Diabetes Forecast

Back to Basics: Carb-Counting Tips

30 top pointers from real people with diabetes

By Tracey Neithercott , ,
30 Tips

The idea isn't complex: Add up the carbohydrates in a meal, dose insulin based on that number (your health care provider will explain how), then test your blood glucose to see the result. Carb counting takes a bit of practice, but it's a great way to learn about eating well with diabetes. We've compiled a list of 30 tips that will help get you started. These aren't "rules"—they're just ideas from which you can pick and choose, straight from people who deal with diabetes every day.

1. Accept your situation.

"You can't ignore that you have diabetes," says Beth Velatini, 42, who was diagnosed with type 2 diabetes in 2000. You may feel fine, she says, but uncontrolled diabetes can wreak havoc on your body that you won't see for years. A better idea: Learn how to treat it now. "It is helpful to go to a nutritionist. Everything matters that you eat. It's a pain that you can't just stick anything in your mouth. [But] it's a manageable disease if you choose to manage it."

2. Educate yourself.

"Attend classes at clinics and hospitals, Diabetes EXPOs—anything your doctor, endocrinologist, or CDE [certified diabetes educator] suggests," says 63-year-old Merrillee Knoll, who has had type 1 diabetes for 62 years. "Read everything you can get your hands on, visit websites. Never stop learning."

3. Start small.

"When I was diagnosed, I was just completely overwhelmed," says Drew Golden, 44, who has had type 1 diabetes since 1987. "Really, there are just a handful of key things you need for carb counting. One, know the insulin-to-carb ratio. Two, it's really important to know what one unit of insulin does to your
blood sugar without eating."

4. Begin at home.

"Start out at home and gradually work your way up [to eating out]," says Golden. "It's always easier to eat at home than [it is to] eat out because you know the ingredients."

5. Test … a lot.

"I was doing a lot of testing when I got diagnosed," says Jamie Bronstein, 42, who was diagnosed with type 2 in January 2010. "I'd eat and later I'd test and see how I reacted. I had to do an awful lot of testing at the beginning before and after meals. If I go on vacation or if I go out to eat, I'll test before and after to see what impact something I've never tried before is having."

6. Enlist help.

"In the beginning, I needed the team to help me," says Denise Costabile, 57, who was diagnosed with type 2 diabetes in April 2010. So when she ate at her favorite Italian restaurant, her husband put the bread on a chair so she wouldn't be tempted to snatch a slice. "Having his help was key. I needed to surround myself with people who will help me."

7. Learn from setbacks.

"Last night, I cheated completely, which I never do," says Costabile. Instead of looking up a food's carbohydrate content, she guessed. "When I do that, it prompts me to learn that number. I really try to be ready."

8. Get to know the nutrition facts label.

"Outside of fresh fruits, vegetables, and dairy, I would not consider buying a food without a label," says Knoll, who finds it easier to dose insulin when the carbohydrates are listed on the outside of the package.

9. Keep it simple.

"When I was first diagnosed, I found things I really love," says Costabile. "I find comfort in keeping it simple. I have a certain salad dressing on my salad that I like. I stick to it. It's simpler that way."

10. Be consistent.

It's not that you have to eat the same thing every day—far from it!—but it pays to think twice before deviating from your normal food habits. "The trick is to be consistent with the volumes [of food you eat]," says Golden. "If you eat 100 grams of carbs at one meal, you're going to be injecting a lot of insulin and that's where you get into trouble, risking these high errors."

11. Find tech that works for you—and use it.

"For me, carrying [a carb-counting book] around was going to be a lot less efficient," says Bronstein, who uses the Lose It iPhone app to look up foods' carbohydrate counts. "It will tell you how many carbs are in everything. It will also do recipes for you. It will let you know all the nutrition information for one serving."

12. Figure out what you can't eat.

Yes, people with diabetes can have almost anything, in moderation, but carb counters sometimes find foods that, for them, just aren't worth the glucose spikes. "Oatmeal was one of the things I had to rule out," Bronstein says. "Cereal and milk I had to rule out. Pizza, I have to only eat one slice."

13. Study your body.

"Measure your food to find out how many carbs are in that portion size and how that insulin dose [affects] blood sugar with those carbs," says Mike Barry, 43, who has had type 1 for 30 years. "A little bit of record keeping goes a long way toward helping you figure things out. And once you figure things out, you can experiment a little."

