There are several different ways people with diabetes can manage their food intake to keep their blood sugars as close to normal as possible. One such method is carbohydrate counting. Carbohydrate counting is a method of calculating the grams of carbohydrate (carb) you eat at meals and snacks. The reason you focus on counting grams of carbohydrate is because carbohydrates tend to have the greatest effect on your blood sugar.
When you understand how to count grams of carbohydrate, you can have a wider choice of foods in your meal plan. It is easier to fit in combination foods such as soups and frozen dinners because you look at the grams of carbohydrate listed on the package, rather than trying to calculate how that particular food fits into the more traditional exchange meal plan. Also, some people find they can control their blood sugars more precisely.
Carbohydrate counting can be used by anyone with diabetes - not just people taking insulin. This method can assure that the right amount of carbohydrates is eaten at each meal and snack. Now that foods are more clearly labeled, it is easy to find the carbohydrate content of packaged foods.
This method is also useful for people who are using more aggressive methods of adjusting insulin to control their diabetes. The amount of meal and snack carbohydrates is adjusted based on the premeal blood sugar reading. Depending on the reading, more or less carbohydrates may be eaten. Likewise, insulin may be adjusted based on what the person wants to eat. For example, if you want to eat a much larger meal, this approach can guide you to determine how much extra insulin to take.
The following is an explanation of how to use carbohydrate meal planning. Feel free to print these pages and discuss them with your nurse educator, dietitian or physician at your next visit.
Tools of the Trade:
In order to count carbohydrates, you must begin by knowing your meal plan and the average carbohydrate values of the food groups. If you don't have some form of a meal plan developed by your health care team, you will be unable to figure out how many grams of carbohydrate you are supposed to eat at each meal and snack. Start by making sure you know the exchange list grouping systems and the average amount of carbohydrate per serving in each food group. Good resources for exchange systems are Joslin's guide, Menu Planning - Simple!, Joslin's Guide to Diabetes (which also contains a chapter discussing meal planning, including carbohydrate counting) or the American Diabetes Association's Exchange Lists for Meal Planning. It is also helpful if you also have a carbohydrate counting reference book. We suggest The Carbohydrate Counters Guide Book by Barbara Kraus, a pocket book published by Bantam Books, 1993. Measuring equipment, such as a food scale, measuring cups and spoons, is essential. Probably the most frequently used tool will be food labels.
Step 1: Know your meal plan
Indicate on the chart below the number of servings from each food group planned as part of your meal plan. The last row will be completed in Step 2.
Food Groups: | Breakfast | Snack | Lunch | Snack | Dinner | Snack
----------------|-----------|-------|-------|-------|--------|-------
Starch or bread | | | | | |
----------------|-----------|-------|-------|-------|--------|-------
Meat | | | | | |
----------------|-----------|-------|-------|-------|--------|-------
Fruit | | | | | |
----------------|-----------|-------|-------|-------|--------|-------
Vegetable | | | | | |
----------------|-----------|-------|-------|-------|--------|-------
Milk | | | | | |
----------------|-----------|-------|-------|-------|--------|-------
Fat | | | | | |
----------------|-----------|-------|-------|-------|--------|-------
Carb Grams | | | | | |
Step 2: Know your carbohydrates
Most of the carbohydrate we eat comes from three food groups: starch/bread, fruit and milk. Vegetables also contain some carbohydrates, but foods in the meat and fat groups contain very little carb. This list shows the average amount of carbohydrate in each food group per serving:
Carb grams Carb grams Starch/bread 15 Vegetables 5 Fruit 15 Meat 0 Milk 12 Fat 0
To make things easy, many people begin carbohydrate counting by rounding the carbohydrate value of milk up to 15. In other words, one serving of starch, fruit or milk all contain 15 grams carbohydrates or one carbohydrate serving. Three servings of vegetable also contain 15 grams. One or two servings of vegetables do not need to be counted. Each meal and snack will contain a total number of grams of carb.
