Staying on Target

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Carb Counting...Eat to Win!
TARGET THERAPY
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What is Carb Counting?
Carb (carbohydrate) Counting is a meal planning method
for people with diabetes. It is a way to count the carb
grams or servings in meals and snacks. By evenly spacing
carb foods through the day and by eating about the
same amount at each meal or snack you get better blood
glucose control so you can stay within your blood
glucose targets. You can also enjoy a greater variety
of meal and snack choices. Carb Counting can be basic
or advanced and is a good meal planning system for
anyone with diabetes.
Why Should I Count Carbs?
Food contains many nutrients such as carb, protein, fat,
vitamins, minerals, and water. Carb, protein and fat
supply the calories in foods that give
you energy. Years of research show that
carb is the nutrient that has the most
effect on your blood glucose. In fact, 90
to 100 percent of the carb you eat
appears in your bloodstream as blood
glucose within a few hours after you have
eaten. Protein and fat have much less
effect on your blood glucose. A healthy diet includes a
balance of carb, protein and fat.
What is Carb?
Carb foods are very important to a healthy meal plan.
They give us energy as well as vitamins, minerals, and
fiber. Foods that provide most of their calories from
carb include fruit, milk, sugar, sweets, breads, cereals,
rice, and pasta as well as starchy vegetables such as corn,
peas, potatoes, and dried beans. Carbs break down
into sugar and are released into the blood stream.
What Kind of Carb Do I Need?
Many studies have shown that all types
of carb foods affect blood glucose in the
same way. It is the amount of carb you
eat during a meal or snack that is
important, not the type of carb.
1
For example: If you have one cup of
vanilla ice cream that has 30 grams of
carb and a sandwich with 30 grams of carb, both
will affect blood glucose levels in the same way.
Are Some Carbs Better for Me?
To eat as healthily as you can, you should eat the more
nutritious high-fiber carbs like whole grains fruits and
vegetables including legumes (peas, beans, etc.). Some
sweets can be included in your meal plan but should be
limited. They often are high in fat and include few
nutrients like vitamins, minerals, or fiber. Carb Counting
will help you decide how to include sweets in your meal
plan. Be aware that sugar-free foods may still contain
a large amount of carb.
For example: Sugar-free apple pie will contain carb from
the apples and the crust. Sugar-free ice cream will have
carb from milk.
2
1
American Diabetes Association Clinical Practice Recommendations 2007, Nutrition
Recommendations and Interventions for Diabetes, Diabetes Care, January 2007,
Supplement 1, vol.30, p S52.
3
Carb-Containing Foods
Fruit, fruit juices (or any food that contains
fruit or fruit juices)
Milk, ice cream, yogurt (or any food
that contains milk)
Breads, cereals, crackers, grains,
pasta, rice
Starchy vegetables (such as corn,
potatoes, peas or beans)
Non-starchy vegetables (such
as broccoli and salad greens
that contain very small
amounts of carb)
Sweets (such as cake,
candy, cookies, pie)
Sugary foods (such as regular soda,
fruit drinks, sherbet)
How Do I Count Carb?
Carb can be counted by either carb servings / choices or
by carb grams. A gram (g) is a unit of measure used for
foods. One carb serving/choice equals 15g of carb. Either
method can be used but however you count carb, you
will also need to learn and recognize portion sizes.
What is Basic Carb Counting?
With Basic Carb Counting, your carb choices can change
from day to day as long as the totals for your meals and
snacks are about the same. (You do not have to eat the
same foods or meals everyday, but you need to eat the
same amount of carb at each meal). Being consistent
is the key to Carb Counting. Eating similar amounts of
carb foods at each meal or snack helps even out the
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ups-and-downs in your blood glucose
level. You can count the amount of carb
you eat as servings, choices or grams.
It is also important to eat balanced
meals with lean protein foods along
with your carb choices. Basic Carb
Countingalong with medication and
exercisehelps keep your blood glucose
levels in your target range so you can
stay as healthy as possible.
Do I Need Advanced Carb Counting?
If you use flexible insulin therapy you can benefit from
Advanced Carb Counting. Flexible management means:
1. Multiple daily insulin injections of
before-meal rapid- or short-acting
insulin or
2. Using an insulin pump and
3. Frequent daily self-monitoring
of blood glucose
In Advanced Carb Counting, mealtime
insulin doses are matched to the amount
of carb you choose to eat. Insulin doses are
based on your current blood glucose level,
your target blood glucose range and the carb
amounts in your meal
plan. Learning how to dose
your insulin builds on
your Basic Carb Counting skills.
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Learning The Basics
How Would I Count Carb by the Serving?
You may be familiar with the ADA (American Diabetes
Association and American Dietetic Association) Exchange
Lists for Meal Planning. These lists group
foods according to their nutrients. The
carb-containing food groups include
Bread/Starch, Fruit, Milk and Other Carbs.
The foods in these groups contain about
15 grams of carb per serving. Therefore,
one carb choice equals 15 grams of carb.
The following servings are each one carb choice equaling
15 grams of carb, so each of these choices will affect
your blood glucose level the same:
1/2 cup orange juice from the Fruit Group
3/4 cup of cereal from the Bread/Starch Group
1 cup of milk (12 grams of carb) from the Milk Group.
Twelve grams of carb is equal to one carb choice.
