0:00 foreign 0:08 I'm so pleased that you're joining us 0:11 today 0:12 diabetes deep Dives is a series of 0:14 videos designed to dive deeper and 0:16 Beyond the surface of different areas of 0:18 diabetes management we are exploring 0:20 those burning questions that you may 0:22 have by featuring Dynamic and engaging 0:24 guests with knowledge or lived 0:26 experience on the topic our goal is to 0:29 share information in ways that will 0:30 spark continued interest and learning 0:32 and leave you with practical tips and 0:35 tools that you can easily use 0:37 we'll be dropping a new video every 0:39 month so subscribe to our YouTube 0:41 channel and click on the notification 0:42 Bell to be notified about new content 0:44 you can also check us out on social 0:47 media to find out when the next one will 0:49 be posted to our YouTube channel 0:51 just a reminder that the information 0:53 shared in these videos in no way 0:55 replaces the advice and direction from 0:57 your Healthcare team if you have 0:59 questions about your care please speak 1:01 to your healthcare provider and team to 1:03 make sure that you are getting the best 1:04 advice 1:06 in this episode our guest speaker 1:08 Gabrielle Schmid will offer her 1:10 practical advice on navigating the 1:12 complex world of counting carbs when 1:14 enjoying your meals with different 1:16 ingredients all mixed together 1:18 Gabrielle will walk us through the key 1:19 learnings that we hope you will get from 1:21 this video 1:23 Gabrielle is a registered dietitian 1:25 certified educator and pump trainer she 1:28 currently works at LMC Healthcare as a 1:31 diabetes educator and clinical 1:33 coordinator for the diabetes education 1:35 program 1:36 she has been living with type 1 diabetes 1:38 for 25 years and ultimately she is 1:40 passionate about driving change in the 1:42 healthcare provider approach to help 1:44 Empower all people living with diabetes 1:49 we hope that you will find this video 1:50 informative and that it will support you 1:52 in managing your blood sugar while 1:54 enjoying your favorite mixed dishes and 1:56 now over to Gabrielle Welcome 1:59 hi everyone and welcome to diabetes 2:01 Canada deep Dives today's topic is tips 2:03 and tricks on carb counting my name is 2:06 Gabrielle Schmid I'm a registered 2:07 dietitian and certified diabetes 2:10 educator in Ottawa 2:11 so let me first start by saying that 2:13 curb counting is a very difficult skill 2:15 to learn you may have learned this early 2:17 on in your diagnosis or maybe you're 2:19 learning this for the first time but 2:21 when we learn crowd counting we learn 2:22 about food labels looking at the grams 2:24 of carbs subtracting our fiber for a 2:26 total amount of carbs or maybe learning 2:29 how to use a food scale but what if our 2:31 environment changes right we don't have 2:32 access to these food scales and food 2:34 labels in a restaurant out with friends 2:36 Etc so today I want to help teach you 2:39 some tips and tricks to help you learn 2:41 more about practical skills so we're 2:43 going to learn practical carb counting 2:45 methods how fat protein and the glycemic 2:47 affects carb Counting hidden sources of 2:50 carbs how to make a best guess when carb 2:53 counting using technology to help and 2:56 Insulin strategies Practical Methods 2:58 so here we're looking at practical 3:00 methods so you'll see on the left hand 3:02 side actually two in one so we're 3:04 looking at both the plate method and 3:06 also a visual like using your hand so if 3:09 you're looking at the plate method here 3:11 you'll see that in the plate you're 3:13 divided in three you have your grains 3:15 and starches in one quart of the plate 3:17 protein in the other quarter of your 3:19 plate and half your plate is vegetables 3:21 although this might not be new to you 3:24 you can actually use this method let's 3:26 say in a restaurant right you can order 3:27 a dish that might mimic this and it 3:29 might help you look at it and understand 3:31 more about your 3:32 carbohydrate portions 3:34 um so looking at your corner of your 3:36 plate now maybe the restaurant plate is 3:37 much bigger but at least you have a 3:39 better understanding of how much 3:41 carbohydrate is in your plate versus a 3:43 mixed dish or something like that 3:45 at the same time you can see the hand so 3:48 beside the graves and starches you have 3:50 a fist so that once this tier you're 3:52 looking about a cup of food so if you 3:54 have a big plate at the