The Diabetic Diet & Role of Carbs: The Ultimate Guide!

A Diabetic Diet and Carb Plan Everyone Can Follow Successfully!

If you've just been diagnosed with diabetes or have been living with it for a while, this blog post about the diabetic diet is for you. I'm going to share with you my top diabetic diet tips that will help make managing your diabetes a lot easier.

What Are The Different Food Groups, And How Do They Affect Your Blood Sugar?

I will talk about carbohydrates in more detail later as this group has the most effect on blood sugar. On the other hand, proteins and fats can also affect blood sugar, although in a less predictable way. 

How Does Protein Affect Blood Sugar? 

We will talk a lot about carbs what we do know about the effect of protein is that in individuals who do NOT have diabetes, protein consumption can stimulate insulin release, which decreases glucose while also causing glucagon release. Glucagon increases blood glucose by causing the release of stored glucose from the liver. Unfortunately, type 1 diabetic individuals do not produce insulin; however, they continue to produce glucagon.

As a result, protein consumption can trigger glucagon release, which increases blood sugar. This can happen 3 to 5 hours after a meal and can frustrate glucose management. It is not uncommon for my type 1 diabetic patients to ask why their blood sugars are still spiking, although they are not eating carbs. On the other hand, the effect of protein on your blood sugar is not easily predictable.

That is why I do not recommend a very high protein diet, especially for type 1 diabetics. Instead,  I recommend that they have a balanced diet that includes a healthy amount of proteins, carbs, and healthy fats. For insulin-resistant type 2 diabetics, the same rules apply. Protein intake can cause a modest glucose increase, and the exact amount of this increase can be unpredictable. Most type 2 diabetics tend to secrete more glucagon after a high protein meal, which can still raise blood sugar.

What Are Carbohydrates and Their Role In The Diabetic Diet?

Carbohydrates are one of the three macronutrients in our diet, along with protein and fat. When we talk about carbohydrates, we usually mean things like sugar, fruits, vegetables, tubers (potatoes, carrots, and beets), and legumes (peanuts and beans). They are the main source of energy for your body.

While there are many types of carbohydrates, your diet benefits most when you take a specific subset of carbohydrates. There really are good carbs and bad carbs. As a diabetic, you should know the difference in order to make the right dietary choices for yourself.

You may have heard that “Not All Carbs Are Made Equal.” This is actually true. The more you know about which carbs are better for you as a diabetic, the better able you will be to make in-the-moment choices about which ones to incorporate into your diet. I will teach you what you need to know about this important macronutrient in this part of the chapter.

Are All Carbohydrates The Same?

While many fitness blogs and videos compel us to resent carbohydrates in a diabetic diet, you need to rethink whether or not you want to go by those kinds of biased recommendations. Ask yourself, do you really know all you need to know about that mouth-watering morsel we call a carbohydrate? If a diet plan (and there are many of these) requires you to sacrifice it for a good three months, would you blindly conform to it?

Or would you dig deeper into why it’s out of the diet regimen in the first place? And if possible, would you figure out if there are any healthy carbs that you can safely squeeze into your diet? Anyone who loves carbs – that makes most of us – will do the latter. Yes, it’s a lot of work, but it’s worth it. As you’ll soon see, not all carbs are created the same, and it is possible to find carbs you can comfortably eat. Many are not only very tasty, but they’re good for you as well. Doesn’t that make you feel better?

How Do Carbohydrates Metabolize In The Body?

A lot of carbohydrate metabolism boils down to the molecular structure of these molecules. At their very foundation, they metabolize into weight-gaining sugars in the body. Most starchy foods like potatoes, some fruits, and processed grains have a very high glycemic index (GI). I will talk more about the glycemic index soon but, with regard to this number, a high GI food is not optimal for diabetes.

This is because they can spike blood sugar levels and insulin in the body after you eat them. Refined carbs, such as the ones in bakery products, have consequential and often adverse effects on your metabolism, blood sugar, and overall health. Besides being mostly carbs and fats, these kinds of foods offer you essentially no important nutrients.

