Diabetes Meal Planning: Advanced Carb Counting

If you’re currently using carb counting as a meal-planning method, you’ve probably learned that a little bit of skill is involved. For accuracy, you need to know how much food you’re eating and how much carb is in that food. In theory, it seems easy. In reality, it can be tricky. Very few people carefully weigh and measure their foods on a regular basis; over time, portion sizes become larger, and knowing how much carb one is consuming isn’t always easy. Nevertheless, with practice and perseverance, carb counting is a meal-planning approach that works well.

Advanced carb counting
Basic carb counting, which we covered last week, involves using either carb choices or counting grams of carb. For example, you might aim for three carb choices at lunch, which translates into 45 grams of carb. This approach can work well whether you manage your diabetes with healthy eating and exercise alone, with diabetes pills, or with insulin.


People who take mealtime (fast-acting) insulin may choose to move to the next “level” of carb counting, which is often called “advanced carb counting.” With this approach, you’re pretty much in the driver’s seat. You can determine how much (or how little) carb you’d like to eat. For example, you can eat a relatively low-carb meal one night for dinner, such as a piece of grilled chicken and a salad; the next night, your meal might be high in carb, like a pasta dish with garlic bread on the side. By adjusting your mealtime insulin accordingly to “cover” the carb, you can essentially eat the amount of carb that you want. Advanced carb counting is used by most people who use an insulin pump or who use what is called “basal-bolus” therapy (the use of fast-acting insulin before meals and a long-acting insulin once or twice a day).

How it works
Insulin-to-carbohydrate ratio: Advanced carb counting involves the use of an insulin-to-carbohydrate ratio. This is the amount of carbohydrate covered by one unit of fast-acting insulin. A 1:15 ratio means that one unit of fast-acting insulin covers 15 grams of carb; a 1:30 ratio means that one unit covers 30 grams of carb. There is no one ratio that works for everyone, and it’s common for a person to have different ratios at different meals. Your doctor or dietitian can help you determine what your ratio is.

Sensitivity factor: Another part of advanced carb counting is the use of the sensitivity, or correction, factor. This is another ratio that tells you how much insulin you need to take to “correct” for a high blood sugar. For example, a sensitivity factor of 50 means that one unit of fast-acting insulin can lower your blood sugar by about 50 points. You would use the sensitivity factor if your premeal blood sugar is above your target range; you might also use it between meals if your blood sugar is high (although you need to be careful about correcting, as this can lead to hypoglycemia, or low blood sugar). Like the insulin-to-carbohydrate ratio, your sensitivity factor can vary based on time of day and should also be determined with the help from a member of your diabetes care team.

Advanced carb counting isn’t for everyone. For one thing, you can only use this approach if you take mealtime insulin. In addition, at least initially, you need to invest some time and effort to make this work. Your ratios have to be tested to make sure they’re correct; they’ll likely need to be adjusted, especially when you get started. You’ll need to check your blood sugar before and after meals, and keep detailed records to ensure that your ratios are indeed working for you. And, of course, careful carb counting is a must — reading food labels, using a food database, and measuring/weighing out food portions is essential, especially as you get started. Another consideration: Being in the mindset that you can eat as much carb as you want — as long as you cover it appropriately — can sometimes lead to weight gain, if you’re not careful.

Is advanced carb counting for you? If you’re interested, talk with your dietitian or doctor. This form of meal planning offers flexibility and freedom from restrictions, but it will require a fair amount of effort to master it.

More on meal-planning approaches next week!

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