Figuring out how many carbs to eat when you have diabetes can seem confusing.
Meal plans created by the American Diabetes Association (ADA) provide about 45% of calories from carbs. This includes 45–60 grams per meal and 10–25 grams per snack, totaling about 135–230 grams of carbs per day.
However, a growing number of experts believe people with diabetes should be eating far fewer carbs than this. In fact, many recommend fewer carbs per day than what the ADA allows per meal.
This article takes a look at the research supporting low-carb diets for diabetics and provides guidance for determining optimal carb intake.
Glucose, or blood sugar, is the main source of fuel for your body's cells.
In people with diabetes, the body's ability to process and use blood sugar is impaired.
Although there are several types of diabetes, the two most common forms are type 1 and type 2 diabetes.
Type 1 Diabetes
In type 1 diabetes, the pancreas is unable to produce insulin, a hormone that allows sugar from the bloodstream to enter the body's cells. Instead, insulin must be injected to ensure that sugar enters cells.
Type 1 diabetes develops because of an autoimmune process in which the body attacks its own insulin-producing cells, which are called beta cells. This disease is usually diagnosed in children, but it can start at any age, even in late adulthood (1).
Type 2 Diabetes
Type 2 diabetes is more common, accounting for about 90% of people with diabetes. Like type 1 diabetes, it can develop in both adults and children. However, it isn't as common in children and typically occurs in people who are overweight or obese.
In this form of the disease, either the pancreas does not produce enough insulin or the body's cells are resistant to insulin's effects. Therefore, too much sugar stays in the bloodstream.
Over time, the beta cells of the pancreas can wear out as a result of pumping out more and more insulin in an attempt to lower blood sugar. They can also become damaged from high levels of sugar in the blood (2).
Diabetes can be diagnosed by an elevated fasting blood sugar level or an elevated HbA1c level, which reflects blood sugar control over a period of two to three months.
Diabetes is diagnosed by a fasting blood sugar of at least 126 mg/dL (7 mmol/L) or an HbA1c of at least 6.5% (3).
Prediabetes
Before type 2 diabetes occurs, blood sugar levels are elevated but not high enough to be diagnosed as diabetes. This stage is known as prediabetes.
Prediabetes is diagnosed by a blood sugar level between 100–125 mg/dL (5.6–6.9 mmol/L) or an HbA1c between 5.7–6.4% (3).
While not everyone with prediabetes goes on to develop type 2 diabetes, it's estimated that approximately 70% will eventually become diabetic (4).
What's more, even if prediabetes never progresses to diabetes, people with this condition may still be at an increased risk of heart disease, kidney disease and other complications related to high blood sugar levels (4).
BOTTOM LINE:Type 1 diabetes is due to the destruction of pancreatic beta cells, while type 2 diabetes occurs when cells are resistant to insulin or the pancreas doesn't make enough. Prediabetes often progresses to diabetes.
Blood sugar levels are affected by many things, including exercise, stress and illness.
However, one of the major factors affecting your blood sugar is the type and amount of food you consume.
Of the three macronutrients — carbs, protein and fat — carbs have the greatest effect on blood sugar by far.
This is because when your body digests carbs, they are broken down into sugar, which enters your bloodstream.
This occurs with all carb-containing foods, such as refined carb sources like chips and cookies, as well as healthy types like fruits and vegetables.
However, whole foods contain fiber. Unlike starch and sugar, naturally occurring fiber in food does not raise blood sugar levels.
When diabetics eat foods high in digestible carbs, their blood sugar can rise to very high levels. Eating large portions of these foods typically requires high doses of insulin or diabetes medication to control blood sugar.
Because they are unable to produce insulin, people with type 1 diabetes need to inject insulin several times a day, regardless of what they eat. However, eating fewer carbs can significantly reduce their mealtime insulin dosage.
BOTTOM LINE:Your body breaks down carbs into sugar, which enters the bloodstream. People with diabetes who eat a lot of carbs require insulin or medication to keep their blood sugar from rising too much.
There are many studies supporting the use of carb restriction in diabetics.
Very Low-Carb, Ketogenic Diets
Very low-carb diets typically induce mild to moderate ketosis, a state in which your body uses ketones and fat, rather than sugar, as its main energy sources.