For example: Whether you drink a 1/2 cup of orange juice
(one carb choice) or 3/4 cup of cereal (one carb choice)
or one cup of milk (one carb choice) each food choice
will affect your blood glucose about the same because
each contains equal amounts of carb. All carb-containing
foods are counted equally. Learning the serving size of
each item in the carb-containing food groups will help
you count your carb servings at meals and snacks.
Remember: 15g of carb = 1 carb serving or carb choice.
You may have an Exchange List meal plan from your
dietitian that suggests specific amounts of carb servings
for each meal and snack. Keep in mind that different
sized portions of fruit, starch, milk, grains, etc. contain
different amounts of carb. What you consider a portion
may actually count as more than one carb serving.
For example: one carb serving of pasta is 1/3 cup (15g
carb); if you eat 1 cup of pasta, your portion is actually
3 carb servings (45g carb).
How Would I Count Carb by the Grams?
Another way to count carb is to count the number of
carb grams in the portions you eat, and add those
amounts together for a meal or snack total. A gram(g)
is a unit of measure for foods. Your meal plan may
suggest specific amounts of carb grams at each meal
or snack. You will need to become familiar with your
portion sizes and the amounts of carb they contain.
For example: If your portion of pasta is one cup, you
are eating 45g of carb.
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Food Carb Grams
Exchange Group Per Item Carb Servings
Starch/Bread 15 g carb 1 carb serving or choice
Fruit 15 g carb 1 carb serving or choice
Milk 12 g carb 1 carb serving or choice
Other Carbs 15 g carb 1 carb serving or choice
Vegetable 5 g carb 1/3 carb serving or choice
Meat/Meat Substitute 0 g carb 0 carb serving or choice
Fat 0 g carb 0 carb serving or choice
Carb Amounts in the Exchange Lists for Meal Planning
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There are many resources you can use to find out how
much carb is in the food you eat, such as:
The Internet
Brand Name Food Books
Bowes and Church's Food Values
of Portions Commonly Used
2
Cookbooks
Restaurant Item Lists
The BD Getting Started
TM
Fast Food Guide
What Supplies Do I Need to
Get Started?
Some helpful carb counting tools include:
Nutrition Facts panel on food labels
Measuring cups for liquids
Measuring cups for solids
Measuring spoons
Food scale
Calculator
Practice is important. First, measure
your usual food portions. Then,
compare them to the serving sizes
listed on the Nutrition Facts panel
on food labels. It is also a good
idea to compare your portions
with the serving sizes in
the ADA Exchange Lists for Meal
Planning. Knowing portion sizes will
be helpful when you are eating in
a restaurant.
2
Pennington. Jean A.T., Bowes and Churchs Food Values
of Portions Commonly Used. Eighteenth Edition, J.B.
Lippincott, Philadelphia. 2004.
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How Can I Use Nutrition Facts on Food Labels?
The most common tool for preparing foods at home is
the Nutrition Facts panel. Nearly everything you buy in
grocery stores, except for meats and fresh produce, has
a Nutrition Facts panel on the label. Once you know
what to look for on the label, you will be able to count
carb by the serving or the gram.
To Find the Amount of Carb Servings:
1. Check the product serving size.
In this example it is 1 cup.
2. See the total g (grams) carb
amount for the serving size.
In this example it is 31g. (The
sugars are already accounted
for in the total carb amount.)
3. Find the dietary fiber amount
for the serving size. If a food
you are planning to eat has
five or more grams of fiber
per serving, subtract the grams
of fiber from the total carb
grams in the meal. Fiber is a
carb that is not absorbed by
the body, so high fiber foods
have less of an effect on
blood sugar levels.
For example: One cup of cooked oatmeal has
25g of carb and six g of dietary fiber. The total
available carb is 19g (25g minus 6g) or one
carb serving.
3
3
Warshaw, Hope S. and Bolderman, Karen M., Practical Carbohydrate Counting: A
How to guide for Health Professionals. American Diabetes Association, 2001, p.43
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4. Find the number of carb servings or choices by dividing
the total g carb by 15. In this example it is 2 (31g
divided by 15 equals 2.06, round to 2). One serving of
this product is equal to two carb servings or choices.
5. Measure your portion. How does it compare to the
serving size on the label? How many carb servings
is your portion?
For example: If you eat one cup your portion is two
carb servings.
6. Add up the total amount of the
other carb foods you are eating.
That will give you a total amount of
carb servings for that meal or snack.
To Find the Amount of
Carb Grams:
1. Find the product serving size. In this example, it is 1 cup.
2. Look at the total carb amount for the serving size. In
this example, it is 31g. One cup of this product contains
31g carb. The sugars are already accounted for in the
total carb amount, so you do not have to count them.
Grams of Carb Count as the following
Carb Servings
0 to 5g Do not count
6 to 10g 1/2 carb serving or choice
11 to 20g 1 carb serving or choice
21 to 25g 1 1/2 carb servings or choices
26 to 35g 2 carb servings or choices
TO COUNT CARB SERVINGS:
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If a food you are planning to eat has 5 or
more grams of fiber per serving, subtract
the grams of fiber from the total
carb in the meal.
3. Measure your portion. How does
it compare to the serving size on
the label? How many servings
is your portion?
4. Multiply your number of servings
times the grams of carb per serving.
One serving of this product is one cup and
has 31 g of carb. If you are eating 11/2 cup, multiply
1 1/2 times 31. This equals 46 1/2 grams of carb
(round to 47g). One- and-one-half cups of this
product would equal 47 grams of carb.
