Carbohydrate Counting... Is it Effective or Necessary?

[Deleted member 596235]

As a newly diagnosed Type 2 diabetic I've noticed many people here
putting a lot of stead on carbohydrate counting (BCC) as an important
(even critical) part of their BG levels, some as part of a sole dietary
therapy, and some as an adjunct only to their medication. It would
seem from the usually very positive and detailed comments posted
on these forums that carb counting is highly regarded in the diabetic
"community".

Personally, I see carb counting as tedious and overly involving, and
even unnecessary—assuming of course one's medication is working
satisfactorily to control one's BG levels in the first instance.

Anyway... a little bit of research brought up THIS site, which in part
suggests that "despite the impact of the total carbohydrate intake in a
meal on the postprandial glucose response, there remains a scarcity of
evidence regarding the effectiveness of basic carbohydrate counting as
a dietary approach for enhancing glycaemic control."

Compared with the standard dietary care group, [they] observed no
treatment effects of the BCC intervention on HbA1c from baseline to
end-of-treatment. Both groups (subject and control) experienced
comparable reductions in HbA1c and MAGE (mean amplitude of
glycemic excursions) from baseline to end-of-treatment at 6 months.

[They] found that BCC as add-on to standard dietary care did not reduce
HbA1c or MAGE, compared with standard dietary care in individuals
with T2 diabetes.

—I'm guessing BBC could be a hot topic on diabetes
forums, so I'm interested in hearing peoples' opinions
on this topic, whether from a pro or a con perspective.

PS: I'm very new to this condition, so I'm hardly an expert, that's for sure.

 

[zand]

Personally, I see carb counting as tedious and overly involving, and
even unnecessary—assuming of course one's medication is working
satisfactorily to control one's BG levels in the first instance.

I have carb counted for over 13 years as a T2. I am on no medication for my diabetes and prefer to keep it that way for as long as possible. My GP once told me that he had 303 diabetic patients and my HbA1c was consistently the lowest of all of them. So in my case I am sure carb counting helps.

As for being tedious, I do it to maintain my health for as long as possible. I can't think of anything more tedious than having diabetic complications.
I'm not sure what the site means by 'standard dietary care' which may vary from practice to practice.

Carb counting gets easier as you get used to portion sizes and carb values.

 

[Sarah69]

I don’t carb count or reduce carbs if I did the latter there wouldn’t be much left I could eat!

 

[Outlier]

I am literal so forgive me if I misunderstand.

I don't "count" carbs - I just avoid eating them. The only carbs that appear in my meals are the negligible amounts hiding in leafy veggies and other components of a keto diet. I do have a couple of squares of dark chocolate most days, and the odd small glass of red wine 10 days a month (a bottle lasts me 5 days hence the number of glasses per month). Sometimes I have a tot of whisky or brandy instead. I daresay I could add more carbs and calculate/measure each time, but I can't be bothered. I've done this for just under 4 years now and my BG has stayed in non-diabetic readings for all but the first few weeks without medication. I have lost a lot of weight, now being in an unremarkable size for my height. It isn't difficult, I eat when I'm hungry so effectively intermittent fasting is an everyday thing but I don't suffer for it. I have never found this regime difficult, boring or restrictive in terms of variety. I'm very happy to do this for the rest of my life.

Prior to that, I calorie counted all my adult life. It was miserable. I'm very happy to have waved all that goodbye.

Edited to add - I am a T2 so different rules apply for other types of diabetes. Also, taking meds and not going low-carb is a choice that many of us make. But that's the answer to a different question.

