Clinical Hub,Patient Education,Health and Nutrition Facts For You,Diabetes, Endocrine

Diabetes: Carbohydrate Counting (371)

Diabetes: Carbohydrate Counting (371) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Diabetes, Endocrine


Carbohydrate Counting

Carbohydrate counting is meal planning to help control your diabetes. It is important to focus on
your total carbohydrate intake to keep blood sugar (blood glucose) at healthy levels.

What is a carbohydrate (Carb)?
ξ Carbs are the body’s source of fuel.
ξ There are 3 types of carbs: sugar, starch, and fiber.
ξ Sugars include processed sugar (soda, molasses, corn syrup, jelly, candies, sweets and
desserts) and natural sugar (fruit, fruit juices, honey, vegetables, milk, and yogurt).
ξ Starches are found in grain products such as breads, rice, pasta, cereals, legumes (beans,
split peas, lentils) and starchy vegetables (potato, sweet potato, corn, green peas, and
winter squash).
ξ Fiber is found in whole grains, cereals, fruits, vegetables, and legumes.
ξ The amount of carb that you need daily depends on your height, weight, and activity
level. The American Diabetes Association suggests eating at least 45-60 grams of carb at
each meal.

How do carbs affect my blood sugar levels?
ξ Carbs, when compared to protein and fat, have the biggest effect on blood sugar levels.
ξ 90-100% of carbs enter the blood stream as glucose 20 minutes to 1 ½ hours after eating.

How do protein and fat affect your blood sugar levels?
ξ Protein and fat eaten in moderate amounts have little effect on blood sugar levels.
ξ Protein sources are: meat, fish, poultry, eggs, cheese, tofu, and peanut butter.
ξ Fat sources are: oil, margarine, butter, nuts, mayonnaise, sour cream, and cream cheese.
ξ Eating a diet high in protein is not advised in most cases.

Getting Started
For foods without a label such as homemade foods, use these resources to estimate the amount of
carb in those foods:
ξ Carb counting books/food list.
ξ Fast food and restaurant menu nutrition information.
ξ Websites and smart phone apps.
ξ The resources found on page 6.

Measure your portions of rice, potatoes, and/or pasta at home to make it easier to estimate the
carb content of your meals. When eating outside the home check the restaurant’s nutrition
information to help you plan ahead.


Use these steps to start counting carbs.

STEP 1: Reading the Food Label for Total Carbohydrate Content
To better understand the effect of your carb intake on blood sugars you first have to know how
much carb you are eating. A food label is a great place to get carb amounts.

STEP 2: Practice Carbohydrate Counting
ξ Keeping track will show you how different foods affect your blood sugar.
ξ It will also show you how activity or exercise affects your blood sugar.

1. Practice carbohydrate counting by keeping a food log for 1-2 weeks. Write down
everything you eat and drink. This will help you to know the carbs in the foods you eat
most often.
2. Use measuring cups and spoons or a food scale (particularly for fruit) to help you figure
out the amount of food you eat. Write down the portion sizes in your food log. Measure
your glasses and bowls so you know how much they will hold. Is the glass 8 ounces or
24 ounces?
3. Write down your blood sugar levels in your food log. Check your blood sugar before and
2 hours after the start of your meal.


Food Record for Carb Counting - Example
Write down every food you eat and drink, along with the amount, and the grams of carb for
each item. Add up the grams of carb for each meal. Check your blood sugar before meals, and
two hours after meals.

Time Blood
Food Amount
(e.g. cups,
Grams of
Blood Sugar 2
hours after
112 Whole wheat
2 slices 30 g Metformin
156mg/dl 9:05AM
Margarine 2 tsp --
Poached eggs 2 --
1 ½ cups 17 g
2 cups --
Skim milk (in
4 Tbsp 3 g
50 g

10 AM Medium apple 1 25 g .
String cheese 1 oz 1 g

STEP 3: Fine Tuning
Be consistent with Carbs
ξ It is important to feed your body energy (carbs) throughout the course of the day.
ξ Eating carbs throughout the day helps to keep blood sugar levels stable. It also helps to
keep you satisfied between meals.
ξ Aim for 45-60 grams of carb at every meal and 15-30 grams of carb at a snack.

Fiber in Meals
ξ The amount of fiber in a food can affect your blood sugar because it is not completely
digested. This slows and delays your rise in blood sugar.
ξ Foods that have 3 grams or more of fiber may have less affect on blood sugar.

Sugar Alcohols
ξ These are ingredients used in “sugar-free” foods. Common sugar alcohols are maltitol,
mannitol, sorbitol, and xylitol.
ξ They have calories and can raise your blood sugar slightly, but have fewer calories and
will not affect your blood sugar value as much as regular sugar.
ξ Eating more than 10 grams of sugar alcohols can cause gas, bloating, and/or diarrhea.

Fat and Protein in Meals
ξ Meals that are higher in fat or protein than what you usually eat can cause the stomach to
empty more slowly and may delay the rise in blood sugar levels after meals.
ξ Higher fat and protein meals, such as pizza or a 10-ounce steak, can cause your blood
sugars to run higher 2 to 3 hours after eating.

Count Your “Free Foods”
ξ Free foods are foods that are low in carb but can still raise your blood sugar if eaten in
large amounts.
ξ For example: ½ cup of cooked green beans has 5g of carb, but it can add up quickly when
you enjoy 2 cups (20g carb) with a meal.

