Advanced Carbohydrate Counting for Diabetics

By American Diabetes Association

Advanced carbohydrate counting is more precise than the basic method. With advanced carbohydrate counting, you track the exact number of carbohydrate grams in the foods you eat. This method of carbohydrate counting is often used by people who are on insulin — usually multiple daily injections or an insulin pump — and need to match the amount of carbohydrate they consume to an insulin dose. Knowing the exact amount of carbohydrate you eat at each meal makes calculating insulin injections easier and more accurate. Discuss your needs with your healthcare team to determine if this method of carbohydrate counting is right for you.

As with basic carbohydrate counting (see the preceding section), the advanced method of carbohydrate counting allows you more freedom to choose which carbohydrate-containing foods you’d like to eat. But in both cases it’s important to still follow basic nutrition principles and balance your carbohydrate intake with healthy proteins, fats, and nonstarchy vegetables. You also want to be calorie conscious when you practice carbohydrate counting if you’re trying to lose or maintain your weight. Don’t let the focus on carbohydrate distract you from good nutrition!

Calculating specific carbohydrate amounts

Advance carbohydrate counting is a little more complex than the basic method and requires some basic math skills, especially for people who are using insulin. People who practice advanced carbohydrate counting use food labels to calculate the amount of carbohydrate in the foods they’re eating. It’s a good idea to familiarize yourself with the Nutrition Facts panel on food labels. The nutrition information in this panel is the most accurate tool to use when calculating the amount of carbohydrate in your foods.

diabetic-panel
Courtesy of the American Diabetes Association

A standard Nutrition Facts panel.

When you’ve determined the grams of carbohydrate in your meal, write the number down! Keeping track of the total grams of carbohydrate that you eat at each meal or snack is very important if you practice advanced carbohydrate counting. These values can help you calculate insulin doses, if you use insulin, and may help you troubleshoot inconsistencies in your blood glucose. So keep a written or electronic record for your own uses and to share with your healthcare provider.

If you use multiple daily injections of insulin or an insulin pump and you’re having trouble matching your insulin doses to your carbohydrate intake, it’s important to make an appointment with a diabetes educator or a doctor. These professionals can help you calculate how many units of insulin you’ll need to balance out the carbohydrate you eat.

Now that you know the basics of advanced carbohydrate counting, let’s take a look at a few methods to figure out the amount of carbohydrate in your foods: using nutrition labels and performing some advanced calculations.

Using nutrition panels

When you’re reading food labels for carbohydrate-counting purposes, the two most important lines in the Nutrition Facts panel are the serving size and the total carbohydrate. To determine the amount of carbohydrate in the food you’re eating, follow these simple steps:

  1. Locate the serving size on the nutrition panel.

All of the nutrition information on the nutrition panel is based on this serving of the food. If you eat more or less of the food than the serving size listed, the amount of each nutrient you’re consuming will be different than listed. For example, if you eat two servings of the food, you will need to double the information on the label.

  1. Locate the amount of “Total Carbohydrate.”

The grams of total carbohydrate given are for the serving size listed. The amount of total carbohydrate on the nutrition panel includes the sugar, starch, and fiber in that food.

  1. Know your carbohydrate goal for your meal, and adjust how much you eat of the food to meet your goal.

For example, say you eat 15 grams of carbohydrate for a snack each afternoon. You would like to eat 1 cup of pretzels as your snack, but you read the nutrition label and see that total carbohydrate grams for 1/2 cup of pretzels is 30 grams. You can serve yourself a half serving of pretzels (1/4 cup) so you don’t exceed your carbohydrate goal. If you eat 1/2 cup of pretzels, your blood glucose will likely be higher afterward than if you eat the 1/4-cup portion that meets your carbohydrate goal.

Reading nutrition labels can be confusing at first, but it gets easier with practice. There are a few common mistakes that people make when learning to calculate carbohydrate grams using food labels that you should be aware of:

  • People often confuse the grams of sugar on the nutrition label for the grams of total carbohydrate, so they only count the sugar grams of their meal and often end up underestimating their carbohydrate intake.
  • Some people may mistake the total grams of food they’re eating (listed after the serving size) for the grams of carbohydrate.
  • Some people add the number of sugar grams listed on the label to the total carbohydrate grams and end up overestimating their carbohydrate intake.

