Counting carbs for type 2 diabetes: The request could not be satisfied
Carb Counting – What is Carb Counting & How to Count Carbs
Carb counting is a way of better understanding how carbohydrates affect your blood sugar, medication requirement and insulin requirement.
For people with type 1 diabetes and those with type 2 diabetes who require insulin, carbohydrate counting is a way of matching insulin requirements with the amount of carbohydrate that you eat or drink.
For people with type 2 diabetes who don’t require insulin, carbohydrate counting is a way of regulating the amount of carbohydrate you consume and monitoring how this affects your blood glucose control, weight management and medication intake.
Carbohydrate counting requires patience and diligence. Learning it successfully means understanding carbohydrates, learning how to adjust your insulin or medication accordingly, and measure yor blood glucose levels regularly for clarity.
What are carbohydrates?
Every carbohydrate we eat is converted into glucose and has an impact on blood sugar levels.
Carbohydrates are commonly found within the following foods:
- Grains (breads, pasta, cereals)
- Root crops (potatoes, sweet potatoes, and yams)
- Most alcoholic drinks ( Beer, cider, lager, most cocktails)
- Desserts and sweets
- Most dairy products, except cheese,
- Sugars including sucrose, fructose, dextrose, maltose
How should I count carbohydrates?
Most people count carbohydrates using grams, with one serving equal to 15 grams of carbohydrate.
Most foods are only partially carbohydrate (although some foods are entirely carbohydrate), but the effect of 15 grams carbohydrate will be the same whether it is from bread, biscuits or other foods.
To ascertain the carbohydrate content of these foods, it is necessary to use food labels, reference books or computer programs, and a scale and list of carbohydrates.
There are two methods of counting carbohydrates: basic carb counting and consistent carb counting. Both ways involve calculating the total carbohydrate of a food, knowing how many carbs you can eat, and then matching this up with the portion size and any medication you take.
Basic carb counting
Basic carb counting can help you learn how certain foods affect your blood glucose levels, and the aim is to eat a consistent amount of carbs each day. This is most likely to be adopted by people with non-insulin treated type 2 diabetes.
A dietitian can advise you on how much carbohydrate you should eat at each meal based on your medication, weight goals and overall diabetes control. In the interim, you could ask your doctor for an appropriate amount of carbs (e.g. 45-60 grams per day) to eat at each meal before your meeting with a dietitian.
Consistent carb counting
Consistent carb counting, also known as advanced carb counting, can be used by people with diabetes who are treated with rapid-acting insulin. To count carbs, you will use an insulin-to-carb ratio, which calculates how much insulin you need to cover the carbohydrate in your meal.
A commonly used ratio is one unit of rapid-acting insulin per 10g of carbohydrate, or 1:10. This can vary from person to person, and your ratio might end up being 1:15, 2:10, or something else. So, if your ratio was 1:15, eating 45g of carbohydrate with a meal would require you to inject three units of insulin.
You can also have different ratios for different times of day.
Carb counting example
John has the following insulin to carb ratios.
- Breakfast: 2 : 10 (2 units of rapid acting insulin per 10g of carbs) [space either side of colon because I’ll introduce a decimal point next which might cause confusion in too cramped a ratio]
- Lunch: 1.5 : 10 (1.5 unit per 10g carbs)
- Dinner: 1: 10 (1 unit per 10g carbs)
Your health care team should help you assess your own insulin-to-carb ratio. Make sure you log your blood glucose levels to see how your ratio affects your readings. It may be you need to inject correction doses of insulin in case your blood sugar climbs too high. You should discuss correction doses with your doctor.
Counting carbohydrates can take a while to become competent, and for some time it will be necessary to weigh and measure foods
It’s come a long way and it’s coming back into fashion. All the people I know who have had diabetes for a long time and are in pretty good nick carb count. It’s a good way of eating healthy and you don’t have to be diabetic to do it. It does help if you have diabetes to get the hang of it. It’s not an exact science but it’s always a little hit and miss.
If you can stick to some basic rules and see how foods effect you then you will understand the foods which work best for you. You may have heard of the traffic light guide – red, orange, green – for foods. With green, they were trying to imply you can eat as much as you like of green foods, etc. Foods in the middle were eat somen, but not a lot and reds were stay away.
It’s easier with diabetics in a way, as you will know that you can eat things like cheese but it won’t have a massive effect on your blood sugar level. It’s still fat, no doubt, fat and protein – so you need to bear that in mind and keep it in context.
A lot of carbohydrates will fit into the middle ground – they will give you energy quite quickly so your basic brown bread gives you a slower release pattern. It marries the effect of insulin as it goes in. Then you have your reds that deliver the energy too quickly for your insulin to be able to match. The traffic light system is helpful.
Another thing that is helpful is labels. Read the label Don’t just look at the sugar content but the carbohydrate content which is probably even more important. There are a lot of badly labelled foods out there. They may say they’re sugar-free, but will be full of carbohydrates; so if you think you can have them because there is no sugar in them, you’ll be sadly mistaken.
Another thing to be aware of is the Glycemic Index For example, if you have a cheese sandwich with pickle then you’re not just eating carbohydrates. The bread is carbohydrate, cheese is protein and fat and the pickle is carbohydrate and some sugars which will release energy quite quickly. The point being you’re not eating one food in one food group – you’re eating a mix. That can affect how they’re absorbed. The release rate may be different from eating bananas all day long.
Most of us eat various different foods that can give spikes of sugar. As a diabetic, to know how much carbohydrate is in a serving and how it’s going to release it’s energy is how you can marry the insulin to the carbohydrate and hopefully end up with good blood sugar control.
What carbohydrate counting equipment do I need?
Many people with diabetes have scales, as well as weighing and measuring equipment to measure volume. Mostly, food labels give both weight and volume measurements, but some do not.
The following techniques can help in understanding carbohydrate counting:
- Use of food labels, scales and a calculator make it possible to identify carbohydrate content in food.
- Using a scale is useful for measuring carbs in a range of different foods from fruit and vegetables to rice and cereal. Refer to the food packaging or you can get carb counts from nutrition books or the Internet.
