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Get Healthy!

Counting Carbs

  • Chris Woolston, M.S.
  • Posted March 11, 2013

Most people who look at a baked potato see -- well, a baked potato. But if you have diabetes, you might see a statistic -- nearly 40 grams of carbohydrates -- or a category: a member of the "starch" group. The question is, should you eat it? That baked potato may be a healthy addition to your meal, or it could be the item that sends your blood sugar soaring. If you have a meal plan, you'll know what to do. If not, it's largely guesswork.

For people with diabetes, a healthy life starts with healthy eating. There's really no such thing as the ideal "diabetes diet," but a registered dietitian can help you set up a meal plan that matches your personal needs and tastes. No matter what your plan looks like, it's up to you to make it work.

Counting carbs

Just as people who are trying to lose weight often keep track of the fat in their foods, many people with diabetes become experts at counting carbohydrates. Carbohydrates are the main source of energy in food. They're also the main source of sugar in the blood. Whether the carbohydrates come from an orange, a slice of whole wheat bread, or a candy bar, the body turns them into sugar and dumps it into the blood stream. As registered dietitian and certified diabetes educator JoAnn Perreault puts it, "When it comes to blood sugar, all carbohydrates are created equal."

Perreault, who works at Waldo County General Hospital in Belfast, Maine, knows a thing or two about controlling diabetes through diet. In addition to her extensive training, she has to manage her own type 1 diabetes every day. In her opinion, carb-counting is an ideal strategy for many patients. She gives her patients a daily goal for carbohydrates, then teaches them how to reach that goal. "One carb" equals 15 grams of carbohydrates.

Your diabetes educator or health professional can help you determine how many grams of carbohydrates you need each day and what each meal should look like. The number can vary, based on your height, weight, how much you exercise, and what medications you take. Most meals contain three servings -- or roughly 45 grams -- of carbohydrates.

The most common sources of carbohydrates are fruit and fruit juices, grains (including bread, cereal, pasta, and rice), starchy vegetables, dairy products, and sweets. For example, a slice of bread, a half-cup of cooked pasta, a serving of fruit, and a cup of milk each contain about 15 grams of carbs (one "carb"). A slice of white cake with chocolate frosting may have about 45 grams of carbs.

A single meal for a diabetic can equal about three or four carbs, or 45 to 60 grams of carbohydrates. If you want to eat the cake, you have several choices: 1) Eat only half of the slice along with something healthier; 2) Eat the whole slice and forego eating anything else until the next meal, or 3) Take the healthiest route by avoiding it altogether and eating more fruits and vegetables.

Diabetics who take the time to count carbs are rewarded with flexibility in their diet. They can mix and match foods in many different ways to meet their daily goals. If they pass on that baked potato, for instance, they may be able to have a scoop of ice cream after dinner.

However, not all carbohydrates have identical effects. Make sure you're testing your blood sugar regularly to determine how different carbs affect you. Beans, for example, contain carbohydrates, but they also contain fiber and so are less likely to send your blood sugar soaring. Fortunately, you don't have to memorize the carb count of every food: Perreault and other diabetes educators urge patients to carry a pocket guide that lists common foods' carb content.

Contrary to common wisdom, sweets aren't completely off-limits for people with diabetes. As long as they don't go overboard on their carbohydrate levels, diabetics can enjoy the occasional dessert or chocolate bar. Moderation is the key, Perreault says. She herself happens to love Three Musketeers candy bars. Instead of eating an entire bar every day, she has a third of a bar every once in a while, leaving plenty of room in her diet for healthier, more substantial foods.

Following the pyramid

While you're watching your carbohydrates, you can't simply ignore the rest of your diet. While proteins, fats, fiber, and other nutrients don't have much effect on your blood sugar, they can have a huge impact on your overall health. For this reason, your dietitian will give you guidance on all types of food, not just carbs.

Your overall meal plan will most likely mirror the "Diabetes Food Pyramid" produced by the American Diabetes Association." (See The base of the pyramid is made up of "starches": grains (preferably whole grains), beans, and starchy vegetables such as corn and squash. The ADA recommends six or more servings of these healthy sources of carbohydrates every day, but many patients fall short, Perreault says. A fear of carbohydrates keeps them from getting the fuel they need, leaving them listless and rundown.

The next tier includes three to five servings of vegetables and two to four servings of fruit each day. Above that are two to three servings of milk or yogurt each day along with four to six ounces of high-protein foods such as fish, meat, cheese, and nuts. The top of the pyramid -- the foods that should be consumed most sparingly -- includes fats such as oil and butter, sweets, and alcohol.

Once you become familiar with the pyramid, you can choose from a wide variety of foods to meet your daily goals. Exchange lists, such as the one published by the American Diabetes Association and the American Dietetic Association, can help you mix and match foods at every level of the pyramid. For more information on exchange lists or to place an order, see

Eating shouldn't be a chore. With a little expert guidance and a solid game plan, you can enjoy your meals without a lot of effort or guilt. Most of all, you can enjoy the health that comes with good eating.


Interview with JoAnn Perreault, RD, CDE.

Joslin Diabetes Center. Carbohydrate counting: as easy as 1-2-3. 2003.

Cleveland Clinic Health System. The importance of counting carbohydrates in your diet.

American Diabetes Association. Using the diabetes food pyramid. No date given.

U.S. Food and Drug Administration. Diabetes information: Food and meal planning. May 2002.

American Diabetes Association. Using the Diabetes Food Pyramid.

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