Managing Diabetes & Carb Counting

By: Rosanne Rust, MS, RDN, LDN —

Diabetes affects approximately 30.3 million Americans, or 9.4% of the population, according to 2015 data from the American Diabetes Association. Of that 30 million, approximately 1.25 million American children and adults have type 1 diabetes, and another one million have pre-diabetes. It’s estimated that 1 million Americans are diagnosed with diabetes every year.

November is recognized in the United States Diabetes Month. November 14th is recognized around the globe as World Diabetes Day. And these statistics most certainly deserve attention when considering both the prevention and treatment of Type 1 and Type 2 diabetes. Read on to learn more about diabetes, and how carb counting can be used as a tool.

Diabetes Terms at a Glance

Pre-Diabetes: Also called impaired glucose tolerance, pre-diabetes is diagnosed when blood glucose levels are higher than optimal but not high enough to be diabetes. People with pre-diabetes are at higher risk for developing type 2 diabetes, and for heart disease and stroke.

Type 1 Diabetes: Type 1 diabetes is usually, but not always, diagnosed in childhood. It is diagnosed when blood glucose and hemoglobin A1C (average blood sugar over the past 2 to 3 months) results are above normal range. In addition to high blood glucose levels in type 1 diabetes, there is also a lack of insulin produced in the body. Type 1 diabetes requires injecting insulin (using syringes, pens, or an insulin pump) and measuring blood sugar levels (using a glucometer or a wearable device called a Continuous Glucose Monitor (CGM)).

Type 2 Diabetes: Type 2 diabetes occurs when blood sugars are consistently high, due to either insulin resistance or poor insulin response in the body. Type 2 diabetes typically presented in middle aged or older adults, but we are now seeing it diagnosed more in younger people. It sometimes requires insulin, but often is managed with oral medication, diet and lifestyle interventions. Measuring blood sugar levels is also essential for managing Type 2 Diabetes, although it is typically done so less frequently compared to Type 1.

Risk Factors

Risk factors for Type 2 diabetes include family history, being overweight, having high blood pressure, age (being over 45), and metabolic syndrome (overweight, low HDL, high triglycerides). A strong family history of diabetes increases risk as well. The good news is that both types of diabetes can be treated and controlled with lifestyle choices and medication.

Education and Treatment

Certified Diabetes Educators (CDE) are trained to help people with diabetes lead healthy lives by creating a blood sugar management plan and helping them stay on track with it. Registered Nurses and Registered Dietitians often pursue this credential. CDEs have comprehensive knowledge about diabetes prevention, pre-diabetes, diabetes, and diabetes management.

Once diagnosed, it’s recommended that patients meet with a dietitian and CDE who will review the physiology of the disease and its potential complications. They will also educate the patient about lifestyle change, diet, and blood glucose monitoring.

How Many Carbs?

Carbohydrates (carbs) have been blamed for weight gain and diabetes over the past few years, creating confusion over this important nutrient. In many cases, some individuals are avoiding carbohydrates for no reason. Carbohydrates provide energy and many carbohydrate foods deliver important vitamins, minerals, and fiber. In addition – these foods add flavor, texture, and enjoyment to the diet.

How many carbohydrates do people need? This depends on multiple factors and should be prescribed by the CDE. A 140 pound woman requires fewer carbs than a 200 pound man. Carbohydrate needs are calculated based on total energy needs required to maintain a healthy body weight. Depending on the person, their medical and diet history, and their weight and activity level, the carbohydrate prescription may be 40-50% of total recommended calories. For someone requiring 1,800 calories, this would be about 200-225 grams a day. For someone needing 2,200 calories, carbohydrate limits would be 250-275 grams per day. Ideally, these carbs are spaced out through the day (at about 15-65 grams per snack or meal), and also planned to match activity and glucose tolerance.

Carbohydrate Counting

Carbohydrate counting (or carb counting) is a dietary strategy to help people with diabetes track their carbohydrate intake to keep blood sugar levels optimal. It involves tracking the grams of carbohydrates consumed through meals and snacks through the day. A registered dietitian (RDN) can determine how many carbohydrates are needed in the diet depending on calorie needs and activity levels. An RDN or CDE will also help patients plan the amounts needed at each meal or snack.

Carbohydrates are one of three macronutrients found in foods and beverages. The other two are protein and fat. Carbohydrates include sugars (simple carbs) and starches (complex carbs). Carbohydrates are found in many foods including breads, cereal, grains, pasta, fruit, vegetables, milk, yogurt, and of course sweets (candy, sugar-sweetened beverages, baked goods and desserts).  Foods such as whole grains, fresh fruits and vegetables are considered complex carbohydrates and contain more nutrients, but since carbohydrates increase blood sugar more rapidly than foods high in protein or and fat, it’s important for those with diabetes to keep track of all of them. Unless a patient is experiencing hypoglycemia, it is usually recommended that simple carbohydrates are avoided for the most part due to their higher glycemic effect.