These common missteps can be avoided by remembering that the total carbohydrate value on the nutrition label already includes the sugar, fiber, and starch in that food. By counting the total carbohydrate grams, you’re taking into account all of the ingredients that have the most impact on blood glucose. So, generally speaking, the total carbohydrate grams and serving size will be your focus when counting carbohydrate.

You won’t find a Nutrition Facts panel on every food you eat. For foods that don’t have labels — such as fresh produce or restaurant foods — there are many online food databases available to help you find out how much carbohydrate is in a serving of the food. The U.S. Department of Agriculture, for example, has an online tool called SuperTracker that can help you find the nutrients in foods without labels. Many diabetes-friendly cookbooks, including all cookbooks published by the American Diabetes Association, provide nutrition information for recipes so you don’t have to estimate the nutrient content of these dishes on your own. As a quick reference, we’ve included carbohydrate grams for a few common foods:

  • 1/2 cup of blueberries = 11 grams
  • 1 small orange = 11 grams
  • 1 small apple = 15 grams
  • 1/2 cup grapes = 15 grams
  • 1 small banana = 23 grams
  • 1/2 cup of cooked green peas = 11 grams
  • 1 medium ear of corn = 20 grams
  • 1/2 baked acorn squash = 14 grams
  • 1 plain baked potato or sweet potato = about 35–40 grams
  • 1/2 cup cooked macaroni noodles = 21 grams
  • 1/2 cup cooked brown rice = 22 grams
  • 1/2 cup mashed potatoes = 23 grams

You may be interested in a few other features of the nutrition panel as well, depending on your other health and diabetes management goals:

  • Calories: Keep an eye on the amount of calories you’re eating, especially if you’re trying to lose or maintain weight.
  • Saturated and trans fats: Minimize the amount of saturated fat you eat and look for foods with 0 grams of trans fat. This is especially important for people who have an increased risk for cardiovascular complications such as heart disease and stroke.
  • Sodium: People who are concerned about their blood pressure may benefit from reducing the amount of sodium they eat. Compare information on nutrition labels and look for products with the lowest amount of sodium.

Remember that the information given on the nutrition label is based on the serving size listed; if you eat a portion that is more or less than the serving size, you’ll need to adjust the nutrition information accordingly.

Getting (even more) technical

For people who practice advanced carbohydrate counting, tracking the total carbohydrate grams in their foods is key; these numbers allow them to manage their blood glucose levels and calculate insulin doses (if needed). The “Total Carbohydrate” value on nutrition panels accounts for all types of carbohydrate in the food — including sugars, dietary fiber, and sugar alcohols — but not all types of carbohydrate affect your blood glucose in the exact same way. Dietary fiber and sugar alcohols may have less of an impact on blood glucose than other forms of carbohydrate, such as sugars and starches. Let’s explore how these two types of carbohydrate affect your body and your meal plan.

Dietary fiber is a part of plant foods that either isn’t digested or is only partially digested by the body when eaten. Fiber is found in fruits, vegetables, grains, beans, and legumes. Fiber helps maintain digestive health and may help you feel full and satisfied after eating. Women should aim to eat 25 grams of fiber per day, and men should aim for 38 grams per day. Many people only get about half of the fiber they need per day. Because fiber isn’t fully digested, you may want to talk to your dietitian or diabetes care team about how fiber may impact your insulin needs, especially if you’re eating a lot of fiber.

Sugar alcohols are reduced-calorie sweeteners used in many foods including “sugar-free” food. Some common sugar alcohols include erythritol, isomalt, xylitol, mannitol, sorbitol, lactitol, and hydrogenated starch hydrolysates. Sugar alcohols contain one-half of the calories of other sweeteners and may cause smaller increases in blood glucose after eating than other types of carbohydrate, but they still have an impact.

Sugar alcohols are safe to eat in moderate amounts. But products that contain sugar alcohols, when eaten in excess, may cause gastrointestinal symptoms such as cramping and diarrhea. It’s also important to note that just because a food contains sugar alcohols or is labeled “sugar-free” doesn’t mean it’s free of carbohydrate. Use caution when selecting and eating these foods.

When it comes to carbohydrate counting, it’s the total carbohydrate grams (not the grams of sugar, fiber, or sugar alcohols) that are important. Consult with your dietitian or diabetes care team to see if and how fiber and sugar alcohols affect your insulin needs.