Carbohydrate
Counting
Goals of Nutrition
• Control of blood glucose
• Normal growth and
development
• Healthy meals and snacks
What Foods Can I Eat?
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Healthy, balanced meals and snacks
Foods with sugar in moderation
Milk, water or sugar free drinks
Fresh fruit instead of fruit juice
The same foods recommended for a person
without diabetes!
Making Healthy Food Choices
• Choose fresh or frozen vegetables and
fruits daily
• Use whole grain breads, cereals, pasta,
and rice
• Choose lower fat food choices more often
• Parents can set an example by eating a
variety of foods.
Why Count Carbohydrate?
• Carbohydrate has the greatest effect on blood
glucose (BG)
– 100% of carbohydrate turns to glucose
after eating
– It is the first source of energy and
important in a healthy diet
– Higher carbohydrate foods are not ‘bad’
• Allows you to adjust insulin based on grams of
carbohydrate eaten
– An Insulin to carbohydrate ratio is used
(example: 1unit per 15 grams carbohydrate)
• Protein and Fat have little or no effect on BG
What Foods Have Carbohydrate?
• Main sources include:
– Breads, Cereals, Grains,
Starchy Veggies
– Fruit and Juice
– Milk and Yogurt
– Sweets and Desserts
What Foods Have Carbohydrate?
• Additional, smaller sources include:
– High protein foods such as peanut butter and
cottage cheese
– Non-starchy vegetables
– Some salad dressings
– Nuts and seeds
– Condiments; such as, catsup, BBQ sauce
Count all carbohydrates, even those low in
carbohydrate!
Sugar Containing Beverages
• Beverages not recommended due to rapid
spikes in blood glucose
– 100% fruit juice and fruit flavored drinks
– Regular soda pop
– Sport drinks
– Kool Aid
– Other sweetened beverages
Choose milk, water or a sugar-free version instead
Where do I get
Carbohydrate Information?
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Food Labels
‘How Food Counts’ handout
‘Calorie King’ book
Websites
Apps
“How Food Counts”
• Shows serving sizes of foods containing 5 to 15
grams of carbohydrate
– Foods in 15 gram servings of carbohydrate:
• Grains & Starch, Fruit, Combination foods, Sweets
– Foods in 12 gram servings:
• Milk and yogurt
– Foods in 5 gram servings:
• Non-starchy vegetables
• Contains helpful tips about each food group
Reading Food Labels
Food labels contain the most accurate
carbohydrate information
1. Check the Serving Size
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Not the gram weight of the serving
located by serving size
253g is the weight of 1 cup of chili
2. Check food labels for grams of ‘Total Carbohydrate’
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1 cup chili = 22g Carbohydrate
Do not use ‘net Carbs’ if listed
My Favorite Foods
• Prepare a list of foods commonly eaten at
meals and snacks for a quick reference at
home
• Measure the quantity typically eaten
• Indicate the grams in this portion
Keeping Breakfast Healthy
• Use ‘Healthy Breakfast Guide’ for healthy food
choices
• Choose breakfast cereals with:
– 8 grams or less of Sugar per serving
– 3 grams or more of Fiber per serving
• Choose whole grains more often, avoiding overprocessed, pre-sweetened foods
• Balance food choices (Milk, Whole grain, Fruit, and
Protein)
Snacking Choices
• Choose whole grain snacks with dietary
fiber
• Offer fruits, vegetables, and dairy foods
• Protein foods are not “free” foods
• Refer to “Healthy Snacks” handout for
ideas
Planning Healthy Meals
How much should I eat?
• Eat to appetite
• Monitor growth at each clinic visit
• Good blood glucose control
contributes to normal growth and
development
Healthy Eating
Division of Responsibilities
• Parent/Caregiver Responsibilities:
– What foods are offered
– When and where they are offered
• Family dining table
• No TV distraction
– Parents be a role model
• Child Responsibilities:
– What they eat
– How much they eat
Tips for Mealtimes
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Schedule meals and snacks
Avoid ‘grazing’ between meals
Avoid short-order cooking
Have family meals
Encourage, don’t force new foods
Offer choices within limits
– Would you like fruit or yogurt for snack?
