5
DM Type 1 and 2: Carbohydrate Management Strategies
➤ The RDN should educate adults with type 1 diabetes or type 2
diabetes on multiple daily injections (MDI) of insulin or insulin pump
therapy on carbohydrate counting using insulin-to-carbohydrate
ratios based on his or her abilities, preferences and management
goals. Research reports that carbohydrate counting using insulin-to-
carbohydrate ratios resulted in significant decreases in A1C of 0.4%–
1.6% and significant increases in quality of life, as well as continued
maintenance of these improvements for ≤44 months. The majority of
research reported no significant change in weight as a result of this
carbohydrate management strategy. (Strong, Conditional)
DM: Educate Adults with Type 1 or Type 2 Diabetes on Fixed Insulin
Doses or Adults with Type 2 Diabetes on Insulin Secretagogues
➤ The RDN should educate adults with type 1 diabetes or type 2
diabetes on fixed insulin doses or adults with type 2 diabetes on
insulin secretagogues, based on his or her abilities, preferences and
management goals, on carbohydrate consistency (timing and amount)
using one of the following carbohydrate management strategies:
• Carbohydrate counting alone
• Plate method, portion control and simplified meal plan
• Food lists (such as Choose Your Foods. Food Lists for Diabetes) and
carbohydrate choices.
For individuals using fixed insulin doses (or insulin secretagogues),
consistent carbohydrate intake with respect to time and amount can
result in improved glycemic control and reduce risk for hypoglycemia.
Monitoring carbohydrate intake, whether by carbohydrate counting
or experience-based estimation remains a key strategy in achieving
glycemic control. A simple diabetes healthful eating plan approach
such as portion control or healthful food choices may be better suited
to individuals with type 2 diabetes who have low health literacy or
numeracy concerns. (Fair, Conditional)
