Diabetes Nutrition Therapy and Carbohydrate Counting

Carbohydrates are digested into glucose, so the amount and timing of carbohydrate eaten strongly influence the rise in blood glucose after a meal. Bread, rice, pasta, fruit, milk, sweets, juice, and many snack foods all contribute carbohydrate. A food does not need to taste sweet to raise blood glucose. Carbohydrate counting gives the patient and care team a practical way to predict that glucose rise. It is especially useful when a person uses mealtime insulin because the insulin dose can be matched to the grams of carbohydrate actually planned for the meal. The clinical goal is not to eliminate carbohydrate. Carbohydrate is a normal energy source. The goal is to distribute it in a pattern that fits the patient’s glucose trends, activity, medications, food access, cultural preferences, and ability to count accurately. A sudden large carbohydrate load can produce postprandial hyperglycemia when insulin is insufficient for that meal. The opposite mismatch is equally dangerous: giving insulin for carbohydrate that is not eaten can cause hypoglycemia.