Managing the amount of carbohydrates consumed at every meal results in better blood sugar management. Many types of foods containing carbohydrate can be included in the meal plan (such as special occasion foods). A unit (or carb-counting serving size) of carbohydrate is generally considered to be 15 grams, and a meal plan may limit carbs to 30-45 grams per meal, or 15-30 grams per snack.

How do Sweeteners Fit?

People with diabetes can still enjoy some foods containing sugar, but they have to be carefully planned into the diet. Overall, high sugar foods and beverages should be strictly limited (this is especially true with sugary drinks, since liquid sugar raises blood sugar levels rapidly). Low- and no-calorie sweeteners (LNCS) can help add sweetness to the diet without the unwanted glycemic effects of caloric sweeteners. For instance, aspartame has no effect on blood sugar, nor on body weight.

Substituting non-caloric sweeteners for caloric ones can also make the diet plan more enjoyable. These include diet soda in place of regular, lemonade or other drinks sweetened with aspartame or another LNCS, light yogurt, sugar free frozen treats, or sugar free pudding. LNCS can also be used to sweeten tea or coffee.

Since LNCS don’t add to the total carbohydrate content of the food or beverage, they can be a very helpful tool for people with diabetes. A newly diagnosed patient who previously enjoyed drinking regular soda or sweet tea will be delighted to hear they can substitute a diet soda that can be integrated into blood sugar management programs.

Summary

Carbohydrate management is a key component of blood glucose management, and, therefore, it’s important that all carbohydrates are accounted for in a patient’s meal plan. Be sure to refer newly diagnosed patients to a registered dietitian and CDE so your patient will have a blood sugar and meal plan management strategy.  In addition, continue to encourage patients to touch base with their educator whenever they are struggling with their blood sugar levels. Keep in mind, achieving a desirable weight and including daily physical activity also play key roles in diabetes management. The more enjoyable and feasible a diet plan is, the more likely your patients will be able to adopt and adhere to it.

Rosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years experience. Rosanne is a paid contributor for the Calorie Control Council. As a Nutrition Communications Consultant  she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.

Low and No Calorie Sweeteners in Diabetes Management

Neva Cochran, MS, RDN, LD –

November is a time to focus attention on diabetes, its prevention and treatment. About 30.3 million people or 9.4% of the U.S. population are living with diabetes while an estimated 84.1 million Americans 18 years or older have prediabetes.

Diet is an essential component of diabetes management. According to the position paper of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes, “medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes.” (1)

While most individuals with diabetes have a moderate intake of about 45% of calories as carbohydrate, research on the ideal amount of carbohydrate for those with diabetes is still inconclusive. Monitoring carbohydrate intake and blood glucose is essential for maintaining glucose control. (2) Ideally, eating fewer foods with refined carbohydrates and added sugars and more carbohydrates from vegetables, fruits, dairy and whole grains is preferred.

What the Science Says

The American Diabetes Association supports the use of LNCS, stating “they may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels.” (2)

An international scientific panel of health experts met in Lisbon, Portugal in July 2017 to develop a consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. By analyzing the evidence related to the role of LNCS, their goal was to develop a useful, evidence-based reference to help reduce sugar consumption consistent with current international public health recommendations. They concluded that replacing caloric sweeteners with LNCS in weight loss plans might aid in weight loss. In addition, their use in diabetes management may contribute to better glycemic although results have been modest. The panel proposed that foods and beverages with LNCS could be included in dietary guidelines as alternatives to products sweetened with free sugars. (3)

In a 2013 scientific review of the role of LNCS in diabetes, the authors noted that research finds LNCS play an important role in diabetes prevention and management. Because added sugars are a source of increased carbohydrate intake, using LNCS is a safe and easy way to reduce carbohydrate consumption for those with type 2 diabetes so they can better manage blood glucose levels and lose weight. Substituting sugars with LCNS allows more flexibility in accommodating their health goals and personal dietary preferences. (4)

What a RD, CDE Recommends

In a recent article (5) by registered dietitian and certified diabetes educator, Kathy Warwick, she outlines the nutritional management of diabetes throughout the lifecycle. According to Warwick, there are a number of eating patterns that are acceptable for the management of type 2 diabetes. Nutrition therapy for adults involves meal planning that takes carbohydrates, fats, and protein into consideration. The amount of carbohydrate in meals can vary from 39% to 57% of energy without negatively affecting glucose control. As far as LNCS use, she suggests that FDA-approved nonnutritive sweeteners may be helpful for weight reduction and are safe to use within the acceptable daily intake range.

What Diabetes Organizations Advise

Leading diabetes centers and organizations all support the inclusion of LNCS as part of a healthful eating plan for diabetes management.

