Let’s get this straight: There is no such thing as a “pro” when it comes to carbohydrate counting. There is no master’s degree or PhD in Carbohydrate Science at any major university, nor is there a course focusing on carbohydrate counting in any dietetics or nutrition science program. And I’ve yet to meet anyone at a circus or carnival who, for a mere dollar, will “guess the carbohydrates” in your favorite food item, lest you win a valuable prize. So why would anyone with diabetes want to count carbohydrates “like a pro”?
Simple. When it comes to keeping blood glucose levels in control, carbohydrate counting works better than any other system. Better than counting calories. Better than avoiding sugar. And certainly better (and simpler) than the exchange system.
Carbohydrate is what raises blood glucose level abruptly after meals. Not fat or protein or vitamins or minerals. Just carbohydrate. Counting and managing the amount of carbohydrate in your diet has important benefits. If you take multiple daily injections of insulin or use an insulin pump, carbohydrate counting allows you to match doses of mealtime rapid-acting insulin to the foods you eat. This allows for almost unlimited dietary flexibility and helps to prevent post-meal highs and lows.
If you control your diabetes with diet and exercise, pills, or just one or two insulin injections a day, you can also use carbohydrate counting to improve your control. Researchers at the University of Texas School of Allied Health Sciences in Galveston found that consistent carbohydrate intake (eating the same amount of carbohydrate at the same meals every day) in people with Type 2 diabetes leads to improvements in blood glucose control, whether or not a person also loses weight. In their study, people who ate consistent amounts of carbohydrate at regular intervals lowered their average blood glucose by 55 mg/dl, and lowered their average HbA1c (glycosylated hemoglobin, or A1C) from 8.8% to 6.9%. (The American Diabetes Association recommends shooting for an HbA1c level below 7% to prevent long-term diabetes complications.)
A few definitions
Carbohydrate counting simply means adding up the total amount of carbohydrate (in grams) in meals and snacks. Carbohydrates include sugars, including sucrose (table sugar), fructose (fruit sugar), and lactose (milk sugar), as well as starches, which include much of the carbohydrate found in bread, rice, cereal, and potatoes. When you eat something that contains starch, the starch is broken down into simple sugars before entering your bloodstream.
Now here’s the kicker: From the standpoint of blood glucose control, it doesn’t matter if the carbohydrates you eat are in the form of sugars or starches. OK, now relax. Take a few deep breaths, then call your mom to say “I told you so.” Both sugars and starches will raise blood glucose by the same amount and at about the same rate. A cup of rice containing 45 grams of starch will raise blood glucose level just as much as a can of regular, sugar-sweetened soda containing 45 grams of sugar. In other words, don’t be overly concerned about the sugar content of a food. Be concerned about the “total carbohydrate” content of a food.
So that’s it? Just count the carbohydrates, and life will be wonderful? Not so fast. Accurate carbohydrate counting is what we’re after: That’s because being off by just 5 grams of carbohydrate can affect blood glucose by 30–40 mg/dl in someone who weighs 50–100 pounds and by 20 mg/dl in someone who weighs 150–200 pounds. But accurate carbohydrate counting had better not require too much work, or nobody’s going to do it.