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Carb Counting for People with Diabetes

Meal planning for people who happen to have diabetes has changed drastically over the last several years. It used to be that sweets were forbidden, but this premise no longer holds true. The key to success both in weight management and glycemic control is to learn as much as you can about developing a meal plan which incorporates your treatment goals (e.g. weight, blood glucose levels, cholesterol, etc.), your lifestyle, and your likes/dislikes. Ideally, this should be done with the assistance of a Registered Dietitian (RD) who also has the credential of Certified Diabetes Educator. Most insurers (including Medicare) pay for this consultation.

One of the newer approaches to meal planning is called Carbohydrate Counting. Since carbohydrates alter blood glucose levels the most of any food group, this approach is based on the total amount of carbohydrate consumed rather than the its source. In this way, it is possible for people who happen to have diabetes to still "work in" that piece of pie or ice cream cone. The basic system of Carb Counting emphasizes being consistent from day to day in the amount of carbohydrate consumed for each specific meal and time of day. For those on flexible insulin regimens, advanced Carb Counting, stresses the balance between the amount of carbohydrate consumed and the amount of insulin required to "cover" in order to maintain glucose control.

Why is Carb Counting Beneficial?

  • Many people may find Carb Counting easier to use than the older Exchange System. Once you learn the basic concepts, you will have enough flexibility to include foods including treats and combination foods like pizza.
  • Another benefit of Carb Counting is that it may be possible to achieve better diabetes control. If you are as consistent as possible with carb intake and medication, and monitor frequently, CC will help you better manage your diabetes because you will then be able to fine tune your treatment plan to achieve the best possible blood glucose control.
  • For those who take mealtime insulin (either by injection or pump), counting carbohydrates allows you to decide how much carb you want to eat at a meal, rather than having to eat a certain amount of carbohydrates, even if you do not want to.
Can Anyone with Diabetes use Carb Counting?

Anyone who has diabetes can utilize Carb Counting as a meal planning approach, whether you take insulin or not.

How Does Carb Counting Work?

  1. Meal plan: A meal plan is a guide that helps you figure out how much carb, protein and fat to eat at meals and snacks each day. If you don’t have a meal plan, meet with a registered dietitian.

  2. Foods with carbohydrate: To know how much carbohydrate you eat, you need to understand which foods are primarily carbohydrate and which contain enough carbs that they require counting. Foods that contain carbohydrate are:
    • starchy foods like bread, cereal, rice, and crackers
    • fruit and juice
    • milk and yogurt
    • dried beans like pinto beans and soy products like veggie burgers
    • starchy vegetables like potatoes and corn
    • sweets and snack foods like sodas, juice drinks, cake, cookies, candy, and chips
    • Non-starchy vegetables have a little bit of carbohydrate
    • Beer, wine, and some liquors

    A healthy meal plan should emphasize those foods that are chock-full of nutrients. These types of food also have a lot of fiber, protein, vitamins and minerals. The additional nutrients play a role in assuring carbs (which covert to glucose) are broken down properly preventing the desire for an increased carb intake. Examples include whole grains and fruits, low-fat (or nonfat yogurt and milk. Good sized portions of vegetables also are beneficial. However, even though choices such as candy, cakes, pasta and regular sodapop do not provide the same nutritional value, they can also be incorporated perhaps in small amounts.

  3. Portion Size: To get the best assurance that you are getting the proper amount of carbohydrate, portion sizes need to be accurate, Standard kitchen tools like a scale and measuring cups and spoons will help you a great deal.

  4. Food Labels: These days, most food products have Nutrition Facts Labels which allow you to see the nutrients contained in the item. Becoming familiar with label reading will allow you to include favorites such as pizza, a piece of pir or ice cream.

  5. Flexible Insulin Programs: For those folks on flexible insulin programs (either by injection or pump), carb counting allows you to decide how much of what to eat at any given meal and dose accordingly. This is especially helpful for those who wish to "sleep in" or eat mores on occasion.

Advanced Concepts

Once you feel comfortable with Carb Counting basics, you may wish to move on to more advanced concepts. This is targeted for those who use either an insulin infusion pump or a flexible insulin regimen. Again, employ the assistance of your RD to learn these concepts. You will need to gain an understanding of appropriate target blood glucose levels along with how your insulin and food intake interact to maintain them. The key to success here will be frequent blood glucose monitoring (before meals and 2 hours afterwards) and assessing blood glucose results over time.

In using this approach, it is also important to recognize that other nutrients do also have an impact on blood glucose levels. For example, that serving of ice cream may result in a different blood glucose level than the 4 ounces of juice. This is because the fat in the ice cream causes the carb to become more slowly absorbed. Through frequent monitoring and trial and error, you will learn how to make appropriate adjustments to your insulin dose and/or timing of delivery.


Fortunately, there are many resources available to help you with Carb Counting, including many books and even apps for smartphones. Consult your dietitian or surf the web. You will find many that suit your needs.

The Bottom Line

While counting carbs allows flexible eating, you cannot just forget the basic elements of the meal plan that you developed together with your dietitian. Always remember that it reflects your treatment goals, your food preferences, and your lifestyle needs. You should not throw your meal plan away and eat as many carbohydrates as you desire. Monitor blood glucose levels frequently, keep your glucose as close to normal as possible--and you'll do well. Always consult your healthcare team before making any major changes.

Is carbohydrate counting a panacea? Certainly not. Just as any system, it has advantages and disadvantages. There is a lot to learn in order to use it properly, and of course, the flexibility it affords can lead to weight gain and increase cholesterol levels if one is not careful. However, it IS fairly simple to learn and excellent glucose is possible without not giving in to those occasional cravings you might have. The key (as has been emphasized before) is to eat a well-balanced meal plan that incorporates all food groups. There are a multitude of articles on the web and books that can also be of assistance as you embark on this learning process. Google for them!

For more information, see:

Carbohydrate Counting at the ADA website

Carbohydrate Counting 101 from the Joslin Diabetes Center

How to Read a Food Label from the University of Iowa

What Are Carbs? from the Diabetes Mall

How To Count Carbohydrates from the Diabetes Mall

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Author: Stephanie Schwartz Quick, RN, MPH


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This page was new at D-is-for-Diabetes on March 26, 2012

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