Furthermore, tools and aids can only do so much. They are not a method. Just because you have a hammer and saw doesn’t mean you can build a house. To move forward you need a clear and cohesive blueprint. To build a strong carb counting program, think of this book as your blueprint. Within these pages, the internationally known authors provide a simple, easy-to-follow carb counting plan that can be tailored to any diabetes management regimen. They teach you how carbohydrate affects your blood glucose, how to use the tools available to you, why different sources of carbohydrate act differently in your body, and much more. They provide tips and tricks to make the process easier. And they present all of this information in a clear, easy-to-understand format that makes the process of learning as simple as possible.
Those who are new to carb counting often find that they have a lot of questions. However, all of these can be distilled down to two basic questions that form the foundation for the rest: Why should I count carbohydrates? And how do I count carbohydrates? The answers to both can be found in this book, which should be read by every physician, educator, and individual with diabetes. I teach our students that we never stop learning, no matter how much we think we know about a topic. It is for this reason that this most recent edition of Complete Guide to Carb Counting needs to be a part of every diabetes library, no matter if you are a health care professional or a person living with diabetes or both.
Irl B. Hirsch, MD
January 2011
Seattle, WA
Acknowledgments
We thank a number of colleagues who have provided valuable critiques on the three editions of Complete Guide to Carb Counting. These individuals include Sandy Gillespie, MMSc, RD, CDE; David Shade, MD; Anne Daly, MS, RD, CDE; Patti Geil, MS, RD, FADA, CDE; Joan Hill, RD, CDE, LD; Lea Ann Holzmeister, RD, CDE; and John White, PA, PharmD. We are also grateful to Irl Hirsch, MD, for writing the Foreword for the second and third editions of this book.
Thanks to the staff at ADA—Abe Ogden, Greg Guthrie, Jennifer Arnold, and Heschel Falek—who helped edit and prepare the manuscript for publication and developed marketing and publicity to ensure the success of this book.
I would also like to thank my family: Rajiv, my husband, and my daughter Anjali. Thanks go out to all of the people with diabetes with whom I have had the privilege to work, who taught me so much.
—Karmeen Kulkarni
Chapter 1:
What Is Carb Counting?
In This Chapter, You’ll Learn:
• Basic facts about carbohydrate
• Which foods contain carbohydrate
• How carbohydrate affects blood glucose
• About the meal planning approach called carbohydrate counting
Would you like to have a better sense of when your blood glucose is going to rise and be able to predict how high it might go today, tomorrow, or the next day? If your answer is YES, then carbohydrate counting—“carb counting” for short—might be an approach to planning your meals that works for you.
Carb counting is not a one-size-fits-all meal planning method. It is simply a method to help you plan and eat balanced meals and control your blood glucose level along with the other elements of your diabetes care plan, such as medications and exercise.
Why Count Carbs?
Foods contain varying amounts of carbohydrate, protein, fat, vitamins, minerals, and water. When you use carb counting, you focus on the carbohydrate in foods. Why is that? Because carbohydrate raises your blood glucose more—and more quickly—than the two other nutrients that provide calories—protein and fat (excluding alcohol).
Adding up the amount of carbohydrate in each meal and snack that you eat each day can help you keep your blood glucose at a steady level, adjust your insulin as needed (if you take it), and feel your best.
Variety: The Spice of Life
Carb counting also allows you to enjoy a wide variety of foods, as long as you eat about the same amount of carbohydrate at each meal and snack each day. The foods don’t need to remain the same, but the amount of carbohydrate should. When you eat about the same amount of carbohydrate at each meal, day in and day out, your blood glucose levels are more likely to fall into a steady pattern. That means better blood glucose control for you.
Carb Counting May Not Be Right for Everyone
As you learn more about carb counting in the pages ahead, ask yourself whether you think this approach will fit your needs and lifestyle. In Chapter 2 you’ll do a self-assessment to determine whether carb counting is right for you. There’s another self-assessment in Chapter 11 to help you determine whether you want or need to progress from basic to advanced carb counting. We’ll explain more as we go along—for now, it’s time to learn which foods contain carbohydrate.
Which Foods Contain Carbohydrate?
Most people tend to equate carbohydrate with starches. Starches, such as potatoes, breads, and pasta, do contain carbohydrate, but they’re not the only foods under the “carbohydrate umbrella.” Here is a complete list of the food groups whose calories come mainly from carbohydrate:
• Starches—bread, cereal, crackers, rice, and pasta
• Starchy vegetables—peas, beans, lentils, potatoes, and corn
• Fruit and fruit juice
• Nonstarchy vegetables—tomatoes, cauliflower, and carrots
• Dairy foods—milk, yogurt, and other dairy foods
• Sugary drinks—regular soda, fruit punch, sports drinks, and flavored waters
• Sweets—candy, cakes, cookies, and pies
After reading this list, you might wonder which foods do not contain carbohydrate. There are a few:
• meats (red meat, poultry, seafood, and eggs)
• fats (oil, butter, and nuts)
Although these foods that don’t contain carbohydrate won’t be part of your daily carb counting totals, you still need to pay attention to them. They contain calories and other nutrients that are also important to a healthy eating plan. You will learn more about protein and fats and how they affect eating plans in Chapter 4.
How Much Carbohydrate Is in These Foods?
The list of foods above includes general groups of foods that contain carbohydrate. But within each food group, there can be a wide range in the actual amount of carbohydrate in each food. For example, the amount of carbohydrate in dairy foods varies quite a bit. On average, 8 ounces of most cheeses contains about 8 grams of carbohydrate, whereas 8 ounces of milk contains 12 grams of carbohydrate.
You can see more examples of this in Table 1-1, and in Appendix 1 at the back of the book. As you learn more, and start using carb counting in your meal planning, you’ll rely on resources like these to help you determine the carb count in everything from apples to zucchini. For now, focus on the some common, simple foods and how they affect your blood glucose.
How Does Carb Counting Help with Blood Glucose Control?
Your blood glucose levels are related to the amount of carbohydrate you eat. If you regularly track the amount of carbohydrate you eat at a meal and check your blood glucose levels one to two