Carbohydrate counting (carb counting) is a component of medical nutrition therapy (MNT) for diabetes management that facilitates the achievement of balance between life (e.g., physical activity, nutrition, stress, infections and medications that may cause glycaemic derangements), the medications needed to manage diabetes and blood glucose levels. It ranges from basic carbohydrate awareness to advanced carbohydrate counting. Carb counting is well-documented as an effective approach to improve glycaemic management in diabetes, particularly in clients who are using a ‘basal-bolus’ insulin regimen to replace endogenous insulin secretion. This regimen includes the use of intermediate- or long-acting insulin in a basal role, together with short- or rapid-acting pre-prandial insulin boluses.
Full insulin replacement is essential for all people with type 1 diabetes mellitus, first for survival and then to achieve the longest possible time in a healthy range of blood glucose that results in the lowest short term metabolic risk and long-term vascular risk. In contrast, many people with type 2 diabetes mellitus may only require insulin supplementation to manage persistent hyperglycaemia, although full insulin replacement may be needed late in the natural history of the condition. Carb counting thus may be useful to complement insulin therapy for the management of both type 1 and type 2 diabetes.
Clear evidence demonstrates that client-centred self-management education and support improves clinical outcomes in diabetes. The input of registered dietitians as part of a multidisciplinary team can contribute greatly by identifying dietary habits, food preferences and daily routines in the negotiation and selection of an individualised insulin regimen. Dietary education offers insight and options, and may help clients feel less restricted in their food choices, improve quality of life, and may help clients feel less restricted in their food choices, improve quality of life, and relieve the actual and perceived burdens of diabetes.