- Take your time with carb counting as it is easy to make mistakes if maths is not a strength or if you’re rushing.
- Be aware that some foods have different carb counts depending on whether the food is cooked or uncooked. This can sometimes make a big difference so be careful with this.
- Nutrition books and online resources can provide useful information and a quick and easy way to look up brand-name food information. Many recipe books include detailed carbohydrate information
- The Carbs and Cals book (or app) is a very popular book for helping with carb counting as it provides images of a range of foods and serving sizes along with the associated carb counts.
There is a vast amount of real-life experience on the topic of carb counting in the Low Carb Forum
How do I understand more about carbohydrate counting?
The best way to learn carbohydrate counting is to take part in a carbohydrate counting course.
If you are on insulin, would like to go on a carbohydrate counting course and have not been on one of these courses in recent years, your GP, diabetes consultant or diabetes specialist nurse can refer you onto one of these courses.
Examples of nationwide carbohydrate counting courses include:
Your diabetes health team should also be able to arrange one-to-one guidance on carbohydrate counting if you need help at any time.
The Low Carb Program is an online education program launched by Diabetes.co.uk that explains the impact of carbohydrates on blood glucose levels.
What the community have to say about carbohydrate counting
- Carbsrok: You need to be counting the carbohydrate in your food. Please go back to your Diabetes team and say: ‘look, I am completely confused. I need help sorting this.’ Take pen and paper with you so you can write things down. Ask for guidance on Carbohydrates. And how to match your insulin to food intake. A low GI/ Glycaemic load need to be considered. Take one day at a time otherwise you will feel completely overwhelmed by it all.
- Copepod: Most food packets have carbohydrate content in the nutritional information – you need to count total carbohydrate, not just the sugar, and also bear in mind some foods have different values for raw & cooked food. Having said that, once I’ve weighed a food once, I just estimate by sight after that, which is useful when eating away from home. For fruit and vegetables, you’ll need a guide, either book or online.
- Gazhay:I would highly encourage every diabetic to go on DAFNE course, even the ‘carb counting haters’. As it can be a very individual thing, and surely getting all the education about it is a good thing, whether you choose to continue it or not.
- Wallycorker: Over the last 5 months after attending sessions on carbohydrate management she had attained a magnificent HbA1c of 5.6 – down from readings near to – or in – double figures. What’s more by following the techniques explained to her she had lost a massive five stones in weight in the same period of time. Yes five stones in five months – I am certain that is what she said – just through carbohydrate management or carb counting as it is sometimes known.
- Hellsbells: I was diagnosed with T2 almost 2 years ago. I waited 5 months to see dietician who advised me to eat carbohydrate based meals. In fact, when I told her I was carb counting as a way of controlling my bg levels she told me my medication (metformin) would not work if I didn’t eat plenty of carbs! I also asked about portion control. She replied that she would discuss this with me at our next meeting which would be in 3 months time. Needless to say, I didn’t go back.
Carb counting and diabetes – Diabetes NSW & ACT
The carbohydrates (or carbs) we eat have the most impact on our blood glucose levels. Understanding which foods contain carb and learning to carb count, lets you know how much carb you are eating at any one time. Depending on your type of diabetes you can use this information in different ways to help with your diabetes management.
Carb counting is often classified as simple carb counting or advanced carb counting.
Simple carb counting
Simple carb counting refers to learning the approximate amount of carbs that are in foods. This helps people with type 2 diabetes or gestational diabetes understand how much carb they are eating and to plan their meals to spread carbohydrates evenly over the day.
When carb is spread over the day evenly it keeps the blood glucose steadier, and is one tool to assist in keeping blood glucose levels in your target range.
Eating too much carbohydrate at one time can result in blood glucose levels rising or spiking after a meal, above your target range.
Simple carb counting can be used successfully for some people with type 1 diabetes too, especially if they eat similar amounts of carbs each day.
Visual carb counting pictorial guides are very helpful when learning simple carb counting. In pictorial carb counting guides, many of the common foods we eat are shown, and how much of these foods have 15g of carb, which is referred to as one carb exchange. For example, a 100g apple contains approximately 15 gram of carb, or one carb exchange. A slice of bread which weighs 30g and has 15g carb in it, is one carb exchange. If you ate this sandwich and small apple, you have eaten 3 carb exchanges at that meal.
Learning how to count in carb exchanges allow you to choose a different meal with a similar amount of carb.
The NDSS has a free online learning program to help you recognise foods that contain carbs and learn different methods to count carbs. Access the Carb Counting online program today. No registration required.
Advanced carb counting
Advanced carb counting is a more detailed and precise way of carb counting. It involves knowing the exact amount carb count in your serve of carb foods.
Resources such as pictorial guides, carb counting books and apps and websites are all of use for advanced carb counting. Carb counting books, apps and websites are also helpful in working out the carb content of recipes.
For advanced carb counting, it is also important to able to interpret food labels and work out the carb content of your serve of packaged foods.
For advanced carb counting, you can choose to count in 15g carb exchanges, 10g carb portions or count in grams. It doesn’t matter which of these carb counting options you choose, but it is important to understand the method you choose well. Most people with type 1 diabetes and some people with type 2 diabetes on insulin, use advanced carb counting to work out insulin doses at each meal.
It is important to use books, apps and websites that refer to the Australian food database. Your health professionals can guide you with carb counting education and introduce you to useful resources. Here are a few Australian resources which may assist you.
|App and Websites||Source||Notes:|
|CalorieKing Australia||Apple and Android||Free|
|CalorieKing ControlMyWeight Calorie Counter||Apple||Fee associated
(Choose Australia in settings)
|Australian Calorie Counter – Easy Diet Diary
|Australian Carb Counter – Traffic Light Guide to Food
|Apple and Android||Fee associated|
|Carb Counting with Lenny (Australia)||Apple and Android||Free|
|Allan Borushek’s Calorie, Fat and Carbohydrate Counter by Allan Borushek, Clinical Dietitian & Health Educator||In print and apple books||Fee associated|
By Helen d’Emden, APD CDE
Net Carbs Vs.