5. Get the total amount of carb for that meal or
snack by adding the amounts of the other carb
foods you are eating.
How Much Carb Do I Need?
Everyone needs a different amount of carb. The
amount that is best for you depends on your age,
height, weight, level of physical activity, current blood
glucose level, and your blood glucose
targets. Most people start with 3 or 4
carb servings (45 to 60g) at each meal
and 1 or 2 carb servings (15 to 30g) for
snacks. Your dietitian can help provide
the amounts that would be best for you.
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Sample Menu
FOOD/BEVERAGE CARB GRAMS
BREAKFAST
1/2 cup orange juice __________________________________________15
2 slices (2 oz.) whole-wheat toast ______________________________30
1 soft-cooked egg _____________________________________________0
2 tsp. Margarine ______________________________________________0
12 oz. coffee__________________________________________________0
1 pkg. Sweetener _____________________________________________3
Total grams carb:_____________________________________________48
LUNCH
2 slices (2oz.) rye bread_______________________________________30
2 oz. sliced turkey _____________________________________________0
2 lettuce leaves ______________________________________________<1
1 tsp. mayonnaise _____________________________________________0
1 small bag (3/4 oz.) pretzels __________________________________15
1 small (4 oz.) apple __________________________________________15
12oz. diet cola soda ___________________________________________0
Total grams carb:_____________________________________________60
MID-AFTERNOON SNACK
16oz. diet iced tea ____________________________________________0
1/2 c. frozen yogurt___________________________________________15
Total grams carb:_____________________________________________15
SUPPER/DINNER
1c. tossed salad greens, cucumber slice _________________________5
1 Tbsp. salad dressing__________________________________________0
3oz. baked chicken breast _____________________________________0
1/2 c. mashed potato _________________________________________15
1/2 c. sliced carrots_____________________________________________5
1 small (1 oz.) dinner roll _____________________________________15
1 tsp margarine _______________________________________________0
2 brownie square ___________________________________________15
12 oz. diet caffeine-free cola soda ______________________________0
Total grams carb:_____________________________________________50
BEDTIME SNACK
1/2 c. juice-packed fruit cocktail _______________________________15
2 small (2/3 oz.) sandwich-type creme filled cookies _____________15
10 peanuts____________________________________________________0
Total grams carb:_____________________________________________30
What Should I do About Protein and Fat?
Counting carb servings or grams does not mean you
should ignore protein and fat in your diet. Meat and
meat substitutes contain protein and fat, which are
also essential nutrients. But eating too many servings
of protein and fat can lead to weight gain and other
health problems, including high cholesterol.
Most active adults should aim for a total of about 6oz.
of cooked meat or meat substitutes per day. Choosing
very lean or lean meats over medium- to high-fat meats
are healthier options. This can be divided between your
meals. A simple way to plan this is to have one small
serving at lunch, and one medium-sized serving at supper.
A 3 oz. serving is about the size of a deck of cards.
Fats that are considered more healthy
are liquid at room temperature. Limit
the use of fats. Most of your fat intake
should be unsaturated fat such as olive,
canola, or peanut oils, nuts, seeds, or
avocado. Limit your amounts of saturated
fats like butter, bacon, cream, solid
shortenings, and high-fat meats. Ask your
dietitian for help.
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Can I Have Alcohol?
Always use caution when drinking alcohol! Pure alcohol,
such as gin, rum, vodka, or whiskey and most wines do
not contain carb, but do have calories.
Research has shown that drinking
alcohol can cause low blood glucose
(hypoglycemia).
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At first, blood glucose
may increase; especially if the drink
contains carb (beer, wine or some mixed
drinks), but blood glucose could drop
several hours after drinking. To prevent
low blood glucose, always eat food,
especially carb, if you drink alcohol.
It is generally recommended that you
limit your alcohol to one or two drinks, one to two
times per week. One drink is equal to:
12oz. light beer (regular beer contains about
15 grams of carb)
5oz. Wine
1.5oz. glass of pure alcohol (distilled spirits)
If you drink alcohol, check your blood
glucose regularly to watch the effects.
You should check your blood glucose
before and several hours after a drink
to determine the effect of alcohol on
your blood glucose. When mixing drinks
with carb-containing liquids like orange
juice you need to count the carb in
the mix.
5
4
American Diabetes Association Clinical Practice Recommendations 2007, Nutrition
Recommendations and Interventions for Diabetes, Diabetes Care, January 2007,
Supplement 1, vol.30, p S54.
5
Franz, Marion J. and Bantle, John P. Editors. American Diabetes Association Guide to
Medical Nutrition Therapy for Diabetes. Clinical Education Series P. 202-204. 1999.
Advanced Carb Counting
Why do I Need to Keep Records?
Once youve learned the basics of carb counting, youre
ready for Advanced Carb Counting. It is important to
understand how your carb intake, insulin doses, and
other factors affect your glucose levels. To do this you
will need to keep four different kinds of records for sever-
al days or weeks.
1. Food and drink records
Name of food or drink ____________________
Portion size ____________________
Carb grams in your portions ____________________
Alcohol intake ____________________
2. Insulin dose records
Kind of insulin ____________________
Time of dose ____________________
Amount of dose ____________________
3. Self-monitoring of blood glucose records
Fasting blood glucose level ____________________
Pre-meal blood glucose level ____________________
Two-hour after-the-start-of-
the-meal blood glucose level ____________________
Bedtime blood glucose level ____________________
4. Records of other factors that can affect
your blood glucose level
Physical activity ____________________
Illness ____________________
Stress ____________________
Low blood glucose and amount
and type of treatment used ____________________
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What is Pattern Management?
