Before I get into the subject of carbohydrate counting, I want to start with my background regarding diabetes and nutrition. I taught in an outpatient setting at my previous workplace near Indianapolis, Indiana for a little over a year until my husband and I decided to move across the country to Colorado. In this position, I educated primarily newly diagnosed and uncontrolled type 2 diabetics in regards to how food can affect glucose levels and how they can fit carbohydrate counting into their lifestyle. I enjoyed being able to help individuals feel confident in controlling their glucose levels and helping them live a long, healthy life.
I want to provide a brief overview of the various types of diabetes:
Type 1 Diabetes is typically diagnosed in children around age 12-13 years old. It is the attack of the individuals own immune system killing off the cells on the pancreas that produce insulin to regulate glucose resulting in insulin deficiency. Because of the lack of insulin, those who have type 1 diabetes must be require manually injected insulin. Without insulin, their blood sugar concentration becomes elevated which can be fatal if too high.
Type 2 Diabetes is usually diagnosed in adults. However with rising childhood obesity rates, more children are being diagnosed early on. This type of diabetes is when the pancreas produces some insulin, but is unable to provide enough to keep up with rising glucose levels in the blood or the insulin produced cannot work efficiently as it should. This is also known as insulin resistance. Oftentimes, manually injected insulin is not required for glucose management, but it can be beneficial to those who have difficulty controlling their glucose levels.
Type 1.5 or Latent Autoimmune Diabetes in Adults (LADA) is when there is a delayed onset of type 1 diabetes in adults. This type can be confused with type 2 diabetes and can often be misdiagnosed as such. It can take anywhere from a few months to several years before an individual requires manually injected insulin.
Gestational Diabetes occurs during pregnancy. If glucose levels become too high during pregnancy/untreated, delivery can be more difficult and may result in harm to the baby. Those who have been diagnosed with gestational diabetes are also more likely to develop type 2 diabetes later on in life making it even more important to eat healthy.
Pre-diabetes or Borderline diabetes is when an individual is at a very high risk of developing diabetes. Some physicians will start individuals on Metformin to prevent the onset of diabetes but for most people diet and exercise can help prevent or even delay the onset.
Carbohydrate counting is a great way for diabetics of any type to take control of their glucose levels and live life to the fullest. How carbohydrate counting works, is by recognizing foods and products which contain carbohydrates and then consuming a certain amount at each meal to keep glucose stable throughout the day. So let’s start with what foods contain carbohydrates:
- Breads, grains, cereals, pasta, rice
- Fruit and fruit juice
- Milk, ice cream, yogurt
- Starchy vegetables – corn, peas, potatoes, soup beans, winter squash
- Desserts, sugary foods
- Sugar-free products
- Fat-free products
There is a difference between natural sugars and added sugars. Natural sugars which are found in whole fruits, milk, and starchy vegetables naturally and are accounted for on the nutrition label under “sugars”. This type should not be avoided necessarily but should also not be consumed in excess. Added sugars are typically the refined sugar you find in soda, ice cream, and chocolate to name a few. These types can make glucose levels rise quickly and should only be consumed in very limited amounts. Added sugars are also accounted for on the nutrition label under “sugars” making it difficult to know how much is actually added sugar. Coming soon in July 2018, the nutrition label will change to address this issue by providing a subcategory called “added sugars” to help distinguish the two.
Foods which are labeled sugar-free are not necessarily carbohydrate free. For example, Werther’s Original Sugar-Free candies contain 1 serving of carbohydrates for 5 candies even though the nutrition label states 0 grams of sugar. But if you notice, the “total carbohydrate” state 15 grams meaning there are other ingredients which contain carbohydrate such as sugar alcohols that are not considered sugar but can influence glucose levels.
Fat-free products can be misleading when it comes to what is considered healthy. On the nutrition label, you can see the “total fat” was reduced to almost 0 grams, but the “carbohydrate” is increased compared to the original ranch salad dressing label requiring it to be counted in our meal plan. This explains why fat-free foods have such an “off” taste compared to the original. Therefore, you are better off going with either the original or lighter versions of salad dressing than the fat-free product.
Fat-free ranch dressing
Original ranch dressing
When counting carbohydrates, you want to look at the “total carbohydrates” and the “serving size” on the nutrition label.
15 grams (g) of carbohydrate is equal to 1 serving
As an example, for an individual who wants to consume 1800-2000 calories on average, you would want to break the amount of carbohydrates up in this manner:
Breakfast 3-4 servings (45-60 grams)
Lunch 4-5 servings (60-75 grams)
Dinner 4-5 servings (60-75 grams)
Snacks 1-2 servings (15-30 grams) – one in between lunch and dinner and one at bedtime
By spreading out your carbohydrates throughout the day, your glucose should be stable as well. The best method to help you get started and stay on track is by keeping a food journal with specific information. A sample breakfast entry would look like this:
1 egg 0 grams carb
2 slices of wheat toast 30 grams carb
1 Tbsp butter 0 grams carb
8 oz low-fat milk 12 grams carb
The amount of carbohydrate and calories each person should have will depend on goals, type of diabetes, pregnancy, and age. To determine the amount that is best for you, talk to a registered dietitian for help as various factors can influence your diet plan. It’s important to not go too low such as the Atkin’s diet which can be harmful to the kidneys and to not go too high. You are looking for that sweet balance to help stabilize glucose levels.