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Dear Diabetes: What is Carb Counting?

The basics of counting carbs in life with diabetes

Dear Diabetes: What is carb counting?

When it comes to managing your blood sugar, carbohydrate counting or carb counting may be a technique that can help. When my clients learn about carb counting, many of them are surprised by how much freedom it can give them to plan and enjoy their meals.

Why count carbs?

Well, eating carbs raises blood sugar generally, of course. But the amount of carbs does matter: eating a lot of carbohydrates at one time tends to raises blood glucose a lot, and eating just a small amount raises blood glucose less. I don’t usually advise avoiding carbohydrates completely, however, because many of the foods that contain them – milk, yogurt, vegetables, whole grains, and others – are often part of a healthy meal plan. So I say, instead of avoiding those carbs altogether, count them! Many people living with diabetes aim for about 45-60 grams of carbohydrate per meal. The amount that’s right for you depends on a number of factors, including activity level and blood glucose targets. Ask your diabetes care team to help you determine the ideal carb counting goal for you. Carb counting is based on each meal and snack, not on a full day or week, so no saving up from one meal to the next!

How to count carbs?

Knowing the amount of carbohydrate in your meal or snack requires that you know your portion sizes. Pull out your measuring cups and food scale, and use them often over the next couple of weeks. You may also use food labels, carb-counting books, diabetic exchange lists, and smart phone apps or websites that provide reliable nutrition information. (Read more about understanding portion sizes here.)

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Tips for using food labels

1. Start with the serving size. The serving for macaroni and cheese in the sample label above is 1 cup.
2. Jump down to Total Carbohydrates. This line shows that 1 cup of this macaroni and cheese contains 31 grams of carbohydrate. Don’t be confused by the numbers for sugar and dietary fiber. For this purpose, you can ignore them because they’re already counted in the 31 grams. You can guess that starch makes up the other 26 grams of carbohydrate. But what really matters when it comes to carb counting is to use the number of total carbohydrates.
3. Compare your portion size to the serving size listed on the label. If, for example, you served yourself 1 cup of mac and cheese, you are eating 31 grams of carbohydrate. However, if you choose to eat only ½ cup, your portion contains just 15 ½ grams of carbohydrate.
4. Use the same procedure for each food you eat. Add the amount of carbohydrate from each food together to determine the amount in your meal or snack. Adjust your portions as necessary to stick to your carb counting goal.

Tips for using nutrition data from carb-counting books, websites, or apps

1. Look up the carb-containing food you want to eat.
2. Determine the amount of carbohydrate in your portion. Many of the online sites and apps allow you to enter your portion size into a calculator. Some books list several portion sizes or various sizes of fruits and vegetables. If you are looking up an apple, for example, you may need to use your food scale to determine the size of your fruit. According to the USDA Nutrient Data Laboratory, a small apple weighing 149 grams (5 ¼ ounces) contains 21 grams of carbohydrate. A large apple weighing 223 grams (nearly 8 ounces) provides 31 grams of carbohydrate. It’s easy to eat too much or too little if you don’t know your portion size.
3. Adjust your portions as necessary to stay close to your carb counting goal.

Carb counting methods

A “carb choice” is a portion of food that contains approximately 15 grams of carbohydrate. People who aim for 45 grams of carbohydrate per meal are aiming for 3 carb choices. Likewise, 60 grams of carbohydrate equals 4 carb choices. Many people who are familiar with the Exchange Lists for Diabetes find it a simple way to count carb choices. The exchange system divides foods into groups based on similar carbohydrate, fat, and protein content. Using the exchange system may make carb counting easier because each serving in the starch, fruit, milk, and sweets groups contains about 15 grams of carbohydrate. They are called exchanges because you can “exchange” one food for another. For example, because both one slice of bread and 1/3 cup cooked rice count as one starch exchange, you can swap one for another and consider them equal.

Carb counting shows how there is flexibility to eat different sorts of foods; it’s still wise, however, to limit sweets, chips, and other junk foods, and talk to your health care team about how carb counting might work for you.

For more stories in the Dear Diabetes series, visit The DX archive.

Jill Weisenberger, MS, RD, CDE*, is the author of Diabetes Weight Loss Week by Week, contributing editor for Environmental Nutrition, and has written for many publications including EatingWell, Diabetic Living, Her Sports + Fitness, and LifeScript. Weisenberger is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor, and not of Sanofi US, its employees, agencies, or affiliates.

*“Certified Diabetes Educator” and “CDE” are certification marks owned and registered by the National Certification Board for Diabetes Educators (NCBDE). NCBDE is not affiliated in any way with Sanofi US. NCBDE does not sponsor or endorse any diabetes-related products or services.

© 2013 The DX: The Diabetes Experience

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