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
Carbohydrate counting helps you maintain your
blood sugar at your target level.
Carbohydrate counting allows you to adjust the amount of
insulin you take based on how many grams of
carbohydrate you eat at a meal or snack. The formula used to determine the
amount of insulin you need is called the insulin-to-carbohydrate
The insulin-to-carbohydrate ratio differs from one person to
another. You and your doctor will calculate your ratio by recording the food
you eat and testing your blood sugar level after meals.
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
Portion control is important. If a package says
it contains two servings and you eat the whole package, you need to double the
number of grams of carbohydrate listed for one serving.
Protein, fat, and
fiber do not raise blood sugar very much. If you eat a
lot of these
nutrients in a meal, carbohydrate will convert to
glucose more slowly than it would with a meal containing a small amount of
protein, fat, and fiber.
Advanced carb counting takes into account the amount of fiber or sugar alcohols in a food. For example, if a food has 5 or more grams of fiber per serving, you can deduct half the amount of fiber from the total number of carbohydrate grams. A food that has 30 grams of carbohydrate and 8 grams of fiber would be counted as 26 grams of carbohydrate. If you use a rapid-acting insulin, you may want to consider sugar alcohols if there are more than 5 grams of sugar alcohol in the food. Divide the number of sugar alcohols in half and subtract that number from the total carbohydrate count.
Exercise affects blood sugar, allowing you
to use less insulin than you would if you were not exercising. 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.
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:
Talking with a
registered dietitian. He or she can help you plan the
amount of carbohydrate to include in each meal and snack.
Measuring your food portions. You won't always have to measure your food,
but it may be helpful when you are first learning what makes up a standard
Eating standard portions of
foods that contain protein. Foods that contain protein
(such as meat and cheese) are an important part of a balanced
Limiting saturated fats. A balanced diet includes a limited
amount of healthy fat. Talk with a registered dietitian about how much fat you
need in your diet.
Other helpful suggestions
food labels for carbohydrate content. Be careful to consider the serving size
on the package.
Check your blood sugar level. If you do this before
and 1 hour after a meal, you will be able to see how the food you eat affects
your blood sugar level.
Record what you eat and your blood sugar
results in a food record(What is a PDF document?). At each regular visit with your
registered dietitian or
certified diabetes educator, or whenever you think
your meal plan needs adjusting, you can review your
Get more help. The American Diabetes Association offers
booklets to help people learn how to count carbohydrate grams in their diet, to
measure and weigh food, and to read food labels. But you will still need to talk with a registered dietitian to
establish a plan that fits your needs.
American Diabetes Association (2013). Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care, 36(11): 3821–3842. DOI: 10.2337/dc13-2042. Accessed December 5, 2013.
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.
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Your level is currently
If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.
People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.
Congratulations on taking steps to manage your health.
However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.
Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.
Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.
One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.
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