Managing Carbs to Manage Diabetes

Instead of following a low-carb diet, you might be better off focusing on moderate portions of nutrient-rich carbohydrates, such as whole grains, fruits, and legumes.

When it comes to diabetes management, few things are more controversial and confusing than carbohydrates, macronutrients found in a variety of foods, such as grains, vegetables, dairy products, sweets, legumes, and fruits. If you have diabetes, you may have heard that carbs are your enemy. But research shows that nutrient-rich carbohydrate choices—when consumed in appropriate amounts—may actually be beneficial for people with diabetes.

What does eating vegetables, fruits, whole grains and beans do for you? Their nutrients, fiber, and other natural compounds are linked to health-protective benefits, such as reducing inflammation, supporting antioxidant defenses, promoting effectiveness of insulin, and shielding the body from some chronic diseases, explains Karen Collins, MS, RDN, CDN, FAND, nutrition advisor to the American Institute for Cancer Research. People with diabetes have a higher-than-average risk for heart disease and some cancers, making it important to look beyond blood sugar to keep an eye on overall health.

What does the science say about controlling carbs? Experts agree that carbohydrates raise blood sugar, and that when people with diabetes eat too much carbohydrate their blood sugar levels may jump too high. What healthcare professionals and researchers don’t always agree on is the ideal amount of carbohydrate for people with diabetes.

Whether higher or lower carb diets win out in research depends on how the low the carbohydrate intake is, the rest of the diet, levels of physical activity, and more. A recent study published in Diabetes Care found that both a low carbohydrate (57 g per day) diet and a high carbohydrate (205 g per day) diet improved some measures of cardiovascular risk and blood sugar control among participants with obesity and type 2 diabetes after 24 weeks. Those following the low carb diet experienced less variability in blood sugar control, took fewer medications to control blood sugar, and saw greater reductions in blood triglyceride levels. Both groups improved their A1C levels (an estimate of average blood sugar over about 3 months), dropped comparable amounts of weight, and had similar reductions in blood pressure and LDL-cholesterol levels.

5 Tips for Managing Carbohydrates with Diabetes

  1. Fill half your plate with low carb vegetables like carrots, tomatoes, spinach, and broccoli to fill you up without blowing your carb allowance for that meal.Measure blood sugar in pairs. Check blood sugar right before eating and two hours later. The difference between the two numbers will help you learn how various foods and amounts of food affect your blood sugar.
  2. If you eat a higher carb meal, take a walk to temper the spike in blood sugar.
  3. Trade up. Swap out less healthful carb choices like packaged snacks and candy for health-boosting ones like fruits, yogurt, and beans.
  4. Enjoy a low carb food such as nuts or low-fat cheese if you’re hungry when your blood sugar is at the high end of your target range

However, carbs are not the only important factor to consider in this study. Fats and calorie restriction also may have played important roles, explains Toby Smithson, MS, RDN, LD, CDE, who has type 1 diabetes and is a spokesperson for the Academy of Nutrition and Dietetics and author of Diabetes Meal Planning and Nutrition for Dummies. Diets low in saturated fat, like the ones used in this study, typically improve some measures of cardiovascular risk. Additionally, the low carb diet was relatively high in unsaturated fats, which also may impact blood sugar control. In this study, participants cut calories to facilitate an average weight loss of more than 25 pounds. Weight loss is determined by calorie intake, not by altering the ratio of carbohydrate, protein and fat, says Smithson.

A recent review article in Diabetes Therapy concluded that low carbohydrate diets frequently show greater short-term improvements in weight loss, blood sugar control, and management of heart disease risk factors, but do not show better outcomes long-term.

Think before you drop carbs. Before you try a low-carb diet, ponder this. Dropping carbohydrate-rich foods may have the greatest impact on blood sugar levels, but this is not without risk, warns Smithson. The American Diabetes Association calls for more research on the long-term safety and sustainability of low carbohydrate diets. We don’t know enough about the long-term effects on kidney function and heart and calcium metabolism, Smithson adds.

Another concern with severely restricting carbohydrate is limiting nutrition, warns Hope Warshaw, MMSc, RD, CDE, president of the American Association of Diabetes Educators and author of Diabetes Meal Planning Made Easy. Many nutrient-rich carbohydrate choices, including whole grains, dairy products, legumes, fruits, and vegetables are good for overall health and disease risk reduction.

The right amount of carbs for you. No specific amount of carbohydrate is ideal for everyone with diabetes, says Warshaw. “Each person needs to find a healthy eating pattern that works for him or her over the years. Don’t think of it as a diet. Rather, it is your way of eating.” It’s best to work with a registered dietitian nutritionist to create a personalized plan. Many people with diabetes do well with 30 – 60 grams of carbs per meal.

Jill Weisenberger, MS, RDN, CDE, FAND, CHWC


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