Diabetes and Carb Counting For Dummies. Shafer Sherri

      Diabetes requires that you control carbohydrates, but that isn’t the whole story. Keeping healthy means eating smart for your weight and heart (see Chapter 16); learning to identify the perfect proteins and the heart-healthiest fats and oils (see Chapter 13); and putting together balanced meals (see Chapter 8 and Part 5). A balanced diet not only assures nutritional needs are met, but blood glucose is also easier to control when meals have appropriate amounts of carbohydrate, protein, and fat.

      

Physical fitness plays an essential role in overall health. While exercise is encouraged for everyone, there are diabetes-related considerations and safety tips to be aware of (check out Chapter 14).

      Whether you loosely manage your carbs or strictly count them depends on your situation. Carb counting is the gold standard if you have type 1 diabetes, but people with type 2 diabetes also stand to benefit from knowing how to count carbs. Establishing carb budgets and adhering to those budgets is one method of managing blood-glucose levels while simultaneously controlling calories and managing weight.

       Counting carbs with type 1 diabetes: An essential tool

      When you count carbs accurately, you know exactly how much glucose is going to end up in your bloodstream. Insulin doses can be adjusted to cover that amount of carb. People with type 1 diabetes don’t make any of their own insulin. If insulin doses are based on carbohydrate intakes, counting carbs as precisely as possible is really important. It takes a little extra time initially, but with experience it gets easier and quicker. Label reading and carb-counting fundamentals are covered in Chapters 7 and 8. See Chapter 9 to add Internet tools to your carb-counting tool chest. For a deeper understanding of the dietary variables that affect blood-glucose readings, check out Chapter 10, and to find out how to line up insulin timing with digestion timing, see Chapter 6.

      • She was putting in effort but had gaps in her accuracy. She never counted the carbs in nonstarchy vegetables, such as green beans and broccoli. Coral was diagnosed at age 9, and at that time she didn’t really eat many vegetables, so her diabetes team told her family that vegetables were “free.”

      • Another issue: No one had ever told her to subtract the fiber from the total carbohydrate when reading food labels. She’s now 28 years old and eating lots of vegetables and whole grains. After nearly 20 years of diabetes, she felt a measuring cup wasn’t needed. What she had been calling “one cup” of rice had gradually grown in size. She was easily having 1⅓ to 1½ cups, thinking it was just a cup. Inaccuracies in carb counting meant she wasn’t getting the right doses of insulin.

       Gaining tighter control over blood-glucose levels with type 2 diabetes

      Type 2 diabetes is characterized by insulin resistance. The body has insulin, but the insulin doesn’t work as well as it should. For better blood-glucose control, strive to spread carbohydrate intake between three meals and perhaps one or two small snacks per day. Chapter 22 offers snack ideas.

      

People who skip breakfast or lunch often end up eating too much in the evening. Big meals with lots of carbohydrate can derail glucose control. There are several ways to set portion limits. The plate model puts perspective on portioning and is a simple visual tool. The carb portioning and counting fundamentals covered in Chapter 8 aren’t reserved for people on insulin. Carb counting is an option for anyone who wants to accurately control carb portions.

       Sticking with consistent carb counts when you’re on set insulin doses

      Do you check your blood-glucose level at mealtime and then refer to an insulin chart to determine what your dose should be? That insulin dosing method is called sliding-scale insulin. The dose goes up incrementally for higher blood-glucose readings. Some individuals are on set insulin doses at mealtimes. In other words, the dose of insulin is the same from one day to the next regardless of blood-glucose levels.

      

The problem with sliding-scale insulin dosing and set insulin dosing is that they don’t take into consideration what you are planning to eat. The carbs in the pending meal will determine how much more glucose enters the bloodstream. Consider a low-carb salad for lunch one day and a burrito the next day. The two meals contain very different amounts of carbohydrate, but sliding-scale or set insulin dosing doesn’t take that carb variability into consideration. These insulin dosing plans require mealtime carb intakes to be consistent from one day to the next.

      Establish mealtime carb targets (with the help of Chapters 5 and 6). You can vary your food choices daily but keep the carb amounts consistent. Sample menus for breakfast, lunch, and dinner with set carb amounts are found in Chapters 19, 20, and 21.

      

Set insulin dosing and sliding-scale insulin dosing aren’t ideal for type 1 diabetes but may suffice for some people with type 2 diabetes. Talk to your healthcare providers to determine a safe and effective insulin dosing plan for you.

       Managing weight with carb counting and portion precision

      Counting carbs and eating appropriate amounts at meals and snacks helps with weight control. When you adhere to budgeted amounts of carbs at mealtimes and snacks, you are automatically putting a cap on portion sizes for fruit, bread, grains, starches, cereals, milk, yogurt, sweets, and many other items. Controlling carb portions helps with blood-glucose control and weight management. Here are some pointers: