The questions revolve around what are carbohydrates, can a diabetic eat them, and why do we have carbohydrate exchanges as part of our nutritional data with our recipes. I’d like to say this is the definitive article on the subject, but we know with the controversies out there about diets that we have to revisit this area again and again.
As a person who uses a pump, I have to count my carbohydrates, so I know how much insulin to give myself before I eat a meal. If you read the article on nutritional guidelines, you know the way we classify food has changed.
We know that carbohydrate exchanges now include starches, milk products except cheeses, and fruits and vegetables. We also know that by counting carbohydrates we can eat a larger range of foods, but we need to know how many grams we are eating. The guidelines include the following:
- Eat a variety of healthy, nutritional foods.
- Reduce the amount of fat and protein to reasonable amounts. Make sure you understand about fats.
- Balance carbohydrates with exercise and medication.
Carbohydrates affect blood glucose levels as we all know. Without carbohydrates, we would have little energy, as they are the main provider of that. High fat intake contributes to obesity, heart disease and high blood glucose levels over the long haul. It has less effect in the short run.
If you take insulin, 1/2 of the insulin you take each day will cover the carbohydrates you eat, while the rest will cover you with a basal rate. Carbohydrate counting specifically measures the upward drive of blood glucose after you eat your meals each day. It allows the food you eat to be balanced with the exercise you do and the medication you take.
If you are like me, you count the grams of carbohydrates you are going to eat and then give yourself insulin to cover that meal. Healthy diets contain about 50% and even for some up to 60% of calories from carbohydrates. You can find these calories in:
- grains, breads, pasta and cereals (try to use whole grain because of fiber content)
- Root crops like potatoes, sweet potatoes, etc.
- Desserts and candies
- Wine, beer, and some hard liquors
- Most milk products, except cheese
- Nutrients that end in -ose like sucrose, fructose, maltose etc.
Now comes the part that takes a leap of faith and that is that exchanges are just weight of food. If you look at the back of any of our books you’ll see what we mean. For example each exchange of fruit contains 60 calories, 0 grams of protein, 0 g of fat and 15 g of carbohydrate.
If you read the lists after this you’ll find just how much of each fruit is in an exchange. You can do the same for each type of food. Why do we use grams? They are very small. It takes 28 grams to make one ounce so we can be very accurate when we measure.
If you take use an insulin pump or multiple injections per day you may be able to use the rule of 500 to estimate how many grams of carbohydrates you need to eat a day. For instance, the number of grams of carbohydrates covered by 1 unit of Humalog insulin equals 500 divided by the total daily insulin dose (TDD= an average of all long acting and short acting insulin used per day, or all basals and boluses typically used per day).
For those using multiple daily injections or an insulin pump, this rule provides a good guide for how much insulin is needed to cover meal carbohydrates. This rule cannot be used by those who are not using multiple daily injections or a pump because carbohydrates are not covered in each meal with Humalog or Novolog.
The accuracy of the 500 rule will be reduced because some long acting insulin taken each day is used to cover the carbohydrate in meals. The 500/450 rules give us the following information. If your total insulin dose is 25, the grams of carbohydrates covered by 1 unit of Humalog are 20 and the grams of carbohydrate covered by 1 unit of Regular are 18. You can find this chart in Pocket Pancreas, copyright 1994, Diabetes Services, Inc.
These rules let you match your meal carbohydrates with insulin for better post-meal reading. However, carbohydrates are also needed to raise a low blood sugar. For this there are two helpful guides:
One gram of carbohydrate raises the blood sugar about 3, 4, or 5 points in persons weighing 200lbs, 150 lbs and 100 lbs respectively.
The glycemic index, protein content and fat content of food can modify the speed and strength of guide rule 1. For example, say you weigh 150 pounds and your blood glucose is 60 mg/dl. If you want to raise you blood glucose level to 100 mg/dl you’ll need 40 points/ 4 points per gram, or 10 grams of carbohydrate. You can take 2 glucose tables, which have 10 grams of carbohydrate per tablet and wind up in the ball park.
