Carb Counting

This is information assembled from the ADA website, and a number of other sources, written as I understand it. Cross reference and double check the accuracy of what I am presenting.

The cornerstone of any diabetic meal plan is carbohydrate counting. And while each meal plan is set up for an individual, the general rules are the same for everyone.

If you are controlling your diabetes strictly with diet, then you'll have an upper limit of how much carbohydrate you can tolerate per meal. For me, when I wrote this, it was 30 grams. Not much. I had NO room for error. That improved to 60 grams within a few months. If you are using insulin, then the amount of carbohydrate you consume is still critical, because your insulin dose will need to be adjusted if you do not meet it, or if you exceed it. When I was using insulin previously, it was simplest just to stick to a set amount of carbohydrate and insulin.

The ADA calls a single serving of carbohydrate an "exchange". One exchange equals 15 grams of carbohydrate. And serving sizes are calculated on that basis, NOT on a basis of familiar serving sizes! So the first thing you have to learn, is how to properly measure foods. It can be a pain at first, but with practice, you'll be able to quickly count up the value of any meal, or serve yourself from a buffet in a restaurant or at a potluck dinner, and accurately dish up a balanced meal.

Here are some common serving equivalents:

There are exceptions to these, so do some more research!

Generally, One Carb Exchange is equal to:

One small piece of fruit, or a 1/2 cup serving of fruit (dried fruit takes MUCH less!)

1/2 cup starchy vegetable (peas, squash, legumes)

1 small slice of bread

1 small potato (you can do 4 oz if you eat the skin, 3 oz if not)

8 oz milk, yogurt, or unsugared icecream

4 oz juice (unsweetened)

1/2 cup brown rice or whole wheat noodles, cooked

1/4 cup flour (if you need to calculate for your own recipes)

1/4 cup rolled oats (dry)

or 15 grams of any carbohydrate.

Watch out for "hidden" inflators - barbeque sauce, sweet and sour sauce, and Asian sweet and spicy sauces can double the carb count. Ketchup is negligible, and spaghetti sauce USUALLY is, but not always. Gravy in small amounts is not countable, but gravies made with milk, or in large portions will be countable.

You can quickly calculate this from any food label, but make sure you read both the carbohydrate grams, AND the average serving size, because the carb count is PER SERVING, and most containers have more than one serving.

Many diet foods have very close to one carb exchange per serving, and many individual serving diet foods have just one per package, some have two, making them easy to incorporate into a diet.

Don't be fooled by labels which say, "only so many Impact carbs". You MUST count them ALL, except fiber. Fiber passes through undigested, so you can subtract out the fiber carbs, but that is all. Sugar Alcohol COUNTS!

Here are some things I learned:

1. Pay attention to portion sizes! Buy small fruits, or use half a fruit, measure juice and milk, and stick to proper serving sizes of breads and other critical items. Use a small glass for juice and you won't be so tempted to overfill. We have a set of cups with 8 oz glasses and with 6 oz glasses. The 6 oz glasses have a pattern on them that ends right at the 4 oz mark, so we use the 8 oz glasses for milk, and the 6 oz glasses "to the top of the design" for juice.

2. Potatoes have less of an effect on blood sugar if you EAT THE SKINS. It is not just fiber. We make hashbrowns, potato soup, baked potatoes, and casseroles with skin-on potatoes. Make sure you stick to a 1/2 cup serving size, or a small potato (we buy bags of small potatoes on purpose). When we make a casserole, we micro-bake the potatoes - just one per person, cut them up in chunks, and then mix them in with the other ingredients. Then when we serve it, we divide it equally by the number of potatoes used so the potato portion is controlled.

3. VARIETY! I am not sure why this is, but my blood sugar is better controlled when I use a variety of carbs. During pregnancy I could have 4 carb exchanges per meal, so I could have a glass of milk, a piece of fruit, a slice of bread, and a potato at a single meal, along with a protein and veggies. If you are limited to just 2 carbs per meal, you may need to use half portions if you want that much variety, but the real trick is to not have more than one serving of any single carb, unless it is something like two slices of bread for a sandwich, or a double serving of pasta. Some types of carbs are REALLY picky about this, and you just don't do more than one serving of them per meal - more on that in the next point.

4. Beans, Rice, and some types of Bread are very reactive for some people. Fruit and juice are also ones you must be careful with. These items are ones that you should never have more than one portion of during a single meal. Even if you use brown rice, fresh cooked beans, and whole wheat bread, they tend to have carbohydrate that absorbs very quickly. Combine them with lots of fresh veggies, a good solid protein (nuts, egg, or meat), and a little fat to slow them down a bit. Slice your bread thin, or make an open-face sandwich to avoid overload.

5. Get your veggies. I also noticed that when I ate fresh veggies with a meal it was easier to control my blood sugar than it was when I ate the SAME MEAL without veggies! I tested repeatedly to verify that result.

6. Watch the Freebies! Some items are considered free foods. Fresh non-starchy veggies, condiments or other items with less than 4 gms of carb per serving are considered "free" foods. BUT, if you have more than about two of them, you HAVE to count them as one exchange. I don't count free veggies at all because they tend to not affect my blood sugar even in high amounts, and they even help balance my sugars, but you may need to. Things like ketchup and steak sauce have sugar in them, and you need to limit the portions if you want to keep them "free". Some low carb candies and snacks also fit this category.

How Much?

Generally if you have a diagnosis of diabetes, you will be instructed by your doctor in how much carbohydrate you are allowed. Here is what my sister and I have experienced:

I am pregnant. At 60 grams of carb per meal (4 exchanges), and 15-30 (1-2 exchanges) per snack, if I ONLY eat when I am hungry (and my blood sugar is low enough to eat), I maintain my weight. With one 75 gm meal per day, I slowly gain, which is appropriate for pregnancy.

At 3 exchanges per meal, and 1-2 per snack, I lose at a rate of about a half pound a week if I am eating only 3 major meals a day.

At 2 exchanges per meal, and 1-2 per snack, I lose at a rate of 1 or more pounds per week.

When I am not pregnant, it does not matter how little I eat, I do not lose weight. This is likely a secondary effect from not being able to exercise due to a muscle disorder.

My sister, who also has diabetes, more severe than mine, can control her diabetes well on 3 exchanges per meal, 1-2 exchanges per snack.

We generally do not count fat and protein - you may need to, so follow your doctor's advice. We do not count the carbs in nuts, non-starchy veggies, or condiments with less than 4 gms per serving, but we do limit ourselves to a single serving. We have found though, that when you balance your meals, even when you limit your carbs quite a bit, overeating is not really an issue, and we don't have to count the other components because we simply cannot eat that much of them!

The bottom line is, learn what the proper serving sizes are and don't cheat! Then learn how your body handles various foods, and do what works for you.

Written by Laura Wheeler, Owner of Firelight Business Enterprises, Inc.