Diabetes and Carb Counting For Dummies. Shafer Sherri

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.

THE EFFECTS OF CARB COUNTING WITH TYPE 1 DIABETES

      Coral took one unit of rapid-acting insulin for every 15 grams of carbohydrate. She hadn’t been completely satisfied with the results. Sometimes her blood-glucose levels were higher or lower than expected. Upon close inspection we identified several issues:

      • 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.

      After our visit she went home, implemented the tips, and returned for follow-up three months later. Her blood-glucose levels had improved and were more predictable, so she felt safer and more confident. We explored how to further hone accuracy with a food scale, and we identified apps and online resources to count the carbs in mixed dishes and ethnic foods.

       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:

      ❯❯ Use the Exchange Lists in Appendix A to choose lean proteins and limit mealtime protein portions to the size of the palm of your hand.

      ❯❯ Choose lower-fat cooking methods and limit added fats.

      ❯❯ Eat plenty of vegetables and salads.

      

The benefits are cumulative. Controlling portions helps with weight loss; losing weight improves insulin action; better-working insulin improves blood-glucose control; and controlling diabetes and weight lowers your risk of heart disease! For more tips on eating smart for your weight and heart, see Chapter 16.

EXPLORING THE GLYCEMIC INDEX

      The glycemic index (GI) is a tool to measure how individual foods are expected to impact blood-glucose levels. The basic concept may be used in addition to carb counting and other carb management strategies. It’s true that not all carb foods affect blood glucose in the same manner, which is why pizza isn’t used to treat hypoglycemia. Liquids move through the stomach quickly, so the sugars in juice and soda show up in the bloodstream in a matter of minutes. That’s just what you need if you’re trying to treat hypoglycemia. Juice isn’t what you need if blood-glucose levels are already running high.

      Instead of deferring to a chart to choose from low, medium, or high GI foods, it pays to get to the bottom of why foods behave the way they do (check out Chapter 10). With a solid grasp of the concepts, you can make food choices work in your favor. For example, whole grains and legumes have fiber and a lower glycemic index than white refined grains and breads. Meals that contain fiber and balanced amounts of carbohydrate, protein, and fat produce a blunter blood-glucose rise and more stability in blood-glucose levels.

Regulating Carb Intakes

      The human body relies on glucose to fuel many functions. The biggest user of this essential fuel is the brain. The minimum recommended intake for carbohydrate is 130 grams of carb per day, whether you are 1, 10, or 100 years old. Who says and why? The National Institutes of Health establish nutrient intake guidelines. The guidelines on carbohydrate intake assure adequacy for vital functions and baseline needs. Actual intake should be assessed individually, as discussed in the following sections.

       Figuring out how much carb you need

      Glucose is an important fuel for the human body. You can’t live without it. The brain requires a steady supply of glucose around the clock and lifelong. Glucose is the preferred fuel source for muscles and other tissues. Foods supply glucose and other nutrients.

      

Carbohydrate requirements depend on age, gender, height, weight, and level of physical activity. Use Chapter 5 to assess your body