To identify your blood glucose patterns you will need
to look over your records. A pattern is a trend in your
blood glucose levels over a length of time. Many blood
glucose meters have software that can assist you in seeing
these trends in blood glucose. Pattern management is
changing your diabetes care so you can stay within your
blood glucose targets. This could mean adjusting your:
Meal plan
Amount of insulin
Level of physical activity
For example: You may see that
your blood glucose levels are
above or below your targets at
certain times of day or after
eating certain foods. Once you notice a trend that
needs correction, you can make the necessary changes.
What is An Insulin-to-Carb Ratio?
This is the amount of rapid- or short-acting insulin
you need to match, or cover, the amount of carb
you have eaten. Your ratio depends on how sensitive
you are to insulin. The more sensitive you are, the more
carb you will need. Knowing your ratio and how to
dose your mealtime insulin to match your carb intake
will give you the most flexibility with improved
blood glucose control.
24.5%
62.0%
PIE CHART ALL BLOOD SUGAR READINGS
TREND CHART BLOOD SUGAR
13.5% Below 80 mg/dL
Above 160 mg/dL
mg/dL
In Target
80...160 mg/dl
May May May May May June June June June June June June June June June June
22 24 26 28 30 1 3 5 7 9 11 13 15 17 19 21
300
255
210
160
80
40
0
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How Can I Find My Ratio?
1. Review your records.
2. Look for patterns. Pay careful attention to the
amounts of carb you ate, your blood glucose readings,
and your insulin dosages. Eat as consistent amounts of
carb at meals and snacks as possible.
3. Use your information to calculate your ratio. If your
pre-meal and post-meal blood glucose readings were
within your target ranges, divide the grams of carb by
your pre-meal rapid-acting insulin dose. The result is
your insulin-to-carb ratio.
For example: Here is how one individual determined
his ratio:
He ate 60g (4 servings) of carb at lunch.
His before-lunch blood glucose level was
within target range.
His before-lunch rapid-acting
insulin dose was 4 units.
His after-lunch blood glucose
level was within target range.
He divided his grams of carb by
his insulin dosage to get his ratio
(60g divided by 4 units equals 15).
His insulin-to-carb ratio was 1:15
(one unit of insulin covered 15g or
one serving of carb).
4. Do these calculations for several meals over many days.
Keep in mind that your ratio could change by meal, day,
or special circumstances, such as active days or inactive
days, illness, or stress. Eating new foods or drinking
alcohol can also affect your blood glucose levels. In
these cases, you may need to change your ratio(s).
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5. A good starting point for most adults might be a
ratio of 1:10. Children and insulin-sensitive people
generally use a 1:10 or 1:15 insulin-to-carb
ratio. Everyone is different and it may
take some time to see what works best
for you. Your diabetes educator can help
you find the insulin-to-carb ratio that
is right for you.
Why is the Insulin Sensitivity
Factor (ISF) Important?
Your ISF is the amount of blood glucose (in mg/dl) reduced
by one unit of rapid- or short-acting insulin over two
to four hours. The ISF helps decide how much insulin
you need to get elevated blood glucose back in your
before-meal blood glucose target range. Your ISF should
be tailored for your needs. Ask your doctor to give you
your ISF. Trial-and-error and keeping detailed records
will help you find your ISF. Typically, adults use an ISF
of about 50 mg/dl, while children and insulin-sensitive
adults use an ISF of 30 to 50 mg/dl. Everyone is different.
How Can I Figure Out My Correction Dose of Insulin?
Once you know your ISF, you can use it to calculate your
correction dose (supplemental dose) of insulin. Depending
on when you check your blood sugar level, you may be
advised by your physician to add your correction dose
to your pre-meal insulin dose, or to take your correction
dose three or four hours after
your meal.
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To calculate your correction dose:
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1. Subtract your target blood glucose level from your
current blood glucose level.
2. Divide by your ISF.
3. The result is your correction dose of insulin.
For example: Here is how one person with
diabetes computed her correction dose.
Her pre-meal blood glucose level
was 249mg/dl.
Her target pre-meal blood
glucose level was 100mg/dl.
She subtracted her pre-meal blood
sugar target of 100mg/dl from her
actual pre-meal blood glucose of
249mg/dl and found she was
149mg/dl over target.
Her ISF was 50mg/dl.
She divided 149 by 50
and got 2.98, which she
rounded to 3.
Her correction dose was 3 units
Here is her same computation
expressed as an equation:
Always check with your physician or healthcare
provider for specific guidelines.
6
Warshaw, Hope S., Bolderman, Karen M., Practical Carbohydrate Counting.
Association, 2001, p.29.
(Current blood glucose target blood glucose) = (249-100) = 149 = 2.98, round to 3
Insulin Sensitivity Factor 50 50
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Things to Remember
A healthy diet is a balance of carb, protein, and fat.
For most adults, this includes about two to four servings
from the milk group each day. Choose fewer salty and
high fat foods, and include fiber-containing foods.
There are many ways to learn the carb gram amounts
of your favorite foods. Read labels, ask
for nutrition information when eating
out and check with your dietitian. Carb
Counting can be a successful meal
planning approach to help manage
your diabetes. With time and
practice, you will become an expert.
The benefits of more flexibility and
better blood glucose control will result
in a winning effort!
