Carb counting is one form of meal planning that people with diabetes use to help them manage their blood sugar levels. Doctors might recommend a target range of daily carbs as part of an individualized meal plan.

In the United States, 30.3 million people have diabetes, and a further 84.1 million have prediabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Diabetes is an incurable yet manageable medical condition in which the body struggles to regulate blood sugar. This happens when the body cannot produce enough insulin, or when insulin does not work correctly.

Insulin is a hormone that the pancreas makes to help the body process glucose, which is the simplest form of sugar. The cells use glucose to create energy. When the cells cannot take in glucose, it remains in the bloodstream, which can lead to severe health problems.

People who have diabetes must be careful about the foods they eat. Consuming an excess of certain foods might lead to persistent high blood sugar. This can lead to severe complications, such as nerve damage, vision and hearing loss, and cardiovascular disease.

In this article, we explore carb counting as a technique to help people with diabetes manage their blood sugar levels.

Carbohydrates are complex sugars. Many people with diabetes need to count the number of carbohydrates in each serving of food to control their blood sugar levels. People refer to this as carb counting.

Carb counting involves more than resisting a chocolate or ice cream craving, as some seemingly healthful fruits and vegetables might also contain a high carbohydrate content that contributes to blood sugar spikes.

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Carb counting can help a person manage their risk of blood sugar spikes.

The first step in carb counting is identifying which foods contain carbohydrates and how rapidly these carbohydrates will boost blood sugar levels.

People can use a system called the Glycemic Index (GI) to calculate this. Every food has a GI ranking, with higher scores demonstrating a food's rapid effect on blood sugar.

Having diabetes often means that people struggle to regulate their blood sugar levels. So, it is also a good idea for people with diabetes to focus on their diet. Consuming low-GI foods can lead to a slower, more controllable increase in blood glucose levels.

Doctors and dietitians will help people with diabetes work out how many carbohydrates they should consume each day and suggest meal plans to help them maintain a healthful, nutritional balance.

Previously, doctors and dietitians suggested a typical range of carbohydrates that was a fit-all solution for everyone with diabetes.

Now, doctors and nutritionists work with individuals on a one-to-one basis to calculate the ideal daily caloric intake and carbohydrate percentages and servings each person needs.

These amounts will vary according to a range of factors, including the person's weight, height, activity levels, and whether they are taking medications.

Carb counting alone is not a substitute for managing diabetes using medical care and prescribed medications.

The goal of carb counting is to keep blood sugar levels steady for the following reasons:

  • maintaining overall health in those with diabetes
  • preventing the complications of excessively high or low blood sugar
  • improving energy levels

Getting started with carb counting

Carb counting may help many people with diabetes to maintain steady blood sugar levels. However, it is only one way to manage diabetes.

Before trying carb counting, people should always speak with a nutritionist, diabetes educator, or doctor to determine:

  • whether carb counting is appropriate
  • the recommended daily allowance for carbohydrates
  • which foods they recommend

Different people will require different amounts of carbohydrates depending on the type and severity of diabetes they have.

Speak to your doctor about the ideal calorie and carbohydrate intake.

Calculating carbs

When a person has to calculate how many carbs they can consume each day, it is vital to know which foods contain carbohydrates, how many they contain, and their caloric and GI value.

In general, 1 gram (g) of carbohydrate provides around 4 calories. This can help a person calculate how many calories a particular snack or meal is providing.

There is no single number of carbs that is safe for every person with diabetes. Doctors shape the target based on individual needs and disease progression.

It is essential for those with diabetes to understand the content of food nutrition labels. Some describe nutrient serving per half portion, so it is necessary to be sure of exactly how many carbs a meal provides.

When reading nutritional labels, take note of the total number of carbohydrates per serving and add these totals into the total daily carbohydrate allowance.

For example, there are approximately 15 g of carbohydrate in each serving of the following foods:

  • a slice of bread
  • one-third of a cup of pasta or rice
  • a small apple
  • one tablespoon of jelly
  • a half-cup of starchy vegetables, such as mashed potatoes.

However, non-starchy vegetables contain only 5 g of carbohydrate per serving. This means that a person with diabetes can safely eat three times more non-starchy vegetables than starchy vegetables.

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Use cups for more effective portion control.

Carb counting may be challenging at first because it forces people to think about meals differently, and people might take a while to get used to it.

Some tips can help make carb counting a little easier, such as:

  • Counting mixed foods by the cup: On average, a fist is the size of a 1-cup serving. For a mixed dish, this is an effective way to judge the carb totals based on cup size.
  • Count tablespoons: It is helpful to know the number of carbohydrates in a tablespoon of food. People can count level tablespoons to create a healthful plate.
  • Count carbs in pizza using the crust: If possible, choose a thin-crust pizza. This will save 5–10 g of carbohydrate per serving size when compared to a slice of regular or pan pizza.
  • Smoothies may not always be the best bet: On average, a 12-ounce (oz.) smoothie might contain more carbohydrates than a regular soda if it contains juice. Drink smoothies in moderation.

Learn how smoothies can affect blood sugar in people with diabetes here.

The primary nutrients in food include protein, fat, and carbohydrates. Carbohydrates are available in healthful and unhealthful forms. The GI of a specific food will indicate its potential impact for a person with diabetes.

People with diabetes need to take special care about which carbohydrates they eat, the overall number of carbohydrates in their diet, and how regularly they eat carbs.

Whole grains, fruits, and non-starchy vegetables are full of energy-producing nutrients, vitamins, minerals, and fiber. These are vital for normal physical growth and development.

The carbohydrates in vegetables offer these benefits. However, carbohydrates in sugary foods and drinks provide little nutritional value.

Foods with high carbohydrate content

Foods that contain carbohydrates include the following:

  • Grains: Bread, pasta, oatmeal, certain types of noodle, crackers, cereals, rice, and quinoa.
  • Fruits: Apples, bananas, berries, mangoes, melons, oranges, and grapefruits
  • Dairy: Milk and yogurt
  • Legumes: Beans, including the dried variety, lentils, and peas.
  • Snacks: Cakes, cookies, candy, and other sweet dessert-type foods are nutritionally weak sources of carbohydrates.
  • Drinks: Juices, soft drinks, sports drinks, and sugary energy drinks
  • Vegetables: Some vegetables contain more carbohydrates than others.

Choosing carbohydrates carefully and being mindful of when and how much they eat means that a person with diabetes need not give up eating their favorite foods altogether.

Starchy and non-starchy vegetables

Not all vegetables are of equal nutritional value. Nutritionists divide vegetables into starchy and non-starchy types. Starchy vegetables contain more carbohydrates than the non-starchy varieties.

Starchy vegetables include:

  • potatoes
  • sweet potatoes
  • peas
  • pumpkin
  • butternut squash
  • fresh beets

Non-starchy vegetables include:

  • asparagus
  • broccoli
  • carrots
  • celery
  • green beans
  • lettuce
  • other salad greens
  • peppers
  • spinach
  • tomatoes
  • zucchini

Good sources of protein and fat

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Eggs are a healthful source of protein.

It is crucial to understand which healthful foods are good sources of protein and fat to avoid carbohydrate-heavy foods.

Some foods do not contain enough carbohydrates to include in a carb-counting regime. Instead, these foods serve as healthful sources of protein and fats. Foods include many types of cheese, tofu, tempeh, and pumpkin seeds.

Good sources of protein include:

  • eggs
  • whey protein
  • chicken and turkey breast
  • fish, including salmon, cod, and rainbow trout
  • nuts, such as almonds and peanuts

Healthful sources of fat include:

  • oils, such as flax, olive, virgin coconut, avocado, and hemp seed
  • grass-fed butter
  • avocado
  • nuts and seeds

Read more about healthful and unhealthful fats here.

Carb counting is one way to help a person with diabetes manage their blood sugar levels.

However, people with type 1 diabetes should not use carb counting in place of medical treatment. Always talk to a doctor or nutritionist who can calculate a suitable amount of daily carbohydrates for an individual's needs.

Q:

Is calorie-counting also effective for managing diabetes?

A:

Calories are not directly linked to type 2 diabetes; however being overweight is a risk factor.

Recommendations for diet include eating healthful foods in moderate portions that include lean meats, whole grains, and low glycemic fruits and vegetables.

Deborah Weatherspoon, PhD, RN, CRNA Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.