Accurately keeping track of the amount of carbs you eat and adhering to your individual guidelines are keys to controlling your blood glucose (blood sugar) levels. Counting carbohydrate grams, or carb counting for short, is a common approach to diabetes meal planning today. The reason for focusing on carbohydrate is because research shows carbs have the greatest impact on blood sugar, especially after eating.
How many grams of carb are in a small bowl of rice? A large apple? A number of years ago, Howard Wolpert, M.D., a senior physician at the Joslin Diabetes Center in Boston and author of Smart Pumping (American Diabetes Association, 2002), posed these questions to 40 people using insulin pumps. Their guesses ranged from 10 to 60 grams for the rice and 10 to 40 grams for the apple.
The real answers? About 15 grams for 1/3-cup rice and 30 grams for the large apple. What would you have guessed?
There are two approaches to helping people learn how to use carb counting: basic and advanced. The type of carb counting you use depends on your interest, your type of diabetes, and how you want to manage it.
Basic Carb Counting
Recommended for: People who have type 2 diabetes and control blood sugar with a healthful eating plan and blood glucose-lowering medication. (Keep in mind that the American Diabetes Association and other organizations recommend that most people with type 2 diabetes start taking a blood glucose-lowering medication when they are diagnosed. The most common medication recommended is metformin.)
How carb counting works: To use this method, you need to know what foods contain carbohydrate and have a sense of how many carbs you need to eat for meals and snacks. Blood glucose control, unless you are using insulin at meal times, requires consistency—meal to meal, day to day.
You can count grams of carbohydrate or carb choices (one choice equals about 15 grams of carbohydrate). Counting grams of carbohydrate is more accurate because it encourages you to use exact counts rather than averages. Plus, many carb-counting references and all food nutrition labels provide carbohydrate grams and not carb choices.
Advanced Carb Counting
Recommended for: People who take multiple daily insulin injections (known as MDI), combining a long-acting insulin with mealtime doses of rapid-acting insulin, or people using an insulin pump.
How it works: This method is flexible because it encourages you to adjust your dosages of mealtime rapid-acting insulin based on the carbohydrate grams you expect to eat and your blood sugar level when you check prior to mealtime.
It's important to accurately estimate the grams of carbohydrate you plan to consume so you don't take too much or too little insulin, which can cause blood sugar to go too low or too high.
Building Your Carb Database
Most people tend to eat the same foods from day to day, so an easy first step is to learn the carb counts of the foods you usually eat:
• List the foods, meals, and snacks you regularly eat.
• Note how many grams of carb are in each portion.
On food packaging, the Nutrition Facts label should be your first source for total carbohydrate content. The listing of nutrients is detailed, consistent, and easy to find.
"When I use packaged foods, I rely on the carb count in the Nutrition Facts label," says Margaret Moore, who was diagnosed with type 1 diabetes in 1989 and uses advanced carb counting. "I no longer guess how much insulin to take. As a result, I'm taking less insulin and gaining better control."