Ketosis usually occurs at daily intakes of less than 50 grams of total carbs, or 30 grams of digestible carbs (total carbs minus fiber). This would be no more than 10% of calories on a 2,000-calorie diet.
Very low-carb, ketogenic diets have been around for many years. Indeed, doctors prescribed them for people with diabetes before insulin was discovered in 1921 (5).
Several studies have shown that restricting carb intake to 20–50 grams of carbs per day can significantly reduce blood sugar levels, promote weight loss and improve heart health markers in people with diabetes (6, 7, 8, 9, 10, 11, 12, 13, 14, 15).
In addition, these improvements often occur very quickly.
For instance, in a study of obese people with diabetes, limiting carbs to 21 grams per day led to a spontaneous decrease in calorie intake, lower blood sugar levels and a 75% increase in insulin sensitivity in two weeks (14).
In a small, three-month study, people were randomized to consume a calorie-restricted, low-fat diet or a low-carb diet containing up to 50 grams of carbs per day.
The low-carb group had an average decrease in HbA1c of 0.6% and lost over twice as much weight as the low-fat group. Also, 44% of the low-carb group discontinued at least one diabetes medication, compared to 11% of the low-fat group (15).
In fact, in several studies, insulin and other diabetes medications have been reduced or discontinued due to improvements in blood sugar control (6, 8, 10, 11, 13, 15).
Diets containing 20–50 grams of carbs have also been shown to lower blood sugar levels and reduce the risk of disease in people with prediabetes (15, 16, 17).
In a small, 12-week study of obese, prediabetic men who followed a Mediterranean diet limited to 30 grams of carbs per day, fasting blood sugar dropped to 90 mg/dL (5 mmol/L), on average, which is well within the normal range (17).
In addition, the men lost an impressive 32 pounds (14.5 kg) and experienced significant reductions in triglycerides, cholesterol and blood pressure, among other beneficial health effects (17).
Importantly, these men no longer met the criteria for metabolic syndrome due to reductions in blood sugar, weight and other health markers.
Although concerns have been raised that higher protein intake on low-carb diets may lead to kidney problems, a recent 12-month study found that very low carb intake did not increase the risk of kidney disease (18).
BOTTOM LINE:Many studies have shown restricting carbs to 20–50 grams, or less than 10% of calories, per day may lower blood sugar, promote weight loss and improve health markers in people with diabetes and prediabetes.
Low-Carb Diets
There is currently no agreement on how many carbs a low-carb diet contains.
However, for purposes of this article, the term "low-carb" will refer to diets containing 50–100 grams of carbs, or 10–20% of calories, per day.
Although there are very few studies on carb restriction for type 1 diabetics, most that exist have used carb intakes in the low-carb range. In each case, impressive results have been reported (19, 20, 21).
In a long-term study of people with type 1 diabetes who were advised to restrict carbs to 70 grams per day, those who complied reduced their A1c from 7.7% to 6.4%, on average. What's more, their A1c levels remained the same four years later (20).
A 1.3% reduction in HbA1c is a significant change to maintain over several years, particularly in those with type 1 diabetes.
One of the biggest concerns for people with type 1 diabetes is hypoglycemia, or blood sugar that drops to dangerously low levels.
In a 12-month study, adults with type 1 diabetes who restricted daily carb intake to less than 90 grams had 82% fewer episodes of low blood sugar than before they started the diet (21).
People with type 2 diabetes may also benefit from limiting their daily carb intake to 50–100 grams, or up to 20% of calories (22, 23, 24).
In a small, five-week study, men with type 2 diabetes who consumed a high-protein, high-fiber diet providing 20% of calories from carbs per day experienced a 29% reduction in fasting blood sugar, on average (23).
BOTTOM LINE:Research suggests a daily carb intake of 50–100 grams, or 10–20% of calories, may lower blood sugar levels in people with diabetes. It may also help reduce episodes of low blood sugar in people who take insulin.
Moderate, Low-Carb Diets
As with "low-carb" diets, there is no formal definition for "moderate, low-carb diets." In this article, "moderate low-carb" will refer to diets providing 100–150 grams of digestible carbs, or 20–35% of calories, per day.
A few studies looking at diets within this range have reported good results in people with diabetes (25, 26).
