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Managing Diabetes Magazine - diabetes

Counting Carbs
An effective tool for managing diabetes

Need a strategy to help you to lose, gain or manage weight, plan healthy meals and keep blood glucose levels within range? If so, carbohydrate counting may be the tool for you.

Diabetes Canada recommends learning how to count carbohydrates, as the quantity of carbs eaten at one time affects diabetes management. Counting carbohydrates and eating a healthy, diabetes-friendly diet can improve your health. These two activities can reduce the risk of developing heart and blood vessel disease for those with type 1 or type 2 diabetes.

Advanced carb counting can also help manage blood glucose levels. It works by matching the type and amount of carbohydrates to your medications. If you use insulin, your diabetes care team can help you to establish an insulin to carb ratio. Your self-monitored blood glucose values can be used to match the amount of carbohydrate covered by one unit of insulin.

What are carbohydrates?

Carbohydrates, protein, and fat are the three main macronutrients that make up our food. They include starch, sugar and fibre. Carbs are found in grains, root and sweet vegetables, all fruits, milk and milk alternatives, legumes, sugar and high-sugar foods like candy, jam and baked goods. Most carbohydrate is converted to glucose, the body’s main source of energy.

Protein is found in all meat, poultry, fish, cheese and legumes. Protein breaks down into amino acids that are used as an immediate energy source and to build and repair tissues. Excess protein is stored as fat. When protein is consumed in appropriate amounts, it has minimal impact on blood glucose.

Fat is found in higher-fat meat and dairy products, as well as in oils, nuts, seeds, butter, margarines, and commercial baked products. It is stored as a source of energy, provides insulation, and transports certain nutrients in the body. A high-fat meal may affect blood glucose, as fat can delay the time it takes for food to move from your stomach. This in turn delays the absorption of glucose, resulting in higher glucose readings later on. A high-fat meal may also cause the body to be less responsive to insulin, either your own or injected. Instead, choose a low-fat meal with a focus on mono and poly-unsaturated fats, including omega-3 fats. Eating this way is better for your heart and can help reduce high blood glucose after meals.

Of the three macronutrients, carbs have the largest impact on your blood glucose. The starch and sugar in carbs break down into glucose during digestion, directly affecting your blood glucose level. The fibre in carbohydrate is not digested, does not break down into glucose, and is not used for energy.

Keep in mind that in order to function, your brain needs the glucose in carbohydrate. For this reason, minimum amounts of carbohydrate are specified in dietary recommendations. Adults require no less than 130 grams of carbohydrate each day.

The effect of different foods on blood glucose can vary

The glycemic index is a system that assigns values of high (70 or more), medium (56 to 69), or low (55 or less) to food. The value indicates how rapidly carbohydrate foods are digested and absorbed in the two hours after it is consumed. A food with a low glycemic index value, such as parboiled rice, causes a smaller rise in blood glucose than a high glycemic index food like instant rice. Diabetes Canada reports that many reliable studies confirm that low glycemic diets help to control blood glucose and blood lipids in people with diabetes.

To manage your blood glucose levels, design your meals to include low glycemic index foods, an appropriate amount of protein and healthy fat.

How carbohydrate counting works

Carb counting involves several steps:

• Begin by learning how to identify foods that are carbohydrates.
• Establish the amount of carbohydrate you are consuming. It may help to keep a food journal of all the food and drink you have over a period of at least three days. Note your portion sizes using measuring cups or food scales.
• Label reading can help with carbohydrate counting and healthy eating. Begin with the nutrition facts table (see sidebar for details). Compare the serving size on the package to the amount you are going to eat. The total amount of carbohydrate in grams includes starch, sugar and fibre. Fibre does not raise blood glucose and should be subtracted from the total carbohydrate listed.

Accurate measurements

Measure food using nesting measuring cups for dry and cooked foods. Other foods need to be measured by volume with a graduated measuring cup. Learning to measure portions accurately takes time. Be patient and become familiar with what your typical portions look like on your plate. For instance, if you typically eat one cup of cereal with half a cup of milk, measure these amounts in your favourite bowl repeatedly until you can ‘eye-estimate’ the amount.