Make a Plan to Fit your Needs
ξ Every person is different. Your body will respond in its own way to food that you eat.
ξ That response may be different compared with someone else who has diabetes.
ξ Keep a food log with your blood sugars to find out which foods affect your blood sugar
the most.
ξ Foods to watch out for are casseroles and mixed dishes, fried foods, and high fat desserts.

STEP 4: Putting It All Together
Build a Diabetes-Friendly Healthy Meal
Build a well-balanced meal and choose foods from different food groups by looking at the
Healthy Plate diagram. Use a 9” dinner plate and other common objects to visualize portion
ξ The Healthy Plate helps you to choose about 45-60 grams of carb per meal.
ξ There are a many ways to create a balanced, diabetes-friendly meal.
o 1 serving of fruit, 1 serving of milk, 1 serving of grains/starchy vegetable.
o 1 serving of milk, 2 servings of grains/starchy veg.
o 2 servings of fruit, 1 serving of milk.
o 3 servings of grains/starchy veg.

ξ Each meal should also include about 1 cup or more of non-starchy vegetables, a source of
lean protein, and a healthy fat.

Serving Size Guide


American Diabetes Association Complete Guide to Carb Counting: 2nd Edition by Hope Warsaw
and Karmen Kulkami. 2004
The Diabetes Carbohydrate & Calorie Counter: 3rd Edition, by Annette B. Natow and Jo-Ann
Heslin. 2006.
The Ultimate Guide to Accurate Carbohydrate Counting by Gary Scheiner, 2006
American Diabetes Association Guide to Healthy Restaurant Eating by Hope S. Warshaw. 2009.
The Calorie King Calorie, Fat, & Carbohydrate Counter 2011, by Allen Borushek. 2011.

EatSmart Digital Nutritional Scale (www.amazon.com)
Nutri-Way Dietary Computer Scale (www.intergrateddiabetes.com)
Salter Digital Nutritional Scale (available at Williams-Sonoma)

Diabetes Nutrition Websites
Tennis ball = 1 serving of fruit (15 grams carbohydrate)
Computer mouse = baked potato (30 grams carbohydrate)
DVD = pancake, bread (15 grams carbohydrate)
Fist = 1 serving of milk (12 grams carbohydrate) 1Cup

There are websites that offer food tracking and recipe analysis tools. These are great tools if you
would like to know the carbohydrate and nutrition facts for common foods, meals or favorite

These same sites may also have free recipes to try, or to compare to your favorites. All of the
tools listed below are free, except Calorie King, which requires a subscription.

ξ My Food Advisor from the American Diabetes Association (see http://tracker.diabetes.org/)
Your Food Advisor can help you set goals for calories, carbohydrates and other nutrients, as
well as track what you eat with great detail.

This site also offers Create A Dish, which can help you figure out the nutrition content of
favorite recipes. The recipe information includes grams of carb per serving.

ξ ChooseMyPlate.gov offers Super Tracker, a free food, fitness and recipe tool. See
https://www.supertracker.usda.gov/default.aspx. You can use Super Tracker to see how your
daily meal choices compare to food group targets and daily limits. The section My Recipe
allows you to build and analyze your favorite recipes to find out carb content and more.

ξ NutritionData.com also has free food search, meal tracking and recipe analysis functions,
see http://nutritiondata.self.com

ξ The American Heart Association also offers recipes that include nutrient content in their
Nutrition Center. See

ξ CalorieKing.com (www.calorieking.com) has a free food search function, but requires a
subscription to use their Food Diary, goal setter, activity planner and charts and graphs.

Phone/Tablet applications
iPhone Apps Android and iPhone Apps Android Apps Blackberry Apps
Diabetes Companion
Cost: Free
Carb Counting with Lenny
Cost: Free
On Track Diabetes
Cost: Free
Cost: $5.99
Diabetes Log
Cost: Free
Cost: $1.99- 2.99

Cost: Free
Calorie Counter
Access at Fat Secret.com
Cost: Free

Go Meals, by CalorieKing
Cost: Free
WaveSense Diabetes Manager
Cost: Free

Islet – Diabetes Assistant
Cost: $0.99
Blue Loop
Cost: Free

Carb Master
Cost: $0.99


Teach Back:
What is the most important thing you learned from this handout?

What changes will you make in your diet/lifestyle, based on what you learned today?

If you have more questions please contact UW Health at one of the phone number listed below. You
can also visit our website at www.uwhealth.org/nutrition

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500.

Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.

Your health care team may have given you this information as part of your care. If so, please use it and call if you have
any questions. If this information was not given to you as part of your care, please check with your doctor. This is not
medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health
needs are different, you should talk with your doctor or others on your health care team when using this information. If you
have an emergency, please call 911. Copyright © 1/2017 University of Wisconsin Hospitals and Clinics Authority. All
rights reserved. Produced by the Clinical Nutrition Services Department and the Department of Nursing. HF#371

Lose It!, by Fitnow
Cost: Free

Nutrition Database for iPhone
Cost: $4.99

Food Record for Carbohydrate Counting
ξ Write down every food you eat and drink, along with the amount, and the grams of carbohydrate your
foods have.
ξ Total up the grams of carbs for each meal.
ξ Check your blood sugar before meals, and about 2 hours after meals. In this way you begin the process
of understand the effect of medicine, carbs and activity on your blood sugar.

Time Blood
Food Amount
g carb Medication
Sugar 2
Time you
tested after