Type 1 Diabetes Carbohydrate Counting

Submitted by Thiruvelan on Wed, 06/23/2010
Type 1 Diabetes Carbohydrate Counting

Carbohydrates have the most significant influence on your blood glucose. After eating carbs, it appears as blood glucose in your bloodstream within hours. So, you need to count the carbs you eat. 

You know! Your body can make glucose even from the protein and fat. Additionally, it cannot cause blood-glucose spikes.

Complete Guide to Carb Counting

What Are Carbohydrates?

Carbohydrates also are known as carbs are one among the three essential macronutrients. The other two macronutrients are protein and fat. Your body needs all these three macronutrients to maintain health. 

Many foods are a combination of carbs, protein, and fat. Blood sugar is mostly from carbs you eat and is utilized by the cells for energy. 

Why do carbs matter?

Carbs get its maximum attention when it comes to diabetes because it directly raises blood sugar when digested by your body.

For non-diabetes, blood glucose rises after eating, but the insulin from pancreas keep the blood glucose level from rising too high. However, if you have type 1 diabetes, your pancreas no longer makes insulin, thus failed to stop blood glucose rise. So you need to take basal (background) insulin as well as offset the carbohydrate in your food (bolus insulin) with mealtime. 

What Foods Contain Carbs?

Carbohydrates include sucrose (table sugar), fructose (fruit sugar), and lactose (milk sugar), as well as starches. 

Almost all food contains carbohydrates. Foods that contain carbohydrate are:

  • Grains such as rice, oatmeal, and barley contain starch. Also, grain-based foods such as bread, pasta, and crackers.
  • Starchy vegetables are potatoes, peas, and corn.
  • Fruit and its juice contain fructose (fruit sugar).
  • Milk and yogurt contain lactose (milk sugars).
  • Sweets and snack: sodas, juice drinks, cake, cookies, candy, and chips may contain sucrose (table sugar).

Non-starchy vegetables like lettuce, cucumbers, broccoli, and cauliflower have minimal carbohydrate and minimal impact on your blood glucose.

Who can use carbohydrate counting?

Carb counting is useful for type 1 diabetes who are intensively adjusting insulin to control diabetes. Insulin needs to be adjusted based on what one wants to eat.  Carbohydrate counting can be useful for all diabetes, not just people taking insulin.

What are the benefits of carb counting?

Once you gain expertise in carb counting, you can comfortably accommodate a wide variety of foods into your meal plan without affecting the blood glucose level. 

  1. Carb counting (CC) provides more choices and flexibility in meal planning to manage your type 1 diabetes. 
  2. Being precise with your carb intake and insulin will help you better manage your blood glucose.
  3. It has positive effects on postprandial blood glucose level and glycosylated hemoglobin concentration (HbA1C).
  4. It might reduce the hypoglycemia episodes.
  5. It can bring tighter diabetes (blood glucose) control.

How many carbs should a person with diabetes have in a day?

There is no magical ideal number of carbs per meal. How much carbohydrate you need is determined by your body size and level of physical activity. Additionally, your body's insulin response is going to be most important.

A great way to begin may be to find how many carbohydrates you eat at your meals and snacks now. To know how different foods are impacting your blood glucose. You need to track your food intake (especially carb) and your blood glucose before and about 2 hours after a meal for a few days.

There are three low carb diet based on how low-carb the meal contain?

  1. Ketogenic low carb diet has under 20 grams of carb per day. 
  2. Moderate low carb diet has 20 to 50 grams of carbohydrates per day. 
  3. Liberal low carb diet has 50 to 100 grams of carbohydrates per day.

It is always better to go for a low carb diet for proper blood glucose control in type 1 diabetes. Try low carb diet by first aiming liberal low carb that is 50 to 100 grams of carbohydrate per day. Once you are convenient with this diet, then you can try a moderately low carb diet for better blood sugar control.

What is carb counting?

Carbohydrate or carb counting is one of many meal planning options for managing blood glucose.

Non-diabetes may see their foods in their plate as it is that is salmon, salad, or bowl of soup. But those with diabetes are always seeing it as numbers (grams of carbohydrate in each food item).

Unfortunately, counting carbohydrate in your food is not as easy as to count 1, 2, 3…

However, you face difficulty at the beginning for the first few days or weeks; after that, you develop expertise.

The carbs you will need to count are starches (break down slowly into sugar) and simple sugars (break down into blood glucose almost immediately).

Accurate carbohydrate counting is necessary because missing just 5 grams of carbohydrate can affect blood glucose by about 30 to 40 mg/dl.

How do you count carbs?

You can estimate how much carbohydrate in your food. Keeping a general serving size in mind will help you determine how many carbs you are eating. A serving of carbohydrate is 15 grams. Once you know the 15-gram carbohydrate portion of food, you can apply it to any other portion size less than or more than that.

Why carb counting accuracy matters?

A non-obese type 1 diabetes with 150 pounds (68 kg.) and the pancreas makes no insulin. Then just 1 gram of carbohydrate can raise the blood sugar by about 5 mg/dl (0.3 mmol/L).

So carb counting accuracy matters a lot for proper blood sugar control.

Is there anything that is out of your control?

You may have noted that you eat the same carb content at two different times, and your blood sugar might be different each time. It is because the insulin sensitivity raises from early morning to night until 11 pm, after that the sensitivity drops from night to early morning. 

You can manage this by consuming less carb for breakfast compared to lunch and dinner. Also, increase the insulin to carb ratio in the morning to prevent blood sugar spikes.

