Why Carbohydrates Matter1,2
Carbohydrates are important because they provide energy and essential vitamins and minerals. Proteins and fats also contain calories, vitamins and minerals but do not contain carbohydrates unless the food is a mixed dish like a casserole.
Proteins and fats take longer to digest and are slower to affect blood glucose. Higher consumption of protein or fat at meals can delay glucose absorption, and create higher blood glucose levels later.
Carbohydrates are the primary foods that affect glucose levels. Nearly 100% of digestible starches and sugars become glucose soon after eating. Glucose is then released into the blood stream to provide immediate energy needs, or stored in the muscle and liver as glycogen. Excess glucose is converted to fat for storage.
What are Carbohydrates?
Starchy vegetables like potatoes, corn and peas, dried beans and lentils, grains like oats, barley, rice and items made from wheat flour.
Naturally occur in milk and fruit, or added during cooking or processing. Common names for sugar are table sugar, brown sugar, molasses, honey, cane sugar, maple syrup, high fructose corn syrup and agave nectar.
Can be found in fruits, vegetables, whole grains, nuts and legumes. Most dietary fiber is not digestible. Fiber contributes to digestive health, keeps you regular and helps make you feel full and satisfied after eating.
Know Your Carbohydrates3,4
Complex carbohydrates include starchy foods and foods with fiber like whole grain pasta, beans, brown rice, or whole wheat bread. Choosing less processed, whole grain products like these are not only more nutritious, but the fiber can have a favorable effect on your blood glucose and digestive health.
Simple carbohydrates include table sugar, honey, syrups, regular soda, fruit juice, jellies and candies. These foods are digested easier and absorbed into your blood stream faster than complex carbohydrates.
Sugar Alcohols include erythritol, glycerol, sorbitol, mannitol, and xylitol among others. They usually end with “–tol”. These sweeteners provide fewer calories than sugar and have less of an effect on blood glucose.
Low-Calorie Sweeteners include Nutrasweet®, Equal®, Sweet ‘N Low®, Splenda® and Stevia®. These sweeteners do not provide carbohydrates or calories to your food or beverages.
Why Count Carbohydrates5
Carbohydrate counting is a great technique to use to help you plan your meals and manage your insulin dosing. Some people count carbohydrates for better portion control and balanced meals. When you have diabetes, it can be beneficial to count carbohydrates so that you may dose meal time insulin based on your carbohydrate intake. This method uses an insulin-to- carbohydrate ratio or "IC Ratio" that is provided to you by your healthcare provider.
Carbohydrates, Insulin & Blood Glucose
What is basal/bolus insulin therapy?6
In order to understand insulin-to-carbohydrate ratios, it is important to understand basal insulin and bolus doses.
Your body needs a small amount of insulin constantly working in the background. If you currently take insulin using Multiple Daily Injections (MDI), you likely use long-acting insulin to address this. If you are using an insulin pump, you get your basal insulin from a constant infusion of rapid-acting insulin called a basal rate.
On top of basal insulin, additional insulin is needed in anticipation of foods that are likely to raise your BGs, like carbohydrates, and/or to correct an elevated blood glucose (BG) value. This additional dose of insulin is called a bolus dose. Whether you are using MDI or an insulin pump, rapid-acting insulin is most commonly used for bolus doses.
Balancing Insulin with Carbohydrates
Your BGs after a meal rely heavily on the balance of insulin to carbohydrates. Accurately counting the amount of carbohydrates in your meal is a key step to achieving this balance.
Know Your Blood Glucose Levels
When you begin carbohydrate counting, it is helpful to know what your pre- and post-meal targets should be. The American Diabetes Association Recommended Range7 are as follows:
- A1C: Less than 7.0%
- Pre-meal Blood Glucose: 80-130 mg/dL
- Post-meal Blood Glucose (1-2 hours after start of meal): Less than 180 mg/dL
What is an IC Ratio
Insulin-to-Carbohydrate Ratios are used to determine your meal bolus dose. This ratio helps you calculate how many units of rapid-acting insulin are needed for the amount of carbohydrates (in grams) you plan on eating.
With this method, the amount of insulin you take for your meals is better customized to what you are going to eat. If you eat more carbohydrates, you take more insulin. If you eat less carbohydrates, you take less insulin. The Omnipod® Insulin Management System may help you with this calculation. After providing the Omnipod® System a current BG and carbohydrate amount, the Omnipod® System can suggest a bolus amount for you.
Three Steps of Carbohydrate Counting
Step 1: Identify the carbohydrates
Foods we eat are categorized into the following:
- Carbohydrates: Starches, starchy vegetables, legumes, fruit, fruit juice, dairy products (not cheese), and sweets.
- Proteins: Meat, fish, eggs, tofu, cheese, and nuts.
- Fats: Cooking oils, butter, margarine, cream, avocado, cheese, and nuts.
- Free foods: Non-starchy vegetables, artificial sweeteners, condiments like mustard or low-calorie dressing.
