Diabetes Nutrition

What is carbohydrate (carb) counting for diabetes?

Carbohydrate counting is a meal-planning strategy to help manage your blood sugar when you have diabetes. You learn how much carbohydrate is in the foods you eat. Then you can adjust food and portions to meet your carbohydrate goal. This helps prevent high blood sugar after you eat and drink.

What foods have carbohydrates?

The healthiest carbohydrate choices are breads, cereals, and pastas made with whole grains; brown rice; low-fat dairy products; vegetables; legumes such as peas, lentils, and beans; and fruits.

Foods made from refined flour, including bread, pasta, doughnuts, cookies, and desserts, also contain carbohydrates (carbs). And carbs are in foods and drinks that have sugar, such as candy or soda.

Diabetes: counting carbohydrates

Our emotions influence what we eat, when we eat, and how much we eat. So negative feelings can interfere with how well you can follow your diet for diabetes. If you can let go of those feelings, you’ll be more likely to follow a healthy diet. These tips can help you manage your feelings.

• Give yourself permission to make choices.
  People often think that following a diet for diabetes means giving up foods they like and having to eat foods they don't like. But actually, you have choices. Try this exercise.

• Make four lists: foods you like, foods you dislike, foods that are "bad" for diabetes, and foods that are "good" for diabetes.
• Cross out the foods in the "foods I dislike" list. You don't have to eat them. You can eat any of the foods in the other three lists.

The fact is:

• There are no "good" or "bad" foods.
• You don't have to give up the foods you like.
• You may need to eat some foods in smaller amounts and less often to prevent high blood sugar. But you can learn to fit them into your diet.

• Recognize your feelings.
  Make a list of all the feelings you have about a diet for diabetes and why you have them. For example:

• You may feel guilty about eating certain foods, such as chocolate cake, if you think they are "bad."
• You may feel angry or resentful if you think you can't eat the foods you like.

Don't judge yourself by your feelings. It's what you do with them that matters.

• Let go of your negative feelings.
  Just identifying a negative feeling isn't enough to get rid of it. You'll need to do something. Record how you plan to deal with each negative feeling. Here are some ideas:

• Write about what you feel. Then read it aloud to yourself.
• Talk with your family, a friend, or your diabetes specialist. You may learn that your negative feeling is based on something that isn't true.
• Join a diabetes support group. Most people with diabetes have had negative feelings about the diet and are willing to share how they dealt with those feelings.

If your feelings keep getting in the way of taking care of yourself, talk with a health professional about counseling.

Carbohydrate (carb) counting is an important skill to learn when you use insulin. It allows you to adjust the amount of insulin you use so you can eat what you want and still keep your blood sugar at your target level. Here are some tips for counting carbs.