They should have no place in the diabetic diet you should be following. Even though there are great differences among the different types, carbohydrates are your body’s primary energy source and a vital part of any diet across the world. These are not only one of the three “macronutrients” that your body relies on for proper functioning – they are the major building blocks of energy. 

What Do Carbohydrates Do?

Carbohydrates provide the only fuel for your central nervous system and are the major energy your muscles need to function. The body cannot produce these macronutrients from scratch as plants can; you can only access them through certain foods in your diet.

A healthy intake of carbs can do these important things for you: » Provide energy » Protect against diseases »  Help in weight control   The foods you eat primarily contain three different types of carbohydrates consisting of starches, fiber, and sugars. Let’s start by exploring what they are and how they affect your body.

What Are Complex And Simple Carbohydrates?

To make it easy, we will divide them into simple and complex carbohydrates.

Complex carbohydrates

Also known as polysaccharides – are a bunch of sugar molecules strung together in a long, complex chain. Just imagine a bunch of sugar cubes all holding hands. Due to the complexity of these types of carbohydrates,  they take longer to break down in the body. Since complex carbs are digested more slowly than simple carbohydrates, they tend not to cause spikes in your blood sugar levels after you eat them.

Yet, not all complex carbs are the same. You will need to choose complex carbs low in the glycemic index, which we will discuss shortly. Whole grains (non-refined) like barley, quinoa, bulgur, steel-cut oatmeal, chickpeas, non-starchy vegetables, and beans are the best food choices. These all contain complex carbohydrates that are low in glycemic index.

They are great foods to eat in your diabetic diet. Examples of starchy vegetables are potatoes, including sweet potatoes, corn, and peas. So when nutritionists tell you to eat complex carbohydrates, they are referring to unprocessed whole-grain foods and non-starchy vegetables. An individual with diabetes should stick to non-starchy vegetables and carbohydrates that have a low glycemic index and low glycemic load.

My favorite vegetables for diabetic individuals are leafy greens such as spinach, romaine, swiss chard, kale, cauliflower, cabbage, eggplant, celery, onion, green bean, bell pepper, and Brussels sprouts. My least favorite starchy vegetables are potatoes and corn. Whole grains and legumes are always good choices. For example, I love farro, kidney beans, lentils, cauliflower rice, hummus, or falafel (made from chickpeas and tahini).

Simple Carbohydrates

On the other hand, simple carbohydrates are already broken down and quickly digested by the body as the name suggests. They are naturally found in most foods like milk, dairy products, fruits, and refined sugars. Table sugars, corn syrups, sodas, bakery products, and store-bought candies are processed carbs that come under this category.

Although simple carbs are typically more rapidly absorbed and their glycemic index matters, the glycemic load of these carbs can make a big difference. The glycemic load is somewhat different than the glycemic index. Let’s learn more about the glycemic index and glycemic load to get a better hang of your diabetic diet. 

What Are The Glycemic Index And Glycemic Load? And How To Use The Glycemic Index To Your Advantage?

When it comes to carbohydrates, it’s important to know that the rate of breakdown and absorption is key to managing blood glucose levels. But how can you tell what foods will have the greatest impact on your next blood sugar reading? The glycemic index is here to help.

The glycemic index is a system of assigning a number to carbohydrate-containing foods according to how fast each food increases blood sugar. The Glycemic Index is scored from 0 to 100; carbs with a low glycemic index value (55 or less) are slowly absorbed by our bodies as compared to carbs with a high GI. They cause blood glucose levels to rise slowly, and therefore, insulin levels rise slowly as well.

Carbohydrates with middle to high values get absorbed much faster, which is why they cause a spike in blood sugar. On the other hand, glycemic load measures the rise in blood sugar based on the number of carbohydrates the food contains in an average serving while accounting for the glycemic index. The glycemic load can actually be more reliable than the glycemic index.

