Carb counting is a very useful skill to learn when taking meal time insulin. Counting grams of carbohydrates helps to determine the appropriate amount of insulin to take BEFORE eating. Taking meal time insulin that closely matches food (and drink) helps to reduce the risk of high or low blood sugar. Carb counting allows for more food freedom because the insulin can be adjusted accordingly. Big meal, more insulin, small meal, less insulin. So how does someone learn to carb count? It's actually pretty easy!
First, it's important to know why carbs need to be counted. Carbohydrates turn into sugar when eaten. So that bowl of pasta, while it doesn't taste sweet, will break down into sugar in the body. This sugar needs insulin in order to get into the body's cells and make energy. Think of insulin as a shuttle for sugar into the cell. If you are insulin dependent, you need to take insulin before eating . If you eat a meal or snack with a substantial amount of carbohydrates, you will need more insulin than a meal with low carbohydrates. Pasta will require more meal time insulin than say salmon and green beans. This is because pasta will make more sugar once digested then salmon and green beans. When too little insulin is taken, blood sugar will be elevated after eating (hyperglycemia). If too much insulin is taken, blood sugar will be low (hypoglycemia) after eating. Carb counting helps to determine a more precise dose of insulin to take before a meal or snack. Now, let's look at what has carbohydrates.
What has carbohydrates? Everything. Well not everything, but almost all foods and drinks with calories have some carbohydrates in them. Here is a list of foods/beverages that contain carbohydrates and will require counting.
Pasta
Rice
Bread
Fruit (yes, fruit)
Potatoes
Corn
Peas
Beans/legumes
Dairy products like milk, yogurt, coffee creamers
Cereal/granola/oatmeal
Crackers
Candy, cake, sweets (yes, even the sugar free has carbs)
Soda and juice
Condiments (dressing, ketchup, BBQ sauce)
Beer/wine/mixed drinks
Most everything has carbs in some amount. Foods/beverages that are low in carbohydrates are listed below:
Meat (non-breaded)
Fish
Tofu
Eggs
Cheese
Nuts
Green vegetables (not peas, see above)
Cauliflower, squash, zucchini, eggplant
Coffee/tea (when nothing is added)
Hard alcohol
Identifying what has carbs will then help with the next step of how to count them.
If something is labeled, this will make carb counting easier. That is not to say that things can't be counted without a label. I will get to that soon.
Reading a label
Check the serving size. For example, on the label below, one tortilla is a serving. This means the label information pertains to the one serving. That is not to say, one must stick with only one tortilla or one serving. It just means that two tortillas would double the nutrition content. Sometimes a label will say one cup is a serving. In that instance, a measuring cup for dry or wet ingredients is a great way for an accurate carb count. One cup of cooked pasta will have less carbs then two cups of cooked pasta. Measuring is an important part of carb counting. If measuring isn't realistic, here is a nice chart to help "eyeball" portions.
Next, check the total carbohydrates to determine how many carbs are in one serving. In the label below, 1 tortilla has 9 grams of carbohydrates. No one will eat one tortilla. Who eats one taco? So 2 tortillas is 18 grams, 3 is 27 grams and so on. Many people (including myself) get confused by all the content included on a food label. For simplicity sake when counting carbohydrates, focus on serving size and total carbohydrates in grams. Fiber and sugar are important but for carb counting, just look at total carbohydrate. Next, the contents that go into or onto the tortilla will then need to be counted as well. Cup of juice to go with it? That gets counted too. All of the carbs get added up and that is the total carbs for the meal.
Let's look at another label together :)
What is the serving size? Remember that's at the top of the nutrition label.
That's right. The serving size is 1/2 cup.
How about the carbs in one serving? Remember go down to Total Carbohydrate on label.
Yes! 12 grams of carbs in one serving.
What if you had 1 cup instead of a 1/2 cup?
Great! 24 grams. You take 12 grams and multiply it by 2 because you are having 2 servings.
What if something doesn't have a label?
There are quite a few easy and convenient ways to look up carbs when food or drinks aren't labeled.
Calorie king - This website (also available as a free app) is an excellent resource to look up foods/drinks that are not labeled. The site and app also include fast food chains such as Dunkin Donuts or McDonalds. Calorie King books can also be purchased if that is preferred.
