors influence the glycemic responsefrom different carbohydrates. Therefore,it is important to explain topatients to focus on the total carbohydratecontent for any given meal ratherthan the amount of sugar present.
Carbohydrate counting is oneapproach to diabetic meal planningand works well for many patients.First, a patient needs to understandwhat types of foods are carbohydrates.Explain to patients that examples ofcarbohydrates include starches (rice,pasta, dried beans, bread, grains, etc),starchy vegetables (potatoes, corn,green peas), fruit, milk, yogurt, andsweets. Understanding actual servingsizes of these foods is a concept manypatients do not have. I use the followingexamples to explain serving sizesfor carbohydrates:
For beans, starchy vegetables, andcooked cereals (oatmeal): 1/2 cup
For bread: 1 slice or 1 medium dinnerroll
For cooked rice and pasta: 1/3 cup
For most cereals: 3/4-to 1 cup
For most fruits: about the size of atennis ball
Many pamphlets and educationalpieces of literature are available thatexplain carbohydrate serving sizes, butthese examples give patients a goodstarting point.
Second, explain that 1 carbohydrateserving is approximately 15 g of carbohydrates.Therefore, 2 carbohydrateservings would equal 30 g, 3 wouldequal 45 g, and so forth. So, for example,a lunch consisting of a ham sandwich(2 carbohydrate servings), anapple (1 carbohydrate serving), 1/3 cupof pasta salad (1 carbohydrate serving),and a diet soda would total 4 carbohydrateservings or 60 g.
For the average woman, a diet consistingof approximately 3 carbohydrateservings (45 g) per meal is reasonable.For the average man, a dietconsisting of approximately 4 carbohydrateservings (60 g) per meal is adequate.In addition, most patients dowell with 1 to 3 snacks per day, 15 g, or1 carbohydrate serving each. This will,of course, vary from patient to patientand may include as few as 2 carbohydrateservings per meal for patients tryingto lose weight or as many as 5 to 6carbohydrate servings per meal forthose patients who are very active orathletic individuals. For that reason,advice and individual meal planningfrom a dietitian are helpful. But sincepharmacists are often the most approachablehealth care providers, wecan provide patients some initial informationto let them know that carbohydrateswill still need to be a healthypart of their diet.
Dr. Brian is a clinical specialist withCornerstone Health Care, High Point, NC.
Some helpful resources forpatients to learn more about carbohydratecounting include:
Carbohydrate Counting and MyFood Plan, both available fromwww.idcpublishing.com.
Flash Carbs and Carb CountingMade Easy, both available from theAmerican Diabetes Association Website, www.diabetes.org.