restaurant and 3:56 you think you have about two fifths of 3:58 food that's approximately two cups so 4:00 then you can do the math in terms of 4:01 what you think the carb count is 4:04 another practical method that I like to 4:06 use is actually using a dry measuring 4:08 cup to actually serve the food on 4:10 someone's plate or my own plate so 4:12 instead of using like a ladle or a big 4:14 spoon I don't know how much that later 4:16 that spoon is actually going to give me 4:17 in terms of the amount of food but if I 4:20 actually use 4:21 um a one cup measuring cup I know that 4:23 I'll be serving myself one cup of food 4:25 and I can do my curb counting a little 4:27 easier that way so using a dry measuring 4:29 cup is actually quite useful for 4:31 actually serving the food on someone's 4:32 plate same thing for liquids if you 4:35 actually want to measure the amount of 4:38 liquid going into a smoothie for example 4:39 maybe pouring it up in a measuring cup 4:42 to see how much milk you're getting or 4:44 fruit Etc to give you a better sense of 4:47 the amount of carbohydrate Hand Visuals 4:51 here's another document to show you more 4:54 visuals so just understanding more 4:56 household objects versus your hand but 4:59 certainly you may not have access to 5:00 these things if you're at a restaurant 5:01 but you have your hand right so looking 5:04 in at your fist was again one cup the 5:07 palm of your hand is about a quart or 5:09 half a cup sorry 5:11 um the Palm here 5:13 is about three ounces a handful another 5:17 ounce so looking at different ways to 5:18 use your hand to look at you know uh how 5:21 much I may be eating in my plate of food 5:23 you could even maybe print this off and 5:25 have it handy for the first couple of 5:26 times just because you may not be sure 5:29 um but you'll get used to it so if you 5:30 start using this now even at home when 5:32 you're in a restaurant or someone else's 5:34 house to eat it might get easier over 5:36 time 5:37 so looking at both household objects and 5:39 also your hands could be another 5:40 practical tip to help you with your carb 5:42 counting a little more accurately Non Carbs 5:46 so what about non-carbs so we know that 5:48 when we eat carbohydrate if we just eat 5:50 the carbohydrate alone it's pretty 5:52 predictable how it might act in the body 5:54 but if I have something that's high fat 5:56 and high protein with the carb food it's 5:59 actually going to slow down the 6:00 absorption of the carb so if I take 6:02 insulin for my carb counting and I think 6:05 you know when I eat it alone and I think 6:07 that it's going to work within two hours 6:09 Etc it might not be the same thing when 6:12 we're actually adding something like 6:13 cheese or something that's deep fried or 6:15 something of that sort you may have that 6:17 experience yourself when you in 6:19 something like pizza or nachos right the 6:22 spaghetti or the noodle itself or the 6:24 chip itself uh maybe the chip because 6:26 it's higher in fat but let's say the 6:28 noodle itself is pretty predictable in 6:30 terms of how it affects your sugar but 6:32 when you add a lot of that cheese or a 6:34 lot of that meat sauce it might change 6:36 the way that it works so looking at 6:38 strategies to help you with that could 6:39 be either using the extend bolts feature 6:42 if you're using an insulin pump if 6:44 you're on injections you might want to 6:45 split urine injection in two and of 6:48 course discussing this with your 6:49 diabetes team to help you learn more 6:51 about those features and understanding 6:53 how to split your injection 6:55 but just understanding the fact that you 6:57 know if I have a plate of food and it 6:59 seems to be quite high fat high protein 7:01 the outcome is going to be different 7:02 than if you're just having a 7:04 carbohydrate with more predictable food 7:05 on the plate like a side salad and a 7:08 small piece of fish or something like 7:10 that Glycemic Index 7:12 and what about the glycemic index so the 7:15 glycemic index is a way to look at how 7:17 carbohydrate is going to impact the 7:19 sugar just the carbohydrate alone so an 7:21 example would be let's say bread if I'm 7:24 eating a white uh bread or one slice of 7:26 white bread my blood sugar might Spike 7:28 fast versus if I have something like 7:31 sourdough bread or rye bread 7:33 surprisingly even though they are still 7:35 white by visually looking at it the way 7:38 that it's made and fermented actually 7:40 it's quite