Carbohydrates & Blood Sugar Control for People with Diabetes

Contrary to popular thinking, people with diabetes can enjoy moderate amounts of carbohydrates in their diets. The emphasis is on carbohydrate control NOT carbohydrate avoidance. Actually, carbohydrates are the body's preferred energy source, and roughly half of your daily calorie intake should come from carbohydrate foods. Carbohydrates are the starches and sugars in food. They are found in grains, starchy vegetables, fruit, milk, and sweets.

What is carbohydrate counting?

Carbohydrate counting is a meal planning approach that evenly distributes your carbohydrate calories throughout your day by counting out the right amount of carbohydrate foods for each meal and snack. The emphasis with carbohydrate counting is on how much carbohydrate you eat at any one time, NOT on which type of carbohydrate you choose. Stay away from fad diets that restrict the amount of carbohydrates you can eat.

What about sugar?

Research has shown that sugar does not raise blood sugar levels any more than starches do. This means you can eat sugary foods (cookies, cakes, pies, and candy) as long as you count them as part of your total carbohydrate intake. Keep in mind that foods high in sugar are often high in fat and calories, and if eaten in excess might elevate sugar and triglyceride levels, and can lead to weight gain.

What about sugar substitutes?

A sugar substitute is a sweetener that is used in place of sugar. The sugar substitutes approved by the Food and Drug Administration (FDA) are aspartame, saccharin, acesulfame potassium, sucralose, and neotame. All can be safely consumed in moderation. Sugar substitutes do not need to be counted in your meal plan. If they are used as a sweetener in food that contains few calories and no other carbohydrate (such as sugar-free soft drinks or sugar-free gelatin), that food is considered to be a "free food." If, on the other hand, the sugar substitute is used in a food that contains other carbohydrate sources (such as sugar-free pudding or sugar-free cookies), the total carbohydrate content must be counted. That food is not considered a "free food."

What about sugar alcohols?

Sugar alcohols, such as mannitol and sorbitol, are carbohydrates that are absorbed very slowly and therefore affect your blood sugar significantly less than sugars and starches. Because of this, they are often used as sweeteners in sugar-free foods. Sugar alcohols are not "free," and must still be counted as part of the total carbohydrate content of any food. Too many sugar alcohols can lead to diarrhea.

How do you count carbohydrates?

You can count grams of carbohydrates or carbohydrate choices. A "carbohydrate choice" is a portion of food from one of the carbohydrate food groups (grains/starches, fruits, milk, and sweets) that contains 15 grams of carbohydrate.

1 carbohydrate choice = 15 grams of carbohydrate. For example, 1 slice of bread from the starch group, 1 small apple from the fruit group, 1 cup of milk from the milk group, and ½ cup of ice cream from the sweets group are each called a carbohydrate choice and contain 15 grams of carbohydrate. Carbohydrate choices can also be calculated by referring to the total carbohydrate content on a food label. Do not count meats, non-starchy vegetables, or fats as carbohydrate choices.

How do you use the food label to count carbohydrates?

Looking at a food label, find the serving size and the total carbohydrate in that one serving. Note: Total carbohydrate includes sugar, starch, and fiber. Use the grams of total carbohydrate when carbohydrate counting.

To calculate the number of carbohydrate choices in that particular serving, simply divide the amount of total carbohydrate by 15.

Refer to the following information to assist with calculating carbohydrate choices:

• Grams of Carbohydrate 0-5
  • Do not count
• Grams of Carbohydrate 6-10
  • Counts as ½ carbohydrate choice
• Grams of Carbohydrate 11-20
  • Counts as 1 carbohydrate choice
• Grams of Carbohydrate21-25
  • Counts as 1½ carbohydrate choices
• Grams of Carbohydrate 26-35
  • Counts as 2 carbohydrate choices
• Grams of Carbohydrate 36-40
  • Counts as 2½ carbohydrate choices
• Grams of Carbohydrate 41-50
  • Counts as 3 carbohydrate choices
• Grams of Carbohydrate 51-55
  • Counts as 3½ carbohydrate choices
• Grams of Carbohydrate 56-65
  • Counts as 4 carbohydrate choices

What can I eat that won't raise my blood sugar?

Foods with fewer than 20 calories and 5 grams of carbohydrate are considered "free" foods. These include sugar-free beverages and sodas, spices, and seasonings. A word of caution: "dietetic," "diabetic," "no-sugar-added," and "low-carb" foods are not necessarily carbohydrate-free or low in calories. Please read food labels carefully.

Dietary fiber

Dietary fiber is the indigestible part of plant foods. There are two types of fiber: insoluble and soluble. Together, these two types of fiber can prevent constipation, lower blood cholesterol, and help you to feel fuller after meals. They might also benefit your blood sugar. The recommended fiber intake for people with diabetes is the same as that for the general population — 20 to 35 grams per day and foods containing whole grains (one-half of grain intake). It is important to gradually increase the fiber in your diet to avoid gas and bloating. It is also important to drink adequate fluids.