For example, watermelon has a glycemic index of watermelon is 72, which is very high. This means it can spike blood sugar rapidly; however, watermelon is mostly water, so the total carbohydrates in one cup of watermelon are low. The glycemic load in a serving of watermelon is only 4, which is extremely low, as the carbohydrate content of watermelon is very small.

Foods with a glycemic load between 4-10 have a very low glycemic load, which is the safest range. A glycemic load between 10 and 20 is moderate. They can spike your blood sugar to some degree but will not keep your blood glucose levels elevated for long periods of time. Foods with a glycemic load higher than 20, however, should be eaten sporadically, as they will spike blood sugar levels and keep them elevated for longer.

My patients are often so surprised to see their blood sugars spiking from 110 mg/dL (6.1 mmol/l) in the morning to 230 mg/dL (12.6 mmol/l) one hour after eating cereal or a piece of toast. Yes, if you are insulin resistant, 30 grams of carbs in an apple versus in 2 pieces of toast can make a difference of up to 100 mg/dL (5.5 mmol/l) in the blood glucose levels after each of these meals.

If you want foods in a diabetic diet that has a low GI, go for whole-grain foods. On the opposite end of the spectrum, avoid refined carbs at all costs, which have a high GI. When calculating the GI of carbohydrates, you might want to use an app that does it for you.

There are many applications found on both iPhone and Android phones; these provide a search function that allows you to search for specific foods to automatically calculate the GI. I personally prefer to use the glycemic load of a given food as it gives you a better picture of the carb load you are getting from the food. Take a look at the table below.  

• Low GI Food    
• Medium GI Food         
• High GI Food 45 or less         
• Between 45 and 70      
• More than 70  

The Glycemic Load of food is based both on the glycemic index and the quantity of food you eat. It is a good measure of how many of the carbs you are eating will get rapidly absorbed into the bloodstream. The definition of a low GL, moderate GL, and high GL food is different from the glycemic index. It looks like this:  

• Low GL Food   
• Medium GL Food         
• High GL Food 10 or less         
• Between 11 and 19     
• 20 or greater 

How many carbs you eat depends on you, your doctor, and your dietitian. You should all be on the same page as to what’s appropriate for you. There is no cookie-cutter approach to diabetes care. This is why a diabetes coach is an essential component of your long-term success.

Unfortunately, insurance companies prefer not to pay for diabetes coaching services. They will, though, pay for expensive medications costing thousands of dollars, which doesn’t make much sense. Even so, it is something you might consider when you get stuck on what kind of diet you should be on.

The Essential Role Of Fiber In Carbohydrates and The Diabetic Diet

As I just mentioned, complex carbs are far healthier and safer for the body than simple ones. Here’s why. The rich fiber content, vitamins, and minerals are what make these carbs a diet-friendly food. Whole grains, non-starchy vegetables, and beans all provide a substantial amount of fiber and essential minerals.

Fiber is a critical component of any diet, but it is especially important for people with diabetes. Fiber helps keep your blood sugar levels from spiking too high. It can help regulate your cholesterol levels and is extremely important for intestinal health. It improves the internal gut environment, which is fundamental for healthy digestion.

Recommendations On Fiber Intake In Your Diabetic Diet

Even when the Academy of Nutrition and Dietetics advises a much higher RDI (Recommended Dietary Intake) for fiber, the majority of adults only consume 15 grams a day on average. So, if you’re looking for a shortcut to a high-fiber diet, then complex carbs are the way to go, of course in moderation while watching your glucose levels.

Refined starches or carbohydrates, such as white bread and white pasta, are starches that have undergone processing. Processing removes the bran and germ of the grain, stripping them of fiber, vitamins, and minerals. What you want to eat instead are whole-grain foods that have not been so heavily processed. These have no place in your diabetic diet.