Total Carbs: What Counts?
People often wonder if they should count their net carbohydrates or total carbohydrates, which appear on some food labels. Medtronic Diabetes Clinical Manager for Cape Cod, Massachusetts, Katie Crupi-Sullivan, RD, CDE, tackles net carbs, and the advice she gives her patients with diabetes.
Net Carbs or Total Carbs: “I’m confused”
One of my patients recently asked me about a low carb bar her Mom had purchased for her to use as a quick snack. She wanted to know, “What is the deal with net carbs?” Net carbs was a phrase coined by the food industry when low carb diets became popular about a decade ago, and doesn’t have a formal definition. It’s not a term recognized by the Food and Drug Administration (FDA) or American Diabetes Association (ADA). Net carbs usually subtract fiber, sugar alcohols, and glycerin from the total carbohydrates. This can be misleading for anyone counting carbs and using insulin to carb ratio to bolus for food.
When is it appropriate to subtract fiber or sugar alcohols from total carbs?
Looking at my patient’s pump download on CareLink, I realized when she ate the low carb bar, her blood sugar dropped. She asked, “What do I do to prevent these lows?” If you notice a low after eating high fiber foods (beans, whole grains, fiber fortified products or foods rich in sugar alcohols, sugar-free desserts and candies), there are rules set forth by the ADA:
- If a meal has more than five grams of total fiber, you can subtract half the total fiber from the total carbohydrate
- If a food contains sugar alcohols, you can subtract half the total sugar alcohol from the total carbohydrate
(Keep in mind that these are general guidelines and might vary for each individual so keep a close eye on your blood glucose.)
What’s the deal with sugar alcohols?
Sugar alcohols are used in many sugar-free items, and small amounts occur naturally in plant foods. When reading food labels, look for erythritol, glycerol, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol, and hydrogenated starch hydrolysates. Sugar alcohols are thought to cause less of a spike in blood sugar after meals, and have a lower glycemic index. They have one half to one third less calories than sugar per gram, but remember, sugar alcohols are not “free” and you need to be cautious how much you’re consuming. In large quantities, sugar alcohols can cause gas, bloating, and diarrhea.
Why does fiber cause my blood sugars to drop?
Fiber is a type of carbohydrate. On a food label, fiber is included in the total carbohydrate and it isn’t fully digested by the body. Sometimes if you eat a meal or snack high in fiber, your blood glucose may drop because the fiber is not digested, it doesn’t turn into sugar or glucose in the body. There are two types of fiber – soluble and insoluble. Soluble fiber dissolves in the water from your food, making a sticky liquid or gel. This gel helps trap certain food elements, slowing down digestion. Insoluble fiber adds bulk to the stool and can help food pass more quickly through the stomach and intestines.
According to the ADA, it’s recommended women eat about 25 grams and men eat about 38 grams of fiber per day. Slowly add in fiber by increasing fruits, vegetables, beans, nuts, seeds, whole grains and oats into your diet.
In the end…
Don’t get caught up in the latest diet trends! When managing your diabetes, total carbohydrate on a food label is the most important place to start.
Resources for carb counting
Calorie King; Free Apple App
My Food Advisor
Guest Blogger – Katie Crupi-Sullivan, RD, CDE
Katie Crupi-Sullivan is a Registered Dietitian, Certified Diabetes Educator, and Medtronic Diabetes Clinical Manager for Cape Cod, Massachusetts. She dedicates her professional career to helping people with diabetes have a better understanding of how food affects diabetes control. She loves to educate people about advanced pump features and continuous glucose monitoring to improve diabetes management.
Tags: carb counting, diet, net carbohydrates, total carbohydrates
6 Tips for Carb Counting With Type 1 Diabetes
Carbohydrates, or “carbs,” are nutrients (coming in the three types: starches, sugars and fiber) found in the food we eat and drink. They are the body’s source of energy — when your digestive system, with the help of insulin, breaks them down into glucose. People with type 1 diabetes (T1D) must balance the amount of carbs they consume with the right dose of insulin. That’s why carb counting is so important. It is often said that to manage type 1 diabetes we have to be doctors, mathematicians, personal trainers, and dietitians, all at the same time. This is definitely true when it comes to counting carbohydrates, but with some basic knowledge and practice, carb counting can become second nature! Here are six ways to improve your carb counting:
Know What to Look For on Nutrition Labels
2. Measure What You Make
Nutrition labels can be pretty easy to follow, but only if you know what the size of your servings are! For more accurate carb counts, use measuring cups when serving sizes are given in volume and use food scales to help count carbs by ounces or grams. Carrying around a food scale is by no means practical but weighing common foods at home can help you guestimate going forward.
3. Use Technology
New carb calculator apps and websites are making carb counting a lot easier, especially when you are eating out or on-the-go! Find a few that you trust. Technology can not only help count carbs on a meal-by-meal basis, but also keep a record of your diet throughout the week and even months.
4. Find Out What’s Right for You
There are recommended proportions of how carbohydrate, protein and fat can make up the daily diet of people with type 1 diabetes. With these as a guideline, you can find what works for you. While everyone needs the energy, vitamins and fiber of carbohydrates, you can decide your carbohydrate intake throughout the day. If you want advice or a full-fledged plan, a dietitian or diabetes educator can help figure out which foods to eat, how much to eat and when to eat based on your body, lifestyle and blood sugar targets.
5. Practice and Have Fun With It!
Often carb counting is not as simple as reading a nutrition label. When eating out or having others cook for you, you won’t be able to measure each ingredient. That’s where estimating comes in. When you are home, train your eye to measure food or use household items to estimate portions. Carb counting is both a science and an art and learning the carbs in food can be hard. Test yourself with our Hidden Carbs quiz to find out your ‘carb-comprehension’.
