To make it easier to estimate serving sizes and carb servings, everyday objects can be used to illustrate. A smaller palm of the hand may represent about 3 ounces while a medium palm may represent a 4-ounce portion. A large hand may have a palm size of 5 or more ounces. The same goes for smaller versus larger thumb sizes.

Another strategy is to fill measuring cups or spoons with some commonly eaten foods and pour them out onto a plate for the patient to visualize what a ½ cup serving of rice, pasta, or green peas looks like on a plate. Once you can visualize it, you may not need to measure it so precisely to get an estimate.

 

Now, let’s try our hand at carb-counting a meal.

Item Portion size Palm of hand, deck of cards 3 to 4 oz Thumb or matchbook 1 T Baseball (hardball) 1 cup Tennis ball 1 cup Volume inside a cupped hand 1/2 cup Muffin or cupcake liner 1/2 cup

*Keep in mind the differences in sizes of a person’s hand and thumb

 

Real World Carb Counting

Ok, now that we’ve discussed how to measure carb servings, how would you evaluate this meal?

It may be easiest to point out what counts as carbs. Not the coleslaw, not the avocado, lettuce, tomato, and mayo. But, the slices of bread, the milk, and the fruit cup--those are what we will count!

Let’s say that the sandwich is on a couple of larger slices of wheat bread. We might estimate that the two slices of bread are really more like three slices or three carb servings because they are a little oversized as compared to the small 1-ounce slice. And, if the milk is 1 cup, then it will count as 1 carb serving. Finally, we might estimate that the small fruit cup is about the size of a cupcake liner or ½ cup for 1 carb serving. So our total is 3 + 1 + 1, or 5 carb servings. That is the max for our optimal carb distribution. So what happens if a lunch mate offers his or her fruit cup? Well, it could be bagged up for later, traded for another carb serving, or our patient could just say “Thanks, but no!”

You get the idea! At your next meal, take a minute to add up your carb servings and see how you do!

 

Here might be a good place to mention a couple of exceptions. Sugar alcohols (polyols) are sweeteners with reduced calories, and include erythritol, isomalt, xylitol, and hydrogenated starch hydrolysates. These sweeteners contain half the calories of other sweeteners (2 kcal/g) and in some patients produce a smaller increase in postprandial blood glucose levels. Some patients may benefit from subtracting half of the sugar alcohol grams from the total carbohydrate grams when calculating the carbohydrate content of foods, as this practice can help if post-meal blood glucose excursions are seen.

And a similar situation exists with dietary fiber, as well. Dietary fiber usually isn’t fully digested, so if a food contains more than 5 grams of dietary fiber, half of the fiber grams can be subtracted from the total carbohydrate grams. This only works for some patients, and so should only be taught to patients who might benefit.

Coleslaw Thick turkey sandwich with avocado, lettuce, tomato, mayo Glass of milk Fruit cup with cut fresh fruit