Quick Tip When in doubt, choose unprocessed grains and those you can “see” in your bread. The more refined the grain, the less brain/ fiber in the grain. Fiber does many things for the diet but, for diabetes, it means it “holds onto” glucose in the GI tract, meaning it can’t be rapidly absorbed into your bloodstream.

Why Does The Body Absorb Refined Carbohydrates Very Quickly And Raise Blood Sugars?

The reason why refined carbohydrates are rapidly digested and absorbed into the bloodstream is that there is no protein, fiber, or fat content present in them. You need fat and fiber to slow the digestive process down. They’re basically “empty calories.” This can contribute to blood sugar and insulin spikes after you eat them. Remember that complex carbohydrates include all starches, regardless of whether they are whole, refined, or have a high fiber content.

In summary, complex carbohydrates such as whole grains are considered “good” carbs because they take much longer to break down in your gut before they are absorbed into the bloodstream. This means you will get lower amounts of sugars released at a more consistent rate instead of a rapid influx of sugar all at once. They typically have a low glycemic index and low glycemic load as well.

If in doubt, quickly check it online or in your carb book. These complex carbs also keep you feeling full and going throughout the day. They can still increase your blood sugars; however, I do not recommend totally avoiding all of these nutritious carbohydrates. Rather, I would pay more attention to portion control, increasing activity level, and taking medications when necessary to overcome sugar spikes.

Quick tip Nutritional labels do not differentiate between the different types of carbohydrates. The term “total carbohydrates” includes all three types of carbohydrates we discussed. This is the number you should  pay  attention   to if you are carb counting. You   might   also    want to pay attention to the “total sugars” and “added sugars.” These represent simple sugars. While you count carbs with the total carbohydrates listed, you want to stay away from those with a lot of sugar or added sugars.

The Role Of Your Diabetes Coach And Endocrinologist in Managing A Diabetic Diet

Whatever guidance you can get from the endocrinologist you see will help you learn more about carbohydrates. So, you can apply this information to your own diabetes management. This information will also make a great difference in your A1c values. I strongly recommend that you work with both a diabetes coach and an endocrinologist who can advise you on your diet and monitor your exercise very closely.

Think of these individuals as good friends keeping an eye on you. That way, you can often avoid taking costly diabetic medications that can also have serious side effects. Even when you are on medications for your diabetes, you should know how to be consistent with your diet regarding the carbohydrates you consume with every meal.

It will be a challenge initially, but once you get the hang of it, you will feel more self-control over your diet. Soon enough, the practice of mindful eating will become second nature. It’s funny how people think about what type of gas they’re putting in their cars and have no understanding of what type of food is going in their tummies. Well, it’s time to make that decision.

In Summary Successful self-management of diabetes is the simple difference between choosing a healthy, complex carb and a refined sugary treat. It will challenge your self-control, but once you get on with healthy eating, there’s no going back.

Here are some ways to improve your intake of healthy carbs and self-regulate your blood sugars:

• Increase your water intake
• Eat more beans, legumes, and peas to increase the variety of minerals, fiber, and proteins in your diet
• Have a decent portion of fiber-rich veggies and fruits with every meal
• Reduce your dairy intake or stick to low-fat versions (although you can consume whole-milk dairy products made from goat milk safely)
• Cut down or limit added sugars like candies, soft drinks, white pasta, French fries, etc.
• Have a limited amount of dried fruits like figs, dates, and raisins
• Make a conscious effort to choose whole grains like brown rice, brown pasta, and wholegrain bread for breakfast and lunch. You will be surprised at how this little change will go a long way in regulating blood sugar levels. Instead of having a bowl of cereal, switch it up with quinoa or healthy granola.

With these simple changes, prepare to be amazed at how well your body begins to manage your diabetes.

How Many Carbs Should A Diabetic Have?

A type 2 diabetic should eat anywhere between 15-60 grams of carbs per meal to control and manage blood sugars effectively. It depends a lot on your age, caloric needs, activity level, and the duration of your diabetes. Individual goals can vary.

