Learn a simple method of counting carbohydrates to live well with diabetes.
Treating diabetes either Type 1 or Type 2 is unique in two very important ways. First, as a patient you bear the ultimate responsibility for your long-term health by carrying out certain day-to-day responsibilities with diabetes self-management. Second, your long-term health is directly and intimately associated with food the choices you make about regular, everyday food can have the greatest impact on how you feel today, and on how you fare over the years. Carbohydrate management, or carb counting, is where self-management responsibilities and your food choices meet.
What goes up does not come down
Diabetes is defined and diagnosed by higher-than-normal blood glucose levels, a condition called hyperglycemia. When a person eats carbohydrates whether they have diabetes or not blood glucose levels begin to rise as digestion frees glucose from food. Glucose is the special sugar that is your body’s favorite fuel, and in the same way your body prefers maintaining a normal temperature of 98.6F, your body prefers maintaining a normal level of glucose in your blood. With a standard metabolism, the body gets blood glucose levels to come down to normal levels by storing the excess glucose in muscle, fat and liver cells to use later. The hormone insulin, which is released from special cells of the pancreas, stimulates these cells to allow the entry of excess glucose and returns blood glucose to normal levels.
When there is an absence or shortage of insulin, or if the glucose storage cells don’t respond normally to it, blood glucose levels do not return to normal levels in a typical way. Diabetes is just that simple blood glucose levels do not come back down normally. Type 1 diabetes results from an absence of insulin production, and Type 2 diabetes usually begins when muscle, fat and liver cells do not respond normally to insulin in other words, insulin resistance. Blood glucose levels that are consistently higher than normal over time can damage blood vessels and nerves, leading to serious complications such as heart disease, stroke, vision loss, kidney failure, sexual dysfunction and more.
Staying healthy a second chance
Accepting the challenges of diabetes self-management gives you a second chance at a long, active life. Controlling blood glucose levels can greatly reduce your risk for complications, but your body needs your help. Medicine alone is not enough. Incorporating healthy eating habits into your daily life is essential for long-term health with diabetes. Managing carbohydrates quantity, quality and timing is where carb counting can make the difference.
First, know that attitude is everything. Your experience with healthy eating and carb counting can be completely positive if you get started (or start all over) with encouraging thoughts. Don’t think you’ve been sentenced to a life of food deprivation and restriction. Healthy eating for diabetes can and should be both delicious and satisfying. And don’t count on a magic bullet there are no secret cures, miracle foods or revolutionary dietary supplements. Self-management, including carb counting, is the most effective way to control blood glucose levels. The sooner you begin, the better your results.
Carb Counting 1, 2, 3
There are three easy steps to carb counting, and its important to take these steps in the following order:
1 Know your budget
Think of carbohydrates as a per diem. You should spend (eat) a specific number of carbohydrate grams per day, which will represent about 40-50 percent of your daily calories as determined by your registered dietitian or your doctor. Since each gram of carbohydrates contains 4 calories, a 1,500-calorie diet would contain around 150-187 carbs daily. Carbs are commonly spent in 15-gram packages called a carb choice, so a perdiem of 150 grams carbohydrate is the same as 10 carb choices. Your carb choices should be distributed among three or more meals, and maybe a snack or two. Remember, more carbohydrates send blood glucose higher and tax your body’s capacity to bring down those levels.
2 Know your carbohydrates
The good news is that carbohydrates are everywhere, so you can enjoy your carbs from a variety of foods. It’s important to note that you need carbs in your diet they’re your body’s most efficient source for energy.But to count carbs, you have to know a carb when you see one. In general, carbs fall into the following groups:
Dairy (milk, yogurt)
Sweets (sugar, syrups)
Beans and lentils
Starchy vegetables (potatoes, corn, peas, parsnips, hard-shell squashes)
Fruit (whole, dried, juice)
Grains (rice, barley, pasta, oats, breads, crackers, alcoholic beverages)
3 Know your portion sizes
The amount of carbohydrates in foods varies per the food, so the portion size representing one carb choice (15 grams carbohydrate) varies. Knowing which portion size equals one carb choice requires memorizing or consulting a resource, but in general, the following portion sizes apply:
Sweets 1 tablespoon
Dairy 1 cup (carbs are insignificant in many cheeses such as Brie, cheddar and grated Parmesan)
Starchy vegetables* cup cooked
Grains cup cooked, 1 slice bread(alcoholic beverages vary greatly)
Beans and lentils cup cooked
2 tablespoons dried fruit,
1 medium apple or orange,
1 cups strawberries,
*Nonstarchy vegetables have carbohydrates,but a portion size for one carb choice is as much as 3 cups raw (1 cups cooked), so these foods are generally not counted as carbs
Tips & Tools
It’s easy to learn the correct portion size for one carb choice of your favorite foods, but even the experts need help. For less common foods, mixed dishes and beverages, don’t hesitate to use assistance.
The nutrition labels on packaged foods will give you the grams of carbohydrate in the foods serving size. The label serving size will likely not be the same as a portion size containing one carb choice, so a little math may be required. Look at total carbohydrate and not just sugars.
Select recipes that give the number of servings and the carbohydrates per serving.
Books, apps and websites
Books, apps or websites can help you with simple carb counting information, or when facing complex challenges like eating out. Along with general information, you can visit individual restaurant websites or utilize apps such as Go Meals for more specific nutrition information.
The glycemic index values of carbohydrate foods are based upon the relative effect of different foods on the blood glucose levels of people with a normal metabolism. So while claims that low glycemic foods have no impact on blood glucose levels may not apply to people with diabetes who do not have normal carbohydrate metabolism these foods can be expected to have a lesser effect than high glycemic foods.
Perfection is not necessary in carb counting. In fact, simply thinking about food before eating is half the battle.
Set your personalized goals with professional help from a registered dietitian. Get your carbs from a variety of sources, spread them throughout the day, limit concentrated sweets, and use all of the available resources to help you succeed.
Toby Smithson, MSNW, RDN, LDN, CDE, is a registered and licensed dietitian, certified diabetes educator and national spokesperson for the Academy of Nutrition and Dietetics. Smithson is a Diabetes Lifestyle Expert with EosHealth and is the founder of DiabetesEveryDay.com, an online guidance and support resource for people with diabetes. She is also the co-author of Diabetes Meal Planning and Nutrition for Dummies by Wiley Publishing released October 2013.