In a 12-month study of 259 people with type 2 diabetes, those who followed a Mediterranean diet providing 35% or fewer calories from carbs experienced a significant reduction in HbA1c, from 8.3% to 6.3%, on average (26).
BOTTOM LINE:A few studies have found that diets providing 100–150 grams of carbs, or 20–35% of calories, per day may lower blood sugar levels in people with diabetes.
How Low Should You Go?
Research has confirmed that many levels of carb restriction effectively lower blood sugar levels.
Since carbs raise blood sugar, reducing them to any extent can help control how much your blood sugar rises after eating.
For instance, if you're currently consuming about 250 grams of carbs daily, reducing your intake to 130 grams should result in significantly lower blood sugar after meals, as the few, moderate, low-carb studies that are available have shown.
However, most studies have looked at blood sugar response in people with diabetes who consume 20–50 grams of carbs per day.
This level appears to produce the most dramatic results, including blood sugar improvement that reduces or even eliminates the need for insulin or diabetes medication.
BOTTOM LINE:Studies have shown that a daily carb intake between 20–150 grams, or 5–35% of calories, may effectively manage diabetes and prediabetes. Very low-carb diets may have the greatest effect.
There are many tasty, nutritious, low-carb foods that do not raise blood sugar levels very much.
These can be enjoyed in moderate to liberal amounts on low-carb diets.
However, there are certain foods that should be limited or avoided because of their high carb content:
- Breads, muffins, rolls and bagels
- Pasta, rice, corn and other grains
- Potatoes, sweet potatoes/yams and taro
- Legumes like peas, beans and lentils (except green beans, snow peas and peanuts)
- Milk and sweetened yogurt
- Most fruit, except for berries
- Cake, cookies, pie, ice cream and other sweets
- Snack foods like pretzels, chips and popcorn
- Juice, soda, sweetened iced tea and other sugar-sweetened drinks
- Beer
Keep in mind that not all of these foods are unhealthy. For example, fruits and legumes can be highly nutritious. However, they can be problematic for diabetics who are trying to manage their blood sugar levels by eating fewer carbs.
On the other hand, you can eat plenty of low-carb vegetables, nuts, seeds, avocados, meat, fish, eggs, full-fat dairy and other foods.
BOTTOM LINE:Although many delicious foods can be included on a low-carb diet, those that are high in carbs should be limited or avoided altogether.
Low-carb diets have consistently been shown to lower blood sugar and improve other health markers in people with diabetes.
However, certain higher-carb diets have also been credited with similar beneficial health effects.
For example, some studies on low-fat vegan and vegetarian diets suggest that this way of eating may lead to better blood sugar control and overall health (27, 28, 29, 30).
In a 12-week study, a brown rice-based vegan diet containing 268 grams of total carbs (72% of calories) lowered people's HbA1c more than the standard Korean Diabetes Association diet containing 249 grams of total carbs (64% of calories) (30).
An analysis of four studies found that people with type 2 diabetes who followed a low-fat, macrobiotic diet containing about 70% of calories from carbs achieved significant reductions in blood sugar and other health markers (31).
The Mediterranean diet has also been shown to improve blood sugar control and provide other health benefits in individuals with diabetes (32, 33).
However, it's important to note that these diets weren't directly compared to low-carb diets, but rather to standard, low-fat diets often used for diabetes management.
In addition, there aren't as many studies on these diets as there are on low-carb diets. While they may be effective for certain people, more research is needed to confirm these findings.
BOTTOM LINE:Studies suggest that certain higher-carb diets may be effective for diabetes management. However, research comparing these diets to low-carb diets is needed.
Although studies have shown that many different levels of carb intake may help control blood sugar, the optimal amount varies by individual.
It is worth repeating that diets containing 20–50 grams of carbs per day have been studied the most and typically produce the most dramatic results in diabetics.
However, in addition to keeping blood sugar levels within a healthy range, it's important to eat the amount of carbs at which you feel best, as well as that you can realistically maintain in the long term.
Therefore, figuring out how many carbs to eat requires some testing and evaluating to find out what works best for you.
To determine your ideal carb intake, measure your blood sugar with a blood glucose meter before a meal and again one to two hours after eating.
