Carbohydrate Counting & Making the Exchange
Some people with diabetes use carbohydrate counting to balance their food and insulin. Carbohydrates, or "carbs," are what our bodies use for fuel. The more carbs you eat, the higher your blood glucose goes. And the higher your blood glucose, the more insulin you need to move the sugar into your cells.
People who use carb counting add all the carbohydrates in the meal they plan to eat. Then they inject enough rapid- or short-acting insulin to process that amount of carbohydrates.
To do carb counting, you need to know how many carbs are in different kinds of food. You and your doctor also have to figure out how much insulin you need to "cover" a certain amount of carbohydrates. A good place to start may be 1 unit of insulin for every 15 grams of carbohydrates. But insulin works a little differently for each person. You may need 1 unit of insulin for every 10 grams, or 1 unit for every 25 grams of carbohydrate. (Talk to your doctor to get the amount that's right for you.)
Carbohydrate counting is pretty easy to learn and practice. Keep in mind though, that counting carbs is not the same as eating healthfully. Sure, you can inject the right amount of insulin to cover a meal of cheeseburgers, fries, and a hot-fudge sundae. If you take enough insulin, your blood glucose may even stay in your target range. That doesn't mean the meal was good for you! People who use carb counting still follow a healthy meal plan, like the one in the food pyramid.
You may be thinking, "Sheesh! I have to memorize how many carbs are in everything I eat?!" That sounds pretty hard. But no, you don't have to go out and buy flashcards and quiz yourself every night on how many carbs are in a glass of milk, a granola bar, and a peanut butter sandwich. You can get books that list carb counts for thousands of foods, and most packaged foods are required to list their carb counts right on the label. So, after a while you probably will memorize a lot of counts, but in the meantime, there are plenty of ways for you to find out how many carbs are in your favorite foods.
Making the Exchange
Another way to plan your meals is to use exchanges. This system divides types of foods into six exchange lists. The lists are very much like the groups used in the food pyramid: starch/bread, meat and meat substitutes, vegetables, fruit, milk, and fat. You can "exchange" any food on the list for any other food on the same list. You get started by talking to your dietitian, who will help you come up with a meal plan that works for you. Then, say your meal plan allows you two bread choices at breakfast. Using your exchange lists, you can decide if you will have a bowl of Cheerios, a bagel, or an English muffin.
To make exchanges work, pay attention to how much of a certain food equals one exchange. Look at our breakfast choices above. Two breads equal a cup and a half of Cheerios. What if you'd rather have oatmeal? Two breads equal one cup of oatmeal. And you can eat two pieces of toast but only one whole bagel.
Like anything new, the exchange system takes some time to learn. But it's helped many people with diabetes stick to their healthy eating plan. You and your parents can learn exchanges and get exchange lists from your doctor or dietitian. You can also call your American Diabetes Association at 1-800-DIABETES (342-2383) and ask for a copy of the latest meal planning exchange lists.
