Counting Carbs and Calories for Type 2 Diabetes

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Counting Carbs and Calories for Type 2 Diabetes

Question:

I have a friend who has type 2 diabetes. He is confused about whether to count carbs or calories? Which is better for diabetes management?

Answer:

It depends whether your friend injects insulin or not. Type 2 diabetes does not always require treatment with insulin.

People with type 2 diabetes have a condition that does not allow their cells to react very quickly when the natural insulin levels in their bloodstream begins to rise. The result is higher than normal blood sugar. This is called "insulin resistance." Most people can improve insulin resistance with weight loss.

Most people who have type 2 diabetes are overweight. The goal is weight reduction by reducing the total number of calories. You do this by reducing your intake of carbohydrates and fats. I often advise people to reduce the number of calories they eat by 250 to 500 calories per day. For most diabetics, the recommended daily total will fall between 1,600 and 2,800 calories.

"Carb counting" is sometimes helpful for people with type 2 diabetes who use insulin injections. This allows a person to predict how much insulin is needed before a meal. A related strategy is to use "food-item exchange lists." In this case, the dose of insulin stays the same, but different types of food are chosen at different meals to "balance" the amount of carbs.

Mary Pickett, M.D., is a lecturer for Harvard Medical School and an assistant professor of medicine at Oregon Health & Science University in Portland, OR. At OHSU, she practices general internal medicine and teaches medical residents and students.

Last updated:	August 07, 2009