From the Guidelines
Carb counts are essential for type 2 diabetics in-hospital to optimize glycemic outcomes and facilitate the creation of a discharge plan. According to the most recent guidelines from the American Diabetes Association, as stated in the 2025 standards of care in diabetes 1, medical nutrition therapy in the hospital should provide adequate calories to meet metabolic demands, optimize glycemic outcomes, address personal food preferences, and facilitate the creation of a discharge plan. The ADA does not endorse any single meal plan or specified percentages of macronutrients, but rather advises individualization based on treatment goals, physiological parameters, and medication use.
Some key points to consider when implementing carb counts for type 2 diabetics in-hospital include:
- Controlled carbohydrate meal plans, where the amount of carbohydrate on each meal tray is calculated, are preferred by many hospitals, as they facilitate matching the prandial insulin dose to the amount of carbohydrate given 1.
- Orders should indicate that the meal delivery and nutritional insulin coverage should be coordinated, as their variability often creates the possibility of hyperglycemic and hypoglycemic events 1.
- Hospital dietitians usually assess individual needs and may modify carbohydrate targets based on the patient's clinical status, medication regimen, and nutritional requirements.
- The practice of carb counting enables more precise glucose management, reduces glycemic variability, and helps prevent both hyperglycemia and hypoglycemia during hospitalization.
It's worth noting that while older guidelines, such as the 2019 standards of care in diabetes 1, also discuss the importance of insulin regimens and glucose management in the hospital setting, the most recent guidelines from 2025 1 provide the most up-to-date and relevant information on this topic.
From the Research
Importance of Carb Counts for Type 2 Diabetics In-Hospital
- Carb counts are essential for managing blood glucose levels in hospitalized patients with type 2 diabetes, as uncontrolled blood glucose levels can lead to deleterious effects on wound healing, increased risk of infection, and delays in surgical procedures or discharge from the hospital 2.
- Carbohydrate counting is an effective and efficient approach to improve glycemic control in hospitalized patients with diabetes, allowing for flexibility in food choices and improved staff satisfaction and confidence in hospital mealtime insulin dosing 3.
- The use of carbohydrate counting in diabetes clinical practice has been shown to be effective in meeting outcome goals and allows flexibility in food choices, with three levels of complexity identified: basic, intermediate, and advanced 4.
Benefits of Carb Counts for Type 2 Diabetics In-Hospital
- Carbohydrate counting can help improve glycemic control, reduce hypoglycemia, and increase patient satisfaction and confidence in insulin dosing 3, 5.
- The use of insulin-to-carbohydrate ratios can help nurses safely achieve glycemic targets and improve outcomes for patients using meal-time insulin 5.
- In-hospital continuous glucose monitoring (CGM)-guided insulin titration by diabetes teams can achieve a higher median time in range (TIR) and reduce time above range (TAR) and time below range (TBR) compared to point-of-care glucose testing 6.
Implementation of Carb Counts for Type 2 Diabetics In-Hospital
- Carbohydrate counting can be used by clients with type 1, type 2, and gestational diabetes, with three levels of complexity identified: basic, intermediate, and advanced 4.
- Nurses can assist and support patients with carbohydrate counting by evaluating glycemic control and providing guidelines for referral to diabetes education programs 5.
- In-hospital diabetes management by a diabetes team and insulin titration algorithms based on continuous glucose monitoring or point-of-care glucose testing can be an effective approach to managing hospitalized patients with type 2 diabetes 6.