 

[JoKalsbeek]

I've kind of stopped counting and started guesstimating, because most of what I eat is low carb or no carb anyway, and numbers are not my thing. If it's carby, it's off the menu, because I've seen what it does to my BG levels. A "normal" goat's cheese sandwich for lunch, would raise my BG to 20+. (That was the last one I ever had, nine years ago). I don't know what my HbA1c was when I started cutting the carbs, because I was diagnosed the day my GP went on holiday via finger prick (after that sandwich, actually), and a HbA1c wasn't done until about 3 or 4 weeks later, upon her return, and by then I'd been trying all sorts of things, and had been put on metformin (big fail) and Gliclazide. At that point in time I was over 75 though, so a fair guess is that my HbA1c was potentially over 100 when I was still eating carbs. Since then I've been on various low carb diets and stopped the gliclazide, went from moderately low carb to keto to carnivore, back to keto, all of it sprinkled with intermittent fasting... And I've been between 42 and 34 or so, ever since. I notice an upwards trend (also in my weight) due to menopause and stress, but I'm still either in the non-diabetic or just barelty the prediabetic range.

And all that is just me. It's my insulin sensitivity and resistance, my stress levels, my fluctuating hormones, my insomnia and nightmares, so I'm just an experiment of one. But this is what I can attest to, and it works for me. Might not be so great for someone else. Might work like a charm.

 

[KennyA]

As a newly diagnosed Type 2 diabetic I've noticed many people here
putting a lot of stead on carbohydrate counting (BCC) as an important
(even critical) part of their BG levels, some as part of a sole dietary
therapy, and some as an adjunct only to their medication. It would
seem from the usually very positive and detailed comments posted
on these forums that carb counting is highly regarded in the diabetic
"community".

Personally, I see carb counting as tedious and overly involving, and
even unnecessary—assuming of course one's medication is working
satisfactorily to control one's BG levels in the first instance.

Anyway... a little bit of research brought up THIS site, which in part
suggests that "despite the impact of the total carbohydrate intake in a
meal on the postprandial glucose response, there remains a scarcity of
evidence regarding the effectiveness of basic carbohydrate counting as
a dietary approach for enhancing glycaemic control."

Compared with the standard dietary care group, [they] observed no
treatment effects of the BCC intervention on HbA1c from baseline to
end-of-treatment. Both groups (subject and control) experienced
comparable reductions in HbA1c and MAGE (mean amplitude of
glycemic excursions) from baseline to end-of-treatment at 6 months.

[They] found that BCC as add-on to standard dietary care did not reduce
HbA1c or MAGE, compared with standard dietary care in individuals
with T2 diabetes.

—I'm guessing BBC could be a hot topic on diabetes
forums, so I'm interested in hearing peoples' opinions
on this topic, whether from a pro or a con perspective.

PS: I'm very new to this condition, so I'm hardly an expert, that's for sure.

Thanks for posting this rather unusual paper. The thing that first jumps out at me about that bit of research is this in the exclusions from test: low daily carbohydrate intake (defined as below 25 E% or <100 g/day).

That would exclude me and a lot of other folks. Given that it's often said that low carb proper starts at a level of under ~130g/day, what the research actually appears to be doing is seeing how well people with a significant carb intake manage to estimate their actual carb intake. In addition the sample size is small, and the individuals involved had an average diabetes duration of 16 years, a high HbA1c (63mmol/l - which must be some sort of an average, although I'd like to know how that was calculated) and nine out of ten were on some sort of medication(s) - eg 41 of 47 participants were on metformin. So - I would guess that few, if any, of these folks were on anything that we'd recognise as a low carb way of eating. So there are a number of potential confounders right there.

However, the critical thing is that the paper says

Total carbohydrate intake remained unchained (sic, presume they mean unchanged) during the intervention period, and we did not find any other dietary changes.

I therefore don't find it in the least surprising that there was no change to HbA1c, regardless of how well or badly the study participants learned to estimate carbs. It seems obvious to me that carb-counting of itself can't do anything about blood glucose levels unless the information is then used to reduce carb intake.

It's a bit baffling that they infer that they sort of expected carb-counting itself to have some impact on blood glucose. My take would be that the study might demonstrate that teaching people with the characteristics of this group to carb count is pointless unless the information is then used to drive carb reduction. No carb reduction, no reduction in HbA1c. And to my mind to reduce carbs you really have to have some idea of how many you're actually eating.