Use food labels

Carbohydrate counting becomes easier if you use a food label. 

Reading food or nutritional labels is an easy way to know how much carbohydrate is in your diet. You first need to find out the serving size. 

2 most important data in the food label are the serving size (& amount of servings per container) and the total carbohydrate (not just sugar or starch grams). 

Because the cereal may contain 1 gram of sugar but comprise 21 grams of carbohydrate, total carbohydrate includes sugar, starch, and fiber.

From the food label of a pack or can, find the total carbs (not just grams of sugar or starch). For example, if the product packaging is 100 g weight and the total carb is 27, then to find carbohydrate per gram of product divide total carb by weight of the pack.

Grams of carb per product gram     = total carb/pack weight.
                    = 27 / 100 = 0.27 grams of carb per gram of the product.

How much portion size you decided to ear? - Portion size, for example, if you chose to eat 50 grams of the product.

Grams of carb in the portion         = Grams of carb per gram of the product X Portion size

                    = 0.27 X 50

                    = 13.5 grams of carb in the product you decided to eat.

Another example: if the pack contains countable pieces such as biscuit, then to calculate carb per piece divides total carb by the number of pieces in the box.

If the total carb is 27 and the number of pieces is 9.

Grams of carb per piece of the product     = total carb / no. of pieces

                        = 27 / 9 

                        = 3 grams of carb per piece.  

Food producers are allowed a total carb error of +/- 20% in their nutritional label. 

Consider if you are taking 50 g of carb for a meal, then

The carb count error = (50 g X 20)/100 = 10 g. 

There may be 10 g in excess or shortage of carbohydrate.

Blood sugar error for 10 g of carb    = 10 g (carb error) X 5 mg/dl (BS raise per 1 g carb)

                    = 10 X 5 = 50 mg/dl (2.8 mmol/L)  

An allowed food label error may end up with a 50 mg/dl (2.8 mmol/L) of blood sugar rise or drop. So, it is wise to choose a low carb diet and be more accurate in carb calculation.

Carb counting; focus on FIBER

Some kinds of fiber aren't broken down in the body and therefore, don't affect blood glucose levels. The general rule is if "insoluble fiber" is listed in the Nutrition label, subtract all grams of insoluble fiber from the total carbohydrate amount.

Like any other new skill, counting carbohydrates will take some weeks to master the art. At the start, it will be difficult to weigh and measure foods. As time passes, the eye & mind trained to measure precisely both serving sizes and weights, whether eating at home or out.

There is no nutrition label, how do you count carb?

For foods that do not have a label, you can use online tools to estimate how much carbohydrate is in it. Supertracker is one such tool, where you can look up the nutrition facts for foods that do not contain a label such as fruits and vegetables.

Five best carb counting app for diabetics

  1. Senza - You've heard about the ketogenic way of eating, and you want to do it right. Let Senza show you how. You can download your app at iTunes & Google Play.
  2. Carb Manager - Keto & Low Carb Diet Tracker: Carb Manager is the world's most comfortable and comprehensive low carb tracker. And macros counter for anyone on a low carb diet or keto diet. Use the barcode scanner to count carbs quickly. But even more than a carb calculator, Carb Manager is your one-stop destination for living a healthy low carb high-fat diet (LCHF) lifestyle. We've bundled low carb diet articles, forums, recipes, a meal planner, an e-book, and much more. You can download your app at iTunes & Google Play
  3. Atkins® Carb & Meal Tracker: Atkins® Carb Counter & Meal Tracker is an essential tool for achieving your weight loss goals. The new & redesigned Atkins app allows you to maintain a healthy lifestyle. They give you the diet tools to set daily goals, log meals, & track net carbs. You can download your app at iTunes
  4. MyKeto: Ketogenic Diet Tracker: A free keto macro calculator helps determine how many calories of fats, carbs (net carbs), and protein you are consuming. Based on your body height, weight, activity level, and gender. You can download your app at iTunes & Google Play
  5. Macros - Calorie Counter: Macros can be used as a calorie counter and as a meal planner. Calculate your calories and register your food diary quickly. Eat what you want! Always respect your carbohydrate, protein, and fat targets. You can download your app at iTunes & Google Play.

How many units of insulin should I take per carb?

The insulin to carb ratio gives you an idea to know how much insulin you need for a bolus dose to metabolize the quantity of carbohydrate you consume in a meal or a snack.

Measure the carbs in your meals correctly. Then you can calculate the insulin requirements to cover this carbohydrate using a formula. For details, visit Insulin Calculation.

Generally, diabetes and even healthy individual spikes more with carbs at breakfast, less with lunch and much less with dinner.

Different insulin to carb ratios at different times of the day is not unusual. You need more insulin for breakfast, less for lunch, and much less for dinner just as it is widespread to have different basal requirements at different times of the day. 

You do not need to eat the same food every day. But it is advisable to eat the same quantity of carbs each day at any specific time for better blood sugar control. 

Beware of sugar with different names

Sugar goes by different names; they are:

  • table sugar,
  • brown sugar,
  • molasses,
  • honey,
  • beet sugar,
  • cane sugar,
  • confectioner's sugar,
  • powdered sugar,
  • raw sugar,
  • turbinado,
  • maple syrup,
  • high-fructose corn syrup,
  • agave nectar,
  • sugar cane syrup,
  • fructose,
  • lactose,
  • sorbitol,
  • xylitol,
  • glycol,
  • glycerol,
  • mannitol,
  • isomalt, and
  • other sugar alcohols.