different and so the outcome 7:42 or the absorption of the carbohydrate 7:44 may look differently than just having 7:45 that white bread so if I have to 7:48 pre-bull this let's say for my sandwich 7:49 with white bread I may not need to 7:51 pre-bull this if I'm having something 7:53 with sourdough bread or rye bread 7:55 because the carb even though the carb 7:57 count might be similar it's how the 7:58 carbohydrate is actually behaving in my 8:00 body once I've eaten it so again it's 8:03 not all about carb counting learning the 8:05 grams of carbohydrate but understanding 8:07 kind of what foods do what and when we 8:09 pair it on top of fat and protein again 8:11 right understanding of that there might 8:13 be a change in the outcome of your sugar Hidden Carbs 8:18 and what about those hidden sources of 8:20 carbohydrate so certainly if you're at a 8:22 restaurant right this is my this might 8:24 be where you might come to face this 8:26 challenge just because if you're at home 8:28 you have more control in terms of what 8:30 you're putting into your recipes 8:32 Etc so if I'm at a restaurant remember 8:34 to look at the sauces the salad 8:36 dressings the condiments the breaded or 8:40 crispy options right those are going to 8:41 be more or higher in carbohydrates so if 8:45 you're having let's say chicken fingers 8:46 right sure the chicken is protein it may 8:49 not be counted but if it's breaded then 8:52 you'll look at not only maybe higher fat 8:54 but also looking at carbohydrate because 8:56 of that breading 8:58 milk Alternatives so not all milk is 9:01 created equally so one cup of cow's milk 9:03 for example is not the same thing as one 9:05 cup of oat milk or if you're looking at 9:08 almond milk so looking at the food label 9:10 because that's often um available to you 9:12 when you are purchasing the milk 9:13 Alternatives but be mindful of that as 9:17 well 9:17 and some nuts and seeds so usually when 9:20 we learn about carb counting we say you 9:22 know don't count your nuts and seeds but 9:24 that's not true not all nuts are created 9:26 equally so looking at cashews for 9:28 example those are actually kind of high 9:31 in carbohydrate depending on the amount 9:32 that you're having but I would actually 9:34 count that towards your carb amount if 9:36 you are eating let's say about a third 9:38 of a cup of cashews compared to if 9:41 you're eating peanuts or almonds 9:43 so here are some examples right so 9:46 ketchup for example a quarter of a cup 9:48 of ketchup often very common when we're 9:50 eating especially during the summer time 9:52 right that can add about 15 grams of 9:54 carbohydrate to your meal but often we 9:57 might forget about it because it doesn't 9:58 visually look like a carbohydrate that 10:00 we might usually count for like the 10:02 bread or a fruit example as example Technology 10:07 so technology so we're lucky today that 10:10 we live in a world where you know we 10:12 have access to lots of things that are 10:13 fingertips in terms of information and 10:15 that includes carb counting not only 10:18 just carbohydrate but all nutrition and 10:20 nutrients found in our Foods so I often 10:23 tell my patients you know start Maybe by 10:25 Googling it so if you don't have access 10:26 to a food label or a food scale or 10:28 really you're just looking at a plate of 10:30 food and you're not sure but you have 10:31 access to it to your phone you could 10:33 Google it you go in your search bar and 10:35 you just type in something like I don't 10:36 know um strawberries right and then you 10:39 can actually choose the amount of 10:40 strawberries that you're going to be 10:41 eating and it will come up with the carb 10:43 count for that amount of food all as 10:46 well as the fiber and all the other 10:48 nutrition for that food 10:50 the other thing I like to teach my 10:52 patients is the fast foods restaurants 10:54 nutrition information so if you actually 10:56 go on Google and do a quick search I can 10:59 actually do a live demonstration here to 11:01 show you how easy it is so let me just 11:03 stop sharing my screen 11:06 if I go to Google and let's say I'm 11:08 going to Subway for lunch 11:11 okay and then I'm going to click on 11:14 subway 11:24 let's see if I can find it somewhere 11:26 else here 11:28 um 11:31 okay 11:34 so nutrition 11:39 I go down to nutrition data tables 11:41 it's a PDF so you can actually print 11:43 this if you're often going to Subway uh 11:46 you can print this keep this handy