6. Find Your Go-To Meals and Snacks
Meal planning is something a lot of busy and health-conscious people are doing these days, and for good reason. It can help you make healthy choices rather than succumbing to unhealthy cravings, especially helpful for those with type 1 diabetes. A meal plan can take into account the timing of your meals, how much to eat and what foods to choose, taking the guesswork out of carb counting. Find meal inspiration from others in the JDRF community here or submit your own!
Carbohydrate counting | Know Diabetes
Carbohydrate counting is often used by people using bolus insulin (usually for type 1 diabetes) to more accurately estimate their meal time insulin doses. It is useful for people with type 2 diabetes to have an awareness of the carbohydrate amount in food, particularly if they are on regular insulin injections.
The impact of carbohydrate on blood glucose
Carbohydrate is a nutrient that is an important source of energy.
All carbohydrates when digested are broken down into glucose which then enters into the bloodstream. When insulin is available the glucose is carried into the body’s cells to provide energy.
The rise in blood glucose from carbohydrates will depend on the following factors:
- The amount and type of carbohydrate eaten.
- Activity and exercise undertaken.
- If using insulin, then the amount of insulin circulating in your blood stream. Factors affecting this including the insulin type, dose and time taken, but also factors such as which part of the body you’ve injected, length of needle (short needles 5mm or less are best) and whether you have any skin changes in your injection sites (lipohypertrophy or “lumpy” skin)
The role of carbohydrate counting in management of blood glucose
To achieve ideal blood glucose control, the amount of carbohydrate eaten needs to be balanced with the amount of bolus insulin taken. There are two ways to approach this:
- Eating similar amounts of carbohydrates at the same time each day.
- Learning to adjust your bolus insulin dose to match the amount of carbohydrate eaten.
Understanding and implementing the principles of carbohydrate counting will assist in keeping blood glucose levels as near to normal as possible.
Different insulin regimens
The approach used will be influenced by the insulin regimen administered (the type and amount of insulin taken).
Twice daily mixed insulin regimen
Insulin used twice daily may contain a mixture of shorter and intermediate acting insulin e.g. Humulin M3; Novomix 30 and is taken twice a day at breakfast and evening meal. Individuals who are on this regimen, are unable to adjust their insulin, but carbohydrate counting can be applied to maintain similar amounts at meals.
Multiple daily injection insulin regimen / basal bolus therapy
This regime includes an injection of bolus insulin e.g. Humalog or Novorapid at each meal. Those who are on this regimen are able to adjust their bolus insulin at each meal time. The amount of bolus insulin taken is directly related to the amount of carbohydrate consumed.
The first step in the process is to identify all items that contain carbohydrate.
There are various resources which can help, these include:
- Carbohydrate reference lists / counting tables.
- Food labels and diaries.
- Handy household measures e.g. scales, cups, spoons.
- Apps e.g. Carbs and Cals app.
- Reference books e.g. Carbs and Cals; Cook and Count.
- Restaurant websites.
Next, it is necessary to work out the carbohydrate content of all foods and drinks consumed.
Carbohydrates can be counted in two ways; in grams or as carbohydrate portions. One carbohydrate portion (CP) is equal to 10 grams of carbohydrate. Your diabetes care team will guide you on which approach is used at your centre.
Example: Using Carbohydrate Reference List (grams)
2 Slices Thick White Toast
Cheese and Cold Ham
The total carbohydrate content of the above lunch is 80 grams.
As every 1 CP contains 10 grams of carbohydrate, calculating the total amount of carbohydrate in grams allows for the CP content of the meal to also be established:
CP Content = Total Amount of Carbohydrate in Meal in grams divided by 10
CP Content = Total Amount of Carbohydrate in Lunch 80 grams divided by 10
The above lunch of 80 grams of carbohydrate is equivalent to 8CPs.
Calculating bolus dose
To work out the bolus dose, you will need:
1. Personal Insulin to Carbohydrate Ratio (ICR).
- This is the amount of bolus insulin you need to inject at meals for a certain amount of carbohydrate.
- The ICR will vary from person to person and can be different for each meal.
- A starting ICR for most individuals is 1 unit of bolus insulin for every 10g of carbohydrate (1 CP). This is based upon the fact that 10 grams of carbohydrate (1 CP) will increase blood glucose by 2 – 3 mmols and 1 unit of bolus insulin will reduce blood glucose by the same amount.
- To work out the most suitable starting ICR for you, it is important to talk to a member of your diabetes care team.
2. The total amount of carbohydrate consumed (grams / CPs).
3. When you know your ICR and have worked out the carbohydrate content of your meal, as the example below illustrates, you can calculate the amount of bolus insulin you need.
Example: calculating the bolus dose
For the above lunch of 80 grams of carbohydrate / 8 CPs, with an ICR of 1 unit for every 10 grams / 1 CP, the required bolus dose is 8 units.
Insulin bolus dose adjustment and carbohydrate counting
When you feel confident in this approach you should be able to:
- Vary the times you eat and the amount of carbohydrate you eat.
- Predict blood glucose response from different foods.
As you must be able to accurately calculate the amount of carbohydrate you eat and drink before adjusting your bolus dose, a carbohydrate log can help you demonstrate this.
It can also be useful to record a detailed diary which outlines carbohydrate eaten, blood glucose, activity, bolus and basal insulin.
An online resource which will provide additional information on the key principles of carbohydrate counting and insulin dose adjustment BERTIE has been developed by the Bournemouth Diabetes Team.
Carbohydrate counting and insulin dose adjustment is a complex process. Before implementing this strategy, it is important to have the support and guidance of your diabetes care team.
Diabetes and carbohydrates | Accu-Chek
Has your doctor talked to you about watching the carbohydrates in the foods you eat? For a long time, people thought that counting carbohydrates wasn’t necessary for those with type 2 diabetes, but that thinking is changing.
If you have a target number of carbs to eat at each meal or snack, accurately estimating carbohydrates can help you keep your numbers within your target range.1 It may help you avoid gaining weight and, by keeping your blood glucose in range, help you feel your best.2,3 Keep in mind that these carb and blood glucose targets aren’t the same for everyone—what works for you may make another person’s blood sugars fluctuate all over the map.
