Research shows that it is the total amount of carbohydrate, which matters most to blood glucose control. In other words, if today for supper you eat all your carbohydrate as pasta and tomorrow you eat carbohydrate as syrup and milk, it won’t likely affect your insulin needs and diabetes control as long as the two meals are fairly equal in total carbohydrate. Of course, to get them to be the same, you must count the amount of carbohydrate.
It’s like saying you have $5.00 to spend each day for supper and no matter what, you should always spend about $5.00, hopefully by making healthy food choices. What you spend the $5.00 on is up to you. It’s true that people who master carbohydrate counting can change the amount of carbohydrate they eat at a meal by using their carbohydrate to insulin ratio, but that’s another article.
If you are currently following the Beyond the Basics (BTB)* meal planning guide, how much carbohydrate you have to spend at each meal can be easily determined. Otherwise, it is best to start by meeting with your registered dietitian to discuss your desire to start carbohydrate counting. He or she can help individualize the nutrition recommendations and give you more information than can be provided here. Life is tough enough without having to memorize pages of portions. Carbohydrate counting may seem difficult at first, but it will get easier with practice. Such is the case with everything in life - it’s no different for people with diabetes.
Let’s get back to the pasta supper before it gets cold. Pretend you normally have the following for supper:
- 2 Grains & Starches choices (one Grains &Starches choice is 15 grams) = 30 grams carbohydrate (CHO)
- 1 Fruits choice (one choice is 15 grams) = 15 g CHO
- 1 Milk & Alternatives choice = 15 g CHO
(Since Fats and Meat & Alternatives choices don’t contain carbohydrates, we won’t worry about them.)
Total meal CHO for supper = 60 grams.
If you decide to have all of your carbohydrate as Grains & Starches then you would have:
- 60 gram CHO/15 grams CHO per Grains & Starches choice = 4 Grains & Starches choices (or 2 cups of cooked pasta).
Of course, you may look at it differently. Maybe you really want that chocolate bar for dessert and the label states that the bar has 31 grams of carbohydrate. Determine the amount of pasta you have at dinner this way:
- 60 g CHO - 31 g in chocolate bar = 29 g CHO divided by 15 g per Grains & Starches choice = about 2 Grains & Starches choices.
Of course, the variables are endless depending on what you want to eat. Things to consider:
- Carbohydrate counting requires doing some math.
- Have an updated meal plan created by you and a registered dietitian.
- Try to keep your calculations to within five grams of the total carbohydrate per meal; note that if you are on insulin, you may have to calculate more closely.
- Remember healthy eating means getting plenty of vegetables and fruits, while limiting fat - so don’t change all your carbohydrate into chocolate bars.
- When reading labels, subtract grams of fibre from the total grams of carbohydrate (fibre is a carbohydrate, but does not affect blood glucose levels). Note that for serving sizes listed in the BTB meal planning guide, the fibre has already been subtracted.
- Check labels and recipe books; you may be surprised to find how many of your favourite foods (sweets, cookies, cereals, crackers, TV dinners, beverages) list grams of carbohydrate per serving.
- Monitor and record blood glucose regularly to learn if your technique for carbohydrate counting needs polishing (i.e., more caution with portion sizes).
- Discuss advanced carbohydrate counting with your registered dietitian to learn how to determine how much extra insulin you would need to cover eating extra carbohydrate at a specific meal time.
I am not going to try to persuade you that healthy eating with diabetes is a breeze, but this technique of carbohydrate counting does make it easier. Now, when you are in a situation that forces you to ask, ‘to be or not to be’ compliant, consider using carbohydrate counting. Then you can avoid deciding between guilt and deprivation, since you won’t face either.
Updated January 2006 by Sharon Zeiler, MBA, RD
Original article by Bev Madrick RD , CDE at the Regional Diabetes Centre at the Colonel Belcher Hospital in Calgary, AB.
* Editor’s note: Beyond the Basics: Meal Planning for Healthy Eating, Diabetes Prevention and Management is available through Diabetes Education Centres and health professionals.