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Our Registered Dietitians are specialists in nutrition. We provide our clients with a personal meal plan that is customized to meet the needs of the individual, based on your lifestyle and food preferences. Contact us today to schedule a visit.

Carbohydrate Counting Overview

Carbohydrate counting is a way for people with diabetes to improve their blood sugar control. It is based on the idea that knowing what foods contain carbohydrates will put you in charge of your diabetes management.

When you are diagnosed with diabetes and meet with a registered dietitian (RD) or certified diabetes educator (CDE), you usually are given a carbohydrate prescription for each meal. This prescription will work with the medicine or insulin you are taking to help keep your blood sugar normal. By learning to count carbohydrates, you can easily keep your carbohydrates to the level that is recommended for you.

Basic carbohydrate counting is easy. When you master that, you can learn more complex ways to balance your blood sugar and insulin doses.

Carbohydrates are components of foods that provide energy to your body, such as sugars and starches. Your body needs carbohydrates to work correctly. Some foods are very high in carbohydrate (white bread, for example), while others are mixtures of carbohydrate and protein and/or fat (milk and cheese). Some carbohydrates are high in fiber and nutrients (fruits, vegetables, legumes, and whole-grain breads and cereals), while others have little nutritional value (sugar and candy).

Diabetes and carbohydrates
Individuals with diabetes need carbohydrates, just like everyone else, to keep their body working. Because some carbohydrates (whole-grain breads and cereals, low-fat or skim milk, fruits, and vegetables) are high in nutrients, it is important to get your carbohydrates from these types of nutrient-dense foods. These carbohydrates also are frequently high in fiber, which may help keep your blood sugar from rising too high.

In the past, people with diabetes were told to avoid carbohydrates, such as sugar, candy, soda, and other sweetened foods that do not have much nutritional value. Now we know that for people with diabetes who are using the principles of carbohydrate counting, it is possible to include these foods, in small amounts, as part of a healthful diet. For many people, adding a favorite sweet now and then can make it easier to stick to an eating pattern.

Including sweets in your diet
The following example will use a diet prescription of 60 grams (g) of carbohydrate at breakfast, 60 g at lunch, and 60 g at dinner. One portion (serving) of a carbohydrate is equal to 15 g; so, you are allowed four carbohydrate choices at each meal to equal 60 g (15x4=60). You can select these four choices from whatever foods you want.

For example:

• Breakfast: You may choose a bowl of cereal, a slice of whole-grain toast, a glass of skim milk, and one half of a large banana
• Lunch: You may select a sandwich on whole-wheat bread, a glass of skim milk, and one small brownie
• Dinner: You may have a hamburger on a 1-ounce hamburger bun, ⅓ cup baked beans, and one half of a large ear of corn on the cob

All of these meals contain 60 g of carbohydrate. You will need a food exchange list or booklet to follow until you learn the portion sizes. Once you start counting carbohydrates, you will quickly learn how many grams are in different foods and meal planning will become easier.

Carbohydrate counting while taking insulin
When you become skilled at basic carbohydrate counting, you can match your insulin dose to the amount of carbohydrate grams eaten at each meal. To master advanced carbohydrate counting, you probably will need to keep records of your meal intake, medication doses, exercise, and blood sugar levels. Once you notice the patterns of eating, exercise, and blood sugar changes in your day, you can use advanced carbohydrate counting and change your insulin doses to control your blood sugar to within strict limits.

Using advanced carbohydrate counting, you can calculate the exact amount of carbohydrate in combination foods, such as spaghetti and meatballs, potato salad, pizza, and other favorite foods. You will learn how to account for fiber, which is a carbohydrate in your foods, and how to consider the effects of protein, fat, and alcohol on rises and falls in blood sugar levels. Spending a little time learning the ins-and-outs of advanced carbohydrate counting can mean much more freedom at mealtime.

It is important to remember that even when your insulin doses meet your carbohydrate intake, it is still important to watch portion sizes, limit your intake of carbohydrates of little nutritional value, and keep saturated and trans fat intake to a minimum to help prevent heart disease.

Additional resources 
If you would like additional information about carbohydrate counting, talk to your doctor, call your local hospital, or look in the Yellow Pages under Diabetes to find an RD who can help you learn more about carbohydrate counting. Most communities offer diabetes treatment classes and individual therapy.

References
Kulkarni KD. Carbohydrate counting: a practical meal-planning option for people with diabetes. Clin Diabetes [serial online]. 2005;23:120-122. Available at:http://clinical.diabetesjournals.org/cgi/content/full/23/3/120. Accessed July 20, 2008.

American Diabetes Association. Carbohydrate counting: the basics. Clin Diabetes[serial online]. 2005;23:123-124. Available at:http://clinical.diabetesjournals.org/cgi/content/full/23/3/123. Accessed July 20, 2008