At first, counting carbs can be a little challenging. Foods with multiple ingredients can be difficult to guesstimate, and official serving sizes often have no relationship to the servings we actually see. We can be surprised how many “healthy” foods are high in carbs and how many “unhealthy” foods aren’t.1 And, as many parents have learned, a “cup of milk” to a preteen boy may be whatever fits in an actual cup—somewhere between 8 and 24 ounces.
Carbohydrate counting isn’t just for grains and sweets but also dairy products, fruits and vegetables. Approximately 15 grams of carbohydrate can be found in:
- Slice of bread
- Small pita
- Small yogurt (3.5 oz)
- Small banana
- Small apple
- Small glass of apple juice (4 oz)
1/2 cup of…
- Cooked pasta or couscous
- Lentils or dried beans
1 cup of…
1/3 cup of…
3 teaspoons of. ..
4 or 5…
Carb counting tips
- Read the label. Sometimes the carb count is right there in front of you. Take a sec to check.
- Get out the cups. Measure your breakfast cereal. Weigh your pasta before it goes in the pot. Get a good sense of what a serving really looks like. Don’t go more than a month or so without refreshing your memory, so those portions don’t have a chance to grow.
- Make a mental note. Once you’ve seen how a 3/4 cup serving of Bran-Os fits in your cereal bowl, you’ll be in a better position to wing it.
- Try your hand. Most people’s palms are about the size of a 3- or 4-ounce portion. Your thumb is probably about a tablespoon. And your cupped hand can hold about a half cup.3
- Use a calculator. You can find complete nutritional data from Web sites or apps such as MyFitnessPal® or Calorie Counter PRO.
How do you read a carbohydrate label?
For people living with diabetes, counting carbohydrates is an important part of managing blood sugar levels. That requires a special eye for the carbohydrates section of nutrition labels. There is no one rule for how many carbs people with diabetes should eat. Experts recommend speaking to your doctor to develop an individualized meal plan with the right balance of carbs to other nutrients for your body’s needs.4
Of course, not all carbohydrates are made the same. You may notice on a nutrition label that there are several lines addressing a food’s carb contents:
- Total Carbohydrates: This line represents the total amount of carbs in one serving. This number is made up of both complex carbs like fiber and starch, and simple carbs like sugar.5
- Dietary Fiber: Some foods, like vegetables and many fruits, contain carbohydrates referred to as “dietary fiber. ”6 These complex carbs slow your body’s absorption of sugar, which is very helpful for maintaining steady blood sugar levels.7 In fact, if a serving of food contains at least 5 grams of dietary fiber, you can subtract half the total dietary fiber gram count from the total carb amount when counting carbs.8
- Sugar Alcohol: While sugar alcohols do add to the total carb and calorie count for a food serving, they are often included in “sugar free” foods. Just like dietary fiber, sugar alcohol does not contribute to blood sugar as much as other forms of carbs can because they are not fully absorbed and you can subtract half the grams of sugar alcohol from the total carb amount for carb counting purposes.9
- Sugar: Sugar is the simplest kind of carbohydrate, meaning it is the easiest for the body to absorb. As such, sugar has the most direct impact on blood sugar. It is listed out separately from total carbs to help anybody seeking to limit sugar, like people with diabetes, find foods that fit their diets.
- Additional Sugar: Finally, some newer food labels may have an additional line under Sugar that lists anything that was added beyond the natural sugars contained in the other ingredients in the food.10
Remember: you can more effectively keep your blood sugar in the ideal range if you focus on eating foods high in dietary fiber and low in sugar. We all need carbs, even if you have diabetes, but choosing the right kinds of carbs goes a long way towards a balanced diet.
How are carbohydrates and sugar related?
BY KAREN FLANAGAN, MA, RD, CDE
Do you know any sugar thieves? Those well-meaning people who steal your real sugar and replace it with stevia, saccharin or other substitutes?
I think about one Thanksgiving a few years ago. There was a huge table filled with pies, cakes, candy and cookies—straight out of Willy Wonka’s dream. The smell alone made my mouth water.
Next to that table was a smaller one with sugar-free apple pie, cookies and gummy bears, just for me. While it was extremely thoughtful and considerate of my diabetes, well, YUCK! I choked down a dry cookie and watched the others enjoy their desserts. Out of politeness, I ate some gummy bears, hoping the sugar alcohol-induced diarrhea wouldn’t hit till after I got home.
It’s been over a decade since the experts announced that sugar is not our enemy. So why won’t people believe it?
Most people don’t understand that there are carbohydrates in sugar-free foods, too. It doesn’t matter where the carbohydrate comes from. If you’re on an insulin pump, you adjust your insulin to the amount of carbohydrate you eat. Instead of adapting our lives to food, we can adapt insulin to fit the situation.
For example a regular chocolate chip cookie has approximately 26 grams of carbohydrate in it. A similar sugar-free cookie has about 20 grams. Real apple pie has about 40 grams of carbohydrate per serving, and the sugar-free variety has about 37. A slice of yellow cake with frosting has about 40 grams of carbohydrate while the sugar-free version still delivers about 28 grams. The sugar-free ones are not free foods.
Why? Carbohydrates come from many sources, not just sugar. Sugar alcohols (usually ending in -tol, such as malitol, xylitol and sorbitol) have fewer calories than sugar, but often aren’t as sweet. It takes more to get the same sweetness, making the carb count rival table sugar. And many carb-free sugar substitutes can’t be used in cooking. Higher-carb options are used instead.
Whatever you choose to eat, remember that it’s not the amount of sugar or where carbs come from that affect the overall rise in blood sugar. It’s simply is the amount of carbohydrate. (Although the source of the carb may impact how quickly blood sugar rises.)
Show your friends that one healthy, sugar-free baked potato has approximately 29 grams of carbohydrate, while a sandwich cookie provides about 8 grams. Amazing!
And remember that even if the source of carbohydrate doesn’t matter to your blood sugar, it will to the rest of your body. Carbohydrates, like everything you eat, should come from a variety of foods. One cannot live on cookies alone. Carbohydrates from whole grains, beans, fruits and dairy offer more essential nutrients, vitamins and minerals. Everyone, diabetes or not, should follow that rule.
