Maybe you're wondering if you can ever have cake again. Here's the good news: there is no diabetes diet. You can still eat the occasional sweet treat -- as long as it's in moderation. Learning about carbs, how they affect your body, and how to count carbs at every meal can help you manage diabetes.
"Diet is a word that we don't recommend using," says Emily Loghmani, registered dietitian and certified diabetes educator at Johns Hopkins Diabetes Center in Baltimore. "The word diet seems to conjure up unpleasant ways of eating and restrictions that people do for a certain period of time. But diabetes is a chronic illness, so we try to teach people how to eat healthy and make food choices that they'll be able to sustain for the rest of their life."
Here are the facts about carbs and your body, along with tips for carb counting.
-> Diabetes and Carbohydrates
-> Everyone needs carbs -- they fuel the body and provide energy so that we can function.
-> Foods that contain carbohydrates include:
-> Bread, rice, cereal, crackers, pasta, and other starchy foods
-> Dairy products, including milk and yogurt
-> Fruit and fruit juice
-> Starchy vegetables such as corn and potatoes
-> Beans and legumes
-> Sugary foods and snack foods such as juice drinks, sodas, cookies, candy, cake, and chips
Your body converts carbs into glucose, or blood sugar. Insulin from the body moves glucose from the blood into cells for energy. But people with type 2 diabetes either don't use insulin effectively or don't produce enough insulin. And people with type 1 diabetes don't produce insulin to be used. So excess glucose can build up in the bloodstream and over time, can cause diabetes complications.
"The challenge when you have diabetes is that you need to find the right amount of carbohydrates that will work with your diabetes medications and your physical activity to keep your blood glucose at a safe level," says Amy Campbell, RD. "That's why we put so much emphasis on counting carbs -- to try to achieve that balance." Campbell is the manager of clinical education programs at Joslin Diabetes Center in Boston.
Counting carbs helps build consistency, Campbell says. "The more someone varies their carb intake, the more their blood sugars will vary." Because carbs will have the greatest effect on blood sugars compared to proteins or fats in a meal, your goal is to try to consume a similar amount of carbohydrates every meal.
Counting Carbs: Three Approaches
Campbell and Loghmani use three different levels of carb counting with their patients. You and your doctor will choose an approach based on the type of diabetes you have, what kind of medicines you take, and your weight goals.
The Plate Method
The basic level, Campbell says, is using the plate method. "You divide your plate so that half of your plate is vegetables, a quarter of your plate is a healthy carbohydrate, like brown rice, and then a quarter of your plate is a healthy protein food like fish, chicken, or lean meat," she says. This method can help people who have just been diagnosed become more aware of carbs and learn how to identify healthier portions.
Basic Carb Counting
"Once a person is comfortable with that, we move on to basic carb counting," Campbell says. Often a person will meet with a registered dietician or diabetes educator who recommends a specific number of carbohydrates based on that person's weight goals, activity level, and gender. Most women aim for about 45 grams of carbs per meal, and men tend to have 60 to 75 per meal. Snacks should contain about 15 to 30 grams of carbs.
You have a choice of either counting carbohydrate servings or counting carbohydrate grams, says Campbell. One serving of carbs equals 15 grams. And one serving is 1 slice of bread, or 1 small fruit. Counting grams is more accurate, but it can be easier to count servings. It's really up to the person, Campbell says.
Advanced Carb Counting
The advanced level of carb counting is for people with type 1 or type 2 who use insulin before a meal. You can adjust the amount of insulin you use before a meal, which will be based on the number of carbs you eat and your pre-meal blood sugar. For example, if you were going to eat a big pasta meal, you would take more insulin. "It offers a lot more flexibility," Campbell tells WebMD.
When counting carbs, you first have to identify which foods contain carbs, figure out the portion size, then determine the number of carbs in the portion, says Loghmani. Food labels provide exact carbohydrates grams, but you need to be careful to note the serving size on the label.
There are also many resources you can use to look up the number of carbs in foods, from books to web sites -- even smart phone apps. These resources can be very helpful for people just learning to count carbs.
All carbohydrates, Campbell says, eventually turn into blood glucose. "Of course some are healthier than others so we want to promote the healthy carbs," she says
Fiber is a particularly healthy carb. "We don't digest it, so fiber doesn't really impact blood glucose," Campbell says. So it's actually good to eat more fiber for that reason, plus it helps you feel full longer.
Carb Counting: Tips for Home and Away
Because it's easy to overestimate portion sizes, Loghmani and Campbell recommend using measuring cups and scales at home. "Keep your measuring cups on the counter, get a little food scale, and keep it in full sight so that you get in the habit of checking your portions of pasta or bread," Campbell says. "It's a really good way to keep portions in check."
Learning portion sizes at home can also help you judge portions more accurately when you eat at a restaurant or at a dinner party. Loghmani and Campbell offer these tips to help you count carbs more accurately.
-> When eating at home, use the same cup, bowl, glass, and plate. "That way if you always pour your milk to a certain point on the glass, or fill your bowl a certain amount, then you know that you're eating a consistent amount of food," Campbell says.
-> Create a spreadsheet or list of foods you typically eat at home and then look up the values. Then if you typically eat a certain brand of cereal, you'll always know how many carbs you're getting.
-> Look up software programs or web sites that can help you analyze your favorite recipes.
-> Pre-portion snack foods by measuring out single servings and putting them in baggies. This can help you control your portions, carbs, fat, and calories. But be watchful of snacks. "People get tripped up with snacking," Campbell says. "It's a really bad habit -- for anybody -- to keep grabbing crackers or something out of the box." It's all too easy to forget how many you’ve eaten.
-> When eating out, if you're not sure about portion sizes, try the “hand” method:
- A woman's fist = 1 cup
- Tip of the thumb = 1 teaspoon
- Whole thumb = 1 tablespoon
- Palm of the hand = 3 oz. serving
-> Before dining out, go online and check the menu so you can plan what to order.
-> Order simple meals when you go out. Avoid fancy mixed dishes with several ingredients and sauces. Campbell recommends getting a plain meal of chicken or lean steak and a vegetable. "That can make it easier to manage," she says.
-> Speak up and ask what's in a dish and how it was prepared, whether you’re at a restaurant or a friend's house.
-> For special dinners, such as during the holidays, eat the foods that are special to you and skip others you can get any time. For example, if you really love pumpkin pie, skip the mashed potatoes and bread and make dessert your carb portion of the meal. Just be sure to watch your portion sizes.
"I think the thing that I like people to know the most is that our body needs food -- we get over 40 different nutrients a day from food. And it's perfectly okay to continue to eat and enjoy food. It's just important also to learn how to balance the food, the medication, and the activity, so that you're meeting your goals for managing your diabetes," Loghmani says.