Let’s say you eat 15 grams of fast acting carbohydrate to correct a low blood sugar by eating a fast carbohydrate glucose tablet (glycemic index+ 100). You will get relief in 10-25 minutes.
If you eat a slow carbohydrate like beans (glycemic index =33) relief will be apparent in 2-3 hours, assuming that your blood glucose level dose not continue to fall over that time frame. Obviously using a fast acting carbohydrate is better to raise a low blood glucose level than a slow one, which is why glucose tablets sit by our beds with a meter as well as in our kitchens.
We’ve given you the formula for deciding how many grams of carbohydrates you need per day, but by popular demand we are providing it again.
There are a few steps, so here you go:
- Figure out what you want to weigh in pounds.
- If you are overweight, a 10% loss from your current weight is a good number.
- You can also base this number on your ideal weight.
Ask your medical team to figure this one out as it is based on your height, your goal weight, and frame size. An honest reporting will take just a few minutes for them to figure out, as they do it routinely.
Choose a calorie factor that describes your activity level:
Determine your total daily calorie need:
Desired weight in pounds X calorie factor (from above) = calories per day
Then divide by 8 (1/2 calories as carbohydrate and 1/4 g per calorie)
to determine how many grams of carbohydrates you need each day.
Cal/day/8= grams of carb/day
If you want to lose weight subtract 500 calories from your daily needs. To gain weight add 500 calories per day
Now it’s up to you to divide or split up how you eat those carbohydrates during the day at breakfast, snacks, lunch and dinner.
How do you count carbohydrates?
Some foods like sugar are entirely carbohydrate. Most are partially carbohydrate, so the easiest way to figure them out is to read labels. Just make sure your serving size is the same as the one on the label. Purchase a book that lists carbohydrates in many foods, or look at the carbohydrate exchanges and size of serving in our recipes on the web or in our cookbooks. You can also purchase a gram scale and weigh foods.
Find the carbohydrate factor in that carbo-counting book we just spoke of, and then multiply. After a while, it begins to come naturally and you can guess about how many carbs in a serving that someone serves you.
The easiest way is to look at the carbohydrate exchange in the nutritional data after one of our recipes. For example there are 4 carbohydrate exchanges or choices in our Millet Cakes with Sun-dried Tomatoes with Cheese over Greens in our Joslin Healthy Carbohydrate Cookbook.
If you look below you will see that there are 65 g. of carbohydrate and 4 g fiber among other nutritional data. If each exchange is 15 grams you have 4 exchanges as you have to subtract the fiber grams from the carbohydrates
You can find the carb factor in books. For example, the carb factor of bread is 0.50. You weigh a piece of bread and it weighs 80 g. Multiply by 0.50 and you are eating 40 g of carbohydrates, or rely on a really good cookbook like ours to tell you exactly how much you are eating so you can know how much your blood glucose will rise.
So how does it all work? First I know how many carbs I eat per meal. Then I just count and give myself the proper amount of insulin. I know that each exchange of carbs is 15 grams and I match that with units of insulin that works for me. I also know how big each exchange is so even if I’m away from home, I make good guesses.
For example, if you eat 1,500 calories per day you might decide to have 45 g. at breakfast, 25g for a snack, 45 g at lunch, another 35g for afternoon snack, 45 g at dinner and finally 25g for a night time snack.
We’re hoping that understanding carbohydrates will help you learn to vary your diet and include many healthy foods. There is no need to eat uninteresting food and deny you of favorites of the past. Just scan through all of our books and recipes on our web site.
Speak to your doctor and figure out the amount of each food group you can eat and then experiment with recipes. It’s easy to stick with your diet if you feel like a part of the family and you have not had to give up all of your favorite foods. The new guidelines and carbohydrate counting allow you foods that have been forbidden for years.