IN THIS CHAPTER

Knowing which foods contain carbohydrate

Determining the right amount of carbohydrate for you

Understanding how to count carbohydrate

Getting specific with advanced carbohydrate counting techniques

Using nutrition labels to calculate carbohydrate

If you’ve been diagnosed with diabetes or prediabetes, you’ve probably heard a lot of talk about carbohydrate. Carbohydrate is an important nutrient for people with diabetes to understand because it’s the nutrient that has the most impact on your blood glucose levels after meals. When you eat carbohydrate-containing foods, your body breaks carbohydrate down into several different types of simple sugars including glucose, which your body uses for energy. The glucose enters your bloodstream, and your blood glucose levels start to rise. Your body needs some glucose in order to function properly; however, if people with diabetes eat too much carbohydrate, their blood glucose can rise well above normal levels. Over time, high blood glucose can cause dangerous side effects. So it’s essential that people with diabetes manage their carbohydrate intake. In fact, carbohydrate control is one of the most important aspects of any diabetes meal plan.

In this chapter, we explore the diabetes meal planning method that deals directly with managing carbohydrate intake: carbohydrate counting. Carbohydrate counting simply means tracking the amount of carbohydrate you eat. To get started with carbohydrate counting, you need to know which foods contain carbohydrate and how much carbohydrate your body needs each day. Then we walk you through the carbohydrate counting basics and even touch on some advanced carbohydrate counting techniques.

Eating foods that contain carbohydrate will cause your blood glucose to rise, but carbohydrate is the main source of fuel for your body and can provide some essential vitamins, minerals, and fiber (if you choose nutritious carbohydrate foods). You don’t need to completely eliminate carbohydrate from your diet. Instead focus on choosing healthy sources of carbohydrate and managing your intake of carbohydrate-rich foods.

Know Your Carbs

Because carbohydrate has such a big impact on your blood glucose levels, it’s important to understand the sources of carbohydrate in our diets. Where does carbohydrate come from? It may surprise you to learn that carbohydrate is found in a wide variety of foods — some very nutritious, others a bit less healthy. Foods that contain carbohydrate or “carbs” include

• Fruit
• Fruit juices
• Starchy vegetables, such as corn, peas, potatoes, and pumpkin
• Beans
• Lentils
• Soy-based foods, such as meat substitutes, tempeh, tofu, and veggie burgers
• Milk
• Yogurt
• Grains, such as oatmeal, quinoa, barley, farro, and rice
• Grain-based foods, such as bread, cereals, pasta, and crackers
• Sweets and snack foods, such as cake, candy, cookies, chips, and regular sodas

Nonstarchy vegetables — such as tomatoes, carrots, peppers, broccoli, and salad greens — also contain carbohydrate. However, they are very low in carbohydrate and can be enjoyed in relatively large quantities with minimal impact on blood glucose. So, don’t be afraid to add some tasty nonstarchy veggies to your plate!

When choosing carbohydrate foods, look for nutrient-rich options like fruits, vegetables, beans and legumes, and whole-grains. These options contain fiber and other important nutrients that processed and refined sources of carbohydrate may not provide. Try to limit your intake of processed carbohydrates such as white breads, white pasta, sugary desserts, and regular sodas.

How Much Carbohydrate Is Right For Me?

The first step to carbohydrate counting is to figure out how many grams of carbohydrate your body needs each day and at each meal. Once you have carbohydrate goals in place, you can begin tracking the amount of carbohydrate you eat to make sure you don’t exceed your goals.

In order to better understand and work toward your carbohydrate goals, it can be helpful to first honestly track the amount of carbohydrate in what you normally eat throughout the day. Many people may find that they’re already within their carbohydrate goals at some meals, but there may be one meal or time of day where what they normally eat exceeds their carbohydrate goals. When they know this, they can focus on meeting their carbohydrate goals for that meal first; this is a good starting point that can provide a lot of benefit in terms of blood glucose management without feeling too overwhelming.

The American Diabetes Association doesn’t recommend a certain amount or range of carbohydrate that all people with diabetes should aim for each day. The amount of carbohydrate that is right for you is based on your individual needs. Determining the right amount for you depends on many different factors including your physical activity level; your eating patterns; your culture, lifestyle, and preferences; and what, if any, medicines you take. The amount of carbohydrate you eat per day should also help you achieve your diabetes goals; for example, if you want to lose weight in addition to lowering your blood glucose, your carbohydrate goals should take that into account. Some people can eat more carbohydrate than others and still keep their blood glucose levels in their target range. Finding the right balance of carbohydrate for you can provide you more control over blood glucose levels, potentially lower your risk of diabetes complications, and help you feel your best.

Discuss your personal carbohydrate needs with a registered dietitian (RD) or registered dietitian nutritionist (RDN) or your diabetes care team. A diabetes nutrition professional can help you determine how many grams of carbohydrate are right for you per day, how to split those grams between your meals, and if and where snacks might fit in your daily carbohydrate goals.

