Diabetes & Carb Counting For Dummies
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Carbohydrate requirements can change throughout life. Your carb demands may even change seasonally if your activity levels vary according to the time of year. The following discussion explores situations that may call for making adjustments to your carb intakes.

Changing carb needs throughout the life cycle

Childhood and adolescence are times when dietary needs are constantly changing. It is important that children with diabetes get the same amount of nutrition and carbs as recommended for all children. Hormones and changing activity patterns call for more frequent visits with the diabetes team to make sure insulin and other medications are adjusted as needed to support a balanced and adequate diet.

Pregnancy and breastfeeding increase the demand for carbohydrates and other nutrients, so close monitoring is required with a team of experts who specialize in high-risk pregnancies.

Elderly individuals typically see a decrease in their calorie and carbohydrate needs as metabolism changes. Their vitamin and mineral needs don't shift much, however, so they need to focus on nutrient-dense food choices.

Altering carb intake to account for activity

Varying activity is a typical reason for adjusting carb intake. Exercise uses up more calories in the forms of carb and fat, so needs change on active days. If you aren't at risk for hypoglycemia, you may not need or want a snack, especially if you're trying to lose weight. If you're at risk for low blood glucose due to insulin use or other medications, you can monitor blood-glucose levels to decide whether you need to add a snack to prevent hypoglycemia. You should always carry carbs to eat as needed and quick forms of sugar or juice for treating lows. Insulin doses can be adjusted on active days to reduce the risk of hypoglycemia. Speak to your healthcare provider for tips on medication.

Adjusting portions when blood glucose is out of control

The American Diabetes Association sets pre-meal blood-glucose targets at 70–130 milligrams per deciliter (mg/dl) and post-meal blood-glucose targets at under 180 mg/dl. What should you do if your blood glucose level is significantly elevated, perhaps even above 180 mg/dl before eating?

Your own insulin, as well as any insulin that is injected, doesn't work as effectively when you're hyperglycemic. Follow your doctor's advice about how to adjust insulin to correct glucose elevations. Limit carbs and fill up more on salad, nonstarchy vegetables, and protein foods to give your blood glucose a chance to return to target levels. If you're frequently above target before meals, you likely need a medication tune-up and should see your doctor for advice. You can't be expected to skip carbs on a regular basis.

Managing sick days

Being sick can make diabetes management a real challenge. Talk to your healthcare providers in advance to make a plan about how to manage illness. Your body responds to illness with stress hormones, which can cause blood-glucose levels to rise. Monitor your blood-glucose levels more frequently when you're sick. People with type 1 diabetes should be monitoring their glucose levels at least every four hours, and people with type 2 should check at least four times daily when sick. Illness increases the risk of producing ketones, so people with type 1 diabetes should have supplies for checking ketones. You're less likely to have ketones if you have type 2 diabetes, but it is possible if you're very ill.

Stick to your usual meal plan if possible. Staying hydrated is important, but that can be difficult to do if you have vomiting or diarrhea. Keep sipping fluids. Choose noncarb fluids, including water, diet drinks, broth, and tea. If you can't eat normal foods, try substituting bland foods such as crackers, toast, cooked cereals, boiled potatoes, soups, yogurt, pudding, applesauce, and canned fruits.

If you can't handle solids, get your carbs from liquids, such as diluted fruit juices, sports drinks, gelatin, popsicles, sherbet, and soft drinks (regular — not diet — in this case).

Vomiting, diarrhea, persistently elevated blood-glucose levels, difficulty breathing, dehydration, or having ketones are all reasons to seek medical attention.

Discuss sick-day management with your doctor. Make a plan in advance. Ask your doctor for the appropriate phone numbers for whom to contact after hours and on weekends. Don't stop taking your diabetes medications when you're sick. Illness can cause blood-glucose levels to rise even if you aren't able to keep any food down. People with type 1 diabetes may require even higher than usual doses of insulin during illness.

About This Article

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Sherri Shafer, RD, CDE, is a senior registered dietitian and a certified diabetes educator at the University of California San Francisco Medical Center. She teaches diabetes self-management workshops and provides nutrition counseling for individuals with type 1 diabetes, type 2 diabetes, prediabetes, and gestational dia-betes. She is also the author of Diabetes Type 2: Complete Food Management Program.

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