• Know your daily amount of carbs.
  Your daily amount depends on several things, including your weight and how active you are. A registered dietitian or certified diabetes educator will help you plan how much carbohydrate to include in each meal and snack. For example, most adults can have 45 to 60 grams at each meal, which is 3 to 4 carbohydrate servings.
• Count your carbs.
  To count carbs, you need to know how many carbs are in each type of food you eat. Most packaged foods have labels that tell you how many carbs are in one serving. For foods that aren't packaged, you'll need to know standard portions of carbohydrate foods. Each serving size or standard portion has about 15 grams of carbs. Portion control is important.
• Measure your food portions. You won't always have to measure your food. But it may help when you're first learning what makes up a standard portion.
• Read food labels for carb amounts, and be aware of the serving size. If a package contains two servings and you eat the whole package, you need to double the number of grams of carbs listed for one serving.
• Figure out your insulin dose.
  By using the number of grams of carbs in a meal, you can figure out how much insulin to take. This is based on your personal insulin-to-carbohydrate ratio. For example, your doctor may advise you to take 1 unit of rapid-acting insulin for every 10 to 15 grams of carbs you eat. Here's how to figure out how much insulin you need:
• Say your meal has 50 grams of carbs, and your doctor told you to take 1 unit of rapid-acting insulin for every 10 grams of carbs you eat.
• Divide 50 by 10, which equals 5. You would need 5 units of insulin to keep your post-meal blood sugar from rising above your target level.
• Record what you eat and your blood sugar results.
  Keep track of what you eat, and test your blood sugar after meals and exercise. This can help you figure out what effect exercise and different types of food have on the amount of insulin you need.
• Protein, fat, and fiber don't raise blood sugar very much. If you eat a lot of these nutrients in a meal, carbs will change to glucose more slowly than they would with a meal that has a small amount of protein, fat, and fiber.
• Exercise affects blood sugar. It allows you to use less insulin than you would if you didn't exercise. Keep in mind that timing makes a difference. If you exercise within 1 hour of a meal, your body may need less insulin for that meal than it would if you exercised 3 hours after the meal.
• Consider advanced carb counting.
  Advanced carb counting takes into account the amount of fiber or sugar alcohols (a type of sweetener used in foods labeled "sugar-free") in a food. For example, if a food has 5 or more grams of fiber per serving, you can subtract half the amount of fiber from the total number of carb grams. A food that has 30 grams of carbs and 8 grams of fiber would be counted as 26 grams of carbs (8 ÷ 2 = 4, and 30 - 4 + 26). If you use a rapid-acting insulin, you may want to consider sugar alcohols if there are more than 5 grams of them in the food. Divide the number of sugar alcohols in half. Then subtract that number from the total carb count.

How does alcohol affect diabetes?

If you have diabetes, you need to be careful with alcohol.

• If you take medicine for diabetes, drinking alcohol may cause low blood sugar.
• Too much alcohol can also keep you from knowing when your blood sugar is low and when to treat it. Drinking alcohol can make you feel lightheaded and drowsy. Both of these feelings may be similar to the symptoms of low blood sugar.
• Other people may mistake symptoms of low blood sugar for drunkenness. Be sure to wear medical alert jewelry and tell people you have diabetes.
• Drinking alcohol over many years can cause damage to your liver, called cirrhosis. If this happens, your body may lose its natural response to protect itself from low blood sugar.

When your goal is healthy eating, dining out can be a challenge. Here are some ways to make healthy choices.

• Plan ahead.
  Before you go out to eat, think about what healthy options you might choose. Try to choose restaurants that mark healthy items on the menu.
• Think about your portions.
  Ask for half-sized or lunch-sized portions. Or choose the smallest fast-food meal option. Split a meal with someone or take half home.
• Make your meals lower in saturated fat.
  Order foods that are poached, grilled, or baked instead of fried. Ask for sauces and dressings on the side. Choose lean meats and dressings that are lower in fat.
• Add fruits, vegetables, and whole grains.
  Try vegetarian options and whole-grain breads and pastas.
• Choose healthy beverages.
  Drink water, flavored sparkling water, or unsweetened iced tea instead of sugary drinks.
• Avoid buffets and all-you-can-eat restaurants.
  It's easy to eat too much at these places.

If you have diabetes, planning meals and snacks with a good balance of carbohydrate, protein, and fat can help you manage your blood sugar.

Planning your meals ahead of time can help make it easier to eat healthy foods and snacks.

Work with a dietitian or diabetes educator to find a plan that works for you.

• Plan your meals a week at a time.
  • Use cookbooks or online recipes to plan several main meals for the week.
  • Plan some quick meals for busy nights. You can double some recipes and freeze half of the meal for a night when you're busy.
• Make a list of the meals you've planned for the week. Post it in your kitchen.
• Make a shopping list of foods that you need to make your meals.
  • Include breakfasts, lunches, and snacks. List plenty of fruits and vegetables.
  • If you're running low on or missing anything you need for your meals, put it on your list.
• Take your list with you when you shop.
• Save some of your menus and grocery lists to use again.

Maintaining a healthy weight is an important aspect of managing your diabetes. For many people, consulting with a dietitian or joining a program or group focused on weight loss provides valuable information and support.

Search for healthy recipes to help maintain your weight offered by the American Diabetes Association.

Parkview Weight Management & Bariatric Surgery offers services and support that may be helpful for you.