The maximum level your blood sugar should reach is 139 mg/dL (8 mmol/L) in order to prevent damage to blood vessels and nerves.
However, you may want to aim for an even lower upper limit.
To achieve your blood sugar goals, you may need to restrict your carb intake to less than 10 grams, 15 grams or 25 grams per meal.
Also, you may find that your blood sugar rises more at certain times of the day, so your upper carb limit may be lower for breakfast than lunch or dinner.
In general, the fewer carbs you consume, the less your blood sugar will rise and the less diabetes medication or insulin you'll require to stay within a healthy range.
If you take insulin or diabetes medication, it's very important to speak with your doctor or health care provider prior to reducing your carb intake so that your dosage can be adjusted to prevent low blood sugar.
BOTTOM LINE:Determining the optimal carb intake for diabetes management requires testing your blood sugar and making adjustments as needed based on your response, including how you feel.
Based on the evidence to date, conventional recommendations that diabetics should consume at least 45% of their daily calories from carbs appear misguided.
Multiple studies have shown that a daily carb intake of 20–150 grams, or between 5–35% of calories, not only leads to better blood sugar control but may also promote weight loss and other health improvements.
Therefore, a carb-restricted approach may be your best bet to keep your blood sugar within a healthy range.
However, even among people with diabetes, some individuals can tolerate more carbs than others.
Testing your blood sugar and paying attention to how you feel at different carb intakes can help you find your own personal range for optimal diabetes control, energy levels and quality of life.
How to Count Carbs in 10 Common Foods
What are carbohydrates?
Carbohydrates are sugar-based
molecules found in many foods, from cookies to cantaloupes.
If you have diabetes, planning your carb intake—and sticking to the plan—is critical to keep blood sugar on an even keel and to cut your risk of diabetes-related problems like heart disease and stroke.
Whether or not you have diabetes, you should aim to get about half your calories from complex carbohydrates (which are high in fiber), 20-25% from protein, and no more than 30% from fat, says Lalita Kaul, PhD, RD, a spokesperson for the American Dietetic Association.
If you have diabetes, planning your carb intake—and sticking to the plan—is critical to keep blood sugar on an even keel and to cut your risk of diabetes-related problems like heart disease and stroke.
Whether or not you have diabetes, you should aim to get about half your calories from complex carbohydrates (which are high in fiber), 20-25% from protein, and no more than 30% from fat, says Lalita Kaul, PhD, RD, a spokesperson for the American Dietetic Association.
How to read a food label
The Nutrition Facts label
lists the total amount of carbohydrates per serving, including carbs from
fiber, sugar, and sugar alcohols. (If you're counting carbs in
your diet, be aware that 15 grams of carbohydrates count as one serving.)
Sugar alcohols are often used in sugar-free foods, although they still deliver calories and carbs. Sugar alcohols and fiber don't affect blood sugar as much as other carbs, because they're not completely absorbed.
If food contains sugar alcohol or 5 or more grams of fiber, you can subtract half of the grams of these ingredients from the number of total carbs. (See more details at the American Diabetes Association and University of California, San Francisco.)
Sugar alcohols are often used in sugar-free foods, although they still deliver calories and carbs. Sugar alcohols and fiber don't affect blood sugar as much as other carbs, because they're not completely absorbed.
If food contains sugar alcohol or 5 or more grams of fiber, you can subtract half of the grams of these ingredients from the number of total carbs. (See more details at the American Diabetes Association and University of California, San Francisco.)
How many carbs per day?
If you eat 2,000 calories a
day, you should consume about 250 grams of complex carbohydrates per day.
A good starting place for people with diabetes is to have roughly 45 to 60 grams of carbs per meal and 15 to 30 grams for snacks. While snacks are key for people with diabetes who use insulin or pills that increase insulin production (otherwise, they run the risk of low blood sugar), they aren’t essential for non-insulin users.
The goal for anyone with diabetes, whether or not they use insulin, is to keep their blood sugar as steady as possible and to maximize their intake of nutritious carbs and minimize consumption of less healthy ones.
A good starting place for people with diabetes is to have roughly 45 to 60 grams of carbs per meal and 15 to 30 grams for snacks. While snacks are key for people with diabetes who use insulin or pills that increase insulin production (otherwise, they run the risk of low blood sugar), they aren’t essential for non-insulin users.