Sugar substitutes can be very useful to people with diabetes according to Gillian Arathuzik, RD, CDE with the Joslin Diabetes Center. In an article on the Joslin website, she recommends using either aspartame or sucralose in moderation depending on a person’s taste preference. (6)

Likewise, the American Diabetes Association confirms the safety and usefulness of LNCS for people with diabetes on their website. They support use of foods and drinks with LNCS as another option that may help curb cravings for something sweet. (7)

Finally, the American Association of Diabetes Educators has two LNCS tip sheets available on their website, one with frequently asked questions (8) and the other featuring a chart listing the amount of sweetener packets and cans of diet soda that can be consumed without exceeding the Acceptable Daily Intake. (9)

In summary, scientists, dietitians and noted diabetes organizations all support the use of low and no calorie sweeteners in moderation as part of a nutrient-rich eating plan for those living with diabetes. As health professionals it is reassuring to have options to recommend to clients to increase eating enjoyment and manage diabetes.

References:

  1. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes” J Acad Nutr Diet 118:343, 2018
  2. Lifestyle Management: Standards of Medical Care in Diabetes – 2018” Diabetes Care 41(Suppl. 1):S38, 2018
  3. Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages” Nutrients 10 818, 2018
  4. The Role of Low-calorie Sweeteners in Diabetes” US Endocrinology 9:13, 2013
  5. Diabetes Management & Nutrition Guide: Diabetes Nutrition Throughout the Lifecycle” Today’s Dietitian 20:33, 2018
  6. The ABC’s of Sugar Substitutes” Joslin Diabetes Center website accessed 10-18-18
  7. Low-Calorie Sweeteners” American Diabetes Association website accessed 10-18-18
  8. Translation of Research to Help Answer Patient Questions About Sweeteners” American Association of Diabetes Educators website accessed 10-18-18
  9. Acceptable Daily Intake (ADI) in Packs of Sweetener Compared to Cans of Diet Soda” American Association of Diabetes Educators website accessed 10-18-18

Neva Cochran, MS, RDN, LD is a registered dietitian nutritionist based in Dallas. She serves as a nutrition communications consultant to a variety of food and nutrition organizations, including the Calorie Control Council. She is passionate about promoting fact-based food and nutrition information to help people enjoy nutritious eating. Follow her on Twitter @NevaRDLD and check out her blog at www.NevaCochranRD.com.

What Steps Can I Take to Prevent or Manage Diabetes Through Diet?

Blood glucose is primarily impacted by the carbohydrates in the foods and beverages consumed. Here are some steps to help prevent and manage diabetes through the diet.

  • As a first step, understand what carbohydrates are and where they are most commonly found.
  • Next, learn how to count carbohydrates. This entails counting the number of grams of carbohydrates in a meal and matching that to your dose of insulin.
  • More broadly, understand how to make sense of Nutrition Facts labels and make informed dietary decisions.
  • Strategize and execute your eating plans. This could mean looking up recipes with nutrition information needed to count carbohydrates, meal planning to help time your meals to keep blood sugars balanced, or seeking out smart substitutions to prevent blood glucose spikes, such as replacing sweetened foods and beverages with low- and no-sugar alternatives.
  • The inclusion of naturally high fiber or fiber-enriched foods in your diet could aid in the management of blood glucose levels, as they have been shown to slow the absorption of carbohydrates. As a result, the rise in post-meal glucose and insulin levels are minimized.
  • Take advantage of online tools such as CCC’s Food Calorie Calculator, which allows users to choose from thousands of foods and brands, and see nutrition facts including calories and carbohydrates.
  • Understand that there are more options than ever before for foods and beverages often labeled as “lite”, “reduced-calorie”, “reduced-sugar”, or “diet” that can help you minimize spikes in blood glucose levels. Those products are typically sweetened with low- or no-calorie sweeteners (LNCS). Learn more about utilize LNCS to manage diabetes here.

What Steps Can I Take to Prevent or Manage Diabetes Through Diet?

Blood glucose is primarily impacted by the carbohydrates in the foods and beverages consumed. Here are some steps to help prevent and manage diabetes through the diet.

  • As a first step, understand what carbohydrates are and where they are most commonly found.
  • Next, learn how to count carbohydrates. This entails counting the number of grams of carbohydrates in a meal and matching that to your dose of insulin.
  • More broadly, understand how to make sense of Nutrition Facts labels and make informed dietary decisions.
  • Strategize and execute your eating plans. This could mean looking up recipes with nutrition information needed to count carbohydrates, meal planning to help time your meals to keep blood sugars balanced, or seeking out smart substitutions to prevent blood glucose spikes, such as replacing sweetened foods and beverages with low- and no-sugar alternatives.
  • The inclusion of naturally high fiber or fiber-enriched foods in your diet could aid in the management of blood glucose levels, as they have been shown to slow the absorption of carbohydrates. As a result, the rise in post-meal glucose and insulin levels are minimized.
  • Take advantage of online tools such as CCC’s Food Calorie Calculator, which allows users to choose from thousands of foods and brands, and see nutrition facts including calories and carbohydrates.
  • Understand that there are more options than ever before for foods and beverages often labeled as “lite”, “reduced-calorie”, “reduced-sugar”, or “diet” that can help you minimize spikes in blood glucose levels. Those products are typically sweetened with low- or no-calorie sweeteners (LNCS). Learn more about utilize LNCS to manage diabetes here.