I always find it fascinating to have a window into diabetes "from the other side" -- i.e. what doctors and healthcare providers are doing and talking about. Something that caught my eye in the latest issue of the AADE's journal, The Diabetes Educator: a new 10-step guide to teaching carbohydrate counting, called (oh so cleverly!) C-O-U-N-T C-A-R-B-S.Carb_counting

It's apparently a program to help nurses teach diabetes patients diet tactics with more confidence, which is "shown to produce better behavioral outcomes that the didactic strategies commonly used in hospitals at present." Well, that sounds good.

Staff nurses are first encouraged to explore each patient's "individual medical and motivational factors." Right, no one size fits all!

Then -- after a number of other preliminaries -- they are encouraged to implement the following steps, based on Gray's evidence-based teaching strategy. Here are the 10 steps in shorthand:

1) Create a typical meal. The nurse is supposed to talk through the details of an ordinary meal the patient eats on a regular basis, including sauces, condiments, and beverages.

Innovation 2015

2) Offer information. Here the nurse defines carbohydrate, and explains which foods from the previous step contain them.

3) Use food lists and labels. A quick lesson in reading food packaging labels, including paying close attention to Serving Size, and the idea of 15-carb "units."

4) Now it's {the patient's} turn. The patient is next asked to try to estimate the total carb value of their typical meal in Step 1.

5) Take time. I quote: "Answer questions and provide clarification and performance feedback. (This step could last several days for many of us :)

6) Compare patient choices to written dietitian recommendations. The nurse is encouraged to be constructive and focus on the positive. (As in, "I see you enjoy your tortilla chips...")

7) Adjust meal. Talk about ways to alter meal choices based on dietitian recommendations. Here's where the nurse can use "visualization" for portion sizes, etc. I'm guessing they mean those plastic chicken legs and such.

8) Recalculate, record, reinforce. (Sound like a contest entry?) The patient gets to recalculate their initial meal as a sample entry in a food diary. The nurse demonstrates how to record BG readings and insulin doses. Learning is reinforced using "case scenarios."

9) Bolus. I guess they're actually practicing eating the meal at this point, 'cause the nurse is supposed to assist with administering an appropriate bolus.

10) Support learning. The nurse is supposed to provide resources for the patient to consult later on, like web sites, support groups, and customized food lists based on the patient's preferences. (Man, I need a list like that!)

So, my question is... how did you learn to carb-count? Did the person who taught you use anything like the method above? If you're like me, do you sort of "have it down" now and yet still feel like you're just eeking by most of the time?

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.