By Amber Marek, BSN, RN
What is Carbohydrate Counting?
Carbohydrate (Carb) counting is a meal planning technique that involves counting the total grams of carbs in food and beverages. This approach enables individuals with diabetes strict control of their blood glucose levels, thereby reducing the risk of diabetic complications. Counting carbs empowers people with diabetes to confidently add more variety into their diet by calculating and maintaining a daily carb budget.
Diabetes and Carbohydrate Counting
Diabetes mellitus is a chronic metabolic disorder characterized by the body's inability to produce or effectively utilize insulin, a hormone responsible for regulating blood glucose levels. Uncontrolled blood glucose levels can lead to severe and potentially life-threatening complications, including cardiovascular disease, nephropathy, neuropathy, and retinopathy (Brutsaert, 2023). Effective management of blood glucose levels is crucial for individuals with diabetes to prevent these complications and maintain overall health.
Carbohydrate counting emerged as a meal planning technique in the 1920s and has since gained widespread acceptance as a helpful tool for diabetes management. This approach involves quantifying the amount of carbohydrates consumed in food and beverages and adjusting insulin doses or dietary intake accordingly. A meta-analysis by Builes-Montano et al. (2022) demonstrated that carbohydrate counting significantly reduces HbA1c levels, a measure of average blood glucose levels over a three-month period, for people who's diabetic education included carb counting compared to those who only received conventional diabetes education.
What are Carbohydrates?
Carbohydrates are sugar molecules found in various food sources, including grains, dairy products, fruits, starchy vegetables, legumes, and beverages. These molecules are broken down into glucose, which serves as the primary energy source for cells throughout the body (MedlinePlus, n.d.). There are three main types of carbs: sugars, starches, and fiber.
Food and Beverages Containing Carbohydrates
· Grains (pasta, crackers, bread, rice, and cereal)
· Dairy products
· Fruits
· Sweet treats (cookies, cakes, candy, etc)
· Starchy vegetables (core, peas, potatoes)
· Legumes (lentils, beans)
· Alcohol
· Juices
· Sodas
How do Carbs Affect Blood Sugars?
The consumption of carbohydrates directly impacts blood glucose levels. According to the Worcestershire Acute Hospitals (2021), an intake of 10 grams of carbohydrates can raise blood glucose levels by 2-3 mmol/L. Individuals with diabetes may use the number of grams of carbohydrates consumed to adjust their insulin doses at mealtimes or follow the Diabetes Plate Method, which limits carbohydrate intake to a quarter of the plate. It is advised people with diabetes consult with a Certified Diabetes Care and Education Specialist (CDCES) or a registered dietitian nutritionist (RD/RDN) to collaborate on an individualized plan of action to properly manage blood sugars safely.
Consequences of Uncontrolled Glucose Levels
Chronic hyperglycemia, or elevated blood glucose levels, can lead to various debilitating and potentially life-threatening complications in individuals with diabetes. Persistent high blood glucose weakens blood vessels and decreases circulation, resulting in cellular death and tissue damage (Brutsaert, 2023). Common complications associated with uncontrolled diabetes include:
1. Ulcers, particularly in the lower extremities, which may necessitate amputation of toes, feet, or portions of the extremities.
2. Nephropathy, or kidney damage, which can ultimately lead to the need for dialysis when the kidneys can no longer effectively filter the blood.
3. Neuropathy, or nerve damage, which can cause numbness, tingling, and pain in the extremities.
4. Retinopathy, or damage to the blood vessels in the retina, potentially leading to vision loss or blindness.
Starting Carb Counting
To get started carb counting, individuals with diabetes are advised to track the current carb count and monitor your blood sugars before and approximately three hours after meals (American Diabetes Association, n.d.). The total amount of carbs in a specific food can be found on the Nutrition Facts label or, in foods without a label, the nutritional data may be accessed online at FoodData Central (https://fdc.nal.usda.gov/) or other reputable website. University of Virginia School of Medicine has created a pdf listing the amount of carbs in many different types of foods (https://med.virginia.edu). Note the serving size to ensure accuracy.
