Diabetes Nutrition Therapy and Carbohydrate Counting

Carbohydrates are broken down into glucose during digestion. As glucose enters the bloodstream after eating, blood glucose rises; the amount of carbohydrate eaten is therefore a major driver of the post-meal glucose response. Carbohydrate counting makes that exposure measurable. Rather than calling a meal “healthy” or “unhealthy” and guessing its glucose effect, the patient identifies the grams of carbohydrate in the meal. That count can then guide meal planning or, for a person using rapid-acting meal-time insulin, the nutritional insulin dose. Foods that commonly contribute meaningful carbohydrate include breads, cereals, rice, pasta, potatoes, corn, legumes, fruit, milk, yogurt, desserts, sweetened beverages, and many snack foods. A drink can contain as much carbohydrate as a meal component and is easily missed. Meat, eggs, cheese, oils, and most non-starchy vegetables generally contribute little carbohydrate, although mixed dishes must be counted from their ingredients or recipe. Protein and fat may slow gastric emptying and delay the glucose rise after a mixed meal, but they do not erase the carbohydrate in that meal. A pizza meal, for example, can produce a later and more...