Carbohydrate counting is a great tool to help control your diabetes. Combined with pumping, it can make your life and meals much more flexible and enjoyable. We need to educate the sugar thieves. Next year, I will be bringing desserts to Thanksgiving dinner. I already have a few new recipes in mind—and nothing will be sugar-free!
Karen Flanagan is a registered dietitian and certified diabetes educator who previously worked with pump users through Roche Diabetes Care. She has been wearing an insulin pump since 1992.
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Carb Counting Made Easy | Free Resource Friday
Carb Counting Made Easy | Free Resource Friday
We get a lot of questions from our community about carb counting. For this week’s Free Resource Friday, we have put together a list of all the carb counting resources we love!
We hope this answers all your questions when it comes to counting carbs.
Handy Cheat Sheets
Diabetes Exchange List – a brief summary of serving size and carbohydrate counts for common foods. Excellent study tool for the exam.
Carb Counting Quick Reference English – We created this Carb Counting Quick Reference sheet based on the ADA handbook.
Carb Counting Quick Reference – Spanish – We created this Carb Counting Quick Reference sheet based on the ADA handbook.
Carb Counting Apps
CalorieKing – includes curated food database with nutrition information, including many fast-food chains and restaurants.
Diabetes Lite– water, meds, exercise, meals with carb counting and goal setting.
Diabetes Tracker – The American Journal of Preventive Medicine ranked this app, which has no free version, No. 1. It boasts an intensive and easy-to-follow educational component in addition to features for monitoring blood glucose, carbs, net carbs and more. Easy to see the big picture with daily and weekly reports. For some, it may be worth the extra expense.
Fitbit with APP – track activity, food, sleep and connect with friends.
Glucose Buddy(diabetes logbook manager) Simple to navigate, Glucose Buddy helps users manage their blood sugar, insulin dosages, and carb intake. Other features track exercise, blood pressure, and weight. Sync data to print it out or view online.
Hedia – digital diabetes personal assistant, developed with insulin using people with diabetes in mind, to increase time-in-range. Allows tracking data in a personal logbook and gives suggestions on carb amounts and insulin doses with a food database designed by nutrition experts.
See our Free Resource Catalog for an entire list of our favorite resources.
Type 1 Diabetes: Nutrition
Earlier, even before the discovery of insulin and immediately after its discovery, the term “diet” was used for a long time in the dietary recommendations for type 1 diabetes mellitus. However, it would be more correct to forget the term “diet” and say that in type 1 diabetes mellitus, dietary recommendations will not differ from those for healthy people, with the exception of one condition – carbohydrates must be taken into account, they require the introduction of a certain dose of insulin.
The main difference between the diet for type 1 diabetes mellitus from the diet of a person without diabetes mellitus: you need to count the carbohydrates in the food. Glucose, which is the body’s main source of energy, is found in carbohydrates. That is why the proportion of carbohydrates in the daily diet should be 55-60%, that is, more than half.
In type 1 diabetes mellitus, it is enough to adhere to two simple dietary recommendations:
- The total intake of proteins, fats and carbohydrates in type 1 diabetes should not differ from that of a healthy person.
- An assessment of digestible carbohydrates on a system of bread units (XE) is required to adjust the dose of insulin before meals.
The system of “bread units” (or XE) was developed to correlate the amount of digestible carbohydrates consumed and the amount of insulin given before a meal (short-acting insulin or ultrashort insulin analogue).
What is 1 XE?
For 1 XE, it is customary to consider 10-12 grams of digestible carbohydrates.
For convenience, XE tables have been created, where each product is converted to XE according to the carbohydrates it contains. This allows you to estimate the amount of carbohydrates in foods “by eye”, and not weigh them. At the same time, at first, it is better to weigh the products in order to understand what an apple (or pear, or other product) looks like, equivalent to 1 XE.
The approximate required daily amount of XE, depending on gender, body weight and physical activity, is shown in the table below.You must calculate and agree on the individual need together with your doctor.
How much XE should you consume in one meal?
It is desirable that there should be 3-7 XE per meal, and the meal consisted of both “complex” and “simple” carbohydrates.
The need for insulin per 1 XE is 0.5-2.5 U of insulin. This need is individual, calculated and adjusted together with the doctor based on the results of self-control recorded in the diary.
The only way to reduce the risk of negative effects of alcohol on the body is to completely stop drinking it. However, it is important to remember that for a person with diabetes, the consumption of alcoholic beverages should not exceed 1 conventional unit per day (40 ml of spirits or 140 ml of dry wine or 300 ml of beer) for women and 2 conventional units.
Correct XE counting, adequate exercise, the correct regimen and dosage of insulin, regular self-monitoring of blood glucose levels and knowledge of your medical condition are key factors in maintaining well-being and target blood glucose levels.
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for visually impaired
90,000 School for patients with diabetes mellitus. Lesson number 3. Food –
School for patients with diabetes mellitus. Lesson number 3. Power
The Children’s School for Diabetics continues its lessons. They are held on Fridays on the VK page, the official website of the medical institution. Weekly lessons are taught by the pediatric endocrinologist of the OKB Elena Sinyakova. Today she will talk about nutrition.
Nutrition is the second pillar for successful diabetes management.
Food consists of 3 components:
• carbohydrates (50-55% of the daily ration) cereals, pasta, bakery products, fruits, potatoes, dairy products
• fats (30-35% of the daily ration) oil, seeds, nuts
• proteins (10-15% of the daily diet) meat, fish, eggs, legumes, nuts, mushrooms
Entering the digestive tract:
• carbohydrates are broken down to glucose
• fats are broken down to fatty acids
• protein is broken down to amino acids
Accordingly, all these substances enter the bloodstream, and blood glucose rises. ..Therefore, it is important to know how much glucose will enter the bloodstream and how much insulin needs to be injected depends on it.
• Carbohydrates are the main food component we pay attention to
• we count carbohydrates!