To increase your fiber intake:

• Choose whole grain foods.
• Choose more fruits and vegetables.
• Do not peel fresh fruits and vegetables.
• Include dried beans and peas in our meals.

How much carbohydrate do I need?

The amount of carbohydrate needed on a daily basis is different for each of us. As noted before, about half of the calories you eat should come from carbohydrates. This amount can vary from day to day depending on your activity level and other factors. Most women need about three to four carbohydrate choices (45-60 grams) at each meal. Men need about four to five carbohydrate choices (60-75 grams) at each meal. Eat one to two carbohydrate choices (15-30 grams) for a reasonable snack. See a registered dietitian to plan your carbohydrate needs.

Sample menu for FIVE carbohydrate choices per meal. Carbohydrate choices are in bold.

Breakfast

• 1 poached egg
• 2 slices whole wheat toast with margarine
• 1 cup grits
• 2 strips turkey bacon
• ½ cup orange juice or 1 small orange
• Coffee or tea

OR

• 1 whole wheat bagel with 1 ½ tsp. peanut butter
• 1 small banana
• Coffee or tea

Lunch

• Peanut butter and jelly sandwich made with 2 Tbsp. peanut butter, 2 Tbsp. jelly on 2 slices whole wheat bread
• 1 kiwi fruit
• 1 cup raw carrots
• Sugar-free iced tea

OR

• 3 oz. grilled chicken on whole grain bun with lettuce and tomato
• 1 Tbsp. light mayonnaise
• 17 small grapes
• 3 ginger snaps
• Sugar-free iced tea
• 1 cup soup

Dinner

• 3 oz. baked chicken
• 1 small sweet potato
• 1 cup green beans
• 2 small cornbread muffins
• ½ cup sugar-free banana pudding
• Sugar-free lemonade

OR

• 3 oz. broiled lean steak
• 1 small baked potato
• 1 ear of corn
• Salad with 2 Tbsp. low-fat dressing
• 1 small whole wheat dinner roll
• 1 cup melon cubes

Sample menu for Four carbohydrate choices per meal. Carbohydrate choices are in bold.

Breakfast

• 1 large bagel
• 1 ½ Tbsp. light cream cheese
• Coffee or tea

OR

• 1 ½ cup oat cereal
• 1 cup fat-free or low-fat milk
• 1 small banana
• Coffee or tea

Lunch

• 1 cup pasta
• ½ cup pasta sauce
• Tossed salad with 2 Tbsp. light dressing
• ½ cup low-fat cottage cheese
• Sugar-free iced tea

OR

• ½ cup tuna salad with 2 Tbsp. light mayonnaise on whole grain bun
• Carrot and celery sticks
• ½ cup light peaches
• 1 cup fat-free milk

Dinner

• 3 oz. lean broiled pork chop
• 1 cup mashed potatoes
• ½ cup carrots
• 1 slice whole wheat bread with light margarine
• ½ cup mixed fresh fruit
• Coffee or tea

OR

• 3 oz. grilled salmon
• 1 small baked potato
• 1 cup cooked broccoli
• 1 dinner roll
• ½ cup low-fat ice cream
• Sugar-free soda

Sample menus for THREE carbohydrate choices per meal.

Breakfast

• 2 slices whole wheat toast
• 1 Tbsp peanut butter
• 1 cup melon cubes
• Coffee or tea

OR

• ½ cup oatmeal
• 1 slice whole wheat toast with margarine
• 1 small banana
• Coffee or tea

Lunch

• 1 cup soup
• 6 soda crackers
• 17 small grapes
• 2-3 oz. low-fat cheese
• Sugar-free lemonade

OR

• 3 oz. turkey on 2 slices of rye bread with lettuce and tomato
• 1 Tbsp. light mayonnaise
• 1 small orange
• Sugar-free iced tea

Dinner

• 3 oz. grilled salmon
• 1 cup sweet potato
• ½ cup green beans
• ½ cup pineapple chunks
• Sugar-free lemonade

OR

• 3 oz. stir-fried chicken
• 1 cup cooked, non-starchy vegetables
• 1 cup rice
• Tossed salad with 2 Tbsp. light dressing
• Sugar-free lemonade

Snack ideas with ONE carbohydrate choice

• 3 cups popcorn
• 1 oz. chips (about 17)
• 1 cup berries
• 6 oz. sugar-free yogurt
• 1 medium cookie
• ½ cup sugar-free pudding
• ½ cup ice cream
• 3 ginger snaps

Snack ideas with TWO carbohydrate choices

• 1 medium granola bar
• 25 mini crackers
• 1 small bagel (2 ounces)
• 1 medium banana (8 ounces)
• ½ cup regular pudding
• ¾ cup low-carb cereal (15 grams of carbs) and 1 cup milk