Food

 Carbohydrates

 Food Labels

 About Sugar

 Eating Out

One of the most important skills anyone with diabetes can learn is "Carbohydrate Counting." Carbohydrates are foods which break down into sugars during digestion.

Why do we count carbohydrates and not protein or fat? Because carbohydrates have by far the greatest impact on your blood sugar. Fat plays only a minor role in short-term blood sugar levels. Protein takes several hours to show up as blood sugar, so it also plays a very minor role in short-term blood sugar control. Carbohydrates are the key. For anyone with diabetes, counting carbohydrates is essential.

Carbohydrates can be found in:

• Grains -- bread, pasta, cereal and rice
  
• Fruits
  
• Vegetables
  
• Alcoholic Beverages
  
• Cakes, cookies and candies
  
• Milk and yogurt (but not cheese)
  
• Sugar, honey, corn syrup and molasses

How to count carbs

Carbohydrates are counted in grams. Grams are a unit of weight. 28 grams equal one ounce.

Some foods are almost entirely carbohydrate. Sugar and foods that are almost pure sugar -- a lollipop or cotton candy -- are easy to figure. 15 grams of table sugar is 15 grams of carbohydrate -- simple as that.

But most foods are a mixture of nutrients. So how do you know how much of any given food is carbs?

The easiest way is to read the label on the food package. The laws requiring that packaged foods be labeled for their nutritional content are a Godsend for people with diabetes. An important note: as with calories, the carbs listed are not for the whole package, but just for one serving -- and servings are often smaller than you would expect! Be sure to check the serving size. If you're eating two servings, double the carb count.

Also: don't be confused if the package lists carbohydrates and sugars separately. The sugars are included in the carbohydrate number. Ignore the sugar listed on the package label. Sugars are included in the carb count.

For foods that are not packaged, like fresh fruits and vegetables, you'll need a book that lists the carb content of foods.

Carbohydrates and insulin

If you take insulin, carbohydrate counting is essential to knowing how much insulin to take. You count the carbohydrates in a meal you are about to eat, and then adjust the amount of short-acting insulin you inject or the "bolus" on your insulin pump to "balance out" those carbohydrates as exactly as you can. When you do that, you are essentially doing what a healthy pancreas does automatically -- releasing just the right amount of insulin to cover the carbohydrates you eat.

How much insulin you need to balance out a given amount of carbohydrate is determined by your carbohydrate-to-insulin ratio. Your diabetes health care team can help you determine your own individual carbohydrate-to-insulin ratio -- and experience will help you refine it. Checking your blood sugar regularly and keeping careful records of your carbohydrate intake, blood sugar levels and insulin doses will soon show if the amount of insulin you're taking to cover your carbs is too much, too little -- or just right.

If you have Type 2 diabetes, counting and recording your carbohydrates is just as important for the same reason: because carbohydrates have the biggest effect on your blood sugars of all the foods you eat. Once you start counting carbs, it won't be long before you notice that eating certain foods causes your blood sugar to "spike," and that you can help keep your blood sugar in range by avoiding them. You will also discover foods you enjoy that you can eat plentifully without adversely affecting your blood sugar.

All carbohydrates break down into sugar once you eat them. But they don't all break down into sugar at the same rate. Scientists refer to carbohydrates that break down into sugar very rapidly as having a "high glycemic index." Carbohydrates that break down into sugar more slowly have a "low glycemic index."

It won't come as any surprise to learn that a teaspoon of table sugar has a fairly high "glycemic index." But you might be surprised to know that a slice of white bread breaks down into sugar in your body just as fast as pure table sugar! And a baked potato breaks down into sugar even faster! So does instant white rice, a loaf of French bread, and most popular breakfast cereals.

On the other hand, some sweet fruits -- highly recommended by dietitians because of their healthful vitamins and antioxidants -- are relatively low on the glycemic index. For example, an apple breaks down into sugar only about half as fast as a slice of bread. So does a pear. So does a peach. And cherries are very low on the glycemic index -- ten cherries break down into sugar in your body three times more slowly than a slice of bread.

Take time to learn something about the glycemic index. Try eating a food with a moderate or low glycemic index -- like pasta -- in place of a carbohydrate with a higher glycemic index, like bread. Then see what your blood sugar tests tell you. You may find that you can level out your blood sugars by replacing high glycemic index carbohydrates with those that are lower on the scale, rather than cutting out carbohydrates altogether.

This article from Diabetes Positive! magazine is provided as a service by LifeScan. All materials are produced independently by Diabetes Positive!, which is solely responsible for its content. Remember that the information provided by this site is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your own physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to health care issues.

Article reprinted with permission from: Diabetes Positive! © Copyright November 2003