For basic guidelines, each food
portion listed contains about 15g of carb and
counts as one carb serving, unless
noted otherwise.
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Carb Servings
Starch
Breads, Cereals and Grains, Starchy Vegetables, Crackers and Snacks,
Beans, Peas, and Lentils, and Starches Prepared with Fat
One serving = 15 g carb or 1 carb serving
FOOD SERVING SIZE
BREAD
Bagel, 4 oz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/4 (1oz)
Bread, white, whole-wheat,
pumpernickel, rye, unfrosted raisin . . . . . . . . . . . . . . . . .1 slice (1oz)
English muffin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2
Hot dog or hamburger bun . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 (1oz)
Muffin, 5oz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/5 (1oz)
Pancake, 4in. across, 1/4 in. thick . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Pita, 6 in. across . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2
Roll, plain, small . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 (1oz)
Tortilla, corn or flour, 6 in. across . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Tortilla, flour, 10 in. across . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/3
Waffle, reduced-fat, 4 in. square or across . . . . . . . . . . . . . . . . . . . .1
CEREALS AND GRAINS
Bran cereals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Cereals, cooked . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Cereals, unsweetened, ready-to-eat . . . . . . . . . . . . . . . .3/4 cup
Granola, low-fat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/4 cup
Grits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Oats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Pasta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 cup
Puffed cereal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1/2 cups
Rice, white or brown . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/3 cup
Sugar-frosted cereal . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
21
STARCHY VEGETABLES
Baked beans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/3 cup
Corn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Corn on cob, large . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cob (5oz)
Mixed vegetables with corn, peas, . . . . . . . . . . . . . . . . . . .1 cup
Peas, green . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Potato, boiled . . . . . . . . . . . . . . . .1/2 cup or 1/2 medium (3oz)
Potato, baked with skin . . . . . . . . . . . . . . . . . . .1/4 large (3oz)
Potato, mashed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Squash, winter (acorn, butternut, pumpkin) . . . . . . . . . . .1 cup
Yam, sweet potato, plain . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
CRACKERS AND SNACKS
Graham crackers, 2 1/2 in. square . . . . . . . . . . . . . . . . . . . . . . 3
Popcorn (popped, no fat added or low-fat microwave) . . . . . 3 cups
Pretzels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3/4oz
Rice cakes, 4 in. across . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Saltine-type crackers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Snack chips, fat-free (tortilla, potato) . . . . . . . . .1520 (3/4oz)
Whole-wheat crackers, no fat added . . . . . . . . . . . 25 (3/4oz)
BEANS, PEAS, AND LENTILS
(also contain about 7g protein per serving and 5-7g fiber)
Beans and peas (garbanzo, pinto, kidney,
white, split, black-eyed), lentils . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Lima beans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2/3 cup
STARCHY FOODS PREPARED WITH FAT (about 5g fat per serving)
Biscuit, 2 1/2in. across . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Chow mein noodles . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Corn bread, 2in. cube . . . . . . . . . . . . . . . . . . . . . . . . . . .1 (2oz)
Croutons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 cup
Granola . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/4 cup
Popcorn, microwave . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 cups
Sandwich crackers, cheese or peanut butter filling . . . . . . . . . . 3
Snack chips (potato, tortilla) . . . . . . . . . . . . . . . . . 913 (3/4oz)
Stuffing, bread (prepared) . . . . . . . . . . . . . . . . . . . . . . . .1/3 cup
Taco shell, 6in. across . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Waffle, 4 in. square or across . . . . . . . . . . . . . . . . . . . . . . . . . . .1
22
Fruit and Fruit Juices
One serving = 15 g carb or 1 carb serving
FOOD SERVING SIZE
FRUIT
Fresh fruit, 1 small . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 (4oz)
Canned fruit, unsweetened . . . . . . . . . . . . . . . . . . . . . . .1/2 cup
Dried fruit, unsweetened . . . . . . . . . . . . . . . . . . . . . . . . .1/4 cup
Blackberries, blueberries . . . . . . . . . . . . . . . . . . . . . . . . . 3/4 cup
Cantaloupe, small . . . . . . . . . .1/3 melon (11oz) or 1-cup cubes
Cherries, sweet, fresh . . . . . . . . . . . . . . . . . . . . . . . . . . .12 (3oz)
Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Grapefruit, large . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 (11oz)
Grapes, small . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 (3oz)
Honeydew melon . . . . . . . . . . . . .1 slice (10oz) or 1 cup cubes
Pineapple, fresh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3/4 cup
Plums, small . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (5oz)
Raisins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Tbsp
Raspberries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 cup
Strawberries . . . . . . . . . . . . . . . . . . . . . .1 1/4 cup whole berries
Tangerines, small . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (8oz)
Watermelon . . . . . . . . . . .1 slice (13 1/2oz) or 1 1/4 cup cubes
FRUIT JUICE
Apple juice/cider, grapefruit juice,
orange juice, pineapple juice . . . . . . . . . . . . . . . . . . . . .1/2 cup
Cranberry juice cocktail, 100% fruit juice blends,
grape juice, prune juice . . . . . . . . . . . . . . . . . . . . . . . . . .1/3 cup
Cranberry juice cocktail, reduced-calorie . . . . . . . . . . . . .1 cup
23
Milk
One serving = 1215 g carb or 1 carb serving
FOOD SERVING SIZE
Fat-free, 1/2%, 1%, 2%, whole, sweet acidophilus . . . . .1 cup
Buttermilk, low-fat or fat-free . . . . . . . . . . . . . . . . . . . . . .1 cup
Chocolate, reduced fat or whole . . . . . . . . . . . . . . . . . .1/2 cup
Dry, fat-free . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/3 cup dry
Evaporated, fat-free or whole . . . . . . . . . . . . . . . . . . . . .1/2 cup
Soymilk, fat-free, low-fat, reduced fat . . . . . . . . . . . . . . .1 cup
Yogurt, plain or sweetened w/nonnutritive sweetener . . . 1 cup
Yogurt, plain low-fat or made from whole milk . . . . . . . .1 cup
Yogurt, flavored and sweetened with fructose . . . . . . . . 3/4 cup
Non-starchy Vegetables
One serving = 5 g carb
One serving is free. Three servings = one carb serving or choice
(15 grams of carb).
