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How many carbs should a type 2 diabetic eat per day?
How many carbs should a diabetic patient eat? A type 2 diabetic should eat anywhere between 15-60 gr of carbs per meal to control and manage blood sugars effectively depending on their age, caloric needs, activity level and diabetes duration. Individual goals can very. You need to understand what your individual needs are. How many carbs should you eat a day personally is a decision between you, your endocrinologist, and your diabetes coach.
We will go over the basics of the carbohydrate needs of any diabetic.
Yes, it is a common question, and we are going to try to reply to this question. It’s not going to be one single answer, but I think at the end of this article you will have an idea about how many carbs you should eat.
How to determine the number of carbs I need?
How many carbs you can eat based on actually is based on your gender, your age, your activity status, and your diabetes duration and severity. I’m going to give you an example. Let’s say you have been a diabetic for 20 years and you are 65 years old and you are a woman. You are on three oral medications. And you’re on basal insulin and you’re on three oral agents. You are inactive you have your problems such as your joint problems. You are generally sitting at home. You’re really not doing anything much. You are around 230 pounds. I would consider that an obese.
So, in this case, how many carbs should you eat? My answer to that would be very little very carbs. Little because I can imagine you as being very insulin resistant. Anytime you eat very little carbs your blood sugar is going to skyrocket.
What is a very low carb diabetic diet (How many carbs should a diabetic patient eat)?
A very low carbohydrate diet is not the same thing as keto diet. In a very low carbohydrate diet a diabetic individual can have 15-30 gr of carbs.
Now, when I say very little what I mean by that? I mean like 20 to 30 grams of carbs per meal. And that’s very generous. And the reason I say it’s very generous is that you’re really not burning any calories. Yes, I know. you may want to eat more. That’s the only thing you enjoy nowadays. And I understand that but if you want to eat more carbs you’re going to need more medications. Sometimes more medications may mean more side effects. Yet, we have a lot of ways, especially at SugarMDs. We have a variety of ways to help our patients.
Even if you want to use medications in addition to what you’re already on, then I would suggest you can go up to a maximum of 45 grams of carbs for a woman at that stage. You may end up needing insulin as well of course.
The good news this, we have a lot of non-insulin medications we can use depending on your activity level and diet. Basically, even for very inactive people or people with disabilities or joint problems we have ways to get them to exercise one way or another. If you’re really not exercising, you’re really looking for 20 to 30 grams of carbs and if you want to force it 45 grams.
How hard is it to stay on a low carbohydrate diet?
Most people will start a no-carb or very low carb diet but will not be able to sustain it in the long term. It is better to set reasonable and sustainable goals for daily carbohydrate goals.
Sometimes, it is very hard to tell these patients not to eat any carbs. They’re just not going to listen. I’m sure there are some people right now reading this article and saying that oh this doctor is recommending eating a bunch of carbs. I am glad you may be a very savvy very dedicated very strong-willed person but a lot of people are not like that. The bottom line, they are just not going to listen to you unless you give them a reasonable goal. So, that’s my job to get my patients motivated. I may start with the 45 grams. I may get them to the goal and that gives them some motivation. Later, we can try to cut their carbs even more. Again, that depends on the individual.
We sometimes get patients to find different recipes or ways to eat while they enjoy it. I think it takes a lot of motivation and a lot of coaching. That’s why at SugarMDs what we not only focus on exceptional patient care but coaching patients as well. We stay in touch with bi-directionally texting, voicemail, phone call, video call whatever… you name it. The SugarMDs team stays on top of them, all the time. We see glucose numbers remotely all the time, that’s another thing without having to do anything. Patients just do a finger stick or use a CGM and we can see glucose values all the time so that’s why our patients do really well. I call this accountability. When people feel accountable, they feel supported and motivated. Then, they do well.
How many carbs do physically active diabetic men can eat?
Physically active men can have 30 to 75 gr of carbohydrates in their diabetic diet.
In this example, the patient has a very active, physical job. He is 35 and has type 1.5 diabetes (LADA). He is on one long-acting insulin and two oral agents. (Some type 1.5 diabetics do not end up on insulin right away) This individual is doing well with his lifestyle and also goes to the gym five times a week and works out one hour on those five days. I would tell this individual that my conservative goal for him could be as low as 30 grams of carbs per meal if he wants to go really low carb. This approach also will help reduce the number of diabetic medications. So, If you’re very active and you’re working out you must have some carbohydrates. Glucose is what your muscles are burning. If you do not eat any carbs you’re going to have significant fatigue with exercise.
