Carbohydrate Counting

A meal-planning method that involves keeping the total carbohydrate intake at each meal consistent from day to day, with the aim of improving overall blood glucose control. Carbohydrate counting has become increasingly popular since the American Diabetes Association (ADA) changed its dietary recommendations in 1994. Based on growing scientific evidence that sugar affects blood glucose levels no differently than other carbohydrates, and that no single meal-planning method works for everyone, the new guidelines essentially lifted the “ban” on sugar-containing foods to focus attention on controlling total carbohydrate intake and individualizing meal plans.

Carbohydrate counting was first embraced by individuals on intensive insulin therapy who used an insulin pump or multiple daily insulin injections. Carbohydrate counting helps people who use insulin tailor their mealtime dose or bolus of insulin to cover the amount of carbohydrate eaten at that meal. However, more and more people with diabetes who don’t use insulin are now taking up carbohydrate counting because it helps control blood glucose levels.

Only the carbohydrate (not the fat or protein) in foods causes a significant rise in blood glucose level after eating. How much it rises depends on the amount of carbohydrate in the foods eaten, the size of the portions, and the amount of insulin available in the body. Eating the same amount of carbohydrate at the same meals and snacks every day can make it easier for a person to keep his blood glucose levels consistently within his target range and to see any unusual patterns of highs or lows.

To determine how many grams of carbohydrate you should eat at each meal or snack, it helps to work with a registered dietitian, who can assess your overall caloric needs and examine your blood glucose patterns to see how your body responds to food. Keeping careful records of the foods and portion sizes you eat, the medicines you take, and your activity and blood glucose levels throughout the day will make it easier to fine-tune your meal plan. Once you’ve determined your carbohydrate goals, you can choose what you’d like to eat and what portion size you can consume at each meal to meet those goals.

For example, if you are allotted 60 grams of carbohydrate at breakfast, you could combine a number of different foods, including the following: A) 1/2 cup orange juice (15 grams carbohydrate), 1 scrambled egg (less than 1 gram), two slices of toast (30 grams), and 1 tablespoon jelly (15 grams); or B) 1/2 cup shredded wheat (15 grams) with one cup skim milk (15 grams), and a 2-ounce bagel (30 grams) with cream cheese (0 grams). These two meals vary in terms of protein, calorie, and fat content, but they should have a similar impact on blood glucose level and require the same amount of insulin.

Because you can substitute one carbohydrate-containing food for another, carbohydrate counting gives you the flexibility to enjoy your favorite sweets on occasion. But doing that too often can lead to a nutrient-poor diet. The mainstay of a healthy diet remains a rich variety of vegetables, fruits, and whole grains, along with low-fat dairy products and fish.

Carbohydrate counting only works if you accurately measure portion sizes of the foods you eat. Underestimating the amount of carbohydrate in a jumbo size bagel or even a large apple can affect your blood sugar readings later in the day. Food items that are preportioned (such as sliced bread) and have detailed labels that spell out the carbohydrate content of each serving make the job easier. To accurately measure the proper serving sizes for some foods, though, you may need to use a food scale, measuring cups, or measuring spoons.

If you currently use the exchange system, you can easily convert to carbohydrate counting simply by noting the grams of carbohydrate in each exchange in your meal plan. One starch, fruit, or other carbohydrate exchange contains 15 grams of carbohydrate; one milk exchange contains 12 grams of carbohydrate; one vegetable exchange contains 5 grams of carbohydrate; and one meat or fat exchange contains 0 grams of carbohydrate.

Want to learn more about carbohydrate counting? Read “Counting Carbohydrates Like a Pro,” “Carb Counting” and “Carbohydrate Counting, Glycemic Index, and Glycemic Load: Putting Them All Together.”