Carbohydrate counting is an important
skill to help you maintain tight control of your blood sugar (glucose) level
when you have
diabetes. It gives you the flexibility to eat what you
want and increases your sense of control and confidence in managing your
is a recommended method of meal planning for people who have diabetes. It
involves matching your insulin dosage to the grams of carbohydrate in the foods you eat to
keep your blood sugar level in your
main source of glucose—affects blood sugar more than any other nutrient. All
forms of carbohydrate increase your blood sugar level. Foods that contain
Contrary to what you may have heard, you can eat sugar when
you have diabetes. But if foods that contain sugar make up a large part of your
diet, you are probably not eating enough of other more nutritious
Which of these foods contain
Wheat bread, rice, peas, and oatmeal all
contain carbohydrate. Carbohydrate is an essential nutrient found in foods such
as bread, cereal, grains, and vegetables. It also is in fruit, milk, desserts,
Cheesecake, skim milk, and pears all contain
carbohydrate. Carbohydrate is an essential nutrient found in foods such as
bread, cereal, grains, and vegetables. It also is in fruit, milk, desserts, and
Continue to Why?
counting helps prevent low or high blood sugar levels, which can cause medical
emergencies. Over time,
high blood sugar levels can damage many body tissues and organs.
Counting carbohydrate grams allows you to match insulin to the food you
eat every day to keep blood sugar at your target level. This method is
effective because carbohydrate is the main nutrient that causes blood sugar to
rise after meals, increasing the need for insulin. Carbohydrate turns into
glucose within 2 hours after you eat.
If you use an
insulin pump or take multiple insulin injections, you
need to know how many grams of carbohydrate are in a meal to calculate how much
rapid-acting insulin to take before you eat. A pump
provides a continuous (also known as basal) rate of insulin throughout the day,
but it must be programmed at meals to provide extra insulin to allow for the
rise in blood sugar after meals. When you know how much carbohydrate you will
eat, you can program extra units, or boluses, of insulin to cover your
You figure out how much insulin to use based on your own
insulin-to-carbohydrate ratio. This ratio may be different from one person to
another, and even your own ratio may change over time. You and your doctor will
calculate the ratio by recording the food you eat and testing your blood sugar
Carbohydrate counting helps me know how much insulin I
need to take at meals.
Carbohydrate counting does help you know how
much insulin to take at meals. You will use your own insulin-to-carbohydrate
ratio to determine how many units of insulin you need to cover the carbohydrate
in your meal.
Continue to How?
count carbohydrate grams at a meal, you need to know how much carbohydrate is
in each type of food, whether it is a slice of bread, a bowl of lettuce, or a
tablespoon of salad dressing. Fortunately, nearly all packaged foods have
labels that tell you how much total carbohydrate is in a single serving.
And you can get carbohydrate guides from diabetes educators and the American
To calculate the carbohydrate in food that
is not packaged, you will need to know standard portions of
carbohydrate foods. Each
serving size or standard portion contains about 15 grams of
When you know the number of grams of carbohydrate in
a meal, you can figure out how many units of insulin to take based on your
personal insulin-to-carbohydrate ratio.
For example: Your doctor may recommend that you take 1 unit of rapid-acting
insulin for every 10 to 15 grams of carbohydrate you eat. So if your meal
contains 50 grams of carbohydrate, and if your doctor has decided you need 1
unit of insulin for every 10 grams of carbohydrate, you would need 5 units of
insulin to keep your post-meal blood sugar from rising above your target
Your insulin-to-carbohydrate ratio may change over time. In
some people it will differ from one meal to another. You might take 1 unit of
insulin for every 10 grams of carbohydrate for lunch but take 1 unit for every
15 grams at dinner. Keep the following in mind when counting carbohydrate
By keeping track of what you eat and testing your blood
sugar after meals and exercise, you can learn to estimate the effect of
protein, fat, fiber, and exercise on the amount of insulin you need.
Count carbohydrate grams and eat a balanced diet by:
I can eat only a certain amount of carbohydrate at one
sitting, or my blood sugar will be too high.
The amount of carbohydrate you eat at a meal
can vary. You keep your blood sugar under control by matching the amount of
insulin you take to the amount of carbohydrate you eat.
Continue to Where?
Now that you have read this
information, you are ready to plan regular meals and snacks and calculate the
amount of carbohydrate in your diet.
Talk with your diabetes
specialist (doctor or other health professional, registered dietitian, or
certified diabetes educator). If you have questions about this information,
take it with you when you visit your diabetes specialist.
need help with carbohydrate counting or meal planning, see a registered
If you would like more information on meal planning for
people who have diabetes, the following resources are available:
The Academy of Nutrition and Dietetics sets standards for all types of prescribed diets. The
organization produces a variety of consumer information, including videos. This group will help you find a registered dietitian in your area who
provides nutrition counseling.
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
Return to topic:
Other Works Consulted
American Diabetes Association (2008). Nutrition
recommendations and interventions for diabetes. Diabetes Care, 31(Suppl 1): S61–S78.
American Diabetes Association (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl 1): S11–S66.
Campbell AP, Beaser RS (2010). Medical nutrition therapy. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 91–136. Boston: Joslin Diabetes Center.
Franz MJ (2012). Medical nutrition therapy for diabetes mellitus and hypoglycemia of nondiabetic origin. In LK Mahan et al., eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 675–710. St Louis: Saunders.
June 24, 2013
E. Gregory Thompson, MD - Internal Medicine
& Rhonda O'Brien, MS, RD, CDE - Certified Diabetes Educator
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