With Diabetes and Insulin, Carbohydrates Count

It's easy to stumble into a dietary rut when you have diabetes and take insulin. Once you've figured out a few menus that keep your blood glucose in a good range, you may feel like you can't stray from the formula. The same old meals and snacks may be nutritious, but they can become boring. What if there were a way to make your eating plan more flexible -- and balance your blood glucose better?

There is. It's known as counting carbohydrates. 

Carbohydrates are one of the three main parts of food; fats and proteins are the other two. All three components can affect your blood sugar level, but carbohydrates do so more quickly, the American Diabetes Association (ADA) says.

Carbohydrates come in two main forms, sugars and starches. Sugars are digested more quickly than starches. Sugars are found in baked goods such as cookies and cakes; soft drinks; fruits; and dairy products such as milk and yogurt. Starches are found in vegetables, breads, rice, cereals and other grains. Your body doesn't distinguish between sugars and starches when it comes to blood sugar. What matters is how much you eat, not the type. The more carbs you eat, the higher your blood sugar level will be.

Just because carbohydrates make your blood sugar levels rise, that doesn't mean you should avoid them, the ADA says. Carbohydrates are an important part of a healthy diet. Good carbs to include in your diet are whole-grain foods, vegetables and fruits. Carbs you can do without are those found in candy and soft drinks.

Knowing exactly how many grams of carbohydrates you're getting is especially important when you take insulin, says Jo-Anne Rizzotto, R.D., a dietitian at the Joslin Diabetes Center in Boston. The size of your insulin dose depends on how many grams of carbohydrate you've consumed, because carbs are what your body uses for fuel. The more carbs you eat, the more insulin you will need to help move the fuel into the cells. Foods that are high in carbohydrates often are high in calories, too. So, not overdoing it on carbohydrates may help you manage your weight. And, losing as little as 10 pounds may improve diabetes control.  

Starting out

Carbohydrate counting takes some practice, but it isn't difficult. Before you begin, talk with your doctor or dietitian. He or she can help you set a carbohydrate goal for each meal and snack.

When counting carbs, you add up all the carbohydrates you plan to eat in one meal or snack. Then you inject or take enough short-acting insulin to match the amount of carbs, the ADA says. This method gives you more flexibility in your meals, but the trade-off is more time to track your carbs through the day.

Get to know carbohydrate counts. Most of the carbohydrates that you consume are in fruit, milk and starchy foods such as pasta. Non-starchy vegetables tend to have less. And, meats and fats such as butter have next to none. Buy an inexpensive carb-counting book and rely on food labels. Some restaurant Web sites list carbohydrates in menu items, too.

A rule of thumb is that you need one unit of insulin for every 15 grams of carbohydrates, the ADA says. Your insulin needs may be different, however. Your doctor can help you determine if this formula is right for you.

Consider serving sizes. If a 1-cup portion of chili has 29 grams of carbohydrates, but your serving is 1½ cups, you need to count those extra carbs. Ms. Rizzotto recommends using a food scale and measuring cups and spoons when preparing foods at home. This helps train your eye to estimate amounts of carbs when eating out.

Remember, counting carbohydrates is just one part of a healthy eating plan. To learn more about how food choices affect diabetes, talk with your dietitian or call your nurse information service, if you have access to one.