Carbohydrate Counting

Carbohydrate counting is one of several methods of meal planning used by people with diabetes. This relatively new approach was one of the meal planning methods used in the Diabetes Control and Complications Trial (DCCT), and it is based on recent advances in the study of diabetes management.
Carbohydrates in the diet have a direct effect on blood glucose levels. All foods that provide calories are converted into glucose by the body. While fats and proteins in a meal are eventually converted by the body into glucose to use for energy, carbohydrates (sugars and starches) are converted to blood glucose quickly- within an hour or so after a meal. Therefore, the level of glucose in the blood after a meal will be directly related to the amount of carbohydrate just eaten.
With the help of a Registered Dietitian, a person with diabetes can determine the amount of carbohydrate that should be eaten per day and at each meal and snack. The total amount of carbohydrate needed daily is based on a person’s calorie needs- carbohydrate should comprise 50 to 60 percent of the day’s calorie intake. For consistent blood glucose levels, the amount of carbohydrate eaten should be spread throughout the day; this will allow for a relatively even release of glucose into the blood from meal to meal and from day to day. For example, a person who needs about 1800 calories a day would need about 225 to 270 grams of carbohydrate a day, distributed evenly among the person’s meals and snacks. The total number of meals and snacks and their timing throughout the day can differ for each person, based on his or her nutritional needs, lifestyle, and the action and timing of medications.
According to recent research, the amount of carbohydrate in a meal is more important than the type of carbohydrate. Foods high in carbohydrates include starches such as rice, pasta, breads, cereals, and similar foods; fruits and juices; vegetables; milk and milk products; and anything made with added sugars, such as candies, cookies, cakes, and pies. Although a glass of fruit juice and the same amount of sugary soda may seem like a "good" versus "bad" choice, each will raise blood glucose about the same amount, because the total amount of CARBOHYDRATE is the same.
Contrary to the "old" philosophy of diabetes management in which sweets were "not allowed", refined sugars such as sucrose can be included in the diet of a person with diabetes, provided that the total carbohydrate content of that meal or snack remains the same. To use the carbohydrate counting method, then, it is very important to know your carbohydrate goal (the number of grams of carbohydrate to eat) for each meal and snack, as well as the carbohydrate content of different foods. Determining the amount of carbohydrate in foods can be done in several ways. The Nutrition Facts labels on packaged foods are very helpful: just look for the Total Carbohydrates line, which will give the carbohydrate content in grams per serving. Be sure to note the serving size listed on the label, as the nutrition information refers to one serving of that food. For people with diabetes who are familiar with the foods and serving sizes in the Exchange Lists for Meal Planning system, the conversion to carbohydrate counting is simple- each Starch, Fruit, and Milk exchange serving contains roughly 15 grams of carbohydrate. The carbohydrate content of foods can also be found in various reference books and charts available in the Nutrition or Food sections of most book stores.
A word of caution: while counting carbohydrates can help manage blood glucose levels, it can also lead to weight gain if the fat and protein contents of foods are ignored. A lot of foods contain both carbohydrate and fat, such as many desserts, which will dramatically increase the calorie content of your food choices and could lead to added pounds. A medium banana and a chocolate candy bar both contain about 30 grams of carbohydrate, but the chocolate bar also contains an extra 15 grams of fat and 150 calories!
For more information on carbohydrate counting and meal planning for people with diabetes, see a Registered Dietitian.