 

[HSSS]

Personally, I see carb counting as tedious and overly involving, and
even unnecessary—assuming of course one's medication is working
satisfactorily to control one's BG levels in the first instance.

As well as being ridiculous that counting alone without modifications could effect anything this is making the assumption one is on medication and is happy to be and has zero side effects. All big assumptions. And the fact that medication alone doesn’t reduce long term complications (hence being known as progressive) as much as proper low carbing seems to I think addressing as close to the root cause as possible is better. If you were lactose intolerant would you drink milk? We are effectively carb intolerant.

Add in that almost all of us that do this have seen significant changes, that your quoted study didn’t, it seems obvious why we do it to me. Most sources do recognise true low carb as an effective tool now too, even if “official“ advice is currently quite mixed. In fact just this morning I read about NICE reviewing their current advice to make their guidance consistent and in line with more up to date NHS and research positions.

As for tedious I kind of agree. But I only actually counted/weighed consistently for a couple of weeks whilst I learned what my regular foods were and how they affected me. The longer I do it the less I need to count/check etc. Its quite rare to do more than glance at a label for me now. It’s been 8 yrs for me. Yes it’s a pain sometimes having to avoid what’s a mainstay of contemporary diets but I prefer my toes, eye and heart intact to having sugary and starchy junk on a regular basis.

 

[lovinglife]

Isn’t managing any condition “tedious” at times?

I’ve “counted carbs” in varying degrees from 100g down to keto for coming up 15 years and still not on any meds apart from a small dose of Metformin that I choose to take more for its other purported properties such as heart protection etc.

I’m on meds for other conditions and I find that remembering to take them at the right times with or without food etc far more tedious and time consuming than thinking oh that’s got rice/potato/pasta/whatever in that so no move on.

 

[Deleted member 596235]

Thanks for your responses thus far folks.

You've certainly explained—and helped clarify for me as
a newbie T2— what carbohydrate counting is all about,
from personal clinical perspectives. (Rather than from
smaller, purely academic studies.)

I'm very interested in different T2 opinions re food/carbs/meds
and their intimate relationships, as it's all a bit overwhelming
for me at the moment. Currently I'm not carb counting—at
least for the moment—as my meds are apparently doing their
jobs okay.

 

[Tony337]

Personally, I see carb counting as tedious and overly involving, and
even unnecessary—assuming of course one's medication is working
satisfactorily to control one's BG levels in the first instance.


PS: I'm very new to this condition, so I'm hardly an expert, that's for sure.

Hi and welcome
As a type 1 for 50 years i find your post fascinating and thought would you mind if i add my opinion??
Pleasantly ?

50 years ago aged just 6 i was taught in hospital that 10grams of carbohydrate was 1 line.
I could have 4 lines for breakfast 40g and the same for lunch and evening meal.

The only way to work this out was to carb count which my mum did as i was just 6 years old.

Insulins and tech has changes for the better but jog on 50 years to today and i still carb count and take insulin.

My last hba1c was 39 which is 5.7 i weigh 11 stone and am 5 ft 7 inch.

I could be in a restaurant now and pretty accurately work out the carbs at a glance of anyones plate.
Its like breathing to me.
Tedious? unnecessary?
It isn't to me ...its been integral in successful control.

I am not saying i'm right i'm just saying that is my belief and please don't think i'm criticizing'

Perhaps i shouldn't be posting but i read your post and it genuinely sent a little shiver down my spine....

I wish you well and again i don't want you to think i'm being rude

Tony

 

[Deleted member 596235]

Thanks Tony for your informative, and very first-hand comments.

And I'm always interested in other peoples' opinions (actually on
a whole range of things!) so please don't be concerned that you
may've offended me.

It's also pleasing to hear that you've got your dietary needs well
in hand—I need someone like you sitting next to me in restaurants!

Cheers.

 

[KennyA]

Thanks for your responses thus far folks.

