By Johanna Burani, MS, RD, CDE,

Often times I am asked how my patients get started on a low glycemic program. In this article I cover the steps that I use with patients everyday.

1. Discuss the patient’s self monitoring blood glucose (BG) numbers:
** Explain reference ranges for fasting, before and after meals, and bedtime.
** Look at the patient’s pre- and post-prandial numbers. Consider a post-prandial elevation of approximately 40 points to be a “normal” response.
** Explain that high post-prandial BG elevations may be due to inadequate and/or inappropriate medication(s) and/or diet.

2. Look at the patient’s food journal.
** Select a very typical day’s food intake.
** Have the patient circle all carbohydrates consumed that day.

3. Relate pre- and post-prandial BG numbers to the carbohydrates consumed at each corresponding meal of the selected day.
? Have the patient calculate the BG elevations before and after meals.

4. Explain to the patient that there are three macronutrients in the diet: carbohydrate (CHO), protein (PRO), and fat (FAT). Briefly explain their metabolic end products.
** CHO = 100% glucose, which goes directly into the blood
** PRO = amino acids + glucose, which goes to the liver
** FAT = fatty acids + glucose (minimal)

5. Explain to the patient that the post-prandial BG elevations are due primarily to the type (glycemic index value) and amount (glycemic load value) of the carbohydrates that were consumed at that meal.
** Glycemic index (GI): quickly-digested CHO (“gushers”) elevate BG higher and more rapidly than the slowly-digested CHO (“tricklers”).
** Glycemic load (GL): helps to predict the BG response to a particular CHO in a particular given amount in a meal.

6. Give examples of high and low GI carbohydrates.
** List factors affecting GI values: type of starch and degree of gelatinization or “swelling”, physical form, fiber, fat, sugar and acid content.

7. Guide the patient in matching post-prandial BG levels with the GI and the GL of the carbohydrates he/she circled in the food journal.
** If post-prandial numbers are satisfactory: encourage continued application of CHO choices.
** If post-prandial numbers are too high: illicit low GI/GL substitutions from the patient; offer suggestions.

8. Summarize at the end of the office visit:
** Carbohydrate intake is primarily responsible for post-prandial BG levels.
** The type of CHO as well as the amount consumed will determine post-prandial BG levels.
**“Gusher” or high GI CHOs are quickly digested into glucose and will cause a sharp and rapid elevation in BG levels.
**“Trickler” or low GI CHOs are slowly digested and absorbed into the bloodstream and cause a more moderate BG elevation.
** The “glycemic load” or the amount of a particular CHO will help predict the post-prandial BG elevation.
** Review the patient’s current CHO choices.
** Encourage low GI, low GL foods for improved glycemia.

Johanna Burani, MS, RD, CDE has spent the last 15 years in nutrition counseling, specializing in individually designed meal plans based on low glycemic index food choices.

Ms. Burani has worked with leading international scientists researching the glycemic index for the past six years and after contributing to 11 books has recently authored her new book “Good Carbs, Bad Carbs”. Her book was just selected this year’s #1 diet book by Self Magazine

Source: Diabetes In Control.com.

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