Circadian Rhythms and

Carbohydrate Counting
Mary Alice Volkert, MS, RD, CDE
Jayne Thomas, MEd, RD, CDE
 Circadian Rhythms

• Circadian rhythms are bodily changes

that follow a roughly 24 hour cycle,
responding primarily to the light and
darkness of the day. Therefore, as our
bodies release certain hormones at
different times of the day, blood sugar
levels, hunger, and metabolism follow
certain patterns throughout the day.
 Circadian Rhythms
• Early in the morning, our bodies know that dawn is
coming, and it is time to wake up. Therefore, the alarm
hormones, cortisol and adrenaline, are released
between 3 and 10am, which together tell your liver to
release glycogen (stored form of glucose) into your
bloodstream to give you a surge of energy in order to
start your day.

• If your body does not make or use enough insulin to

cover that extra sugar released by the liver, blood
sugars can be higher in the morning hours.
 Circadian Rhythms of the Day
• By 10:00am, your body believes that you
should be up by now. Therefore, the liver
stops releasing glucose, and you have
your first dip in blood sugar for the day.
This is why a mid- morning snack is
important to prevent a lower blood sugar.
Circadian Rhythms of the Day
• The next drop in blood sugar is around
3:00pm. Stress hormone levels begin to
decline, energy and focus decline, fatigue
sets in, and you may be most prone to
stress induced eating. Again, this is why a
healthy afternoon snack before this blood
sugar drop happens can be helpful.
 Circadian Rhythms of the Day
• The third drop in blood sugar is between 2 and
3am. Signs of this drop include vivid dreams and
night sweats, as your body is trying to wake you
up. The worse the dream, the lower the blood
sugar.

• A small bedtime snack between 8 and 11pm can

aid to prevent this overnight drop in blood sugar
levels.
 Circadian Rhythms
Knowledge of the Circadian Rhythms can help you
to:
1. Set your daily Carb Ratios;
2. Set your daily Correction Factors;
3. Adjust your Diabetes Medications;
4. Decide on Meal and Snack Times;
5. Keep you from getting too Hungry.
Carbohydrate Counting
 Why Count Carbohydrates?
• 90-100% of Carbs (Sugars and Starches) break down into
Glucose to nourish the Cells.

• Carbs include (per Choice or Unit):

Breads/Starches - 15 grams
Fruits - 15 grams
Milk/Yogurt - 12 grams
Low Starch Veggies - 5 grams

• Try to limit to 40-50% of total Calories/Day

Basic Nutrients - Carbohydrates
Energy Carbohydrates
Source
Sugar (Simple) Starch (Complex)
Sugar, Fruit, Fruit Breads, Rice, Cereals, Pasta,
Sources Juice, Soft Drinks, Dried Beans, Vegetables
Candy, Desserts

Functions 1. Fuel for quick energy

2. Spares protein from being used as fuel
3. Causes a rapid rise, then fall in blood sugar when
insulin is released
4. Works efficiently with insulin
5. Higher fiber choices provide longer term energy

Caloric 4 calories / gram

Value
Digestion 15-60 minutes
Time
 What about Proteins?
• About 58% of Protein Calories can be broken
down to Glucose.

• Important to count with a High Protein Diet

• Consider counting every 3 cooked ounces above

three ounces as 1 Carb choice.

• Try to limit Protein to 20-30% of your total

Calories/Day.
 Basic Nutrients - Protein
Energy Protein
Source

Sources Meat, Fish, Poultry, Cheese, Milk, Eggs, Beans

Functions 1. Can be used for fuel if needed
2. Prefers to be used for tissue growth and repair
3. Also used to make hormones and enzymes
4. Its gradual digestion stabilizes blood sugar
Caloric 4 calories / gram
Value
Digestion 3-5 hours
Time
 What about Fat?
• Less than 10% of Fat grams are converted into
Glucose.
• They can still cause high BG if you eat a
significant serving, such as fried foods, cream
sauces, abundant salad dressings, etc.
• There is no good way to calculate for such
overages.
• Limit to 25-35% of total Calories/Day.
 Basic Nutrients - Fat
Energy Fat
Source

Sources Margarine, Mayonnaise, Salad Dressing, Bacon, Oils

Functions 1. Prefers to be permanent storage
2. Gives satiety to food
3. Its slow digestion sustains blood glucose
4. Can block the action of insulin if consumed in excess
Caloric 9 calories / gram
Value
Digestion 5-6 hours
Time
 How do I Count My Carbs?
• Work with a Registered Dietitian or CDE to
Develop a Meal Plan.

• Know your appropriate Portions

• Weigh and Measure Foods at Home

• Keep a careful Food Diary along with your CGMS

or BG Log
 Refer to Good Resources
• Choose Your Foods Exchange Lists for Diabetes
by the American Diabetes Assn.
• Websites such as CalorieKing.com or fitday.com
• Phone apps such as myfitnesspal
• Cookbooks with Nutrient Breakdowns
• Nutrition Facts on the Food Label
Food Labels—Counting Fiber
 Food Labels—Sugar Alcohol
• Most end with the Letters “-ol”, such as Sorbitol,
Mannitol, Xylitol.
• Man-made Sweeteners, made NOT to be fully
Digested.
• Divide the Grams of Sugar Alcohol by 2 to
calculate Carbs.
• Don’t eat too much (>10 grams). It can have a
“Laxative Effect”!
Sugar Alcohol Label
What’s the bottom line here?
Counting Our Dinner
It’s just a Salad! Isn’t it free?