One serving of a non-starchy vegetable is:
1 cup raw:
1/2 cup cooked:
Artichoke
Artichoke hearts
Asparagus
Beans (green,
wax, Italian)
Bean sprouts
Beets
Broccoli
Brussels sprouts
Cabbage
Carrots
Cauliflower
Celery
Cucumber
Eggplant
Green onions
or scallions
Greens (collard,
kale, mustard,
turnip)
Kohlrabi
Leeks
Mixed vegetables
(w/o corn, peas,
pasta)
Mushrooms
Okra
Onions
Pea pods
Peppers (all varieties)
Radishes
Salad greens
(endive, escarole,
lettuce, romaine,
spinach)
Sauerkraut
Spinach
Summer squash
Tomato
Tomatoes, canned
Tomato sauce
Tomato/vegetable
juice
Turnips
Water chestnuts
Turnips
24
Sweets and Desserts
1 carb serving = 15 g carb
2 carb servings = 30 g carb
3 carb servings = 45 g carb
These foods are listed according to how many carb and fat
servings they contain.
FOOD SERVING SIZE SERVINGS
Angel food cake, unfrosted . . . .1/12th cake (about 2oz) . . . . . . . . . . . . . 2 carbs
Brownie, small, unfrosted . . . . . .2in. square (about 1oz) . . . . . . . . .1 carb, 1 fat
Cake, unfrosted . . . . . . . . . . . . . . 2in. square (about 1oz) . . . . . . . . .1 carb, 1 fat
Cake, frosted . . . . . . . . . . . . . . . . 2in. square (about 2oz) . . . . . . . . 2 carbs, 1 fat
Cookie or sandwich cookie
with creme filling . . . . . . . . . . . . . 2 small (about 2/3oz) . . . . . . . . . .1 carb, 1 fat
Cookies, sugar-free . . . . . . . . . . 3 small or 1 large (3/41oz) . . . . .1 carb, 12 fats
Cupcake, frosted . . . . . . . . . . . . . . .1 small (about 2oz) . . . . . . . . . . 2 carbs, 1 fat
Doughnut, plain cake . . . . . . . . . . .1 medium (1 1/2oz) . . . . . . .1 1/2 carbs, 2 fats
Doughnut, glazed . . . . . . . . . . . . . 3 3/4 in. across (2oz) . . . . . . . . 2 carbs, 2 fats
Fruit juice bars, frozen,
100% juice . . . . . . . . . . . . . . . . . . . . . . . .1 bar (3oz) . . . . . . . . . . . . . . . . . . . .1 carb
Fruit spreads, 100% fruit . . . . . . . . . . . .1 1/2 Tbsp . . . . . . . . . . . . . . . . . . . .1 carb
Gelatin, regular . . . . . . . . . . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . . . . . . . .1 carb
Granola or snack bar,
regular or low-fat . . . . . . . . . . . . . . . . . .1 bar (1oz) . . . . . . . . . . . . . . . .1 1/2 carbs
Honey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp . . . . . . . . . . . . . . . . . . . . . .1 carb
Ice cream . . . . . . . . . . . . . . . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . .1 carb, 2 fats
Ice cream, light . . . . . . . . . . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . . .1 carb, 1 fat
Ice cream, low-fat . . . . . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . .1 1/2 carbs
Ice cream, fat-free,
no sugar added . . . . . . . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . . . . . .1 carb
Jam or jelly, regular . . . . . . . . . . . . . . . .1 Tbsp . . . . . . . . . . . . . . . . . . . .1 carb
Pie, fruit, 2 crusts . . . . . . . . . . . . . . . . . .1/6 pie . . . . . . . . . . . . .3 carbs, 2 fats
Pie, pumpkin or custard . . . . . . . . . . . .1/8 pie . . . . . . . . . . . . . 2 carbs, 2 fats
Pudding, regular (made
with reduced-fat milk) . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . . . . 2 carbs
Pudding, sugar-free or
sugar-free and fat-free . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . . . . . .1 carb
(made with fat-free milk)
25
Meat and Meat Substitutes
Most adults should plan to have a total of 4-6 oz. per day.
Each of these servings = 1 oz. meat.
1oz. cooked chicken, turkey, fish, lean beef, pork,
lamb, wild game
1 slice cheese
1/4 cup cottage cheese or tuna
1/2 cup tofu
1Tbsp peanut butter
1egg
Fat
Try to limit your fat intake to 3 to 5 servings per day. One
serving = 5 g fat.