• Offer a variety of food groups
Reading Food Labels for
Carbohydrate Content
• Serving Size
• Total Carbohydrate
• Dietary Fiber / Sugar Alcohols
– Very few foods will require total carbohydrate
adjustment for fiber and sugar alcohols grams
• Adjusting grams of Carbohydrate for
portion sizes
Reading Food Labels –
Higher Fiber Foods
• Lower BG may occur after a high fiber
meal. Fiber is not completely broken
down by the body.
– If 5 or more grams of Dietary Fiber are
listed per serving, subtract half (1/2) the
fiber grams from Total Carbohydrate
• Higher fiber cereals (ex. Raisin Bran, Wheat
Chex, Shredded Wheat)
• Beans (Kidney, Pinto, Navy, etc)
Lite or Sugar Free Foods
• Does not mean carbohydrate free
• May contain sugar alcohols (words ending in ‘ol)
– Sorbitol, mannitol, xylitol, maltitol, etc
– If 5 or more grams of Sugar Alcohol are listed per
serving on the label, subtract half (½) the sugar
alcohol grams from Total Carbohydrate
– Sugar alcohols affect BG at a slower rate and may cause
gas and diarrhea
– The only SF or lite foods recommended are SF beverages
(which do not contain sugar alcohols)
Adjusting Carbohydrate grams for
Portion Size
What if you want 20 crackers?
Cheez-It Crackers
Serving Size = 27 crackers (30g)
Total Carbohydrate g = 16g
Dietary Fiber = Less than 1g
Carbohydrate grams ÷ Label serving size x Your Portion
16 grams ÷ 27 x 20 = 11.8 or 12 Total Carbohydrate grams
Determining Grams in Recipes
• Use the ‘Calorie King’ booklet
• Use similar food labels
• Use ‘Cooking Information’
handout
– Add grams of each ingredient
– Divide by the number of portions
Eating Out and
Special Occasions
• Use labels, Apps or the ‘Calorie King’ booklet to
help plan meals when eating out
• Look up restaurant websites using ‘Fast Food
Websites’
• ‘Foods for Occasional Use’ contains
carbohydrate information on candy and sweets
Using Your Insulin Ratio
Lunch
Hamburger on Bun
2 Tbsp Catsup
8 Tator Tots
8oz 2% Milk
½ cup Green Beans
1 apple
Grams
22g
3g
15g
11g
3g
14g
Total Grams
68g
Ratio=1unit Humalog for 15 grams
4.5 units (68 ÷ 15 = 4.5 units)
Educating
School/Day Care Providers
• Refer to the School Section handouts in the notebook
• Do not withhold food for high blood glucose readings
• Check school district website for carbohydrate information.
If not available, request it from the district food service
director or food service supervisor
• Extra carbohydrate may be needed for PE
– General guide: 15 grams for 30-45 min of more
strenuous activity
Exercise
• Be active or exercise 60 minutes/day
• Exercise may lower blood glucose up to 24
hours after activity
• Strenuous exercise may require “exercise
carbs” (carbs you do not dose for)
• Look at BG patterns to see if you need
“exercise carbs”
• Check blood glucose before, during, and
after activities
Bedtime
• Blood glucose goal: 110 to 150mg/dl
• If less than 110,
– Give a 15 gram carbohydrate snack containing fat
without dosing insulin (crackers & cheese or peanut
butter, ½ cup ice cream)
• If less than 70,
– Treat the low with 15 grams of fast acting carbohydrate
– Follow with a high fat, 15 gram carbohydrate snack
without dosing insulin
Nutrition Education Summary
• Measure foods for 1-2 weeks using measuring
cups, spoons, and food scale
• Read labels and count grams of carbohydrate at
all meals and snacks
• Use your ratio to calculate insulin dose
• Bedtime BG goal: 110 to 150mg/dl