You need to understand what your individual needs are. How many carbs you should eat per day is a personal decision you need to make. It’s all between you, your endocrinologist, and your diabetes coach., We will go over the basics of the carbohydrate needs of the average diabetic. 

What Does “Counting Carbs” Mean?

Counting carbs (also called “carb counting”) is a type of meal planning. Some patients with diabetes use this with precision, especially when they are on insulin. Counting carbs means knowing the number of carbs you plan to eat or have just eaten.

When patients with diabetes count carbs, they keep track of how many carbs they eat for each meal and snack. People with diabetes need to know how many carbs they eat because eating carbs raises their blood sugar levels. There are reasons why “carb counting” is particularly important for diabetics taking insulin for every meal.

This is because diabetic patients will need to adjust their insulin doses according to the carbohydrate content of the food they plan on eating. However, even for those who do not take insulin, carb counting can help keep blood sugar levels from getting too low or too high. It increases your awareness of the carbs in your diet, which helps control caloric intake as well.

How Do I Count Carbs In A Diabetic Diet?

If your food has a nutrition label, please make sure to check out the information on the label. You need to look at certain things. A common misconception is that patients look at the amount of “sugar” or glucose on the label and disregard total carbohydrates. As I mentioned earlier, you should note that all the carbohydrates you read on the label turn into sugar (except the fiber content). There are other tricks you need to understand about carb counting, including these:

• Total carbohydrates: Let’s say you are on a diet for diabetes and want to count carbs to help manage it. You look at nutrition labels and find the total carbohydrates on the label. Total carbohydrate on the label will tell you how many carbs are in 1 serving of the food. For example, if you see a number of 27 grams, it means one serving of that food has 27 grams of total carbohydrates. If one serving is one piece of that food, having two pieces will give you 54 grams of carbohydrates.

• Serving size: This tells you how much food is in 1 serving. If you have two servings, the number of carbs will be two times the number of carbohydrates listed.
• Dietary fiber: Fiber is a carbohydrate that is not digested. As a result, it does not raise your blood sugars. Foods with a lot of fiber can help control the blood sugar of patients with diabetes. If a food has more than 5 grams (g) of fiber, less insulin is needed for that food. You can subtract the fiber grams from the total carbohydrates to count your carb intake. If there is 5 g of fiber in 1 serving and 30 g of total carbohydrates are listed, you can safely use 25 g of carbs in your calculation of how much insulin you need.
• Foods without labels: Unfortunately, many foods, such as fresh fruits and vegetables, don’t have a nutrition label. For these foods, you will need to learn about the usual serving sizes of different foods. You can easily do so by searching the item in Google or using phone applications that provide the same data or old-school carb counting books.

You will also need to learn how many carbs are in one serving in those fruits and vegetables. For example, it is straightforward to learn that one small apple and one small orange are each only 15 g. After you get to know how many carbs are in these fruits and vegetables, you will be able to memorize very easily how many carbs are in the foods you commonly eat. This is one of the best way to stay within your diabetic diet.

Do I Have To Count Carbs For Diabetes Or Are There Any Other Alternative Ways?

Yes, there are. One way I sometimes recommend is called exchange planning in a diabetic diet. With exchange planning, you can categorize all the foods you eat as carbohydrates, meat or meat substitutes, or fat. In this system, one serving of sugar (like one small orange, which is 15 g) can be exchanged for any other sugar (like 1/3 cup of rice). You can do that because both portions contain about 15 grams of carbohydrates. As a result, you can also easily find out the total carbohydrate content of your meals and snacks using the exchange method.

Do I Have To Eat At The Same Time Every Day?

Meal timing can be very important. For some patients with diabetes, eating at the same time every day is crucial. This is because certain medications cause low blood sugar if you skip a meal. For patients who are on mealtime insulin, however, meal timing is not as important.

