Counting Carbohydrates: How and Why
By Blondy2061h and Lloyd
Carbohydrate counting is important for all types of diabetes, including: type 1, type 1.5, double diabetes, type 2, pre-diabetes and gestational Diabetes.
Some people can control their Type 2 diabetes with diet and exercise. Does that just mean eat good foods? Well, that is a part of it, but carbohydrates raise your blood sugar, not just sugar. Just because a food doesn't taste sweet, doesn't mean it won't raise your blood sugar. Exercise will usually lower it. If you are controlling your diabetes with diet and exercise, limiting your amount of carbohydrate intake can help control spikes in your blood sugar, and therefore help you reduce your risk of complications, such as heart disease, amputation, and eye problems.
Many people with type 2 diabetes are on oral medications to help them control their blood sugar. They work by different mechanisms. Some will prevent your liver from releasing too much glycogen (stored glucose), while others will increase insulin sensitivity, while still others will push your pancreas to release more insulin. Some medications work by multiple means. While these drugs can be a big help, most of them have as the number 2 listed side effect, after possible hypoglycemia, as weight gain, though weight gain for most people is a natural effect of controlling blood sugar. Added body weight usually leads to added insulin resistance, which raises blood sugar and you end up with still more fat stored- a vicious circle. This makes limiting carbohydrate intake even more important- it helps break the cycle.
A natural progression of type 2 is the pancreas cells "exhausting." The pancreas can no longer keep up with the high insulin needs, and needs help. The help comes in the form of injected insulin. There are many different forms of injected insulin, and all type 1s, most type 1.5s, and some type 2s and gestational diabetics need it in some way. Any way you do it, however, this basic concept needs to remain in your mind. Insulin and exercise lower blood sugar, while carbohydrate raises it. Therefore, you want these things to balance to prevent hyper and hypoglycemia.
If you are on an insulin pump, you tell the pump how many carbohydrates you are going to eat and most pumps do the math to give you the right amount of insulin to match the carbohydrates. If your carbohydrate factor is set correctly, this usually works out well.
You can also use "Multiple Daily Injections" to match your insulin dose to what you eat. With MDI you take a shot of long acting insulin once or twice a day, and then take injections of fast acting insulin every time you eat (unless, of couse, you are eating because you are low).
With an old school "2 shot a day" programs it was very important to keep track of carbohydrates, because the insulin peaked, meaning you had to eat the same amount at the same time everyday to cover this peak.
With gestational diabetes it's important to count carbohydrates because you want to consume enough carbohydrates to help your baby optimally, but you need to control spikes in your blood sugar too.
With pre-diabetes carbohydrate counting is important because it can help slow the progression to full-fledged diabetes.
Diabetes is a progressive disease. Type 1s leave the "honeymoon phase" while type 2s deal with increased insulin resistance and more beta cell exhaustion. Type 1.5s also are on a path where less and less insulin is produced. The further you are along this path, the harder glucose control becomes, and the more careful you need to be with your carbohydrate counting for success. Counting carbohydrates is part science and part art. You can read labels and check in books when at home; and measure and weigh foods. When you eat out, you have to guesstimate. That takes practice, the more you do it the better you get, just like most things in life.
How to count Carbohydrates:
A food scale is small, fairly inexpensive, and the most accurate way we know to measure portion sizes. In the US, anyway, we would look for one with both ounces and grams, and also what is called a taro function. That simply means it has a button it to set the scale to zero whenever you wish.
Here is a good way to use the scale:
Put a plate on the scale.
Set the scale to zero.
Add a food to the plate, until the desired amount shows on the scale.
Set the scale to zero
Add another food.
You end up with a plate with food on it, and you now know how much of each food you have. And you have not dirtied any measuring cups doing it. The package, can, box, or book you are looking in will tell you how many carbohydrates in a serving. You can weigh out 2/3 of a serving, you will have 2/3 of the carbohydrates.
If a food is only listed in a volume measure, like a cup of milk, you can do this:
Put a measuring cup on the scale
Zero the scale
Add a cup of milk
Write down how many grams a cup of milk weighs.
From here on, you can put a glass on the scale, zero it, and add a cup of milk without measuring, just add the right weight.
Some scales have even more helpful features. Some scales have food databases right in them, or let you enter the carbohydrates per serving and figure the exact carbohydrate for you- not just the weight. Some scales will even total it for you as you go along.
There are many, many ways to figure out how many carbohydrates are in foods. The Cozmo, Animas, and Omnipod pumps have food databases right in them, while Accu-Chek and Calorie King make a software program that can be loaded onto a PDA with a carbohydrate database.
There are a million and one books on carbohydrate counts- some with a focus on food in restaurants.
There are also many web sites, with CalorieKing - Diet and weight loss. Calorie Counter and more.
being a popular and thorough one.
Another way to count carbs is to use "carb factors." This basically tells you how many carbs 1 gram of any food has. It's a very precise, though sometimes difficult way to count carbs, and works well with a food scale. You simply weigh the food and multiply it by it's "carb factor" to get the total carbohydrate value. More about carb factors can be found here: FWD-Carb Factors Resources
An "old school" way to count carbs was using the exchange system. It was designed to help people eat a balanced diet. We know you're not idiots though, and can figure out how to do it yourself. We further know that you don't want to eat the same exact thing everyday. Finally, the exchange system over complicates things, with no added benefit over straight out carb counting. So we don't recommend it. However, if you are used to the exchange system, it's easy to convert to carb counting:
1 Bread Exchange = 15 grams of carb
1 Fruit Exchange = 15 grams of carb
1 Milk Exchange = 12 grams of carb
1 Vegetable Exchange = 5 grams of carb
1 Meat Exchange = 0 grams of carb
1 Fat Exchange = 0 grams of carb
A free food is one with negligible impact on blood sugars.
(From page 67 of Think Like a Pancreas by Gary Scheiner)
No matter what your treatment, or what type of diabetes you have, carbohydrates are an inevitable part of life, and counting them will make your life so much easier.
- Lloyd and Blondy2061h