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"Basic Carbohydrate Counting"
Written by Kher Pui Ling, Dietitian, National Kidney Foundation of Malaysia


Carbohydrate provides the energy our bodies need. During digestion, our bodies break down the carbohydrate into glucose (commonly known as ‘sugar’); then with the help of insulin, the glucose is supplied to our body cells and becomes energy.

It is essential for diabetics (one in every two kidney failure patients is a diabetic!) to note that their insulin production is impaired as compared to healthy individuals. Excessive carbohydrate consumption causes the sugar to build-up in the blood stream which directly leads to high blood glucose level that might jeopardize the patient’s life! Thus, it is crucial for diabetics to count the amount of carbohydrate which can be consumed in order to control their blood glucose level.

‘Carbohydrate counting’ is a basic technique taught to diabetics and individuals with glucose intolerance for better blood glucose management. This is a meal planning approach that highlights the total amount of carbohydrate consumed throughout the day, and the frequency of the carbohydrate intake at specific intervals or meals. Hence, diabetics and individuals with glucose intolerance should plan their meals wisely – they should know what food to eat and how many carbohydrate servings they can eat, in order to keep their blood glucose level within the controlled range.

Carbohydrate Foods

Carbohydrate is the sugar, starches and fibers found in foods. Plants are the primary sources of carbohydrates - with the exception of milk; which contains sugar known as ‘lactose’. The common carbohydrate foods include:
• Rice, noodles and pasta
• Breads, biscuits and cereals
• Starchy vegetables; such as yam, pumpkin, potato and tapioca
• Legumes; such as beans, peas and lentils
• Milk and dairy products; such as cheese and yoghurt
• Fruits
• Sweets and desserts; such as candies, cakes, chocolates and ice cream

Carbohydrate Serving Size

Carbohydrates are measured in grams (g). For diabetic meal planning, one carbohydrate serving is equivalent to 15 g of carbohydrates. Weighing or measuring the foods using household measure is a key component to help the patients understand how a serving of carbohydrate food looks like. Household measuring tools that can be helpful to patients are such as food scales, measuring cups, spoons, bowls and scoops.

Table below is the food list for carbohydrate counting:



Non-starch vegetables such as green leafy vegetables:- 1 cup of raw vegetables or ½ cup cooked vegetables is counted as zero carbohydrate servings or “free” foods. When three or more servings are consumed at one meal, it is counted as one carbohydrate serving.

Carbohydrate Counting Meal Plan

An appropriate mean plan enables patients to know how many carbohydrate servings they can consume during meals and snacks. For adults, consuming three to four servings of carbohydrate foods (45 to 60 grams of carbs) at each main meals; and one to two carbohydrate servings (15 to 30 grams of carbs) for snacks usually works well. Some of the patients may need more or less carbohydrate during meal times depending on their lifestyle, diabetes medications they are taking as well as their blood glucose profile. Patients can always refer to their dietician or diabetes educator for the right amount of carbohydrates they can consume so they can select the right portion size of carbohydrate foods.

Carbohydrate Counting using Food Labels/Nutrition Facts Panel

There are two steps for reading food labels and calculating the carbohydrates amount:
  1. Look for the standard serving size of the food. It is usually located at the top of the label.
  2. Check the total carbohydrate amount in one standard serving. It is usually located towards the middle of the food labels. The total grams of sugar on the food label can be neglected because it is already included in the grams of the total carbohydrate amount.
  3. Divide the grams of total carbohydrate amounts by 15 (1 serving carbs = 15 grams); the answer yields the number of carbohydrate servings in one standard serving. The table shown below is the guideline in estimating carbohydrate servings when reading food label:


Example

The label shown here indicates total carbohydrate = 31g

One portion of carbohydrate = 15g carbohydrate

Thus, dividing 31g with 15g of carbohydrates; 31÷15 = 2

In conclusion: 1 cup (228g) of the food above provides you with 2 servings of carbohydrate.
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