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QOTW: How to Carb Count

Question of the Week (QOTW) is a Thursday post that usually centers around questions that are sent in to me. This particular post wasn't sent to me by one particular individual, but instead, from families I see daily.

I work in an Endocrine clinic where I talk with both Type 1 and Type 2 diabetes families. One of the first meetings we have results in us talking about carb counting. I love educating these families and hearing their sigh of relief when they understand how carb counting works! From my experience, I have found that it is one of the more poorly explained concepts in the adult care world, so I wanted to try to provide some clarification, but this advice is not taking the place of your health care team.

When you have diabetes, your diet plan is one of the most important parts of management. Read below for a quick breakdown of carb counting and be sure to talk with your own health care team. If you don't have diabetes and you're just interested in the amount of carbohydrates in foods, this article can hep you better understand them.

Simply explained, when we eat carbs, or carbohydrates, our blood sugar raises and causes the body to release insulin. Insulin comes in to the blood stream, grabs that sugar from the blood, and delivers it to our cells for energy. With Type 1 diabetes, the body does not produce insulin. In Type 2 diabetes, the body does not produce enough insulin for the body and in some cases can stop producing insulin altogether. Either way, if insulin is required in the treatment, carb counting is also important.

The world of diabetes is much more complicated than that, I just wanted to give you the general idea. To learn more about diabetes or to get involved, check out Diabetes.org. You can also read this previous Be Well post  to learn a little more about the difference between type 1 and type 2.{Apparently, when I wrote that post, I was less-than-impressed with Paula's decisions}.




The reason we count carbs is so we can estimate the amount of sugar going into the bloodstream and then estimate the amount of insulin needed to deliver that sugar to the cells. This equation is different for everyone and that's where your doctor and diabetes educators can help make sure you have your own care plan.

So, you go to the doctor and see all the professionals and still have the question... "how do I count carbs?". If there is a nutrition label available, always read it! Check out Calee's previous post on How to Read a Nutrition Label for help. When you look at the label, the first thing to notice will be serving size. Next, skim down to the total carbohydrates section. There, you will see a number with the letter "g" beside it. This is how many grams of carbohydrate is in one serving. Take another look at the top of the label and you will see "servings per container". If you eat the whole container and need to count the carbs, you would multiply total carbohydrates x servings per container and that would equal the amount of carbs you need to count.

If there is no nutrition label available, you will need to make an educated guess. With diabetes, we make educated guesses based on 15 grams of carbohydrate. Once you memorize the 15 gram serving size, you can add/subtract/multiply/divide accordingly.

There are 3 nutrients that give us calories (energy). These are carbohydrates, proteins and fats. They are called macronutrients. With diabetes, we only have to count the carbohydrates.

Carbs mainly come from starches, fruits, milk and sweets and other desserts. Non-starchy vegetables, proteins, and fats do not give us carbs so we call them free foods.

Here are the 15 gram serving sizes for the carb sources:

  • Starches/grains:
    • 1 slice of bread
    • 1/2 hot dog or hamburger bun
    • 1/4 of a bagel
    • 1 small tortilla or waffle
    • 1/2 cup cooked cereal
    • 1/2 cup mashed potatoes, or other starchy vegetable
    • 1/3 cup cooked rice or pasta
  • Fruits:
    • 1 small fresh fruit
    • 17 small grapes
    • 1/2 canned fruit
    • 1 cup melon
  • Milk (12 grams of carb):
    •  1 cup milk
    • 6 ounces yogurt (reduced sugar or light)
  • Sweets and other desserts:
    •  1 tablespoon syrup or jelly
    • 1/2 cup ice cream
    • 2 creme filled sandwich cookies
Now that you are familiar with carb sources, here are the free food sources. Free foods do not give us carbohydrates; therefore in small portions, they do not change our blood sugar. A free food can be defined (in most cases) as less than 5 grams of carb per serving.
  • Non-starchy vegetables (green leafy vegetables, 1 cup raw vegetables)
  • proteins, cheese and meat substitutes (peanut butter, turkey)
  • fats and condiments (nuts, dressings)
So, given an example of a ham and cheese sandwich, small apple, cup of yogurt and some Ranch with carrot sticks, we would have about 60 grams of carb. A typical 2,000 calorie diet comes out to about 75 grams of carb per meal. 

If you had a taco, the only part you would have to count would be the shell...the meat, lettuce, salsa, sour cream, cheese and sauce would all be free. 1 small tortilla shell is about 15g of carb, so the entire taco is around 15g of carb.

For this meal:
 
You would count the grapes (15g), milk (12g), brownie (30g), and mashed potatoes (15g) for a total carb count of 72g of carb. The carrots, broccoli, and chicken are all free foods.

If you have diabetes, be sure to talk with your own registered dietitian, diabetes educator, and doctor about your meal plan. This is not a medical article, it is simply meant to help you understand carb counting a little better. 

Do you have any tips for helping new diabetes patients understand care and management?
Anything you want to know about nutrition? Email rainiecarterrd@gmail.com and be featured as our QOTW. 

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