ready 11:47 to go you can actually find this in your 11:49 phone as well okay so PDF comes up and 11:52 in the PDF I'll make this a bit bigger 11:54 here you see here the carbohydrate and 11:57 the dietary fiber 11:58 so you can do the math 12:00 okay so if I'm looking at perhaps 12:05 the turkey 12:06 43 minus five so I'm looking at about 38 12:10 grams of carbs first my six inch 12:13 sandwich okay so you can literally like 12:15 I said like I said print this off have 12:17 it handy uh take a picture with your 12:20 phone uh but again keeping track of the 12:22 things that you're often ordering can be 12:24 very helpful and maybe it's once or 12:25 twice a need to look it up and then 12:27 after that you'll know it by heart so 12:29 that's just an information how easy it 12:31 is to find nutrition information your 12:33 carb counting online 12:36 so let me just reshare my screen 12:44 okay perfect the other thing that we can 12:46 do as well is if you again look online 12:48 are Canadian nutrient file has a huge 12:51 array of different foods that we've come 12:53 up with over the years in terms of the 12:54 nutrition available to us so again just 12:57 looking up a certain food you'll find 12:59 all the nutrients related to that food 13:01 including the carb count 13:04 another thing that we all use these days 13:05 for multiple reasons are apps on our 13:08 phone so for example carbs and cows carb 13:11 manager MyFitnessPal Calorie King these 13:14 are examples of carb counting apps so 13:16 you might be already using a diabetes 13:18 app or um not for anything right so 13:21 downloading another app on your phone to 13:23 help with this it's not that you need to 13:25 use it every time that you need to card 13:26 count I mean you can but it could be for 13:29 those things that you're just really not 13:30 sure about there's often big databases 13:32 of different types of foods ethnicities 13:34 all types of foods available to you 13:36 different restaurants even if you travel 13:39 to a different country you'd be 13:40 surprised what you can see there or 13:42 different chains so again using these 13:44 apps uh when you want can really help 13:46 and like I said if you often visit these 13:49 restaurants or have these meals over and 13:52 over again you might need to look it up 13:53 once or twice a few times and then 13:56 you'll know it off by heart after after 13:58 a few times of looking it up 14:00 so these are some of many apps available 14:02 to you these are the most popular that I 14:04 see but certainly looking on your phone 14:06 and looking either in your app store to 14:09 see what's available to you when you 14:10 type in carbohydrate counting you'd be 14:12 surprised what you can see there so take 14:14 a look Strategies 14:17 so of course when we're carb counting 14:19 we're often doing that to take our 14:20 insulin with our carb ratio or perhaps 14:23 just looking at learning more about 14:24 carbohydrates so we can come up with the 14:26 carb ratio for you so here are some 14:29 strategies to help you with your insulin 14:31 but also to help your insulin work 14:33 better especially when there's a 14:34 situation where you're not sure about 14:35 the carb count 14:36 so consider taking your correction if 14:38 you're a little high before eating so at 14:41 least get some insulin circulating in 14:43 your system if you're really not sure if 14:45 you can't pre-bull this for your meal 14:46 making sure that you have at least a 14:48 correction going in so that you can be 14:50 maybe less above Target when you're 14:53 eating your food again if you can and 14:55 you can remember 14:57 if you're at a restaurant don't pre-bull 14:59 this at a restaurant you don't know 15:00 what's happening in the kitchen there 15:02 might be a fire there someone might be 15:04 delayed whatever it is so really make 15:06 sure that you're only bullisting when 15:08 your plate of food arrives at your table 15:09 then you can take a look at it do some 15:11 calculation maybe looking at your hands 15:14 to see if it mimics the plate method or 15:15 whatever it is and then bolus when you 15:18 have a better understanding of your card 15:19 count and again when it's in front of 15:21 you 15:22 use your extend Bulls feature on your 15:24 pump like we talked about in terms of 15:26 high fat high protein certainly a 15:28 situation that would happen more often 15:29 in a restaurant and if there's something 15:31 that you're often eating in a restaurant 15:33 that you