The recommended daily carbohydrate intake varies based on factors such as age, weight, sex, height, and activity level. According to Warshaw & Kulkarni (2011), On average, men need 4-5 servings of carbs (60-75 grams) for each meal. Women need 3-4 servings (45-60 grams) for each meal. The table below provides an estimate of the recommended daily carbohydrate intake and servings based on total caloric intake:
Daily Calories | 1200-1400 | 1400-1600 | 1600-1900 | 1900-2300 | 2300-2800 |
Carbs (grams) per day | 130-160 | 150-180 | 180-210 | 215-260 | 260-300 |
Carb Servings per day (15 g carbs per serving) | 8-10 | 9-11 | 11-13 | 13-16 | 16-19 |
Fruits (per day) | 2-3 | 2-3 | 3 | 3-4 | 4-5 |
Milk (per day) | 2 | 2 | 2 | 2 | 2 |
Vegetables (per day | 3 | 4 | 4 | 5 | 5 |
Grains, beans, and starchy vegetables | 4-5 | 5-6 | 6-8 | 8-10 | 10-12 |
Warshaw & Kulkarni (2011). Complete Guide to Calorie Counting. Data Retrieved from Table 2-2.
Staying Motivated
While carbohydrate counting may initially seem challenging, motivation and consistency are key to achieving desired results. Tracking progress of your A1C's with a diabetic specialist can assist with motivation and accountability. Setting obtainable goals within specific time frames and participating in diabetes support groups can help provide encouragement and support.
Conclusion
Carb counting is an evidence-based meal preparation technique that enables individuals with diabetes to estimate how their blood glucose will be affected by each meal. By closely managing blood glucose, people with diabetes can significantly reduce the risk of developing debilitating and potentially fatal complications.
It is advisable to consult with a certified diabetes educator or a registered dietitian nutritionist before implementing a carbohydrate counting regimen to ensure proper education and guidance tailored to individual needs.
References
American Diabetes Association. (n.d.). Food & nutrition: Carb counting and diabetes. https://diabetes.org/food-nutrition/understanding-carbs/carb-counting-and-diabetes
Brutsaert, E. F. (2023). Complications of diabetes mellitus. Merck Manual. https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/diabetes-mellitus-dm-and-disorders-of-blood-sugar-metabolism/complications-of-diabetes-mellitus
Builes-Montano, C. E., Ortiz-Cano, N. A., Ramirez-Rincon, A., & Rojas-Henao, N. A. (2022). Efficacy and safety of carbohydrate counting versus other forms of dietary advice in patients with type 1 diabetes mellitus: A systematic review and meta-analysis of randomized clinical trials. Journal of Human Nutrition and Dietetics, 35(6). 1030-1042. https://doi.org/10.1111/jhn.13017
Gillespie, S. J., Kulkarni, K. D., & Daly, A. E. (1998). Using carbohydrate counting in diabetes clinical practice. Journal of the American Dietetic Association, 98(8). 897-905. https://www.sciencedirect.com/science/article/abs/pii/S0002822398002065
University of Virginia School of Medicine. (n.d.). Carbohydrate food List. https://med.virginia.edu/vcdpe/wp-content/uploads/sites/287/2021/03/Carbohydrate-Food-List.pdf
Warshaw, H. S., & Kulkarni, K. (2011). Complete Guide to Calorie Counting: How to Take the Mystery Out of Carb Counting and Improve Your Blood Glucose Control (3rd ed.). American Diabetes Association. https://books.google.com/books?hl=en&lr=&id=PlbDBwAAQBAJ&oi=fnd&pg=PR5&dq=carb+counting+how+to&ots=Goto9Ymo9p&sig=55lopAQKLfiuW-h6dOQak2lb0Dk#v=onepage&q=carb%20counting%20how%20to&f=false
Worcestershire Acute Hospitals. (2021). Carbohydrate Awareness for People with Diabetes. NIH. https://www.worcsacute.nhs.uk/documents/documents/patient-information-leaflets-a-z/carbohydrate-awareness-for-people-with-diabetes/#:~:text=As%20a%20general%20rule%3A%2010g,is%20260g%20of%20carbohydrate%20daily. Assessed and Endorsed by the MedReport Medical Review Board