The goal for anyone with diabetes, whether or not they use insulin, is to keep their blood sugar as steady as possible and to maximize their intake of nutritious carbs and minimize consumption of less healthy ones.
Fine-tune your intake
You may need to work with a
nutritionist or diabetes educator to fine-tune your carb requirements, based on
your activity level, whether you want to lose weight, and whether or not you
use insulin.
Checking your blood sugar before and after meals is also important as you test-drive your carb-counting plan. If certain foods—like fruit juice or pasta—cause your blood sugar to spike, you’ll need to consume these in smaller portions.
Checking your blood sugar before and after meals is also important as you test-drive your carb-counting plan. If certain foods—like fruit juice or pasta—cause your blood sugar to spike, you’ll need to consume these in smaller portions.
Bread
1 slice of bread = 15 grams or
1 serving of carbohydrate
Although white and wheat bread have similar carb content (check the food label for details), whole-wheat bread is your best bet; it typically has more than twice as much fiber as white bread, meaning you digest it more slowly and your blood sugar will rise more gradually after you eat it.
People with diabetes should aim to consume 30 grams of fiber daily, even though this can be hard on the digestive system for some people, says Kaul, a professor at Howard University College of Medicine, in Washington, D.C. She also suggests trying extra-thin bread, which can slice your calorie intake in half.
Although white and wheat bread have similar carb content (check the food label for details), whole-wheat bread is your best bet; it typically has more than twice as much fiber as white bread, meaning you digest it more slowly and your blood sugar will rise more gradually after you eat it.
People with diabetes should aim to consume 30 grams of fiber daily, even though this can be hard on the digestive system for some people, says Kaul, a professor at Howard University College of Medicine, in Washington, D.C. She also suggests trying extra-thin bread, which can slice your calorie intake in half.
Cooked pasta
One-third cup of pasta = 15
grams or 1 serving
Again, opting for whole-wheat noodles rather than pasta made with white flour is a healthier choice. But it’s important to remember—and easy to forget—portion size.
Just one-third of a cup, which is about half the size of a baseball, contains 15 grams of carbohydrate. If you overload your pasta bowl, you could easily get a day’s worth of carbs in a single meal.
Again, opting for whole-wheat noodles rather than pasta made with white flour is a healthier choice. But it’s important to remember—and easy to forget—portion size.
Just one-third of a cup, which is about half the size of a baseball, contains 15 grams of carbohydrate. If you overload your pasta bowl, you could easily get a day’s worth of carbs in a single meal.
Cereal
3/4 cup of dry cereal = 15
grams or 1 serving
Eating breakfast is important for all of us, but especially so for people with diabetes; a balanced morning meal helps you start the day healthy and energized.
A bowl of cereal with skim milk is a great choice for the first meal of the day, says Kaul, but you should avoid sugary, low-fiber cereals like corn flakes.
Oat bran cereal is a better option, the nutritionist says. Try it, and if you don’t like it, choose something else.
Eating breakfast is important for all of us, but especially so for people with diabetes; a balanced morning meal helps you start the day healthy and energized.
A bowl of cereal with skim milk is a great choice for the first meal of the day, says Kaul, but you should avoid sugary, low-fiber cereals like corn flakes.
Oat bran cereal is a better option, the nutritionist says. Try it, and if you don’t like it, choose something else.
Crackers
4-6 Saltines = 15 grams or 1
serving
When you snack on crackers, checking the label for trans fat and sodium is just as important as looking out for carb content, Kaul notes. Even relatively low-carb crackers may contain unhealthy fats and too much salt.
Choose crackers with no more than 200 milligrams of sodium per serving of carbs, and leave the ones that contain trans fat on the supermarket shelf.
When you snack on crackers, checking the label for trans fat and sodium is just as important as looking out for carb content, Kaul notes. Even relatively low-carb crackers may contain unhealthy fats and too much salt.
Choose crackers with no more than 200 milligrams of sodium per serving of carbs, and leave the ones that contain trans fat on the supermarket shelf.
