Introduction
Carbohydrate counting is an important skill to help you maintain tight control of your blood sugar (glucose) level when you have diabetes. It gives you the flexibility to eat what you want and increases your sense of control and confidence in managing your diabetes.
Key points:
- Carbohydrate counting helps you maintain your blood sugar at a safe level.
- Carbohydrate counting allows you to adjust the amount of insulin you take based on how many grams of carbohydrate you eat at a meal or snack. The formula used to determine the amount of insulin you need is called the “insulin-to-carbohydrate ratio.”
- The insulin-to-carbohydrate ratio differs from one person to another. You and your diabetes health professional will calculate your ratio by recording the food you eat and testing your blood sugar level after meals.
What is carbohydrate counting?
Why is carbohydrate counting important?
How do I count carbohydrate grams in my diet?
Where to go from here
Return to topic:
What is carbohydrate counting?
Carbohydrate counting is a recommended method of meal planning for people who have diabetes. It involves matching insulin to the grams of carbohydrate in the foods you eat to keep your blood sugar level in your target range.
Carbohydrate—the body's main source of fuel—affects blood sugar more than any other nutrient. All forms of carbohydrate increase your blood sugar level. Foods that contain carbohydrate include:
- Fruits and vegetables.
- Milk and yogurt.
- Starchy foods (such as breads, cereals, and vegetables such as potatoes and corn).
- Sugary foods (such as candy and cakes).
Contrary to what you may have heard, you can eat sugar when you have diabetes. However, if foods that contain sugar make up a large part of your diet, you are probably not eating enough of other, more nutritious foods.
Test Your Knowledge
- Which of these foods contain carbohydrate?
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Wheat bread, rice, peas, and oatmeal
The answer is correct
Wheat bread, rice, peas, and oatmeal all contain carbohydrate. Carbohydrate is an essential nutrient found in foods such as bread, cereal, grains, and vegetables. It also is in fruit, milk, desserts, and candy. Both answers are correct.
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Cheesecake, skim milk, and pears
The answer is correct
Cheesecake, skim milk, and pears all contain carbohydrate. Carbohydrate is an essential nutrient found in foods such as bread, cereal, grains, and vegetables. It also is in fruit, milk, desserts, and candy. Both answers are correct.
Continue to Why is carbohydrate counting important?
Return to Carbohydrate counting for people who use insulin
Why is carbohydrate counting important?
Carbohydrate counting helps prevent low or high blood sugar levels, which can cause medical emergencies. Over time, high blood sugar levels can damage many body tissues and organs.
Counting carbohydrate grams allows you to match insulin to the food you eat every day to keep blood sugar at a safe level. This method is effective because carbohydrate is the main nutrient that causes blood sugar to rise after meals, increasing the need for insulin. Carbohydrate turns into glucose within 2 hours of eating.
If you use an insulin pump or take multiple insulin injections, you need to know how many grams of carbohydrate are in a meal to calculate how much rapid-acting insulin to take before you eat. A pump provides a continuous (also known as basal) rate of insulin throughout the day, but it must be programmed at meals to provide extra insulin to allow for the rise in blood sugar after meals. Once you know how much carbohydrate you will eat, you can program extra units, or boluses, of insulin to cover your meals.
You figure out how much insulin to use based on your own insulin-to-carbohydrate ratio. This ratio may be different from one person to another, and even your own ratio may change over time. You and your diabetes health professional will calculate the ratio by recording the food you eat and testing your blood sugar after meals.
Test Your Knowledge
- Carbohydrate counting helps me know how much insulin I need to take at meals.
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True
The answer is correct
Carbohydrate counting does help you know how much insulin to take at meals. You will use your own insulin-to-carbohydrate ratio to determine how many units of insulin you need to cover the carbohydrate in your meal.
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False
The answer is incorrect
Carbohydrate counting does help you know how much insulin to take at meals. You will use your own insulin-to-carbohydrate ratio to determine how many units of insulin you need to cover the carbohydrate in your meal.
Continue to How do I count carbohydrate grams in my diet?
Return to Carbohydrate counting for people who use insulin
How do I count carbohydrate grams in my diet?
To count carbohydrate grams at a meal, you need to know how much carbohydrate is in each type of food, whether it is a slice of bread, a bowl of lettuce, or a tablespoon of salad dressing. Fortunately, nearly all packaged foods have labels that tell you how much total carbohydrate is in a single serving. Carbohydrate guides also are available from diabetes educators and the American Diabetes Association.
To calculate the carbohydrate in food that is not packaged, you will need to know standard portions of carbohydrate foods. Each serving size or standard portion contains about 15 grams of carbohydrate.
Once you know the number of grams of carbohydrate in a meal, you can figure out how many units of insulin to take based on your personal insulin-to-carbohydrate ratio.
For example: Your health professional may recommend that you take 1 unit of rapid-acting insulin for every 10 grams of carbohydrate you eat. So if your meal contains 50 grams of carbohydrate, you would need 5 units of insulin to keep your post-meal blood sugar from rising above your target level.
Your insulin-to-carbohydrate ratio may change over time. In some people it will differ from one meal to another. You might take 1 unit of insulin for every 10 grams of carbohydrate for lunch but take 1 unit for every 15 grams at dinner. Keep the following in mind when counting carbohydrate grams:
- Portion control is important. If a package indicates it contains two servings and you eat the whole package, you need to double the number of grams of carbohydrate listed for one serving.