Alexa or Siri- These are 2 smart women! Need to know how many carbs are in a slice of pizza? Just ask Alexa or Siri. While these two lovely ladies don't know the carb count of everything, they offer a wide database.
Check the nutrition facts on restaurants' websites. Many chains list the nutrition content for the items they offer. For example, Chick-fil-a is just one of the many chains with detailed nutrition info including grams of carbs. Non-chain restaurants may not be able to provide nutrition information. Grandma Ida's homemade apple pie isn't labeled either. In these cases, Calorie King is helpful to get an educated estimate for the carbs in nearly everything.
Carb counting homemade foods
Cooking from scratch can certainly make carb counting a challenge, but it is not impossible. Carb counting does not need to be perfect. It just needs to be an accurate estimate and this is most often the case with homemade food. Sometimes the recipe, when found online or in a cookbook, lists the nutrition facts for each serving. However, not every recipe will come with nutrition info. Here are a few ideas for homemade recipes and carb counting:
Tally up the total carbs in the recipe ingredients and then divide by the number of servings. Let's say a homemade chicken pot pie recipe has a total of 400 grams of carbs (this includes the crust, flour, peas, etc). The pot pie has 8 servings. So 400 grams of carb/8 servings would mean each serving has about 50 grams of carbs. This method requires a bit of math. The good thing is if the recipe is made often, the nutrition info can be written down or saved somewhere.
Not big on math? Check out this site for calculating recipes. The ingredients just get entered into the website and nutrition facts are calculated per serving. No math needed.
Quiz Time!
The best way to learn anything is to practice. Let's review 3 scenarios and practice counting carbs.
A nutrition label on a package of pasta shows that 1 cup (cooked) is 55 grams of carbs. You have 1.5 cups of cooked pasta. You then add 1 cup of sauce to the pasta. One serving of sauce is a 1/2 cup which has 10 grams of carbs. You also want a glass of milk to go with it. 8 oz of 2% milk has 12 grams of carbs. You pour 8 oz. How many carbs did you have?
Pasta 55 grams x 1 1/2 servings=about 83 grams of carbs
Sauce 10 grams x 2 servings=20 grams
Milk 12 grams x 1 serving = 12 grams
Total for the meal: 115 grams of carbs
You are eating on the lighter side tonight. You use the labels on the packages and Calorie King to help you count those items not labeled like the lettuce. You have a salad with 2 cups of Romaine lettuce (3 grams of carb per 2 cup serving), 1 cup of chopped of chicken breast (0 grams), 1 small apple chopped (15 grams per small apple), 1/4 cup of walnuts (4 grams per 1/4 cup) and 4 tbsp of poppyseed dressing (each tbsp has 3 grams per tbsp). How many carbs did you have?
Romaine 3 grams
Chicken 0 grams
1 Small apple 15 grams
Walnuts 4 grams
Dressing 12 grams
Total for salad: 34 grams
Mexican tonight at a local place. Yum! You check the restaurant's website and they don't have nutrition info listed. You use Calorie King to help you estimate. You have a bowl of tortilla chips with salsa (19 chips is 21 grams of carbs, salsa 2 tbsp is 2 grams of carbs), 2 margaritas (13 grams per margarita), 3 tacos with shredded pork (each taco shell is 16 grams of carbs, pork is 0 grams) and about 1 cup of rice (1 cup cooked is 45 grams). How many carbs did you have?
Chips/salsa about 30 grams
2 margaritas 26 grams
3 tacos with pork 48 grams
1 cup of rice 45 grams
Total for meal: 149 grams
Which meal would require the most meal time insulin?
That's right, the Mexican meal
Which one would require the least amount of meal time insulin?
That's right, the salad.
I hope Carb Counting 101 helped. Meal time insulin is tricky to take when using a set dose or a sliding scale. Learning to count carbs is a useful skill to learn when taking meal time insulin.
Feel free to reach out to me directly with questions on carb counting. Your insurance may cover a visit with me or a diabetes educator in your area.
Now that you feel more comfortable counting carbs my next blog post will go over an insulin to carb ratio, a correction factor, active insulin time and blood sugar target.