If your blood glucose control changes, get the measuring tools out again.

Measuring Carbohydrate
A weigh scale can help you to figure out the amount of carbohydrate available in one gram of a given food. Some digital nutrition scales have a built-in carb/fibre and available carb tracker. Weigh the carb food choice. Determine the amount of available carb in that choice using a carb factor list or other method (see Figuring out carb content sidebar). Multiply by that factor. Example: One 10-inch tortilla contains 38 grams of available carbohydrate.
Weight	X	Carb Factor	Available Carb
74 grams	x	.52	Available Carb
To count the total number of carbohydrates in a recipe, consider the number of servings it makes. List all of the ingredients that are carbohydrates. Find the carb and fibre amount for each ingredient (see Figuring out carb content sidebar). Add up all available carbohydrate. Divide this number by the number of servings in the recipe to determine the carb amount.

It can really help to work with a dietitian who can assess your nutritional requirements, including carbohydrate needs, based on your age, gender, weight, activity, and weight goals. Set carbohydrate goals for each meal and snack that meet your overall goals for managing blood glucose, weight, and lifestyle interventions.

Advanced carbohydrate counting can help establish insulin to carb ratios for each meal you eat, as well as for insulin pump therapy. This counting includes increased monitoring of blood glucose before meals and two hours after meals. Work with your diabetes care team to determine insulin to carb ratios along with insulin correction factors. Advanced carb counting can allow additional freedom with the type of food and amount you eat, timing of meals, and the basal and bolus balance of an insulin regimen. However, healthy eating remains the cornerstone of diabetes management.

Whether you are using carbohydrate counting to gain awareness about the amount and type of food eaten, or for matching medication or insulin to the amount of carbohydrate eaten, use the same simple principle.
Be consistent about the spacing and intake of carbohydrate, as well as with the spacing and regularity of your meals. This consistency may help control blood glucose and weight.

Your nutrition therapy should be specific to you. It should be regularly evaluated by a registered dietitian along with your diabetes education team. Choose a strategy that works for you, such as Eating Well with Canada’s Food Guide, the plate method, or carbohydrate counting. The best option for you, and the one that will be easiest to maintain, is the one that fits with your values, preferences and treatment goals.

Counting Carbs in a Sample Lunch This lunch includes a chicken sandwich, fruit and veggies, and two beverages.
Food	Portion Size	Grams of Carbohydrate	Carbohydrate Choices
Whole wheat bread	2 slices	30 g	2
Chicken breast	2 oz/60 g	0	0
Margarine	1 tsp/5 mL	0	0
Carrot sticks	1/2 cup/125 mL	0	0
Green grapes	1/2 cup/125 mL	15 g	1
Milk	1 cup/250 mL	15 g	1
Tea/coffee	1 cup/250 mL	0	0
TOTAL		60 g	4 choices
SOURCE: * diabetes.ca (search carbohydrate counting)

Using the Nutrition Facts Label
Serving size	Compare the serving size on the package to the amount that you eat.
% Daily Value (% DV)	Assess whether there is a little or a lot of a nutrient in one serving by comparing the percentage in similar products. Choose foods with a lower percent DV of fat and a higher percent DV of fibre.
Fat	Choose foods with lower fat content. Choose foods with little or no saturated fat. Choose foods with no trans fat.
Sodium	The Daily Value of sodium percentage is based on the maximum intake of 2,300 mg per day. Aim for foods that are less than five percent of the Daily Value of sodium. Foods with 15 percent or more Daily Value of sodium are considered high. Try to avoid foods with 400 mg of sodium or more per serving.
Carbohydrate	The amount listed is for the serving size given. Are you eating more, less, or the same amount? Compare your serving size to figure out the amount of carbohydrate you are eating. The total amount of carbohydrate in grams is listed first. This number includes starch, sugars and fibre. (Starch is not listed separately.) As fibre does not raise blood glucose, subtract it from the total carbohydrate (for instance, 36 g carbohydrate - 6 g fibre = 30 g available carbohydrate).
Fibre	Choose foods high in fibre. Aim for 30 g or more of fibre per day.
SOURCE: * Diabetes Canada - Understanding the nutrition label

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