What are carbohydrates? How to count them?
For ease of calculation, carbohydrates are usually considered in Bread units XE)
1 XE = 10-12 grams of carbohydrates
In XE they count:
• (bread, cereals, pasta)
• fruits, potatoes, legumes
• liquid dairy products
• sweets, juice, kvass
I ask you not to use the last point every day, only for hypoglycemia.
• are quickly absorbed and immediately enter the bloodstream
• increase blood sugar within 5-10 minutes
NECESSARY FOR HYPOGLYCEMIA
• sugar, honey, fruit juice, lollipops, glucose tablets
• slowly increase blood sugar, after 20-25 minutes
• pasta, cereals, vegetables, fruits
And also carbohydrates differ in the rate of absorption – according to the glycemic index
• high glycemic index (GI) (> 70): puffed rice, honey, cornflakes, watermelon, white bread, sugary drinks, raisins
• medium GI (56-69%): boiled potatoes, pasta, grain bread, boiled rice, oranges, bananas)
• low GI (<55): apples, beans, lentils, peas.
The suction speed determines how quickly and how high the sugar rises. The suction speed can be influenced!
• processing method (polished rice raises glucose faster than unpolished rice)
• excess of salt or sugar in food
• liquid consistency
• availability of dietary fiber
• presence of fat
• food temperature (cold raises sugar more slowly)
• heavy physical activity (food will be absorbed more slowly).
How much XE can you eat and how often?
To calculate XE, tables are used, where it is calculated how many grams of a certain product are contained in 1XE.
For accurate counting, you need to weigh the product that you plan to eat and see in the table how much XE it will be.
Although the diet for type 1 diabetes mellitus is considered liberalized (that is, you can eat anything, just count carbohydrates and add insulin), there are still a few rules:
• avoid light carbohydrates (i.e.because even a sufficient amount of insulin injected on time will not be able to prevent hyperglycemia)
• for one meal, eat no more than 6-7 XE
There is a daily requirement for XE, which should not be exceeded:
• children 1-3 years old – no more than 10-11 XE
• children 4-6 years old – no more than 12-13 XE
• children 7-10 years old – no more than 15-16 XE
11-13 years old
• boys – 18-20 XE
• girls-16-17 XE
15-18 years old
• girls – 18-20XE
!!! It is IMPORTANT to evenly distribute the daily amount of XE.
How to calculate the amount of XE in a finished product?
On any product packaging, the amount of carbohydrates, fats and proteins is always indicated. Based on this, we look at how many grams of carbohydrates are written on the package (in 100 grams), weigh how much of this product we consumed, convert the amount of carbohydrates to XE (1 XE -12 g), set the corresponding amount of insulin
In a 100 g jar of yogurt.- 13.2 grams of carbohydrates. The mass of yoghurt is 125 grams.
We make the proportion:
125 * 13.2: 100 = 16.5 gr.
In a jar of yogurt 16.5 gr. Carbohydrates, now we translate into XE:
16.5: 12 = 1.3 XE
And so with all products!
And if you decide to make pancakes … We take the products from which we prepare pancakes, and we consider:
2 eggs – 0 XE
1 glass of milk – 1 XE
7 tbsp.tablespoons of flour – 7 XE
Total: in test 8 XE
We start baking pancakes: it turned out 8 pieces. In 1 pancake -1 XE
Foods containing protein and fats can also affect blood glucose levels. But a few hours after eating.
That is why, if you eat more than 75 grams. protein – you need to count this as 0.5 XE and pin up insulin.
For foods containing a large amount of protein and fat, it is advisable to use the concept of Protein-Fat Unit (FFU)
How to take into account the FFU when calculating the insulin dose?
1 gr.carbohydrates are formed 4 kcal
1 gr. protein – 4 kcal
1 gr. fat – 9 kcal
1 BJE = 100 kcal
For example, let’s say we have a pizza that has the amount of proteins, fats, carbohydrates and calories on the box.
• in the whole pizza 858 kcal and 107.6 gr. carbohydrates.
• Because from 1 gr. carbohydrates are formed 4 kcal, then from 107.6 gr. carbohydrates – 404.3 kcal
• now we find out how many kcal proteins and fats will give us: 858-430.4 = 427.6 kcal
• the resulting quantity is divided by 100 (i.e.K. 1 BZHE = 100 kcal)
• 427.6: 100 = 4.3 BJE
How much insulin do you need to inject for 1 BJE?
The amount of insulin is calculated as 1 XE.
If you put 1 unit on 1 XE. insulin, then 1 BZHE also 1 unit.
For 4 BZHE – 4 units. insulin, but insulin should be given after a meal.
If you have an insulin pump, you should use the “square bolus”. Indeed, sugar raises protein and fats slowly and for a long time, from 2 to 4 hours.
What is diabetes mellitus
Diabetes is a condition associated with high blood sugar (glucose) levels.
Why is blood sugar needed and where does it come from?
First, sugar enters the bloodstream from food; secondly – from the sugar reserves that are contained in the liver. Glucose is the main source of nutrition for all cells (the smallest building blocks of the body).Inside the cell, glucose is converted into energy, which allows cells to work, and, accordingly, the entire body (just as a car cannot drive without gasoline, so a cell cannot work without fuel, which is sugar for it). However, glucose can penetrate into the cell only with the help of insulin.
What is insulin and where is it produced?
Insulin is a hormone produced in the pancreas (beta cells). Beta cells register an increase in blood sugar and respond by sending a certain amount of insulin into the bloodstream, thereby lowering blood sugar levels.
What causes type 2 diabetes?
1. Obesity is the main reason for the development of type 2 diabetes (about 80% of patients with type 2 diabetes are overweight)
2. Heredity (if one parent is sick, then the likelihood of developing diabetes is about 40%, if both parents are 75%)
What happens with type 2 diabetes?
In this disease, the pancreas produces insulin, but it is either insufficient or it does not work well (in most cases, this is due to an excess of adipose tissue in the body, which interferes with the action of insulin, while the insulin content in the blood can significantly exceed the norm).As a result, a large amount of sugar accumulates in the blood and its level rises.