You've certainly explained—and helped clarify for me as
a newbie T2— what carbohydrate counting is all about,
from personal clinical perspectives. (Rather than from
smaller, purely academic studies.)

I'm very interested in different T2 opinions re food/carbs/meds
and their intimate relationships, as it's all a bit overwhelming
for me at the moment. Currently I'm not carb counting—at
least for the moment—as my meds are apparently doing their
jobs okay.

If you're interested in the individual stuff.....the other thing is that I only need to be able to count to 25 or so, as that's my daily ration. So there's not a lot of arithmetic to do, as I don't eat any of the high-carb items* (and haven't for over five years) and it's just a question of making sure that the typical 2gs, 3gs, and 5g amounts in what I do eat don't tot up to too much. My aim is to stay in mild ketosis rather than using glucose as the main fuel, and I think I've got a bit of headroom for that at 25g/day. It's working well for me. Close enough is good enough, and I've never found the need to weigh and calculate.

I can't speak from experience about combining carb reduction with diabetic medication, as I've never been on any glucose restricting/lowering medication for T2. I have however been able to stop all the stuff I was on to deal with the impact of my raised blood glucose and other diabetic symptoms and stop using a CPAP.

The point of all this is the result, not the process. The result should be (my opinion) a BG at levels that can be sustained indefinitely and which won't cause or lead to eg physical damage to nerves and capillaries now or in the future. How anyone gets there is a matter both of what works for the individual, and personal choice.


(* For me this means potatoes, bread, cereals, fruit, pastry, pasta, rice, anything with sugar etc. I seem to handle carbs in beans and legumes reasonably well, but have a real problem with anything flour-based)

 

[EllieM]

I carb count too but like @Tony337 I am T1 so I need to carb count in order to dose my insulin dose correctly. (And I'm very attached to my insulin, because I'd be dead pretty fast without it.)

Am guessing with T2s who are not using insulin it's a question of eating whatever doesn't send their blood sugars too high (or too low if on glucose lowering meds) ? Carb counting is one method that may or may not help with this, depending on the individual.

 

[AndBreathe]

In my early days, I used a certain amount of carb counting as part of my overall personal T2 education programme. I also used a food diary, so that I could have better insight into whether X food or drink was impacting my blood sugars or not.

After a while I developed a decent idea of where the good stuff lay for me, and which food/drinks were not my friends.

For me, years of logging or counting carbs hasn't been necessary, but for some folks, it can become important as a means of staying on track. Carb creep can become an easy trap to fall into - particularly if blood sugar measurements are relaxed at the same time.

Bottom line is, we all have to develop our own ways of managing this condition, but for me, putting in the work up front to better understand what I was dealing with was important, and paid dividends.

I'm fortunate that I have never taken medication for diabetes, and that remains a long term aim, ideally staying in the non-diabetic ranges, whilst still living a full and active lifestyle.

Edited to change "carb count" to "Carb creep" which was my original intent.

 

[TC1763]

My area diabetes specialist nurse doesn’t believe in the low carbohydrates diet as helping for type 2 diabetic so although I was following the lower carbohydrates diet as per Diabetes UK diet and my readings were now from high 100s down to only 44 which is pre diabetic they have told me to go back to eating wholemeal bread in morning or porridge and having more carbohydrates in my diet so since I restarted my levels are back to on 79% in range and 8% over 13.3 according to my Libre sensor. So for me carbohydrates counting is getting to be a depressive thing as I watch my diabetic control go haywire again.

 

[Pipp]

Thanks for your responses thus far folks.

You've certainly explained—and helped clarify for me as
a newbie T2— what carbohydrate counting is all about,
from personal clinical perspectives. (Rather than from
smaller, purely academic studies.)

I'm very interested in different T2 opinions re food/carbs/meds
and their intimate relationships, as it's all a bit overwhelming
for me at the moment. Currently I'm not carb counting—at
least for the moment—as my meds are apparently doing their
jobs okay.

