Carbohydrate Counting 101

There are several different ways people with diabetes can manage their food intake to keep their blood glucose (sugar) as close to normal as possible, and one such method is 'carbohydrate counting'. Carbohydrate counting is a method of calculating grams of carbohydrate consumed at meals and snacks. We count carbohydrates because they have the greatest effect on glucose. Before starting any new treatment or meal plan, you should always consult with your diabetes care professional.

What are the benefits of counting carbs?

Counting carbohydrates is a good solution for many people with diabetes. Once you learn how to convert grams into their equivalent amount of carbohydrates, it is easier to incorporate a wider array of foods into your meal plan, including combination foods such as those in frozen dinners. For example, by consulting the Nutrition Facts on a frozen dinner, you can easily calculate the number of carbohydrates in the meal,  rather than trying to calculate how that particular food fits into the more traditional exchange meal plan.

Another benefit of counting carbohydrates is that it can bring tighter control over your glucose readings. Being as precise as possible with your carb intake and medication will likely allow you to regulate blood glucose after a meal.

Lastly, counting carbohydrates may also allow you to adjust the amounts of carbohydrates you eat at each meal, rather than feeling like you have to eat a certain amount of carbohydrates, even if you do not want to.

Who can use 'carbohydrate counting'?

Carbohydrate counting can be used by anyone with diabetes, not just people taking insulin.

This method is also useful for people who are using more aggressive methods of adjusting insulin to control diabetes. The amount of meal and snack carbohydrate is adjusted based on the pre-meal blood sugar reading. Depending on the reading, more or less carbohydrate 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 than usual, carb counting can help you determine how much extra insulin to take. Depending on the situation, you must then adjust the amount of carbohydrates you eat at each subsequent meal to be certain it fits into your overall carbohydrate allowance, however, it does afford some flexibility with regard to how carbs are distributed throughout the day.

The following is an explanation of how to use carbohydrate meal planning. 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 having a meal plan and also knowing the average carbohydrate values of various 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.

Good resources for exchange systems are Joslin's 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 to have a carbohydrate counting reference book. We suggest: CalorieKing Calorie, Fat & Carbohydrate Counter by Allan Borushek, The Complete Book of Food Counts by Corinne Netzer, The Diabetes Carbohydrate and Fat Gram Guide by Lea Holzmeister, Calories and Carbohydrates by Barbara Kraus, Carbohydrate Guide to Brand Names and Basic Foods by Barbara Kraus, The Carbohydrate Addict's Gram Counter by Richard Heller, and The Restaurant Lovers' Fat Gram Counter by Kalia Doner. 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
Fruit
Vegetable
Milk
Protein
Fat
Carbohydrates

Step 2: Know your Carbohydrates

Most of the carbohydrates we eat come from three food groups: starch, fruit and milk. Vegetables also contain some carbohydrates, but foods in the meat and fat groups contain very little carbohydrates. This list shows the average amount of carbohydrates in each food group per serving:

	Carbohydrate Grams		Carbohydrate Grams
Starch	15	Vegetable	5
Fruit	15	Meat	0
Milk	12	Fat	0

To make things easy, many people begin carbohydrate counting by rounding the carbohydrate values of milk up to 15. In other words, one serving of starch, fruit or milk all contain 15 grams of 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 carbohydrates.

Complete the following chart to test your understanding:

2 slices bread = ______grams of carbohydrates

1 whole banana (9" size) = ______grams of carbohydrates

1 cup oatmeal with 1 cup milk = ______grams of carbohydrates

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 carbohydrates eaten at each meal should remain consistent (unless you learn to adjust your insulin for a change in the amount of carbohydrates 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 carbohydrates. (This is based on a meal plan of 3 starch servings, 4 protein, 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 carbohydrates you need to meet your 75 gram total. Add about 15 more grams of carbohydrates (one serving of fruit or milk, for example) and you have almost matched your total.

The final word on carbohydrate counting

Counting carbohydrates allows flexibility in your meal plan, but you can't abandon your meal plan and eat as many carbohydrates as you desire. Keep in mind your overall goals--to keep your carb intake at a certain amount each day, and keep your glucose as close to normal as possible--and you'll do well. Remember to consult your healthcare team before making any of the changes discussed here.