For example, if you have a meal of grilled chicken, mashed potatoes, green beans, corn and a fruit cup, you would focus on just the potatoes, corn, and fruit for your carbohydrate count!
Step 2: Estimate the Portions8
After you have identified the carbohydrates in your meal, it’s time to estimate how much you plan to eat. There are several ways you can do this:
- Measuring cups – Initially, you will find it helpful to use measuring cups to get an understanding of how much of a certain food looks like. Before you know it, you will be able to “eye-ball” a portion and be fairly accurate!
- Nutritional food scales – Some find scales helpful as this is the most accurate way to determine carbohydrate grams. This method tends to be a little more complicated and not widely used.
- Estimate by comparison – You may find these comparisons helpful when estimating portions.
- 1 teaspoon of margarine is the size of one dice.
- 3 ounces of meat is the size of a deck of cards.
- 1 cup of pasta is the size of a baseball.
- 11⁄2 ounces of cheese are the size of four stacked dice.
- 1⁄2 cup of fresh fruit is the size of a tennis ball.
Step 3: Calculate the Grams
Once you know the portion size of the carbohydrates in your meal, it’s time to count the grams of carbohydrates using the nutrition label or food lists!
Nutrition Facts Label9
If you have this available on your food product, here is some advice on where to look. The two key pieces of information on the nutrition facts label for carbohydrate counting are the serving size and total carbohydrates.
Serving size: Nutritional facts are calculated based on this portion.
Total carbohydrates: Includes grams of sugar, sugar alcohol, starch, and dietary fiber.
Fiber: If there are more than five grams of fiber in a serving, subtract half of the grams of fiber from the total carbs, and use the adjusted number as the food’s total carb count.
Added sugars: Sugars that are either added during processing or packaging.
How Many Carbohydrates Per Meal is Ideal?1,5
To Maintain Current Weight:
- Meals: 60-75 grams
- Snacks: 15-30 grams
To Lose Weight:
- Meals: 45-60 grams
- Snacks: 15 grams
To Maintain Current Weight:
- Meals: 45-60 grams
- Snacks: 15 grams
To Lose Weight:
- Meals: 30-45 grams
- Snacks: 0 grams
Common Carbohydrate Foods?10
See pages 12 and 13 of the Podder™ Guide to Carbohydrate Counting for a table showing the serving size and carbohydrates in common carbohydrate foods.
Carb Counting Resources
Online Carbohydrate Food Lists:
Calorie King: www.calorieking.com
Nutrition and Carb-Counting Books:
American Diabetes Association: www.store.diabetes.org or 800-ADA-ORDER (800-232-6733)
American Association of Diabetes Educators: www.diabeteseducator.org
Other Helpful Sites:
F ind a Registered Dietitian: www.eatright.org/programs/rdfinder/
More Diabetes Information: www.diabetes.org
Find a Certified Diabetes Educator: www.diabeteseducator.org/DiabetesEducation/Find.html
Resources for the Omnipod® System: MyOmnipod.com Customer Care (available 24/7) 800-591-3455
Carb Counting Resources
- Making Healthy Food Choices. American Diabetes Association Website. http://www.diabetes.org/ food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/. UpdatedAugust26,2014. Accessed April 27, 2016
- Beaser RS. Joslin’s Diabetes Deskbook: A guide for primary care providers. 3rd ed. Boston, MA: Joslin Diabetes Center; 2014.
- Types of Carbohydrates. American Diabetes Association Website. http://www.diabetes.org/food-and-fitness/ food/what-can-i-eat/understanding-carbohydrates/types-of-carbohydrates.html. Updated March 9, 2015. Accessed April 27, 2016
- Low Calorie Sweeteners. American Diabetes Association Website. http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/artificial-sweeteners/?loc=ff-slabnav. Updated December 16, 2014. Accessed April 27, 2016
- Carbohydrate Counting. American Diabetes Association Website. http://www.diabetes.org/food-and-fitness/ food/what-can-i-eat/understanding-carbohydrates/carbohydrate-counting.html. Updated March 11, 2015. Accessed April 27, 2016
- How Do Insulin Pumps Work? American Diabetes Association Website. http://www.diabetes.org/living-with- diabetes/treatment-and-care/medication/insulin/how-do-insulin-pumps-work.html. UpdatedMarch9,2015. Accessed April 27, 2016
- American Diabetes Association. Standards of Medical Care in Diabetes – 2016. Diabetes Care. 2016; 39 (Suppl. 1): S43
- Serving Size vs. Portion Size: Is There a Difference? Academy of Nutrition and Dietetics Website. http:// www.eatright.org/resource/food/nutrition/nutrition-facts-and-food-labels/serving-size-vs-portion-size-is-there-a- difference. Updated March 20, 2015. Accessed April 27, 2016
- U.S. Food and Drug Administration Website. http://www.fda.gov/Food/IngredientsPackagingLabeling/ LabelingNutrition/default.htm. Updated June 30, 2016. Accessed September 23, 2016
- USDA Food Composition Database Website. https://ndb.nal.usda.gov/ndb/search/list Accessed September 1, 2016