Complete the following chart to test your understanding:
2 slices bread = ______grams carbohydrate
1 whole banana (9" size) = ______grams carbohydrate
1 cup oatmeal with 1 cup milk = ______grams carbohydrate
Look back at your meal plan in Step 1. Total up the number of grams of carbohydrate for each meal and snack and write the totals in the last row. It is more important to know your carbohydrate allowance for each meal and snack than it is to know your total for the day. The amount of carbohydrate eaten at each meal should remain consistent (unless you learn to adjust your insulin for a change in the amount of carbohydrate eaten).
Step 3: Using carbohydrate counting in meal planning
Here is an example to show how carbohydrate counting can make meal planning easier. Let's say your dinner meal plan contains 5 carbohydrate servings or 75 grams of carb. (This is based on a meal plan of 3 starch/ bread servings, 4 meat, 1 vegetable, 1 fruit, 1 milk and 3 fat.) The label on a frozen dinner of beef enchiladas says it contains 62 grams of carbohydrate. Instead of calculating how many exchanges that converts to - just figure out how many more grams of carbohydrate you need to meet your 75 gram total. Add about 15 more grams of carbohydrate (one serving of fruit or milk, for example) and you have almost matched your total.
Try another example. If you want to have chili for lunch, what else can you have with it? The label on the chili says it contains 29 grams of carbohydrate per 1 cup serving.
My lunch carbohydrate allowance:_________
This is what I will eat:
The amount of food you eat is closely related to blood sugar control. If you eat more food than is recommended on your meal plan, your blood sugar goes up. Although foods containing carbohydrate (carb) have the most impact on blood sugars, the calories from all foods will affect blood sugar. The only way you can tell if you are eating the right amount is to measure your foods carefully.
Measuring hints:
| Practice, practice, practice. Don't rely on measuring once and then just "guesstimating". Pull out the scales at least once a week to check yourself and reinforce your skills. |
| Use a glass which you know only holds 4 or 8 ounces to better control your portion. You can also place a piece of tape on the outside of a glass to mark a 4 or 8 ounce line so you will be able to measure easily. |
| A bread serving is based on a one-ounce slice of bread. Many single bread servings may weigh more than one ounce, and therefore have more impact on blood sugar. Check the weight or the label of such things as light breads, bagels or rolls. |
| To be more precise, know the weight of fruit servings for portion control. |
| Check your cereal portion using measuring cups. The cereal label will give you a more precise nutrition information such as calories, carbohydrate and fat grams than the food group averages. |
Test your memory:
How much of each of these foods can you have for a 15 gram carbohydrate (or 1 fruit or 1 bread) serving?
Cherries ________________ Rice ___________________
Raisins _________________ Vanilla Wafers ___________________
Grapefruit juice _________________ Lentils/dried beans_________________
It is commonly thought that people with diabetes should avoid all forms of sugar. Most people with diabetes can eat foods containing sugar as long as the total amount of carbohydrate (carb) for that meal or snack is consistent. Many research studies have shown that meals which contain sugar do not make the blood sugar rise higher than meals of equal carbohydrate levels which do not contain sugar. However, if the sugar-containing meal contains more carb, the blood sugar levels will go up.
Which will have the greater effect on blood sugar?
____ 1 tsp sugar or ____ 1/2 cup potatoes
The potatoes will contribute about 15 grams of carb, while a level teaspoon of sugar will only give 4 grams of carb. Therefore, the potatoes will have about three times the effect on blood sugar as compared to the table sugar.
Meal Planning Practice
Using the following foods, plan two breakfast meals containing approximately 45 grams of carbohydrate. Notice that there are some foods on this list you might think would not be "allowed" on your meal plan. But again, any of these foods can be used as long as you limit the amount of carbohydrates you eat at a given meal to what your dietitian has told you to have for that meal. (In the example below, this means you can choose whatever foods you want as long as the total carbohydrate equals no more than 45 grams).
