Diabetes Meal Planning: Carb Counting

If you’ve been recently diagnosed with diabetes or perhaps need a refresher on diabetes management, using the plate method, which we looked at last week, can make sense to help you get started. The plate method is a simple tool that can yield big results. In fact, some people never go beyond using the plate method to manage their food. And that’s fine as long as it’s helping a person reach his diabetes and health goals.

This week, the focus is on the next level of meal planning, which is carbohydrate counting. Carbohydrate (carb) counting is a popular meal-planning approach that many people with diabetes use to help manage their condition. While seemingly new, carb counting was used many years ago by Dr. Elliot Joslin, founder of Joslin Diabetes Center, to help his patients. There are actually a couple of different “levels” of carb counting: basic and advanced.

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Basic carb counting
Years ago, people who had diabetes were usually taught how to use the exchange system for meal planning. While the use of exchanges is indeed helpful and effective, the reality is that some people find this approach confusing. In addition, exchanges, while meant to be flexible, can often seem rigid. Enter carb counting, a “newer” or perhaps “resurrected” form of meal planning that is designed to a) help improve and maintain blood glucose control and b) provide flexibility.

As the name implies, carb counting puts emphasis on the total amount of carb you consume. The assumption, at least initially, is that “a carb is a carb.” This means that, as long as you stay within your carb goal for a given meal or snack, it doesn’t really matter if you eat, say, an apple or a chocolate chip cookie: the end result on blood sugar is pretty much the same. In reality, however, this isn’t exactly the case. First of all, the goal is to choose healthy foods. Chocolate chip cookies are fine for an occasional treat, but they fall short of important nutrients and they supply empty calories. And second, thanks to studies on the glycemic index, researchers have learned (as you likely have, too) that not all carbs behave the same way on blood sugar.

For now, though, here’s how basic carb counting works:

Based on your calorie needs, blood sugar and HbA1c results, and other health factors, a dietitian or perhaps doctor will determine the total amount of carbohydrate that seems appropriate for you for a given day.

One carb choice is equal to 15 grams of carbohydrate (for example, 1 slice of bread or 1 small orange). You can choose to count choices or actual grams.

Because of the nature of carbohydrate, the goal isn’t to merely aim to achieve that total carb amount in a day; rather, the carb is spread out over your meals and snacks (if you eat snacks). So, for example, if your carb goal is 180 grams per day, a certain amount is allotted at breakfast, at lunch, at dinner, and perhaps at one or two snacks. Here’s how it might look:

Breakfast: 45 grams of carb
Lunch: 45 grams of carb
Snack: 15 grams of carb
Dinner: 60 grams of carb
Snack: 15 grams of carb

Moving forward, you would aim to consume the designated amount of carb at each of your meals and snacks each day. Doing so would help you to eat a consistent amount of carb, which, in turn, can work (along with medication and physical activity) to help you get and keep your blood sugars and HbA1c in a safe range.

What does 45 grams of carb look like, anyway? Here are two examples of a 45-gram-carb breakfast:

Breakfast 1:
2 slices whole-grain toast (30 grams carb)
1 cup cantaloupe cubes (15 grams carb)
2 teaspoons of peanut butter (0 grams carb)
1 boiled egg (0 grams carb)
Black coffee with stevia-based sweetener (0 grams carb)

Breakfast 2:
1 cup cooked oatmeal (30 grams carb)
3/4 cup blueberries (15 grams carb)
6 almonds (0 grams carb)
1/2 cup low-fat cottage cheese (0 grams carb)
Green tea (0 grams carb)

Note that these two breakfasts are very different (hence, the flexibility) yet still provide the same amount of carbohydrate.

Making carb counting work for you
In theory, carb counting can seem easy. You need to know what your carb goals are for meals and snacks, and you need to know how much carb is in the food you eat. While a dietitian can help you with your meal and snack carb goals, knowing how much carb is in your food isn’t always as easy as it seems. Here’s what will help:

Ask your dietitian for a food choice list to help get you started. You can also find such a list on the Internet or by purchasing a booklet from the American Diabetes Association.

Read food labels: Look at the serving size and the total grams of carb. Make sure you know what YOUR serving size is (if you eat twice as much, for example, the carb grams will double).

Purchase a carb-counting book or use a website that contains a food database, such as CalorieKing. Not all foods come with a label, so you’ll need to refer to one of these sources.

Weigh and measure your foods, at least for a while. Most people can’t accurately estimate their portions. What you THINK is 1 cup of pasta is often two to three times as much. Use a food scale for weighing out breads and fruit.

Watch your portions of non-carb foods, too. Just because beef or olive oil doesn’t have carb doesn’t mean you can eat as much of them as you want — all calories count.

Keep a food record when you first start carb counting, either on paper or with a smartphone app. This helps you know if you’re eating the “right” amount of carb for you and how it’s affecting your blood sugars. Bring your food records to your dietitian, too.

Check your blood sugars. Try checking before a meal and 2 hours after. Doing so will help you see the effect of the carb on your blood sugar. From there, you and your diabetes team can determine how everything is working and if any tweaks are needed, such as adjusting your medication or changing your carb goal.

Next week: Advanced carb counting!