- Protein, fat, and fiber do not raise blood sugar as quickly or as high as carbohydrate. If you eat a lot of these nutrients in a meal, carbohydrate will convert to glucose more slowly than it would with a small amount of protein, fat, and fiber.
- Exercise affects blood sugar, allowing you to use less insulin than you would if you were not exercising. Keep in mind that timing makes a difference. If you exercise within 1 hour of a meal, your body may need less insulin for that meal than it would if you exercised 3 hours after the meal.
By keeping track of what you eat and testing your blood sugar after meals and exercise, you can learn to estimate the effect of protein, fat, fiber, and exercise on the amount of insulin you need.
Count carbohydrate grams and eat a balanced diet by:
- Talking with a registered dietitian. He or she can help you plan the amount of carbohydrate to include in each meal and snack.
- Weighing or measuring your food. You won't always have to weigh or measure your food; however, it may be helpful when you are first learning what makes up a standard portion.
- Counting either grams or servings of carbohydrate. A registered dietitian will help you plan how much carbohydrate, including sweets, to have in each of your meals and snacks.
- Eating standard portions of foods that contain protein. Foods that contain protein (meat and cheese) are an important part of a balanced diet.
- Limiting fats. A balanced diet includes a limited amount of healthy fats. Talk with a registered dietitian about how much fat you need in your diet.
Other helpful suggestions
- Read food labels for carbohydrate content. Be careful to consider the serving size on the package.
- Check your blood sugar level. If you do this before and 1 hour after a meal, you will be able to see how the food you eat affects your blood sugar level.
- Record what you eat and your blood sugar results in a food record. At each regular visit with your diabetes specialist, or whenever you think your diet plan needs adjusting, you can review your food record
(What is a PDF document?). - Get more help. The American Diabetes Association offers booklets to help people learn how to count carbohydrate grams in their diet, to measure and weigh food, and to read food labels. See the Where to Go From Here section below for the address and phone number of the American Diabetes Association. However, you will still need to talk with a registered dietitian to establish a plan that fits your needs.
Test Your Knowledge
- I can eat only a certain amount of carbohydrate at one sitting or my blood sugar will be too high.
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True
The answer is incorrect
The amount of carbohydrate you eat at a meal can vary. You keep your blood sugar under control by matching the amount of insulin you take to the amount of carbohydrate you eat.
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False
The answer is correct
The amount of carbohydrate you eat at a meal can vary. You keep your blood sugar under control by matching the amount of insulin you take to the amount of carbohydrate you eat.
- Calculate the carbohydrate content in the following breakfast. Use the information in the carbohydrate foods and foods that contain protein links to calculate the carbohydrate. The breakfast includes 2 eggs, 1 cup of milk, 1 slice of toast, and 2 teaspoons of margarine.
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30 grams of carbohydrate
The answer is correct
This breakfast contains 30 grams of carbohydrate. The eggs and margarine have no carbohydrate, while the milk has 15 grams and the toast has 15. If you had problems with this exercise, take the question with you to your next visit with your diabetes specialist. Have him or her help you learn how to calculate the carbohydrate content in food.
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35 grams of carbohydrate
The answer is incorrect
This breakfast (2 eggs, 1 cup milk, 1 slice of toast, and 2 teaspoons margarine) contains less than 35 grams of carbohydrate. The correct answer is a. The breakfast contains 30 grams of carbohydrate. There is no carbohydrate in the eggs and margarine, 15 grams in the milk, and 15 in the toast. If you had problems with this exercise, take the question to your next visit with a diabetes specialist to learn how to calculate the carbohydrate content in food.
Continue to Where to go from here
Return to Carbohydrate counting for people who use insulin
Where to go from here
Now that you have read this information, you are ready to plan regular meals and snacks and calculate the amount of carbohydrate in your diet.
Talk with your diabetes specialist (doctor or other health professional, registered dietitian, or certified diabetes educator). If you have questions about this information, take it with you when you visit your diabetes specialist.
If you need help with carbohydrate counting or menu planning, see a registered dietitian.
If you would like more information on the diet for people who have diabetes, the following resources are available:
Organization
| American Diabetes Association (ADA) | |
| 1701 North Beauregard Street | |
| Alexandria, VA 22311 | |
| Phone: | 1-800-DIABETES (1-800-342-2383) |
| E-mail: | AskADA@diabetes.org |
| Web Address: | www.diabetes.org |
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The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes. |
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References
Other Works Consulted
Hill JV, Beaser RS (2001). Carbohydrate counting and Necessity of carbohydrate counting for patients using an insulin pump sections of Medical nutrition therapy. In RS Beaser et al., eds., Joslin's Diabetes Deskbook, pp. 90–92. Boston: Joslin Diabetes Center.
Credits
| Author | Caroline Rea, RN, BS, MS |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Michele Cronen |
| Associate Editor | Pat Truman |
| Primary Medical Reviewer | Caroline S. Rhoads, MD - Internal Medicine |
| Specialist Medical Reviewer | Matthew I. Kim, MD - Endocrinology & Metabolism |
| Last Updated | August 14, 2007 |
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