Many individuals with type 1 diabetes manage their blood sugar by counting carbohydrates, which, along with fats and proteins, make up our diets. Yet while the practice is widespread, some research suggests it may not be very effective. In an analysis of six different studies, researchers found that carb counting did not significantly change subjects' levels of hemoglobin A1C, which measures average blood sugar levels over an extended period of time. Still, four of the studies were in favor of carb counting, reports Internal Medicine News.

What Is Carb Counting?

Carb counting allows people with type 1 diabetes to adjust how much insulin they take based on the amount of carbohydrates they have consumed. Insulin is a hormone that converts sugar into energy and controls blood sugar levels; people with type 1 diabetes do not produce it. Carbohydrates, which are found in foods like fruits, vegetables, legumes, grains, and starches, raise blood sugar levels. The thinking is that with carb counting, an individual with type 1 diabetes can simply calculate how many carbs are in a meal or a snack, and then take enough insulin to "cover" those carbs.

Carb counting, which is tremendously popular, gives an individual with diabetes a lot of flexibility, says Spyros Mezitis, MD, an endocrinologist at Lenox Hill Hospital in New York City. "People can match the insulin to the food they are eating," he says. And as carb counting has become more prevalent, the development of a variety of insulin delivery systems such as the pump and insulin pens mean more freedom for individuals with diabetes in terms of what and when they eat.

The Dangers of Carb Counting

However, says Mezitis, carb counting can be risky if a person gets too focused on monitoring carbohydrates and loses track of other components of the diet. There is also the temptation to replace some of the carbs in the diet with fats and proteins, says Toby Smithson, a registered dietician-nutritionist (RDN), licensed dietician-nutritionist (LDN), certified diabetes educator (CDE), spokesperson for the Academy of Nutrition and Dietetics and founder of And eating too many fats can be detrimental to anyone with diabetes. "When you have diabetes, you already have two to four times greater the risk of developing heart disease than if you didn't have diabetes," Smithson says. "If you are substituting foods with a lot of saturated fats for carbs, this can be dangerous."

Additionally, she says, it's tempting (especially for young people) to sub in some unhealthy carbs, like sugary drinks, pastries, and candy, for nutrient-dense carbs like fruits, starchy vegetables, and lowfat dairy products.

Monitoring Your Diet

Some research shows that in addition to carbs, both fat and protein may play a part in blood sugar control. So from the standpoint of maintaining good blood sugar control, it's important to monitor the intake of fats and proteins as well as carbohydrates.

So what's the best way to maintain good blood sugar control?

Carb counting can work, Mezitis says. But after three months of counting carbs, reassess. If there is no difference in your hemoglobin A1C, you should seek further instruction from a healthcare professional on how to accurately measure the carbohydrates in foods, and how to calculate your appropriate insulin dose.

Consider supplementing carb counting with the "plate method," an effective visual cue to remind you of how to portion out the food. With the plate method, you fill half your plate with non-starchy vegetables, one quarter with lean protein, and one quarter with carbs such as fruit, lowfat dairy products, and whole grains.

Finally, a word of caution on the hemoglobin A1C: "Since this measures the average blood sugar over a period of time, it can look like you are in good control when you have actually had a lot of low blood sugars," Smithson says. "So it is not really giving the true picture."

Toby Smithson, RDN, LDN, CDE, reviewed this article.



Wendling, Patrice. "Counting Carbs Comes up Short in Type 1 Diabetes." Internal Medicine News. Web. 24 June 2013. Page accessed 20 August 2013.

Smart, Carmel E. et al. Presentation Abstract: "From Nutrients to Meals: How Food Affects Diabetes Control." Paper presented at American Diabetes Association's 73d Scientific Sessions; June 21-25, 2013; Chicago.{89918D6D-3018-4EA9-9D4F-711F98A7AE5D}

"Carbohydrates." MedlinePlus. Web. Page last updated 19 August 2013. Page accessed 27 August 2013.