Food Amount Carb grams | Food Amount Carb grams
---------------------------------------|----------------------------------------
1 % fat milk 1 cup 12 | yogurt, fruited 1 cup 40
Bran Chex 2/3 cup 23 | yogurt, fruit 1 cup 19
Frosted Flakes 3/4 cup 26 | with NutraSweet
Raisin Bran 3/4 cup 28 | fruit juice 1/2 cup 15
bread/toast 1 slice 15 | banana 1/2 15
sugar, white table 1 tsp. 4 | pancake syrup 2 Tbsp 30
pancakes - 4" 2 15 | lite pancake 2 Tbsp 15
low-fat granola 1/2 cup 30 | sugar-free syrup 2 Tbsp 4
--------------------------------------------------------------------------------
Sample Breakfast #1 | Sample Breakfast #2 | Sample Breakfast #3
carb gms | |
| |
Fruit yogurt (with 19 | |
NutraSweet) | |
Cinnamon-sugar | |
toast - 1 slice, | |
with 1 tsp. sugar 19 | |
and 1 tsp. margarine | |
Milk, 1/2 cup 6 | |
| |
Carb total = 44 | |
Does this mean I can eat cake and not worry about it?
No! A slice of white cake with chocolate icing ( 1/12 of a cake or 80 gram weight) will give you about 300 calories, 45 grams of carbohydrate and 12 grams of fat. That is three starch/bread servings and over 2 fat servings. Before you have a slice of cake - ask yourself the following questions: Will that small piece of cake be satisfying or will I still be hungry? How it will fit into my meal plan? Do I have 300 calories to "spend" on this? Are there other choices I could make which would contribute less fat? A 1/12 slice of angel food cake has less than 1 gram of fat and only 30 carbohydrates. This may be a better choice.
Controlling all carbohydrates
It is important to realize that sugar is not the only carbohydrate that you have to "control". The body will convert all carbohydrate to glucose - so eating extra servings of rice, pasta, bread, fruit or other carbohydrate foods will make the blood sugar rise. Just because something doesn't have sugar in it doesn't mean you can eat as much as you want. Your meal plan is designed so that the carbohydrate content of your meals remains as consistent as possible from day to day.
A word of caution:
Although sugar does not cause the blood sugar to rise any higher than other carbohydrates, it should be eaten along with other healthy foods. If you choose to drink a 12 ounce can of a sugar-sweetened soft drink, that would use up about 45 grams of carbohydrate-and you wouldn't have gotten any nutrition (protein, vitamins or minerals). What a waste of calories!
High sugar foods are more concentrated in carb. Therefore the volume would be smaller than a low sugar food. What is your eating style? Are you able to control your portion size - or are you likely to overeat? High sugar foods might not be a good choice if they will just tempt you to eat more. If you would rather eat larger portions, select low sugar choices. Look at the differences in portion size you get for equal amounts of carbohydrate in these cereals!
1/4 cup 1/3 cup 3/4 cup 1 cup 1 1/4 cup Granola Frosted Flakes Cornflakes Cheerios Puffed Wheat
In addition, many sugar-containing foods also contain a lot of fat. Foods such as cookies, pastries, ice cream and cakes should be avoided largely because of the fat content and because they don't contribute much nutritional value. If you do want a "sweet" - make a low-fat choice, such as low-fat frozen yogurt, gingersnaps, fig bars or graham crackers and substitute it for another carbohydrate on your meal plan.
Talk with your diabetes dietitian educator to select the best "sweet" choices for your meal plan. If you have not met with a dietitian in the past year or if you do not have a personal meal plan, scheduling an appointment with a dietitian would help you to incorporate these guidelines in the best way for you and your diabetes control.
The preceding is based on material from the Joslin Clinic and distributed by Ronald Chusid, D.O.
Dr. Chusid has practiced Internal Medicine in Muskegon since 1985, and has held positions including Chairman of the Department of Medicine and Chairman of the Critical Care Committee at Muskegon General Hospital. He is also an Assistant Clinical Professor of Medicine at Michigan State University, Medical Director of IHS Home Care, and a member of the Council on Complications of the American Diabetes Association. His office is located at 1762 E. Oak Avenue, Muskegon, Michigan. Phone (616) 773-3258.
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