Who has type 2 diabetes?
Previously, it was believed that this type of diabetes mainly affects people over 40-45 years old. However, in recent years, type 2 diabetes mellitus has noticeably “younger”, which is associated with a high prevalence of obesity, incl. and in young people
How is diabetes mellitus diagnosed
Diabetes mellitus is diagnosed when fasting blood sugar (glycemia) is more than 6.1 mmol / L (fasting glycemia refers to the blood glucose level measured in the morning before breakfast after preliminary fasting for 8 hours).
Also, the diagnosis of diabetes mellitus can be established after the detection of glycemia more than 11.1 mmol / l at any time of the day.
Occasionally, an oral glucose tolerance test is done to clarify the diagnosis.
(In the morning on an empty stomach, blood is taken for sugar, after which the patient drinks 75 grams of glucose and after 2 hours the blood sugar level is re-examined). With a glycemic level of more than 11.1 mmol / L, a second measurement establishes a diagnosis of diabetes mellitus.
What is the difference between type 1 diabetes mellitus and type 2 diabetes mellitus?
In type 1 diabetes, the pancreas stops producing insulin.The disease occurs at a young age (usually before the age of 40). For these patients, the only treatment is lifelong insulin
How is type 2 diabetes treated?
3. Sugar-lowering tablets
4. Sometimes, insulin is prescribed
Why do you need to control your blood sugar?
Regular monitoring of sugar levels is the key to successful treatment and prevention of the development of complications of diabetes !!!
It is important to know that periodic testing of blood sugar in the clinic is not sufficient for good control.It is imperative that you regularly measure your blood sugar yourself.
How often should measurements be taken?
Patients with type 2 diabetes mellitus receiving antidiabetic pills should take several measurements per week (at different times of the day). Once every 2 weeks, it is advisable to test blood sugar 4-6 times a day (throughout the day: before meals and 2 hours after meals).
What are blood sugar targets?
These are the sugar levels you should aim for to avoid complications:
• Fasting (before meals) 3.3-6.0 mmol / l
• 2 hours after meals up to 7.8 mmol / l
What is hypoglycemia?
This is a condition in which the blood sugar drops below 3.3 mmol / L. At the same time, you may feel tremors, chills, sweating, hunger, irritability, headache, pallor, palpitations.
What to do in case of hypoglycemia?
You need to eat 4 lumps of sugar or drink 1 small packet of juice (200 ml). Do not use chocolate, sweets, confectionery, bread and fruits to relieve hypoglycemia – they slowly increase blood sugar !!!
How to eat properly with type 2 diabetes?
• Food should contain a sufficient amount of carbohydrates (about 60%), i.e.because they are the main source of nutrition for the cells of the body. Carbohydrates include: bread, potatoes, pasta, buckwheat, rice, oatmeal and other grains, as well as fruits and vegetables. It is important to understand that although these foods increase blood sugar, they do it slowly!
• Exclude fast-digesting carbohydrates (honey, jam, juices, sugary drinks, sugar, sweets), because they raise blood sugar very quickly!
• Weight loss is an integral part of diabetes care. To this end, it is necessary to limit the amount of fat in food as much as possible to 15%.Fats do not increase sugar, they lead to weight gain !!! Fatty foods include: caviar, fatty fish (salmon, salmon, carp, sturgeon, herring) and any fatty meat, canned food in oil, all sausages, sausages and small sausages, lard, cheese with a fat content of more than 40%, seeds and nuts, fatty dairy products, mayonnaise). It is important to know that both butter and all types of vegetable oil are fats and contribute to weight gain, so you need to limit any of its types!
• The daily diet should contain about 30% protein (lean fish (perch, cod, icefish), lean meat and poultry; dairy products with a fat content of less than 1.5%; cheese with a fat content <30%). Proteins do not increase blood sugar !!!!
Tips for reducing calorie intake
• Do not fry! Use other cooking methods: baking, boiling, steaming, on the grill, over an open fire
• When cooking meat, poultry, remove the skin and remove all visible fat before cooking
spices, mustard, vinegar, lemon juice) instead of oil and mayonnaise
• Start your meal with a glass of mineral water and vegetable salad, ie.O. You will be able to “trick” the stomach and the satiety process will occur faster
• Try to eat in small portions 4-6 times a day
Is it possible to drink alcoholic beverages in case of diabetes mellitus?
1. Alcohol lowers blood sugar and can lead to the development of hypoglycemia (lowering sugar below 3.3 mmol / l), therefore, you should always eat (bread, potatoes, cereals, pasta, fruits) before consuming it. Remember that in the case of alcohol consumption, the symptoms of hypoglycemia may be “blurred”
2.Drinking alcohol should be moderate !!! (no more than 1 glass of dry wine (or brut) or 50 g of strong alcoholic drink per evening)
3. Eliminate sugary alcoholic beverages
4. Remember that drinking alcohol (especially in large quantities) while being treated with certain drugs to reduce sugar is unsafe (e.g. metformna)
What is glucose-lowering therapy?
Anti-hypoglycemic therapy refers to the various drugs prescribed for diabetes mellitus to lower blood sugar levels.Which pills to prescribe to the patient is decided in each case individually by the doctor.
• Regular exercise is extremely beneficial for all patients with diabetes mellitus. they lower blood sugar, help to reduce weight, reduce the risk of complications
• Exercise should be individualized according to your age, diabetes complications and comorbidities
• Moderate exercise, such as walking instead of driving, is recommended for most patients , climbing stairs instead of an elevator
• Remember to exercise regularly (daily walks for 30 minutes, swimming for 1 hour 3 times a week).
• Exercise is not recommended with blood sugar levels above 13-15 mmol / L – this can lead to an additional increase in blood sugar
• In the absence of serious complications and concomitant diseases, patients with type 2 diabetes can engage in any sports
• Necessary remember that during physical exertion, as well as within a few hours after it, sugar can decrease, therefore, in order to prevent hypoglycemia, it is necessary to refuel before and after exercise (for example, with fruits).