Counting carbohydrates at restaurants and eating out

You compare with the portions you know from home. At a restaurant it is a good idea to choose dishes with the least complex structure, so that you can then mentally break the plate down into its component parts. You need to practice separately for the main course, the side dish, the bread, the sauce, the drink and the dessert. You can ignore the meat, the fish, the aged cheeses and the non-starchy vegetables from the outset. Even if you know what you ordered, it is easier to estimate the carbohydrates once the plate has arrived at the table [1].

When you have no access to a scale you have to rely on visual references. Your closed fist is equivalent to roughly 150 g of cooked rice or pasta. Your cupped hand holds half that much [2]. Do not forget that restaurant portions are often two to three times larger than the portions in the tables [3]. When you hesitate it is better to estimate slightly low, because hypoglycemia is more dangerous than a possible rise in blood glucose.

You ask about how it is prepared, not about grams. In the European Union, a restaurant is only required to declare the allergens, without a "Carbohydrate" line [4]. The number you actually need does not appear anywhere as a matter of obligation. As a result you have to find out for yourself what you need, through simple questions:

• whether the dish is breaded or grilled;
• whether the sauce is thickened with flour;
• whether the glaze, dressing or marinade contain sugar;
• whether the sauce can be served on the side, so that you decide how much to use;
• whether the side dish can be swapped for a salad or for something else that suits you better;
• how large the portion is for each dish you order [1].

These are ordinary questions, which restaurant staff hear every day. Allergen legislation has made this kind of conversation at the table something quite normal [4].

Mixed dishes, in which the source of carbohydrate is not easy to identify or to quantify by eye. Pasta with sauce, risotto, pilaf, lasagna, stews and some Asian dishes with sweet sauces fall into this category [5]. It is hard to judge how much pasta or rice lies under a thick sauce, and equally hard to tell how much starch was added to thicken it.

Thickened cream soups, home-made pies and cakes are also hard to estimate, as are all-you-can-eat side dishes. A watery sauce adds weight, but less carbohydrate. As a rule, 100 g of a mixed dish brings less than 100 g of plain pasta [6]. Sweet sauces are the most problematic, so it is better to avoid them as far as possible.

You measure them by eye, using your hand as the unit. A fistful of cooked rice or pasta brings roughly 40 g of carbohydrate [2]. A restaurant side dish often comes to a fist and a half, sometimes two. The bread on the table is easily forgotten when you count carbohydrates. A 30 g slice of bread brings about 15 g of carbohydrate.

French fries are the classic trap. Frying drives off the water and concentrates the starch, so 100 g brings about 40 g of carbohydrate, which is double that of boiled potatoes or even more [7]. Oil adds no carbohydrate, but it delays the rise in blood glucose. With mashed potato you have to allow for the milk. With any side dish, do not forget to add any sauce poured over the top.

They do, and in the large chains counting carbohydrates is generally easier. Restaurants publish their nutrition values on their website and sometimes in specialized apps [8]. In large restaurants the recipe and the portion are standardized, so the figure you read matches what you get more closely. A small restaurant, with home-style cooking, cannot offer you that level of predictability.

European regulations do not require restaurants to display carbohydrate values on the menu. You have to find out what the rules are in your own country [9]. Carbohydrate information is published voluntarily, so check the values before using them wherever you can. Watch out for the sauces, the drink and the large meal deals, where it is mainly the side dish and the glass that grow [10]. A half-liter sweet drink means roughly 50 g of carbohydrate on its own.

First you walk the length of the buffet without a plate. You see everything that is there and put together a plan. Then you go in two rounds. In the first round you take what counts for little: salads, non-starchy vegetables, meat, fish, aged cheeses, eggs [1].

The second round brings the carbohydrate part. You count it in visual units: a ladle, a large spoon, a slice, a fistful of rice [11]. It is best to count the carbohydrate while you are putting it on your plate, not at the end, from memory [12]. Splitting the dose for any complex situation such as this one is discussed with your doctor beforehand.

You treat a festive meal as several small meals. The starters, the main course, the cake and the repeated snacks stretch over several hours. A single dose given at the start does not fit that rhythm [13]. Work out with your doctor which approach suits you best. Do not forget to check your blood glucose two hours after the main course.

Alcohol calls for separate attention, even though in itself it does not count toward carbohydrate. Note that beer brings about 15 g of carbohydrate per half liter, and sweet cocktails a great deal more. You have to expect a tendency to hypoglycemia later on, overnight and the following morning, especially if you drink on an empty stomach [14]. Check your blood glucose at least in the evening, before bed and in the morning, ideally monitoring it with a sensor.

You prepare the ground before you leave. Look up a few typical local dishes at your destination and find out what their base is: rice, wheat, corn, potato or plantain. Download a carbohydrate counting app that also works without an internet connection. You relate unfamiliar food to something you already know. You compare a flatbread with slices of bread, and a portion of rice with your fist [11].

Changing time zones can bring additional problems. Traveling east shortens your biological day, which calls for adapting to a schedule with an earlier bedtime. In the other direction, traveling west lengthens your biological day, which calls for adapting to a schedule with a later bedtime and waking time. Adjusting the timing of your insulin doses for large time differences is done on your doctor's instructions [15].

You keep your insulin, your glucose and the rest of your medical devices in your hand luggage, never in the hold. Make sure in that case that you carry double the supplies you normally would. Do not forget to have something to eat with you at all times [16].

You wait and look at the trend in your blood glucose before adding insulin. Blood glucose usually rises in the first or the second hour. After a fatty meal, though, it can go up much later. The arrows on your sensor show you whether the value is still rising or has already started to come down [17]. Your doctor gives you the correction rule. In principle it is better not to rush, and to make small, repeated corrections if they are needed.

Remember that mealtime insulin acts for about four hours. Corrections given too early add up and can lead to hypoglycemia one or two hours later [18]. Write down the dish, your estimate and the result. Next time you will start from a better estimate of the carbohydrate. The same dish thus gradually becomes easier and easier to work out.

Fast-acting glucose, first of all. Here is what is worth having with you every time:

• fast-acting glucose — tablets, gel or a small sweet drink, in an amount sufficient for more than one hypoglycemic episode [16];
• your blood glucose measuring device — a meter with strips or a sensor, together with the phone on which you read its estimate;
• a spare meter, even if you generally rely on the sensor alone;
• your mealtime insulin, with a spare needle or with your pump supplies;
• a snack with a known amount of carbohydrate, in case the food is very late;
• your medical ID card or bracelet, stating that you have type 1 diabetes and that you use insulin [19].

Your phone battery should be as fully charged as possible, especially if your glucose estimate can only be seen there. The card or bracelet is of great help in situations where the signs of severe hypoglycemia can be mistaken for the effects of alcohol [14].