Published by PMR of NY & CT
If you or someone you love has diabetes, you may have seen "CCHO" on a hospital meal order or heard it from a diabetes educator. It stands for consistent carbohydrate, and the CCHO diet is a meal plan widely used in hospitals and diabetes education.
It's sometimes called a carb controlled diet, but it isn't about cutting carbs out. The goal is to keep the carbohydrate in each meal and snack about the same from day to day, eaten at roughly the same times. That steady pattern makes blood sugar more predictable and helps some diabetes medicines work as intended.
Your diabetes care team or a registered dietitian will set carb amounts that fit your body, medicines and activity.
What is a CCHO diet?
A consistent carbohydrate diet is a meal pattern rather than a list of banned foods. It's often recommended for people with type 1 or type 2 diabetes who take set doses of insulin or certain diabetes pills. If you adjust mealtime insulin to the carbs you eat, your care team may give you a more flexible plan.
Carbohydrates in bread, rice, pasta, cereal, fruit, milk, starchy vegetables, beans and sweets have the biggest effect on blood sugar. Protein and fat raise it much less.
Why consistency matters for blood sugar
Fixed doses of mealtime insulin, and some diabetes pills such as sulfonylureas, work best when you eat a predictable amount of carbohydrate. Eat far fewer carbs than usual and your blood sugar may drop too low. Eat far more and it may climb too high.
Consistency also makes your readings easier to understand. When carbs stay steady, you and your care team can see how medicine, activity, stress and illness affect your blood sugar.
Counting carb choices
Many people on a CCHO diet count carb choices. One carb choice is about 15 grams of carbohydrate, and each of these is roughly one:
- 1 slice of sandwich bread
- 1/3 cup of cooked rice or pasta
- 1/2 cup of cooked oatmeal
- 1 small apple or orange
- 1 cup of milk
- 1/2 cup of corn, green peas or mashed potatoes
For packaged foods, check total carbohydrate on the Nutrition Facts label and compare the listed serving with what you actually eat. Nonstarchy vegetables, such as cucumbers, broccoli, mushrooms and green beans, are low in carbs, so most plans let you enjoy them generously.
Your care team will tell you how many carb choices to aim for at each meal and snack.
Building a day of CCHO meals
- Eat at about the same times each day, and don't skip meals, especially if insulin or a sulfonylurea is part of your treatment.
- Spread carbs across the day instead of saving them for one big meal.
- Choose whole grains, beans and whole fruit more often than refined starches and sweets, since fiber helps blunt blood sugar spikes.
- Pair carbs with protein and nonstarchy vegetables.
- Drink water or other zero-calorie drinks, and save juice for treating low blood sugar.
For example, if your plan calls for three carb choices at lunch, a turkey sandwich on two slices of whole-grain bread plus a small apple fits.
How diabetes can affect nerves and joints
Over time, high blood sugar can damage nerves, a problem called diabetic neuropathy. It often starts as numbness and tingling or burning in the feet, so check your feet daily for cuts or sores you might not feel. People with diabetes also have higher rates of frozen shoulder and carpal tunnel syndrome.
Tell your doctor about any new nerve symptoms. EMG and nerve conduction testing can help show which nerves are affected and how much. Treating stiff or painful joints early also helps you keep moving, which supports blood sugar control.
Low and high blood sugar: when to act fast
Low blood sugar can come on quickly. Signs include shakiness, sweating, a fast heartbeat, hunger, irritability and confusion. Follow the plan your care team gave you, which often means taking 15 grams of fast-acting carbohydrate, such as 4 ounces of juice, and rechecking in 15 minutes.
Call 911 if someone with diabetes is very confused, has a seizure, passes out or can't swallow safely, and give glucagon if it has been prescribed. Don't give food or drink to a person who is unconscious. Also get emergency care for high blood sugar with vomiting, belly pain, fruity-smelling breath or fast, deep breathing.
Frequently asked questions
Is a CCHO diet the same as a low carb diet?
No. This plan focuses on keeping carbs steady from day to day, not necessarily low, and many people eat a moderate amount of carbohydrate at every meal. Some people with diabetes do choose lower-carb eating, but that change should be planned with your care team, since cutting carbs sharply can send blood sugar too low if your medicines aren't adjusted.
Can I still have dessert on a CCHO diet?
Often, yes, in small portions. Sweets count toward your carb choices, so a small dessert can take the place of another carb at the same meal, such as a slice of bread. Because sweets offer little fiber or nutrition, most plans keep them occasional. Checking your blood sugar afterward shows how a particular treat affects you.
Is a CCHO diet used for gestational diabetes?
A consistent carbohydrate pattern is often part of managing diabetes during pregnancy, usually with smaller meals and snacks spread through the day. Carb targets in pregnancy differ from other plans and can change as pregnancy progresses, so follow the plan from your OB, midwife, diabetes educator or registered dietitian rather than general guidelines.
Get help for nerve and joint symptoms
Staying active is one of the best things you can do for your blood sugar. If numbness, shoulder stiffness or joint pain is slowing you down, Physical Medicine & Rehabilitation of NY & CT (PMR) can evaluate what's behind it while your diabetes care team manages your meal plan. Request an appointment and our team will contact you.
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