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Last4digitsofPSUID#4351

Nutr 453, Spring 2014


CHOCounting/CorrectionFactorHW
15Points
BASICCARBOHDYRATECOUNTING:
YouaskedDebbietocomebackintwoweekswitha24hrrecalltoseeifshehasbeenfollowing
thedietRxyouprescribed.Whenshereturnssheinformsyouthatshedecidedtostoptakingher
metformintoseeifshecouldcontrolherbloodglucosewithdietalone.However,nowher
glucoselevelsareelevated.Shedoesnotwanttobeginhermedicationagainsosheislookingfor
additionalguidance.Her24hrrecallislistedbelow:
B1largeblueberrybagel,1.5Treducedfatcreamcheese,1.5Tstrawberryjam,1small
banana(4oz.)and16oz.coffeewith2TFrenchVanillacreamer
Snack1cupbabycarrots,1/3cupRoastedRedPepperhummus
L2sliceswholegrainbread,3.5oz.tunasalad,2slicestomato(nonstarchy),1Romaineleaf
(nonstarchy),6oz.containeroflowfat,fruitedyogurtandasmallapple,16oz.water
DTacos:3oz.groundturkey,1cupmixedgreens(nonstarchy),1cupdicedtomatoes(non
starchy),1cupdicedroastedredpeppers,1oz.reducedfatshreddedcheddarcheese,26flour
tortillas,12oz.gingeraleand3gingersnaps
HScupregularFrenchVanillaicecream,2Tchocolatesyrup
1. WriteoutthedietRxthatyouusedintheexchangeHW.BasedonthatdietRx,andthe
macronutrientdistribution(%CHO,PRO,FAT)youprovidedDebbie(intheexchange
HW),usethecarbcountingguidelinestodeterminehowmanycarbohydratechoicesyou
wouldrecommendtoher.Howmanytotalcarbohydratechoicesperdaydoyou
recommend?(Note:1carbohydratechoice=15gramsofcarbohydrate;notethat
eventhoughamilkexchangecontains12gofCHO,itisstillcountedas1CHO
choiceequalto15gofCHOwhenusingthecarbohydratecountingmethod.)To
determinetheCHOchoices,dividethetotalCHOginyourRxby15gCHO/choice.
ThisisthetotalCHOchoicesinyourRx.
Rx:1900kcaldiet,32%fat(68g)with10%fromPUFA(21g),nomorethan10%fromSFA
(21g),and12%fromMUFA(26g),52%CHO(247g),16%protein(76g)with6080%(46
61g)ofproteinfromHBV,andasodiumrestrictionof2300mg.
Rxof247g/dCHO:247/15=16.5CHOchoices

2. Basedonher24hrrecall,howmanytotalcarbohydratechoicesisDebbiecurrently
consumingperday?Permeal/snack?Todothis,filloutthetablebelow.DoNOTlistthe
gramsofCHO.YouaretoONLYlisttheCHOchoicesusingthecarbohydratecounting
method(CHOchoices=gramsofCHO/15).
BREAKFAST
Largebagel
TReducedfatcreamchs
TJam
Smbanana
16ozcoffee
2TFlavoredcreamer
SNACK
1c.Carrots
1/3c.Hummus
LUNCH
2sl.WholegrainBread
2sl.Tomato
6ozfruitedYogurt
Smapple
DINNER
1c.Tomatoes
1c.greens
1c.Redpepper
1oz.Cheddarcheese
26tortillas
12oz.Gingerale
3gingersnaps
HS
c.Icecream
2T.Chocolatesyrup
TOTALCHOCHOICES
Meal/Snack
Breakfast
Snack
Lunch
Dinner
HS
TOTAL

#CHOchoices
4
0
1.5
1
0
2
0
1
2
0
1
1
1
1
2
2.5
1
1
2

#ofchoices
7.5
1
4
7.5
3
23

3. A.UsingthedailyCHOdistributionthatwasprovidedintheexchangehomework,how
manyCHOchoicesshouldDebbieconsumeateachmeal/snack?Youshouldalready
havefiguredouthowmanygramsofCHOshewouldbeconsumingateachmeal/snack
bycompletingstep8intheExchangeHW.Allyouhavetodohereisconvertthegof
CHOpermeal/snackintoCHOchoicespermeal/snack.
Frompart8ofexchangehw:
Meal
Breakf
ast
Snack
Lunch
Dinner
HS
Snack