Can I go with no carbs to cure my diabetes?
No carb or very low carb diet can help put diabetes in remission but will not cure diabetes in the long term.
Exercise also has many benefits. I know there are a lot of keto people out there and they think that the carbs are poison for you. That’s not true. You have to have some healthy carbs in your diet to make sure that you have enough fuel for your muscle during exercise. You have to exercise in addition to the diet because exercise will help your cholesterol in addition to many other health benefits. Those people who eat fat all the time and not exercise, don’t think that they’re looking forward to a very good heart outcome or great cholesterol. So, the bottom line is you want to have some healthy carbs. You should have a min of 15-30 grams per meal in your diabetic diet. Moreover, If you’re very active and exercising five times a week meaning you are physically active, then you can try eating 45 up to 60 grams per meal. Believe me, you can still be very fit you can still be controlling your blood sugars very well just because you are physically very active.
Are women and men carbohydrate goals different?
For a woman, my maximum carbohydrate recommendation is 45 grams per meal in a diabetic diet compared to men who can eat up to 75 gr of carbs provided that they are physically active. Again, the exact amount depends on you and your lifestyle. Most of the time women need fewer calories and fewer carbs than men.
In most cases, If you’re looking from a carbohydrate eating standpoint you’re looking for a percentage of total calorie intake. So, if you want to be on the low carb side you may go down to 30 percent of your total calories. If you want to be on the more on the generous side, because you’re physically active, you may go up to 35 to 45 percent of your total calories as carbs. That is true for both men and women.
The basic thing here to understand if you want to keep your blood sugar under control while eating healthy carbs and being physically active. If you’re not physically active then your goals are down to 15 to 20 grams for women and less than 45 grams for sure for men. On the other hand, this goal can be as high as 60 to 75 gr of carbs per meal for men who are very very active.
A sedentary lifestyle and carbs for diabetics (How many carbs should a diabetic patient eat if they are sedentary)
Let’s say you’re a 60-year-old man, retired. You’re mostly at home especially with this virus going on, you’re not doing anything. You don’t want to go outside etc. Assume that you are already overweight or obese then you should really not eat more than 45 grams per meal at all. If you want to really control your diabetes with fewer medications then you should go down to 30 grams or below per meal for healthy carbs. For a sedentary woman in the same situation goal is 15 to 30 carbs maximum per meal. With medication help, these goals can definitely be relaxed. It all depends on how you want to manage your diabetes.
Diabetic patients can find a lot of carbohydrate alternatives for healthy eating. So, you can definitely avoid things with flour and highly processed carbs. Actually, if you avoid refined sugars and carbohydrates that are in the market today you will have very few reasons from natural sources to spike your blood sugar. Fruits for example will have much less effect on your blood sugars.
Carbohydrate goal and diabetic diet for older/elderly diabetic patients (How many carbs should a diabetic patient eat later in life)
On the other end of the spectrum, people who are like really frail, some already losing weight unintentionally at an already advanced age are a different class of diabetics. As we discussed in the previous articles, I m not super strict with their blood sugars in that class. I let them go to 150 mg/dl range in the morning up to 200 mg/dl after meals. Again, that is for those older, frail individuals. I don’t restrict them too much because they don’t have a good appetite, to begin with, Some are cancer patients. We sometimes limit their carbohydrates because sugar really drives your cancer cells. But, if you are like you’re really losing too much weight and you really are not looking to cure this cancer, really there’s no point in torturing these people with low carbs. I just tell them, if your cancer doctor said that the chances of recovery from this cancer are nothing, then maybe just enjoy your life. Some are already on heavy chemo and don’t even have an appetite. I am not going to give that person a diet.
Yet, the majority of the time most diabetics fall into the previous category who needs tight control. I hope it is now clear how many carbs should a diabetic patient eat. I hope this article was helpful. For individualized goals and treatment regimens please do not hesitate to contact our office at 561-462-5053.
Please feel free to contact us directly for any questions or concerns.
Ahmet Ergin, MD, FACE, CDCES, ECNU
Endocrinologist in West Palm Beach, FL and New York.
2260 Palm Beach Lakes Blvd. Ste 212 Unit #7
West Palm Beach, FL