One fat serving is:
1tsp margarine, butter, mayonnaise, oil
1Tbsp cream cheese, salad dressing, and half-n-half cream,
reduced-fat margarine or reduced fat mayonnaise
1Tbsp sesame, pumpkin, or sunflower seeds
2Tbsp sour cream, reduced-fat cream cheese, reduced-fat
salad dressing
FOOD SERVING SIZE SERVINGS
Sherbet, sorbet . . . . . . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . . . . . . . . 2 carbs
Sports drinks . . . . . . . . . . . . . . . . . . . . .8oz. . . . . . . . . . . . . . . . . . . . . . .1 carb
Sugar . . . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp . . . . . . . . . . . . . . . . . . . . .1 carb
Sweet roll or Danish . . . . . . . . . . . . .1 (2 1/2oz) . . . . . . . . . . 2 1/2 carbs, 2 fats
Syrup, light . . . . . . . . . . . . . . . . . . . . .2 Tbsp . . . . . . . . . . . . . . . . . . . . .1 carb
Syrup, regular . . . . . . . . . . . . . . . . . . .1 Tbsp . . . . . . . . . . . . . . . . . . . . .1 carb
Yogurt, frozen . . . . . . . . . . . . . . . . . .1/2 cup . . . . . . . . . . . . . .1 carb, 01 fat
Yogurt, frozen, fat-free . . . . . . . . . . .1/3 cup . . . . . . . . . . . . . . . . . . . . .1 carb
Yogurt, low fat with fruit . . . . . . . . . . . .1 cup . . . . . . . . . . . . . . . . 3 carbs, 01 fat
26
Combination Foods
These foods have servings from several food groups:
FOOD SERVING SIZE SERVINGS
Spaghetti or pasta sauce, canned . . .1/2 cup . . . . . . . . . . . . . . . .1 carb, 1 fat
ENTREES
Tuna noodle casserole, lasagna,
spaghetti with meatballs, chili
with beans, macaroni
and cheese . . . . . . . . . . . . . . . . . .1 cup (8oz) . . . . . . . . . . . . .2 carbs, 2 meats
Chow mein
(without noodles or rice) . . . . . . 2 cups (16oz) . . . . . . . . . . . .1 carb, 2 meats
FROZEN ENTREES AND MEALS
Dinner-type meal . . . . . . . . . . . . . .generally 1417oz . . . . 3 carbs, 3 meats, 3 fats
Pizza, cheese, thin crust . . . . . . . . .1/4 of 10 in. (5oz) . . . . . 2 carbs, 2 meats, 1 fat
Pizza, meat topping, thin crust . . .1/4 of 10 in. (5oz) . . . . 2 carbs, 2 meats, 2 fats
Pot pie . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 (7oz) . . . . . . 2 1/2 carbs, 1 meat, 3 fats
Entree or meal with
less than 340 calories . . . . . . . . . . . . . about 811oz . . . . . . . . 23 carbs, 12 meats
SOUPS
Bean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 cup . . . . . . . . . . . . . . . . .1 carb, 1 meat
Cream (made with water) . . . . . . . . .1 cup (8oz) . . . . . . . . . . . . . . . .1 carb, 1 fat
Instant . . . . . . . . . . . . . . . . . . . . . . . . .6 oz prepared . . . . . . . . . . . . . . . . . . . .1 carb
Instant with beans/lentils . . . . . . . . .8 oz prepared . . . . . . . . . 2 1/2 carbs, 1 meat
Split pea (made with water) . . . . . . .1/2 cup (4oz) . . . . . . . . . . . . . . . . . . . . .1 carb
Tomato (made with water) . . . . . . . .1 cup (8oz) . . . . . . . . . . . . . . . . . . . . .1 carb
Vegetable beef, chicken noodle,
or other broth-type . . . . . . . . . . . . . . .1 cup (8oz) . . . . . . . . . . . . . . . . . . . . .1 carb
27
FAST FOODS
FOOD SERVING SIZE SERVINGS
Burrito with beef . . . . . . . . . . . . . .1 (57oz) . . . . . . . . . 3 carb, 1 meat, 1 fat
Chicken nuggets . . . . . . . . . . . . . . . . . .6 . . . . . . . . . . . .1 carb, 2 meats, 1 fat
Chicken breast and wing,
breaded and fried . . . . . . . . . . . . . . .1 each . . . . . . . . .1 carb, 4 meats, 2 fats
Chicken sandwich, grilled . . . . . . . . . . .1 . . . . . . . . . . . . . . . . . 2 carb, 3 meats
Chicken wings, hot . . . . . . . . . . . . . .6 (5oz) . . . . . . . . .1 carb, 3 meats, 4 fats
Fish sandwich/tartar sauce . . . . . . . . . .1 . . . . . . . . . . . . 3 carb, 1 meat, 3 fats
French-fries . . . . . . . . . . . . . . .1 medium serving (5oz) . . . . . . . . . . . 4 carb, 4 fats
Hamburger, regular . . . . . . . . . . . . . . . .1 . . . . . . . . . . . . . . . . . 2 carb, 2 meats
Hamburger, large . . . . . . . . . . . . . . . . .1 . . . . . . . . . . . . 2 carb, 3 meats, 1 fat
Hot dog with bun . . . . . . . . . . . . . . . . .1 . . . . . . . . . . . . .1 carb, 1 meat, 1 fat
Pizza, individual pan . . . . . . . . . . . . . . . . .1 . . . . . . . . . . . . . 5 carb, 3 meats, 3 fats
Pizza, cheese, 1/4 medium (12 round)
thin crust . . . . . . . . . . . . . . . . . . . . . . . about 6oz . . . . . . . . . . . 2 1/2 carb, 2 meats
Pizza, meat, 1/4 medium (12 round) 2 1/2 carb
thin crust . . . . . . . . . . . . . . . . . . . . about 6oz . . . . . . . . . . . . . . 2 meats, 1 fat
Soft-serve cone . . . . . . . . . . . . . .1 small (5oz) . . . . . . . . . . . 2 1/2 carb, 1 fat
Submarine sandwich . . . . . . . . . . . .1 sub (6 in.) . . . .1 vegetable, 2 meats, 1 fat,
3 carb
Taco, hard or soft-shell . . . . . . . .1 (3-3 1/2oz) . . . . . . . .1 carb, 1 meat, 1 fat
28
Free Foods
These foods contain less than 5 g of carb and have less than
20 calories per serving. If a serving size is given, limit the food
to three servings per day.
