1. Beck, Connie M. BSN, RN

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One of my patients newly diagnosed with diabetes doesn't understand carbohydrate counting. What suggestions could help him?-R.M., TEX.


Connie M. Beck, BSN, RN, replies: Carbohydrate counting is a way for people with diabetes to estimate the amount of carbohydrates in a meal and use this information to adjust their insulin dosage. Made of starches and sugars, carbohydrates are found in many foods made from flours, sugars, starches, grains (whole or processed), and some vegetables. Examples include breads and other baked goods, cereals, crackers, pasta, and starchy vegetables such as corn, peas, and potatoes. They're also found in dairy products; fruits; nonstarchy vegetables such as lettuce, broccoli, and carrots; and desserts and other sweets.1


Lists can be found online and in most nutrition books. (See Resources for patients.) Carbohydrates are also listed on food labels in grams. National fast food restaurants list them in their nutritional information.


Generally, one serving of carbohydrates is equal to 15 g of carbohydrates, or the amount of carbohydrates in a slice of white bread. Other examples of portions that are equivalent to one serving of carbohydrates are a 5-cm (2-in) diameter apple, half a banana, or 1/2 cup of pasta.


Teaching patients with diabetes to keep track of their carbohydrate intake along with pre/post-self-monitoring of blood glucose (SMBG) can help them identify patterns and better manage food intake and maintain glycemic control.2 "Carb counting" increases meal planning options and reduces the risk of hypoglycemia. With the help of a diabetes educator or dietitian, motivated patients can learn to use a personalized insulin-to-carbohydrate ratio to help determine the correct insulin dosage needed to control their blood glucose levels.3


Multiple daily insulin injections, which include basal and bolus insulin, can be adjusted up or down depending on the blood glucose/carbohydrate count. With the guidance of their primary care provider or diabetes educator, some patients control their blood glucose well enough to reduce the amount of medications needed.


The easiest way to learn how to do carb counting is to remember that one serving equals 15 g of carbohydrates. A general guideline to use for carb intake per meal is 45 to 60 g of carbs for women and 60 to 75 g for men, with 15 g for snacks.1


Serving size matters too. Remind patients that a package may contain more than one serving. (Many patients don't always check to see what a serving size really is.) The total carbohydrate grams are what matters. Many patients incorrectly check only the grams of sugar. Reading nutritional labels for not just the grams of carbohydrates but for serving size too will help patients determine how much they can eat while maintaining glycemic control and the recommended carb count for the day.4


Patients with diabetes who wish to use carb counting should also be aware of its drawbacks. This method requires that patients be motivated to perform SMBG more frequently, calculate carbs to be consumed before and after each meal, and account for "hidden" carbs in foods and drinks, such as artificial creamers used in coffee or tea and condiments like ketchup and mustard. Because not all patients want or need to do math with their meals, matching dietary approach and patient motivation is crucial to successful diabetes control.3


All patients with diabetes, not just those who choose carb counting to control their diabetes, need to be educated on how an increase or decrease in physical activity and any illness or surgery can affect blood glucose. These changes may require that patients, with the guidance of their provider, have their calories, carbohydrate, and/or insulin adjusted for better control during these stressful times.5


With the right information, patients with diabetes can successfully use carb counting to help maintain glycemic control and live a healthy, active life.


Resources for patients


* American Diabetes Association.


* American Diabetes Association, American Dietetic Association. The Diabetic Exchange List.




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2. Watts SA, Anselmo JM, Kern E. Validating the AdultCarbQuiz: a test of carbohydrate-counting knowledge for adults with diabetes. Diabetes Spectr. 2011;24(3):154-160. [Context Link]


3. Henske JA, Griffith ML, Fowler MJ. Initiating and titrating insulin in patients with type 2 diabetes. Clin Diabetes. 2009;27(2):72-76. [Context Link]


4. Hunt M, Hooley I, Hartley L. West Suffolk Hospital, Bury St. Edmunds. Carbohydrate counting-the West Suffolk way. J Diabetes Nurs. 2011;15(5):199. [Context Link]


5. Childs BP, Grothe JM, Greenleaf PJ. Strategies to limit the effect of hypoglycemia on the diabetes control: identifying and reducing the risks. Clin Diabetes. 2012;30(1):28-33. [Context Link]