really want to get correct in 15:35 terms of bolusing maybe discussing this 15:37 with your diabetes team taking notes so 15:40 maybe the first time you're not actually 15:42 using extendable list you just take a 15:43 you take your insulin as you usually 15:45 would and see what happens to your sugar 15:47 and then maybe you'll see that maybe in 15:49 four hours or six hours you need more 15:51 insulin well we can use the extend Bulls 15:53 feature to help you with that 15:56 be careful it's better to underestimate 15:59 than to overestimate when we're looking 16:00 at our carb count I would say if you're 16:02 really not sure give it a guess but try 16:05 to guess a little lower than maybe what 16:07 you think is actually in your plate 16:09 um so better to do that than to overdo 16:11 it and then have too much insulin on 16:12 board and cause a low 16:15 if you're really not sure bullets for 16:17 some right or half if you think of an 16:19 idea of how much it is Monitor and 16:22 adjust as needed we can always give 16:24 Corrections later on but certainly you 16:26 want to give it enough time you don't 16:27 want to give a correction half an hour 16:29 after eating you want to at least wait 16:31 two three four hours to give your 16:33 correction 16:34 um so just keep that in mind just give 16:36 some before if you can 16:39 um and if you have no idea you can eat 16:42 your plate of food think of how much you 16:44 ate and go from there right some insulin 16:46 is better than no insulin Summary 16:50 so I hope that today we learned about a 16:53 few things ultimately we know carb 16:55 counting is hard work we never expect 16:56 Perfection you shouldn't as well right 16:59 that is a lot of work to just do that 17:01 um so be mindful of that skill use your 17:04 hands or visuals to help you understand 17:06 your portions like we talked about those 17:08 household items if you have them around 17:09 but certainly using your hand is good 17:11 enough 17:12 model the plate method at a restaurant 17:14 when possible so if you're at a 17:16 restaurant and you want to order 17:18 something if you can see if it fits more 17:20 into that plate method versus a mixed 17:22 dish certainly you know it might 17:24 increase your chances of getting a more 17:26 accurate carb counting but don't make 17:27 that your deciding factor for what 17:29 you're going to order but it could be a 17:31 helpful strategy for sure 17:33 look out for those hidden sources of 17:35 carbohydrate like we said in those 17:37 sauces and the condiments pay attention 17:39 to how high fat and high protein meals 17:42 affect your sugars and discuss with your 17:44 team so maybe you won't use the extended 17:46 bolus or give insulin a different way 17:48 you'll just see how your sugar reacts to 17:50 a certain food take note of that and see 17:52 what happens and you can discuss that 17:54 with your diabetes team 17:56 a best guess is better than no guests 17:58 and use technology to help with your 18:00 carb Counting 18:02 I hope today's presentation helped you a 18:04 little more with your curb counting 18:05 skills and like I said please reach out 18:07 to your diabetes team if you need more 18:09 uh review or skills or practical 18:11 knowledge on learning how to carb count 18:13 thank you so much Outro 18:16 thank you so much for joining us to dive 18:18 deeper into how card counting can help 18:20 support your diabetes management please 18:22 take the opportunity to let us know what 18:24 you learned what you liked and how we 18:26 can do better 18:27 you can do that by posting a comment in 18:29 the comments section below or by 18:31 clicking the link to the feedback survey 18:33 in the description box 18:35 if you have ideas for other topics you'd 18:37 like to learn more about you can include 18:39 that in the comments or feedback survey 18:41 as well 18:43 you can also find the website linked to 18:45 the Canadian nutrient file mentioned in 18:47 the video in the description box as well 18:49 as some additional helpful resources on 18:52 this topic from diabetes Canada 18:54 if you are looking for more resources 18:56 about diabetes management please visit 18:58 our website at diabetes.ca you can also 19:01 email us at info diabetes.ca or call our 19:05 info line at 1-800banting that's 19:10 1-800-226-8464 and speak to one of our 19:12 information and support Specialists who 19:14 can address your needs thanks again for 19:17 joining us and see you next time 19:19 foreign 19:21 [Music]