Fruit
One small piece = 15 grams or
1 serving
You really can’t go wrong with fruit, says Kaul, as long as you keep an eye on portion size. However, if you have diabetes, fruits like apples, bananas, berries, cantaloupes, strawberries, and peaches are the best choices. Pears and grapes can have too much sugar, she explains.
A medium banana has about 15 grams of carbs, plus it is filling and chock-full of potassium. Berries are rich in fiber and antioxidants. But just remember how much fruit you’re eating.
One serving of berries is just 3/4 of a cup, but it’s easy to eat three times this much—or more—if you’re not careful.
You really can’t go wrong with fruit, says Kaul, as long as you keep an eye on portion size. However, if you have diabetes, fruits like apples, bananas, berries, cantaloupes, strawberries, and peaches are the best choices. Pears and grapes can have too much sugar, she explains.
A medium banana has about 15 grams of carbs, plus it is filling and chock-full of potassium. Berries are rich in fiber and antioxidants. But just remember how much fruit you’re eating.
One serving of berries is just 3/4 of a cup, but it’s easy to eat three times this much—or more—if you’re not careful.
Fruit juice
1/2 cup fruit juice = 15 grams
or 1 serving
Kaul tells her clients to choose fruit instead of fruit juice, because fruit contains fiber. And juice—even the unsweetened, natural kind—is high in calories. “Three glasses will give you 300 to 400 calories,” she says.
People who don’t want to give up their OJ should have a small glass with breakfast, she says. And instead of consuming giant-size bottles of sweetened drinks, drink water or unsweetened tea.
Kaul tells her clients to choose fruit instead of fruit juice, because fruit contains fiber. And juice—even the unsweetened, natural kind—is high in calories. “Three glasses will give you 300 to 400 calories,” she says.
People who don’t want to give up their OJ should have a small glass with breakfast, she says. And instead of consuming giant-size bottles of sweetened drinks, drink water or unsweetened tea.
Milk
1 cup nonfat skim milk = 15
grams or 1 serving
Dairy foods provide calcium, protein, vitamin D, and other key nutrients, so if you like them, definitely include them in your diet.
But skip full-fat milk for skim, and choose low- or no-fat dairy products.
People with diabetes frequently have high cholesterol and high triglycerides, and weight is often a concern, hence avoiding dairy fats is important, Kaul explains.
Dairy foods provide calcium, protein, vitamin D, and other key nutrients, so if you like them, definitely include them in your diet.
But skip full-fat milk for skim, and choose low- or no-fat dairy products.
People with diabetes frequently have high cholesterol and high triglycerides, and weight is often a concern, hence avoiding dairy fats is important, Kaul explains.
Yogurt
1 cup of light or plain yogurt
= 15 grams or 1 serving
Yogurt is a great, healthy choice, as long as you go the nonfat route.
Flavored yogurt is frequently full of sugar, so check the carb content. You may want to skip it and make your own by adding chopped-up fruit and nuts to plain, nonfat yogurt (which is also likely to be less expensive if you buy a quart-size tub).
Yogurt is a great, healthy choice, as long as you go the nonfat route.
Flavored yogurt is frequently full of sugar, so check the carb content. You may want to skip it and make your own by adding chopped-up fruit and nuts to plain, nonfat yogurt (which is also likely to be less expensive if you buy a quart-size tub).
Cookies
2 cookies = 15 grams or 1
serving
Being diabetic used to mean being told to kiss tasty treats—like cookies—good-bye.
But these days, says Kaul, diabetes experts agree that indulging in sweets now and then is okay, as long as you consume them in small portions, and with meals.
Being diabetic used to mean being told to kiss tasty treats—like cookies—good-bye.
But these days, says Kaul, diabetes experts agree that indulging in sweets now and then is okay, as long as you consume them in small portions, and with meals.
Ice cream
1/2 cup of ice cream = 15
grams or 1 serving
Kaul advises her clients to stay away from ice cream—if they can—and try low-fat alternatives like frozen yogurt, sherbet, and even sugar-free popsicles.
Because ice cream contains so much fat, it should only be an occasional treat, enjoyed in small portions, she adds.
Kaul advises her clients to stay away from ice cream—if they can—and try low-fat alternatives like frozen yogurt, sherbet, and even sugar-free popsicles.
Because ice cream contains so much fat, it should only be an occasional treat, enjoyed in small portions, she adds.
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