Your carbohydrate needs may change over time. You may need to adjust your carbohydrate goals if your weight, activity level, or medications change. As your diabetes progresses, it may become more difficult to manage your blood glucose using the same methods you first did and your carbohydrate goals may need to change at certain meals or over the course of the day. Don’t be afraid to reevaluate your carbohydrate intake with your healthcare team!

Basic Carbohydrate Counting: Be Consistent

Carbohydrate counting is really just a way to keep track of the amount of carbohydrate you’re eating. But there are actually two methods of carbohydrate counting: basic and advanced.

The goal of basic carbohydrate counting is consistency. People who follow a basic carbohydrate counting plan will have a target number of carbohydrate grams to aim for at each meal and snack. If you’re using this method of carbohydrate counting, eating around the same times each day and knowing how many carbs to eat at each of those times is the goal. Your carbohydrate goals may be different for breakfast, lunch, and dinner, but you have a goal for each meal and try to stay within that range.

Although the amount and timing of your carbohydrate intake should stay consistent with basic carbohydrate counting, you’re encouraged to eat a variety of healthy foods.

You can enjoy any carbohydrate-containing food as long as you account for it in your meal plan. If you practice basic carbohydrate counting, you’ll read the label on the food to determine how many grams of carbohydrate are in a serving and how many servings you actually want to eat of that food to get to your goal. You can keep a record of the amount of carbohydrate you eat at each meal using any method that works best for you. Some people like using a diabetes logbook, others like simple pen and paper, and others prefer using a food-tracking program or mobile applications. It’s a good idea to keep a record of what you eat, especially the amount of carbohydrate you eat, for a few days or a week prior to an appointment with your doctor or dietitian. That way if there are any changes in your blood glucose levels, you’ll have a record of your eating patterns.

It’s important to pay attention to serving sizes when you’re counting carbohydrate. If you double the serving size of a food, you double the amount of carbohydrate you’re eating. Eating more carbohydrate than you normally do at a meal will likely make your blood glucose level higher than usual after several hours. It’s a good idea to measure your foods with measuring cups and spoons if you’re not sure exactly what 1 cup of soup or ⅔ cup of yogurt looks like.

This basic counting strategy works for many people with diabetes, especially those with type 2 diabetes. Why? Because if you eat about the same amount of carbohydrate at each meal and snack, your blood glucose levels should become a bit more predictable. Reducing fluctuations in blood glucose levels can help lower your risk for diabetes complications and keep you feeling strong and healthy. Basic carbohydrate counting can also help you notice trends in how your body reacts to carbohydrate foods. Note: Other factors besides the carbohydrate you eat can affect your blood glucose; keep that in mind if your blood glucose readings are not what you expected.

The basic carbohydrate counting method is a meal-planning approach that generally works for people who can manage their blood glucose with diet and exercise alone or take fixed doses of insulin. Ask your healthcare provider if this meal-planning method is right for you.

Advanced Carbohydrate Counting

Advanced carbohydrate counting is more precise than the basic method. With advanced carbohydrate counting, you track the exact number of carbohydrate grams in the foods you eat. This method of carbohydrate counting is often used by people who are on insulin — usually multiple daily injections or an insulin pump — and need to match the amount of carbohydrate they consume to an insulin dose. Knowing the exact amount of carbohydrate you eat at each meal makes calculating insulin injections easier and more accurate. Discuss your needs with your healthcare team to determine if this method of carbohydrate counting is right for you.

As with basic carbohydrate counting (see the preceding section), the advanced method of carbohydrate counting allows you more freedom to choose which carbohydrate-containing foods you’d like to eat. But in both cases it’s important to still follow basic nutrition principles and balance your carbohydrate intake with healthy proteins, fats, and nonstarchy vegetables. You also want to be calorie conscious when you practice carbohydrate counting if you’re trying to lose or maintain your weight. Don’t let the focus on carbohydrate distract you from good nutrition!

Calculating specific carbohydrate amounts

Advance carbohydrate counting is a little more complex than the basic method and requires some basic math skills, especially for people who are using insulin. People who practice advanced carbohydrate counting use food labels to calculate the amount of carbohydrate in the foods they’re eating. It’s a good idea to familiarize yourself with the Nutrition Facts panel on food labels (see Figure 18-1). The nutrition information in this panel is the most accurate tool to use when calculating the amount of carbohydrate in your foods.

When you’ve determined the grams of carbohydrate in your meal, write the number down! Keeping track of the total grams of carbohydrate that you eat at each meal or snack is very important if you practice advanced carbohydrate counting. These values can help you calculate insulin doses, if you use insulin, and may help you troubleshoot inconsistencies in your blood glucose. So keep a written or electronic record for your own uses and to share with your healthcare provider.

If you use multiple daily injections of insulin or an insulin pump and you’re having trouble matching your insulin doses to your carbohydrate intake, it’s important to make an appointment with a diabetes educator or a doctor. These professionals can help you calculate how many units of insulin you’ll need to balance out the carbohydrate you eat.

Now that you know the basics of advanced carbohydrate counting, let’s take a look at a few methods to figure out the amount of carbohydrate in your foods: using nutrition labels and performing some advanced calculations.