STUDENT CONTRIBUTOR: Adam Brooks | School of Nutrition, Ryerson University
November 11, 2020
Carb counting made easy!
Carbohydrate, or 'carb' counting has always been a hot topic when it comes to diabetes management. There is a ton of information online that can bring up hundreds of questions. So, what's the real deal when it comes to counting carbs? How many carbs should you be eating? How can you tell the difference between simple and complex carbs? How does fibre help? What the heck is a carb anyway?
If you’re asking yourself these questions you’re not alone. A recent Canadian study found that many people with type 1 diabetes “face difficulties in the management of their disease, specifically when it comes to carbohydrate counting”.
Through this blog, we hope to clear up some of the confusion, as well as provide you with the tools necessary to master the art of counting carbs.
What is a ‘carbohydrate’ ?
To put it simply carbs, are the sugars, starches, and fibres that make up the majority of our diet. Carbs are our body’s preferred energy source, and we eat more of them than the two other macronutrients recommended to make up a healthy balanced plate; proteins, and fats. Foods that are high in carbs include breads, grains, potatoes, fruits, starchy vegetables, and dairy products. Carbs are everywhere, and they are classified by their effect on blood glucose levels using a measure known as the glycemic index.
When we eat a meal high in carbs, our bodies go to work breaking down those carbs into glucose which our bodies can use for energy. This process causes an increase in blood glucose (or blood sugar) levels. Bottom line with diabetes is that you've gotta get good at counting those carbs!
The way you count carbs will depend on whether you have type 1, or type 2 diabetes.
If you have type 1 diabetes, your pancreas is unable to produce insulin; an enzyme that our body releases when our blood glucose levels increase. Because of this, you will need to take insulin to offset the rise in blood glucose. It is important to know exactly how many grams of carbohydrates you eat in a meal to ensure that you are using the correct mealtime insulin dosage (also known as an insulin to carbohydrate or I:C ratio).
If you have type 2 diabetes, your pancreas can still produce insulin, your body has either become resistant to it or it may not produce enough to offset your carbohydrate intake. It's important to eat a consistent amount of carbohydrates throughout the day, as opposed to eating lot of carbs during one meal. This will help to minimize a spike in your blood glucose level.
In order to be successful at counting carbs, we first need to be able to identify carbs in our diets. The best way to do this is to get really good at reading food labels. All packaged foods in Canada require a nutrition label that shows an appropriate serving size, along with all necessary nutrition information. The nutrition label will show you exactly how many carbohydrates are in a serving; this is the number you need for counting carbs. It’s also important to take a look at the amount of fibre in a serving, fibre does not raise blood sugar, so it should be subtracted from the total amount of carbohydrates. For example, 2 slices of whole wheat bread contain 24g of carbohydrates and 3g of fibre. You would subtract the fibre from the carbohydrates, leaving you with a total of 21g of carbohydrates.
For foods that aren’t packaged, such as fruit or vegetables, there are a number of websites, tools, and apps that can help you determine exactly how many carbs are in a serving. The American Diabetes Association has a great list to get you started. Just as with any new skill, counting carbs takes practice. The more you do it, the better you’ll get at it and soon enough you will know exactly how many carbs are in that cup of strawberries you’ve been eyeing for breakfast.
In diabetes slang, a S.W.A.G. is a 'scientific, wild-a** guess". This skill can come in very handy as you become a carb ninja. Following the basic approach to counting carbs by using the plate method helps you to limit the amount of high-carb foods that have the potential to spike your blood sugar, and allows for some flexibility in eyeballing or 'swaggin' the count. A healthy, balanced plate looks something like this:
Filling 1/2 a 9-inch plate with non-starchy veggies (e.g., spinach, broccoli, salad)
Filling 1/4 of the plate with a lean protein (e.g., eggs, skinless chicken, tofu)
Filling 1/4 of the plate with a whole grain or starch (e.g., potato, rice, pasta)
The plate method works well because it doesn’t take a lot of time and it requires less calculations. You are able visualize the carbohydrates in your food and estimate an appropriate serving size in relation to your fats and proteins. Be aware though that this method does have its limitations and is not suitable for everyone. Diabetes Canada has a great video on using the plate method, as well as some other basic carb counting tools.
