The Sweet Stuff
Yes, you can work carbs into your life with diabetes, but it takes some planning
It may be the first thing people said to you when you were diagnosed with diabetes: "No more sugar!" Of course, that's not really true. But if you have diabetes, you probably hear a lot about sugar, carbohydrates, and carb counting. So what's it all about?
Carbohydrate is the general term for starches and sugar in the food you eat. It's how your body gets energy, and it's also the part of your diet that has the biggest and most direct effect on your blood glucose levels. That's why carbohydrate plays such a central role in your diabetes management.
But carbs can be confusing, from figuring out how much and which kinds you should have to understanding how they work in your body. Here's what you need to know about the relationship between your diabetes and the carbs you eat.
How It Works
Carbohydrates aren't only found in sugary foods. They're also in grains and breads, milk, beans, and even some vegetables (see "Where's the Carb?" below). After you eat, these foods are quickly broken down into glucose, a kind of sugar, which is deposited in the bloodstream.
To help glucose move from the blood into muscle and fat cells, where it can be used for energy, the pancreas secretes the hormone insulin. Before you developed diabetes, your body was able to produce as much insulin as you needed, no matter how much carbohydrate you ate and drank. It's different now. If you don't have enough insulin in your body to cover the carbohydrate from a meal, your blood glucose levels will go too high, which can do damage to cells and organs.
If you were recently diagnosed with type 2 diabetes, you may still be making some insulin. But your body can't handle a big load of carbohydrate at one time. This is where meal planning comes into play. A dietitian can help you figure out how many grams of carbohydrate your body can handle at each meal and snack. The recommendations will be based on many factors, including your weight, whether you are trying to gain or lose weight, your age, and your activity level. So for one person, an appropriate plan may allow for 75 grams of carbohydrate at a meal, while a plan designed for someone else might have only 45 grams. To give you a sense of how that looks in terms of real food, two slices of toast and a small glass of orange juice would get you to the 45-gram mark. (See "How Many Carbs Does It Have?" below.)
If you have type 1 diabetes or long-standing type 2 and use insulin, your body makes very little or no insulin of its own. You need to inject enough to cover the carbohydrate in a meal. If you are on set or fixed doses of insulin, for example, "10 units premixed insulin before breakfast and before dinner," you will need a meal plan that assures that you have the appropriate amount of carbohydrate for the amount of insulin you're taking. If you take mealtime insulin as a separate injection (not a premix), you can learn how to adjust the dose to cover the amount of carbohydrate you plan to eat. This will allow you to introduce flexibility into your meal plan, because you will not always have to eat a minimum amount of carbohydrate to "cover" your insulin.
While all carbohydrate foods provide your body with energy, some of them also contain other important nutrients. That's why Christy Parkin, MSN, RN, CDE, a diabetes educator in Carmel, Ind., says, "Don't give up carbs, because they're important. But you need to choose them very wisely."
What to Eat?
Whole grains, beans, and starchy vegetables provide vitamins, minerals, and fiber. In contrast, foods made with white flour, such as regular pasta and any bread item that is not true "whole wheat," have little fiber. Fruit has vitamins, minerals, and fiber, and no cholesterol, while milk products provide vitamins and minerals. (But whole or 2% milk, cheese, and sour cream have saturated fat, which is bad for your heart.) Another bonus: The carb foods that contain substantial fiber can also make you feel fuller and more satisfied, and you may be less likely to overeat.
Candy and other sweet treats, on the other hand, are "empty" calories—they have little if any vitamins, minerals, or fiber. Sweets are often mixed with fat (such as in chocolate and pastries), in which case they have a lot of empty calories. Still, people with diabetes can occasionally indulge in sweets. The keys are care and moderation. If you simply drink regular soda instead of your usual diet version, that will put the meal over your recommended carbohydrate (and calorie) range. Your after-meal blood glucose level will probably be higher than you'd like, unless you adjust your premeal insulin dose or exercise more after the meal. And if you frequently use extra insulin to cover extra carbs (whether it's sugary desserts or whole-wheat bagels), you'll gain weight.
You may also have heard about the "glycemic index," which ranks carbohydrate foods based on their effect on blood glucose levels. Foods with high values (such as corn flakes and instant potatoes) tend to raise blood glucose levels faster than foods with lower values (such as oatmeal). Using the glycemic index sounds like a great solution for a person with diabetes, but in reality it's pretty complicated. Many factors affect the actual glycemic index of a food, including how the food is prepared and even the time of day it's consumed. And since most of us eat more than one type of food in our meals, you would need to figure those in, too. But it is worth noting that different carbs will affect your blood glucose differently, and with good monitoring, you will get a sense over time of which carbs are better and worse for your post-meal glucose levels.
Fat is also a factor. It slows your body's absorption of carbohydrate, so it can cause a delayed rise in your blood glucose. (That's why it's better to use fat-free carbs like juice or glucose tablets to treat low blood glucose episodes.)
Yes, meal planning for diabetes can be complicated at first. But you can get the hang of it, and remember, you can also ask for help. A dietitian should be a vital part of your diabetes care team. A good dietitian will design a realistic meal plan for you—one that helps you reach your blood glucose goals and improve your overall health.
Marie McCarren is the author of Guide to Insulin & Type 2 Diabetes, Carb Counting Made Easy for People with Diabetes, and A Field Guide to Type 2 Diabetes.
How Many Carbs Does it Have?
You can't judge the amount of carb you're eating solely by how much food you're eating. Sugary foods pack a lot of carb in a small volume. For example, 4 tablespoons of maple syrup adds 53 grams of carb (and 200 calories) to your breakfast. In contrast, fresh fruit has water bulking it up. One small (4 oz.) apple has about 15 grams of carb.
You can find out how much carb is in a serving of food by looking in carb-counting books. Some cookbooks have this information, too. It may be listed with each recipe, or it may be listed for all the recipes in a chart at the end of the book.
For packaged foods, you have the information at your fingertips, in the Nutrition Facts all such foods are required to include. You want to pay particular attention to Serving Size and Total Carbohydrate.
Serving Size 1 slice (32 g)
Servings Per Container 21
Amount Per Serving
Calories from Fat 10
Total Fat 1 g
Saturated Fat 0 g
Cholesterol 0 mg
Sodium 170 mg
Total Carbohydrate 14 g
Dietary Fiber 2 g
Sugars 2 g
Protein 4 g
1. Note the Serving Size. For this bread, it's one slice.
2. Total Carbohydrate is for one serving. One slice of this bread has 14 grams of carb. Make a sandwich and you'll have 28 grams of carb from bread. (If you make a peanut butter and jelly sandwich, you'll need to add the grams of carb from the jelly, too—about 13 grams per tablespoon.)
3. Total Carbohydrate includes the grams of Dietary Fiber. Fiber is not digested and doesn't raise blood glucose. The general rule is: If a serving of the food has 5 or more grams of fiber, subtract the grams of fiber from Total Carbohydrate. Some people call what's left "net carbs" or "available carb."
4. These could be Sugars that naturally occur in the food, or they could be added sugars. The grams of Sugars are already included in Total Carbohydrate, so you don't have to pay special attention to this line.
A Fine Balance
You'll find carbohydrates in a number of different places.
Rice, flour, pasta, oats, cereal, tortillas, couscous
Fresh, dried, juice
Potatoes, corn, peas, plantains, butternut squash
Sugar, honey, candy, desserts, jelly, syrup, soda