The Basics of Carbohydrate Counting and Exchanges
We all eat to live (and, indeed, live to eat), but for someone with diabetes, that adage isn’t just academic. It’s a matter of staying well and living longer. Because diabetes is a disorder in how your body processes foods, every choice you make to eat or drink is important. The benefits of eating well are powerful, helping to keep your blood glucose, blood fats and blood-pressure levels under control and helping prevent complications of diabetes. Most of all, eating right helps you feel in control.
But that doesn’t mean eating has to be like taking medicine. Eating is one of life’s most fundamental pleasures, and it’s part of our social fabric. Food plays a central role in family celebrations, holidays and business deals; special foods are part of the traditions that define us. Food shouldn’t lose all that importance just because you have diabetes.
For the most part, eating to manage diabetes means eating with your eyes open—knowing what’s going into your body and when. That means planning for, and keeping track of, your meals.
Ideally, you’ll work with a dietitian or diabetes educator to determine an eating plan that works with your schedule and your needs. You’ll likely use one of two methods: Carbohydrate Counting or the Exchange System.
The Exchange System
Used in diabetes management for over 50 years, this method groups together foods that have roughly the same amounts of calories, carbohydrate, fat and protein into “Exchange” groups, so that one may be exchanged for another. One exchange in the “Starch” group, for instance, could be a 6-inch corn tortilla or 1/2 cup of green peas or 1/3 cup of pasta; an exchange in the “Lean Meats” group could be an ounce of tuna or lean pork. If you’re following the Exchange System, you’ll work with a dietitian to plan out your daily meal pattern: which exchanges to include in each meal and how many.
For most people with diabetes, Carbohydrate Counting is a more flexible and simple alternative to the Exchange System. It centers on keeping a count of the carbohydrate you take in at each meal, aiming to stay within a predetermined daily range. Carbohydrate is measured in terms of Carbohydrate Servings (see below), or in grams.
No matter which system you use to plan and track your eating, you’ll be staying on top of the amount of carbohydrate you consume, trying to keep it consistent throughout the day, and from one day to the next. That’s because of all the nutrients we eat—protein, carbohydrate and fat—carbohydrate affects blood-glucose levels the most.
But that doesn’t mean you must avoid carbohydrate altogether. That’s nearly impossible—and dangerous. Even with diabetes, some carbohydrate is vital to maintain a steady supply of glucose to cells in the body, particularly to the brain, for fuel. The brain needs about 130 grams of glucose from carbohydrate each day (about 9 Carbohydrate Servings) to function well. And carbohydrate-containing foods are important sources of vitamins, minerals and fiber. Today’s nutrition guidelines recognize that people with diabetes need a wide variety of foods to stay healthy, and most recommend that people get about half their daily calories from carbohydrate.
There are two different forms of carbohydrate—sugars and starches—but both are made up of the same building blocks: sugar molecules. What we call “sugars” are simply short chains of sugar molecules, while “starches” are longer chains of sugar molecules. When you eat a carbohydrate-containing food, no matter where it comes from, the process of digestion breaks down those sugar molecules into glucose—the form your body can use.
Carbohydrate is found chiefly in plant-based foods, such as grains, fruits and vegetables, and in sweets, as well as in dairy foods like milk and yogurt. These are the kinds of foods you’ll be monitoring closely if you are Carbohydrate Counting.
Basics of Carbohydrate Counting
The goal of Carbohydrate Counting is to make sure you’re eating a fairly consistent amount of carbohydrate each day, in a similar pattern. You can do this in either of the following ways:
Count Carbohydrate Grams. You aim for a specific amount of carbohydrate grams at each meal—say, 30 grams at breakfast, 45 grams at lunch and 60 grams at dinner. You track your carbohydrate through the day by keeping a running total.
Count Carbohydrate Servings. You track carbohydrate by thinking of it in terms of portions of foods. One Carbohydrate Serving, sometimes called a “Carbohydrate Choice,” is a portion of food that contains 15 grams of carbohydrate—about the amount in a small potato, a slice of bread or a medium apple. You aim for a predetermined amount of Carbohydrate Servings at each meal, typically, 3 to 5 Carbohydrate Servings at main meals and 1 to 2 Carbohydrate Servings for snacks. For most people, the daily total number of Carbohydrate Servings will be about 12 (for a 1,500 calorie/day plan) or 16 (for a 2,000 calorie/day plan).
With either system, you’ll need to know the carbohydrate content of a food first. Your diabetes specialist can provide you with food lists to get you started. As you become more familiar with standard portions, you’ll be able to estimate the carbohydrate of more complex foods, like pizza. Recipes with nutrition information, like those in this book, are a good source of carbohydrate amounts. On packaged foods, such information is on the nutrition label: First, check the food’s “Serving Size,” then look for the “Total Carbohydrate” value in grams. The “Dietary Fiber” listing is also important. The higher the better, as explained with the Carbohydrate-Servings Calculator