Carbohydrates and Diabetes

Healthy eating is an important strategy when it comes to controlling blood sugar. This includes what you eat, what your portion sizes are and when you have meals and snacks. Foods contain three major types of nutrients: carbohydrates (carbs or CHO), proteins and fats.

There are two kinds of carbohydrates, both of which turn into glucose, or blood sugar, when digested. Simple carbohydrates, which have the biggest impact on blood sugar levels, are chains of sugar molecules most often found in fruits, vegetables and grains. 

Complex carbohydrates are longer chains of sugars absorbed more slowly into the blood which don't have as much of an effect on one's blood sugar.

Simple carbohydrates

• Fruit juices
• Jams, jellies 
• Candy
• Sugar, maple syrup, honey
• Sweeteners in food: dextrose, high fructose, corn syrup
• Kool-Aid
• Cakes, pies, cookies, ice cream, pudding

Complex carbohydrates

• Whole grain breads, crackers
• Rice
• Pasta
• Tortillas
• Beans
• Corn, peas, lima beans

Why count grams of carbohydrates?

• Counting carbohydrates helps control blood sugar levels, even when not using insulin.
• Keeping carbohydrate intake consistent from meal to meal can help stabilize blood-sugar levels.
• Eating too many carbohydrates can lead to weight gain, especially if combined with insulin.

Helpful hints

The magic number is "15" for counting carbohydrates because, 15 grams of carbohydrate = one carbohydrate choice or serving.

1. If the food label indicates 5g of fiber or more per serving, subtract this from the total carbohydrate amount, as fiber does not directly affect blood sugar values.
2. If a snack includes 15g or more of carbohydrate, you may need more insulin (possibly 1/2 the amount normally taken) depending on your individual blood sugar values.
3. Sweet alcoholic beverages may require additional insulin, so choose dry wine, light beer, etc. over sweet wine. Make sure when drinking alcohol to also eat something to keep your blood sugar level from dropping. Avoid alcohol during pregnancy!
4. The glycemic index for a food indicates how quickly/how much blood sugar increases after eating the food. Keep a record of everything you eat and your blood sugar levels to help identify which foods are more likely to cause blood sugar levels to climb. quickly. 
5. The cooking method can also affect the glycemic index of a particular food.

Easy steps to carbohydrate counting

1. Identify which foods have carbohydrates:
   • Starches
   • Fruit juices
   • Vegetables
   • Milk/yogurt
   • Sweets
2. Determine the portion size of any foods you plan to eat. For example, measure by volume (1 cup), weight (3 oz) or count (2 each).
3. Determine the number of grams of CHO food you plan to eat: (food labels, carbohydrate counting books, exchange lists).
4. Total the grams of carbohydrates you plan to eat for each meal.

   Food	CHO g
   2 slices of bread (starch)	30
   Ham, cheese (meat)	0
   1 cup peach (fruit)	30
   1 cup pasta (starch)	30
   1 cup low-fat milk (milk)	12
   Total	102

5. Start with the carbohydrate factor at 15, or use a factor according to your weight. Divide the total cho grams at each meal by your factor. This is how much regular/humalog [fast-acting] insulin you will take before you eat. The factor is the number of grams of cho one unit of regular/humalog insulin will cover.
6. Always check your blood sugar before you eat.
   • If your pre-meal bs is over 150 mg/dl, consider 1 additional unit of regular/humalog for every 50 points over 150.
   • If you are pregnant and your pre-meal bs is over 100 mg/dl, use the supplemental insulin sliding scale your physician or nurse gives you. You will probably need more insulin for elevated blood sugars.
7. Give yourself the appropriate amount of insulin for the grams of carbohydrate you plan to eat at the meal plus or minus any extra insulin needed based on your blood sugar.
8. Record your blood sugar value in your log prior to eating the next meal.
9. Make any needed adjustments in the factor based upon this blood sugar. If your blood sugar is still too high, you may need to reduce your factor by several points (more insulin). If your blood sugar is too low, you may need to increase your factor by several points (less insulin).

Examples of carbohydrate counting (examples coincide with 1-9 above)

1. Total grams of CHO for each meal.
2. 102g CHO ÷ 15 [factor], you should take 6.8 units Regular/Humalog insulin. Even if you do not take insulin, being aware of how much CHO you eat at a meal can help control your blood sugars.
3. For example, if your blood sugar is 200 mg/dl you may need 1 additional unit of fast-acting insulin to take care of the pre-meal elevated blood sugar. If you are already pregnant, consult with your physician or nurse. You will probably need to add more insulin according to a sliding scale designed for you!
4. Give 6.8 units Regular/Humalog insulin for the CHO you plan to eat + 1 unit for the high pre-meal BS. A total of 7.8 units.
5. Your BS before your next meal should range between 80-140 mg/dl. If you are already pregnant, your pre-meal BS should be <95 and/or <120 mg/dl 1 hr after meals.
6. Your CHO factor may vary from meal to meal. You may need more insulin with breakfast.

Recommended references:

American Diabetes/American Dietetic Associations, 1995, Exchange Lists for Meal Planning
Holzmeister, Lea Ann, 1997, The Diabetes Carbohydrate and Fat Gram Guide.
Kraus, Barbara, 1995, Calories and Carbohydrates, 12th Ed.
Borushek, Allan, 1999. Gram Guide, The Doctor's Pocket Calorie, Fat & Carbohydrates Counter

*Specific Individual diets should be approved by your health care provider. This information is provided for educational purposes only and cannot be used to plan individual dietary programs.