% CHO
kcal

CHO
kcal

CHO
g

20%
15%
30%
25%

198
148
296
247

50
37
74
62

10%

99

25

Breakfast:50g/15=3.33CHOchoices(roundto3.5)
Snack:37g/15=2.5CHOchoices
Lunch:74g/15=5CHOchoices
Dinner:62g/15=4CHOchoices
HS:25g/15=1.67CHOchoices(roundto1.5)

B.ModifyDebbiescurrent24hourintakesothatsheisabletomeettheappropriate
amountofcarbohydratechoicesforeachmeal.Todothisyouneedtowriteoutanew
samplemenubaseduponthefoodsDebbiereportedeatinginher24hrecall.Setupa
tableliketheoneinquestion2toshowhowyoumodifiedherchoicestoproduceamore
appropriatemenuforher.
BREAKFAST
plainbagel
2Treducedfatcreamchz
5
/8c.freshstrawberries
12ozcoffee,vanilla
flavoredbeans
Sm.banana
SNACK
1ccarrots
1/3chummus
3/8cblueberries
3gingersnaps
LUNCH
2sl.Wholegrainbread
2sl.Tomato
1romaineleaf
6ozfruitedyogurt
Smallapple
cupapplejuice
DINNER
Sugarfree(diet)gingerale
1ctomatoes
1cgreens
1credpeppers
1ozcheese
26tortillas
HS
c.Chocolateicecream
TOTAL

#CHOchoices
2
0

Mealtotal
3.5

1
2.5
0
1

1
5
2
0
0
1
1
1
4
0
1

1
2
1.5
1.5
16.5

Debbieadmitstoyouthatsheisgettingabetterunderstandingofexchanges,butsheoftenfinds
ithardtoadheretothediet.YousuggestthatDebbiestarttakingafriendorfamilymemberwith
hertoattenddiabetesclassesatthelocalhospitaltohelpherwithcarbohydratecounting.
DebbieasksherfriendTimshemetatwateraerobicstogowithherasheisaTypeIDiabetic.

Heisingoodcontrolandactivelyparticipatesinthewateraerobicsprogram3timesperweek
andtakeswalksaroundtheneighborhoodwithhisdogeachmorning.Forbreakfast,Tim
typicallyeats45gmCHOandtakes5Uofrapidactinginsulin;forlunchheusuallyeats75gof
CHOandtakes5Uofrapidactinginsulin;fordinnerheusuallyeats68gmofCHOandtakes4
Uofrapidactinginsulin.
4. WhatisTimsinsulin:CHOratioforeachmeal(fillinthetablebelow)?
B:45/5=9gCHO/U,ratio:1:9
L:75/5=15gCHO/U,ratio1:15
D:68/4=17gCHO/U,ratio1:17
UsualCHO
45
75
68

B
L
D

UsualInsulin
5
5
4

Insulin:CHOratio
1:9
1:15
1:17

5. TimandDebbiemakeplanstogooutforlunchafterwateraerobicsonSaturday.Tim
anticipatedeatinghisnormalsizelunchandpossiblyadesserttoosohecompensatedby
eatingfewercarbohydratesduringbreakfastanddinner.Usetheinsulin:CHOratiosyou
calculatedinquestion4todeterminehowmuchinsulinTimwouldneedtotakeforthemeals
below.Roundyouranswerstothenearest0.1U.
B:35/9=3.88=3.9Uinsulin
L:90/15=6Uinsulin
D:60/17=3.53=3.5Uinsulin
B
L
D

PlannedCHOintake
35
90
60

Insulinneeded
3.9U
6.0U
3.5U

6. InadditiontotherapidactinginsulinthatTimtakes(seeintroductiontoquestion#4,above),
healsotakes7Uofthelongactinginsulinglargineeachnight.CalculatehisISF.Thatis,
oneunitofinsulinwilllowerherbloodglucosebyabouthowmuch?(Roundyouranswer
tothenearestwholenumber).
TDD=5+5+4+7=21Uinsulin
1800/TDD=ISF
1800/21=85.7=86mg/dL

7. Timcheckedhisbloodglucose4hoursafterhislunchwithDebbie.Itwas245.Histargetis
115.Usingyourfinalanswerfrom#6above,calculatehowmanyunitsofrapidacting
insulinTimshouldtaketobringhisglucoseintothetargetrange.(Roundyouranswerto
0.1U)
245115=130over
130/86=1.5
Needcorrectivedoseof1.5Uinsulin
8. IfTimweretakingshortactinginsulin,whatwouldhisISFbe?Showyourcalculations.
(Roundyouranswertothenearestwholenumber)
1500/TDD=ISF
1500/21=71.4=71mg/dL

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