FAT-FREE OR REDUCED-FAT FOODS
FOOD SERVING SIZE
Cream cheese, fat-free . . . . . . . . . . . . . . . . . . . . .1 Tbsp (1/2oz)
Creamers, nondairy, liquid . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp
Creamers, nondairy, powdered . . . . . . . . . . . . . . . . . . . . . 2 tsp
Mayonnaise, fat-free . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp
Mayonnaise, reduced-fat . . . . . . . . . . . . . . . . . . . . . . . . . . .1 tsp
Margarine spread, fat-free . . . . . . . . . . . . . . . . . . . . . . . .4 Tbsp
Margarine spread, reduced-fat . . . . . . . . . . . . . . . . . . . . . .1 tsp
Nonstick cooking spray
Salad dressing, fat-free or low fat . . . . . . . . . . . . . . . . . .1 Tbsp
Salad dressing, fat-free, Italian . . . . . . . . . . . . . . . . . . . . 2 Tbsp
Sour cream, fat-free, reduced-fat . . . . . . . . . . . . . . . . . . .1 Tbsp
Whipped topping, regular . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp
Whipped topping, light or fat-free . . . . . . . . . . . . . . . . . 2 Tbsp
SUGAR-FREE FOODS
Candy, hard, sugar-free . . . . . . . . . . . . . . . . . . . . . . . . . .1 candy
Gelatin dessert, sugar-free
Gelatin, unflavored
Gum, sugar-free
Jam or jelly, light . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 tsp
Sugar substitutes, alternatives, or replacements*
Syrup, sugar-free . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Tbsp
*FDA (Food and Drug Administration) approved include:
Equal

(aspartame) Sweet-10

(saccharin)
Splenda

(sucralose) Sugar Twin

(saccharin)
Sprinkle Sweet

(saccharin) Sweet n Low

(saccharin)
Sweet One

(acesulfame K)
29
FOOD SERVING SIZE
DRINKS
Bouillon, broth, consomm
Bouillon or broth, low-sodium
Carbonated or mineral water
Club soda
Cocoa powder, unsweetened . . . . . . . . . . . . . . . . . . . . . .1 Tbsp
Coffee
Diet soft drinks, sugar-free
Drink mixes, sugar-free
Tea
Tonic water, sugar-free
CONDIMENTS
Catsup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp
Horseradish
Lemon juice
Lime juice
Mustard
Pickles, dill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1/2 large
Salsa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1/4 cup
Soy sauce, regular or light . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp
Taco sauce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Tbsp
Vinegar
Yogurt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Tbsp
SEASONINGS
Flavoring extracts
Garlic
Herbs, fresh or dried
Pimento
Spices
Tabasco

or hot pepper sauce

Wine, used in cooking
Worcestershire sauce
30
Food Diary
NAME_____________________________________ DATE___________________
MEAL PLAN GOAL_____________________________________________________
NUMBER OF CARB CHOICES:
Breakfast___________________________________________ carb choices
Lunch_______________________________________________ carb choices
Dinner______________________________________________ carb choices
Snacks______________________________________________ carb choices
Record all the food that you eat for at least 3 days below. This record will
help you and your health care team decide if changes in medication and
or your meal plan should be made.
TIME AMOUNT SNACK/MEAL FOOD EATEN / PREPARATION CARB CHOICES
GOAL:
EXERCISE:
07D016-151128
Educational Information from BD Medical Diabetes Care.
BD, BD Logo and all other trademarks are the property of Becton, Dickinson
and Company. 2007 BD.
All other brands are trademarks of their respective holders.
BD provides this brochure for informational purposes only. It is not intended to be a
substitute for professional medical advice, diagnosis or treatment. Always seek the
advice of your physician or other qualified healthcare provider with any questions
you may have regarding a medical condition. Never disregard professional medical
advice or delay in seeking it because of something you have read in this brochure.
Written by:
Karen M. Bolderman, RD, LD, CDE
Ellicott City, MD
We wish to acknowledge the following health professionals for
reviewing this publication and providing their valuable insights:
Ann Fittante, RD, MS, CDE
Seattle, WA
Dina Hulbert, RD, CDE
Wayne, NJ
Karen Boomer, RD, CDE
Louisville, KY
Karen McBride, RD, CDE
BD Medical Diabetes Care
Dallas, TX
Brenda Bellrichards, RD, MS, CDE
Saint Louis, MO
1 Becton Drive
Franklin Lakes, NJ 07417-1883
1.888.BDCARES (232.2737)
www.BDDiabetes.com/us