If you are using multiple daily injection therapy, an insulin pump, or if you just want to be more accurate with your carbohydrate intake, the advanced counting method is probably better suited to your goals. For this method, you'll need a calculator, some measuring cups, and a food scale. This is particularly import for individuals with type 1 diabetes. Studies have shown that people are likely to underestimate a portion size by as much as 46%, so be sure to make use of measuring cups (or the scale, if the serving size is by weight) to get an accurate idea of what your portion sizes look like.
Once you've mastered the scale, you can consider really stepping up your game and introducing carb factors to your mealtime routine. A carb factor is a number that describes the carbohydrate content of a certain food, by specifying the percentage of that food which is carbohydrate. For example, the carb factor of Kellogg’s Cornflakes is 0.83, which means that 83% of its weight comes from carbohydrates; the carb factor for fresh strawberries is 0.06 which means that carbohydrates make up 6% of its weight; the carb factor for apples is 0.13, which means apples are made up of 13% carbohydrate. Carb factoring can be a game-changer for people with type 1 diabetes looking to tighten up their BG range.
Who knew you had to be a mathematician with diabetes! It may be a little tedious at first, but the more you practice, the more comfortable you’ll get with serving sizes and ratios. By using this method, you will know exactly how many carbs you are eating, and exactly how much insulin you need to maximize your post-meal blood sugar management.
Quality over Quantity
It’s important to note that all carbs are not created equal! The healthiest carbs come from vegetables, fruits, beans, legumes, and whole grains. These foods have a higher number of vitamins and minerals and are more fibre dense. As we mentioned previously, fibre does not increase blood sugar levels and is the part of a food that makes you feel “full”.
Low-quality or 'simple' carbs are usually processed and found in white bread, rice, baked goods, and sweetened juices and soft drinks. These foods contain less fibre, and are usually loaded with sugars, salt, and preservatives. Limiting these overly processed foods can help to prevent spikes in blood sugar levels.
When monitoring carbohydrate quality, try to include:
Dark green leafy vegetables (spinach, kale, mixed greens)
Whole grains (brown rice, quinoa, barley)
Beans and legumes (black beans, kidney beans, lentils)
Potatoes, French fries, potato chips
Baked goods (croissants, biscuits, donuts)
Breakfast cereals high in sugar
To substitute or not to substitute, that is the question...
Since sugars are carbohydrates that raise your blood glucose levels, it makes sense to try and substitute sugars in your diet with artificial sweeteners. There have been many studies conducted on the effects of sugar substitutes and their effect on people with type 1 and type 2 diabetes, and unfortunately there isn’t a clear consensus on the subject.
Here's some info that helps to break down the more common sugar substitutes, as well as some safety and nutrition recommendations for each...
Sugar alcohols are only partly absorbed by your body and have no major effect on blood sugar. It should be noted that while these sweeteners do not increase blood glucose levels, their intake should be limited, and you should always consult your registered dietitian about how to effectively incorporate sugar, sugar alcohols, and artificial sweeteners into your diet plan.
There is no advantage in using one sweetener over another for people with diabetes. The most important thing you can do is limit your daily intake where possible.
Carb counting is a skill that every person with diabetes should try to incorporate into their daily routine. It's one of the most effective strategies to manage blood sugars when planing your meals, eating healthier, and preventing spikes in blood glucose.
As with any skill, practice makes perfect! The more you practice reading nutrition labels, identifying carbohydrates in your diet, and weighing and measuring out portion sizes, the more you will be comfortable with carb counting.
It is important to always speak to your registered dietitian before making any dietary changes. Your dietitian is there to help you count carbs effectively and guide you on your journey to becoming a carb counting master!