Many of our members with T2 manage their condition by reducing the carbs in their diet. Which necessitates being aware of the carb content of what they consume, and to start with this involves counting the carbs. Once they have established what level is optimal for their own personal circumstances, particularly if they tend to eat the same sort of meals, counting is less important, as they just know.

When newly diagnosed folks with T 2 are often told by HCPs that they have a progressive condition that will be managed by ever increasing meds. Should they choose that path that is up to them. Depending on such things as age, how high the HbA1c levels become at some stage they may need to start on insulin. The carb counting is essential then.

 

[Antje77]

And I'm always interested in other peoples' opinions (actually on
a whole range of things!)

I'm another T1 cross posting after this invitation.

Unlike the other T1's in this thread, I'm not much of a carb counter, although I know how many carbs my slice of low carb bread or a bottle of beer has, and with packaged foods I check the package to have an idea on the carbs. But I don't weigh the amount I eat so I'll still only have a rough idea on the carbs.
I usually eat lowish carb, but for my insulin dosing I go by choosing between virtually no carbs (no insulin except when it's my first meal; very little carbs; a bit more carbs; and impossible meal to dose for, all bets are off. For the first three I usually get it right with dosing, the last is the exception for special occasions.

So no tedious counting, weighing and calculating for me, more a general awareness of carbs.

 

[Antje77]

My area diabetes specialist nurse doesn’t believe in the low carbohydrates diet as helping for type 2 diabetic so although I was following the lower carbohydrates diet as per Diabetes UK diet and my readings were now from high 100s down to only 44 which is pre diabetic they have told me to go back to eating wholemeal bread in morning or porridge and having more carbohydrates in my diet so since I restarted my levels are back to on 79% in range and 8% over 13.3 according to my Libre sensor. So for me carbohydrates counting is getting to be a depressive thing as I watch my diabetic control go haywire again.

Well done on lowering your hba1c to healthy levels!

Why are you eating the things they tell you to if you clearly see it doesn't work?
Many of our members have been eating low carb for years, no matter what their diabetes nurse tells them.

 

[VashtiB]

Hello and welcome @ausGeoff from another aussie

Upfront to declare my bias is that I have managed my condition by diet alone for more than 4 years. I have only ever had one HbA1C reading in the diabetic range- because of this site.

Before my diagnosis I counted calories all the time- yes tedious and exhausting but I didn't know any better.

When I was first diagnosed I had a bit of a meltdown (well actually huge one) as I love carbs and couldn't imagine life without them. I went keto pretty much immediately as I wanted results fast- I'm not really that patient. I got the results fast so it paid off.

For me- like others above, the joy of keto is the lack of counting. I pretty much only eat things with minimal carbs. So not tedious. I struggle with keto from time to time and want to eat carbs- very quickly I return to the ease of not counting carbs by basically not eating any.

I want to avoid medication as long as possible. That may not be forever. For me at this time the choice that works for me is keto and no medication and no counting. But that's because this works for me at the moment.

However, the really important thing for me is that everyone chooses what works for them and their life but keeps the levels under control. If medication and not counting carbs works for you- go for it. The most important thing is managing your blood glucose levels- the method is much less important.

 

[Resurgam]

After 8 years I don't really need to count the carbs it is more down to estimating the percentage of a pack to have for a meal. I do check the weight once in a while, and glance at the nutrition info as - with carbs being cheap, - it is often good for the profits to reformulate to something higher in carbs every so often.
My usual ploy is just to tip out 1/2, 1/4 or 1/5th of the pack - depending on what it is, and what it is to be eaten with, and over the course of a week my daily carbs should even out to under 40 gm a day, with any luck. If I miscalculate or over indulge I might end up with rather fewer carbs than usual - but as I don't need medication or carbs to balance on a daily basis it is of little consequence.
When first starting out I was checking, counting and weighing but after a few months and seeing that I was no longer in the diabetes range, I was not so cautious.
Once in a while I go through and check that I am still on track, so far so good.