14. Plan it out …

"I'm a total geek about it," says Velatini (below). "I do my grocery shopping and planning on Saturday. I make my meals the night before so I know what I'm having."

15. … but learn how to improvise, too.

"When I leave the house, I don't know if I'm going to have 30 grams of carbohydrates or 60 grams of carbohydrates," says Barry. "I don't take the insulin until I see the menu."

16. Do your homework.

"I almost always check the menu before I go. Even if they don't have a menu online, I have them fax it to me. They almost always do," says Velatini. "I always pick three things that are healthy because they may be out of something. It's OK to ask for substitutions. I know going into it how many carbs there are, because I've done my research."

17. Stay current.

"Although there is no exact science for counting carbs, it helps to stay on top of things, as sometimes the counts change," says Knoll. "I use many lists, as some differ in what they cover: Some tell about restaurant foods, foods in certain cultures, uncommon foods, popular foods, fast foods, etc. It helps to keep current on what the food industry has to say."

18. Get comfortable with guesswork.

"Dinner at a friend's house, I would guesstimate," says Knoll. "If the meal is mainly pasta, I would estimate the quantity of noodles and dose for that. If there is no carb count, what other route do you have but to guess? Not eat? I don't think so."

19. Get up to speed on the Internet.

"I weigh everything I eat. But you can't do it when you go out to eat," says Velatini. "[For that], the Internet is so great. You can look up anything on a BlackBerry."

20. When eating out, order simply.

"It's really, really tricky eating out if you don't know the exact carb counts," says Golden. "A lot of the chain restaurants sweeten their foods to make them taste better. It's always easier to stick with simple meat and fish."

21. Be suspicious of restaurant meals.

"If it's a completely unknown restaurant, I try to order lower-carb items," says Golden. "But what you get on your plate, it's still up for debate if it's really low-carb. Did they put sauce on it with sugar? Never take anything for granted."

22. Pay attention to portion size.

"I've moved away from really gigantic portions," says Barry. He learned what average portion sizes look like and avoids jumbo meals when eating out. "Sometimes you go to a fancy restaurant and get a dollop of mashed potatoes. At [a big chain restaurant], you can get a heap."

23. Split your plate.

"That's the other danger of eating out. You get this huge plate and they're all-American portion sizes. If you eat that whole plate, you're going to eat 200 grams of carbs," says Golden. "If I'm eating at a restaurant and they bring out a big plate of rice, I split the rice up on the plate into portion sizes."

24. Weigh your food with a scale.

"If I use the scale . . . I calculate the carbohydrates pretty accurately," says Barry. He uses his food scale to measure the number of grams of a given food (like nuts and pretzels that he then bags into individual servings) and calculates the carbohydrates. "I eat peanuts pretty regularly at work, so I'll measure three servings of nuts. I know that each serving is 7 grams of carbohydrate. I'll eat one third with breakfast, one third at lunch, and one third when I get home."

25. Be smart about mindless munching.

"When you're eating things like chips, instead of eating your way through the bag or bowl, take a napkin and count out one portion. So count out 10 chips. Then, when you're done with them, you tear off the edge of the napkin as a reminder," says Drew Golden. His trick works for dinner parties, too, when you're grazing but want to keep track of the food you've eaten.

26. Don't expect your book, app, or list to have all the answers.

"I have to think, is this the closest to what I'm eating?" says Bronstein. "I also try to gravitate toward things that I know aren't too bad: chicken or fish or meat. I try to stay away from things that I know are going to spike me, [like] sweet-and-sour chicken."

27. Learn the rules—then ignore ones that don't work.

"Someone's going to give you a rule of thumb at the outset—say, [eat] 45 grams at a meal. The only way you know if that works for you is to test at the outset and see how it works for you. Learn what different foods do for you," says Bronstein. "They said at the outset maybe 45 grams of carbs at a meal, and personally that would have been too much for me."

28. Know thyself.

"What works for you may or may not work for me," says Knoll. "Carb counting is individual. Eat and test is the rule of thumb."

29. Don't worry about being an expert.

"You never feel like you have it 100 percent," says Golden. "You get used to it. I never just take it for granted. It's probably one of the reasons I keep going back to diabetes classes."

30. Have faith that it will all get easier.

"Once you're doing carb counting, it's not at all hard," says Golden. "After a while, you know, you've got the doses right and you don't worry about it as much. You become gradually more comfortable."



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