Carb counting is one form of meal planning that can help people with diabetes manage their blood sugar levels.

Diabetes is an incurable, yet manageable, medical condition where the body's blood sugar levels are too high. This happens when there is not enough insulin in the body, or the insulin does not work properly.

Insulin is a hormone that is made by the pancreas. It helps the body to process glucose (the simplest form of sugar), which is used by the cells to create energy. When this doesn't happen, sugar stays in the bloodstream. This can lead to serious health problems.

This article explores carb counting as a meal planning method that can help people with any form of diabetes manage their blood sugar levels.

Diabetes and the role of carbohydrates

In the United States in 2014, approximately 9 percent of Americans, totaling nearly 29 million people, were found to have diabetes. Diabetes is classified into different types and includes:

• Type 1 diabetes: In this type, the body does not produce insulin. This is due to the body attacking its own insulin producing cells within the pancreas. It is most commonly diagnosed in children and young adults.
• Type 2 diabetes: In this type, insulin is either not made in high enough quantities or not used efficiently. This form of diabetes affects people of all ages and is the most common type.
• Gestational diabetes: Some pregnant women will develop a typically temporary form of diabetes called gestational diabetes. This raises their risk of developing type 2 diabetes later in life. Most times, once the baby is born, this form of diabetes disappears.

What happens after carbohydrates are eaten?

The digestive system breaks down the carbohydrates into sugar. This enters the bloodstream and is used by the body's cells for energy.

Typically, when the body receives the signal that sugar is in the bloodstream, the pancreas produces insulin. This aids the body's cells in using the sugar for energy and helps to keep blood sugar levels steady.

However, this doesn't happen in the bodies of people who have diabetes. These people may need to take an external form of insulin to maintain normal levels of blood sugar.

As they have a condition that affects their blood sugar levels, people with diabetes need to be cautious about how much sugar they take in on a daily basis. This is more involved than simply curbing a chocolate or ice cream craving.

Many people with diabetes need to count the number of carbohydrates in each serving of food. This is referred to as carbohydrate counting, or carb counting, and helps to control blood sugar levels.

Understanding carb-heavy foods

The main nutrients found in food include protein, fat and carbohydrates. Carbohydrates, like any other nutrient, come in healthful and unhealthful forms. People with diabetes need to take special care about which carbohydrates they eat and how regularly.

Foods such as whole grains, fruits and vegetables are full of energy producing nutrients, vitamins minerals, and fiber. These are vital for normal physical growth and development. However, carbohydrates in sugary foods and drinks offer little nutritional value.

It is important for those with diabetes to understand:

• how many carbohydrates they need on a daily basis
• how to count carbohydrates
• how to properly read a food label

Foods that contain carbohydrates include:

• Grains: Including bread, pasta, oatmeal, certain noodles, crackers, cereals, rice, and quinoa.
• Fruits: Including apples, bananas, berries, mangoes, melons, oranges, and grapefruits.
• Dairy: Including milk and yogurt.
• Legumes: Beans (including dried), lentils, and peas.
• Snacks: Cakes, cookies, candy, and other sweet dessert-type foods.
• Drinks: Juices, soft drinks, sport drinks, and sugary energy drinks.
• Vegetables: Some vegetables contain more carbohydrates than others.

Starchy and non-starchy vegetables

Not all vegetables are created equal. They can be broken down into "starchy" and "non-starchy" types. Starchy vegetables contain more carbohydrates than the non-starchy varieties.

Starchy vegetables include:

• potatoes (including sweet potatoes)
• peas
• pumpkin
• butternut squash
• fresh beets

Non-starchy vegetables include:

• asparagus
• broccoli
• carrots
• celery
• green beans
• lettuce
• other salad greens
• peppers
• spinach
• tomatoes
• zucchini

Healthy sources of protein and fat

To avoid carbohydrate-heavy foods, it is important to understand which foods are healthful sources of protein and fat.

Fish, meat, poultry, many cheeses, nuts, oils and fats do not contain enough carbohydrates to be considered when carb counting.

Healthful sources of protein include:

• eggs
• whey protein
• chicken and turkey breast
• fish, including salmon, cod, and rainbow trout
• nuts, such as almonds and peanuts
• tofu and tempeh
• pumpkin seeds

Healthful sources of fat include:

• oils, such as flax, olive, virgin coconut, avocado, and hemp seed
• grass-fed butter
• avocado
• nuts and seeds

Aims of carb counting

Carb counting alone is not a substitute for seeking medical care to make sure that normal or close to normal blood sugar levels are maintained.

Many people with diabetes also need to take insulin or other medications to aid in the process, and should also regularly engage in physical activity.

The goal of carb counting is to keep blood sugar levels steady in order to:

• help those with diabetes stay healthy
• prevent complications
• improve energy levels

How carb counting works

The first step in carb counting is identifying what foods have carbohydrates and how many grams (g) per serving.

Doctors and dietitians may help people with diabetes work out how many carbohydrates they should have each day. This helps them calculate a daily total that they can stick to.

The typical range for carbohydrate intake is between 45 and 65 percent of the total calories taken in per day. After a daily calorie intake is calculated, carbohydrate percentages and servings can be worked out.

Calculating carbs

There is around 4 calories in 1 g of carbohydrate. So, to work out the number of carbohydrates per day, total calorie intake will need to be divided by 4.

Here is an example calculation based on a daily intake of 1,800 calories and 45 percent carbohydrate:

• 0.45 x 1,800 calories = 810 calories
• 810 ÷ 4 = 202.5 g of carbohydrate

Based on this calculation, a person can have approximately 200 g of carbohydrates per day. The next thing to work out is how much carbohydrate there is in a single serving of a particular food item.

When reading nutritional labels, it is important to take note of the total number of carbohydrates per serving so that these totals can be added into the total daily carbohydrate allowance.

For example, there are approximately 15 g of carbohydrate in each serving of the following foods.

• 1 slice of bread
• 1/3 a cup of pasta or rice
• 1 small apple
• 1 tablespoon of jelly
• ½ cup of starchy vegetables

According to the figures used above, an individual can have 13.5 servings of these foods each day:

• 202.5 g of total carbs ÷ 15 g per serving = 13.5 servings

However, non-starchy vegetables have just 5 grams of carbohydrate per serving, which means that an individual can eat a lot more of them.

Meal suggestions

Those who are carb counting may find it challenging at first to work out carbohydrate totals in home cooked meals, and when eating out. There are some tips that can help make carb counting a little easier, such as:

• Counting mixed foods by the cup: On average, a woman's fist is the size of a 1-cup serving. For a mixed dish, this is a good way to approximate the carb totals based on cup size.
• Count tablespoons: Knowing how many grams of carbohydrates are in a tablespoon of food is helpful. People can simply count level tablespoons to create a healthful plate.
• Calculate pizza by the crust: If possible, choose a thin-crust pizza. This will save 5-10 g of carbohydrate per serving size compared to a slice of regular or pan pizza.
• Smoothies may not always be the best bet: On average, a 12 oz. smoothie actually has more carbohydrates than a regular soda if it contains juice, so should be consumed in moderation.

Getting started with carb counting

Carb counting may help many people with diabetes to maintain steady blood sugar levels. However, it is only one way to manage diabetes. In order to know how a certain food will affect blood sugar levels, a person must consider the type of carbohydrate the food contains and how much fiber is in it.

Before trying carb counting, people should always speak with a nutritionist, diabetes educator, or doctor to determine:

• whether carb counting is appropriate
• what is the recommended daily allowance for carbohydrates
• what foods are recommended