If you are on sulfonylurea agents such as glipizide, glyburide, and glimepiride, which are not taken in direct relation to your meals, sticking to consistent mealtimes can be very important.

Diabetics who take medications that do not cause low blood sugar, such as metformin, Ozempic, Trulicity, Rybelsus, Jardiance, Farxiga, and Invokana, have more flexibility with their diet and timing after meals. For those individuals, skipping or delaying a meal will not usually increase their risk of developing low blood sugar.

How Do I Determine The Number Of Carbs I Need In My Diabetic Diet?

How many carbs you can eat in your diabetic diet is largely based on your gender, age, activity status, and the duration and severity of your diabetes. I’m going to give you an example. Let’s say you have been a diabetic for 20 years, and you are a 65-year-old woman. You are on three oral medications along with basal insulin injections. You are inactive, and you have problems such as joint pain.

Mostly, you just sit at home, not doing much. As a result, you weigh 230 pounds (which is in the obese range). In this case, how many carbs should you eat? My answer to that would be to eat very few carbs(15-20 gr per meal). I recommend this because I can imagine you are very insulin-resistant. Anytime you eat even a few carbs, your blood sugar may skyrocket.

I definitely do not let this happen to my patients and help them with medications to improve their blood sugar control. On the other hand, my advice in the office with my own patients is not intended to underestimate the power of knowledge and coaching in your diabetes management. That is one of the main reasons I have decided to write this book. You should know more about diet and diabetes so you can have more meaningful discussions with your coach or doctor.

On the other hand, physically active men with diabetes can have 30 to 75 grams of carbohydrates per meal in their diet. Like everyone with diabetes, it depends on the usual things: age, level of exercise, type of diabetes, and the severity and length  of diabetes. For example, consider the man with diabetes who 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 for 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 on a really low-carb diet. This approach also helps reduce the number of diabetic medications he might need. On the other hand, if he works out a lot, he will eat carbs for his endurance and prevent low blood sugar. Glucose is what your muscles are burning. If you do not eat any carbs, you’re going to have significant fatigue with exercise. So for this very active man, I can allow up to 75 g of carbs per meal even if he is a diabetic. 

Do Men And Women Have Different Carbohydrate Goals?

For a woman, my maximum carbohydrate recommendation is 45 grams of carbohydrates per meal in a diabetic diet compared to men who can eat up to 75 grams of carbs, provided that they are physically active, as discussed earlier. 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 standpoint, you’re looking mostly at carbs as a percentage of total calorie intake. So, if you want to be on the low-carb side of things, you may drop down to 30 percent of your total calories.

If you want to be more generous about carbs, especially if you’re physically very active (working out more than 3 hours a week), you may be able to increase your carb intake to 35 to 45 percent of your total calories as carbohydrates.

That is true for both men and women. The basic thing you need to understand is that if you want to keep your blood sugar under control while eating healthy carbs, you also need to be physically active.

If you’re not physically active, then your goal, if you are a woman, is to eat 15 to 20 grams of carbs per meal. If you are a man who isn’t physically active, you should stick to less than 30-45 grams of carbs per meal. On the other hand, this goal can be as high as 60 to 75 gr of carbs per meal for men and women who are extremely physically active.

How Many Carbs Should A Diabetic Person Eat Later In Life?

On the other end of the spectrum, people who are extremely frail and elderly, who are already losing weight unintentionally, and who are at an advanced age are a different class of diabetics. I will not be very strict with their blood sugars or carb intake on their diabetic diet.

I often allow blood sugars after meals to be as much as 180 mg/dL (180 mmol/l). Part of the problem is that these are people who don’t have a good appetite anyway, so it doesn’t make much sense to further restrict their diet. Others have diseases like cancer, so they need all the nutrition they can get. Their blood sugar can still be reasonably controlled with medications.

On the other hand, cancer cells are driven by sugar, so if they reduce their carbohydrate intake, they can improve their survival from this medical problem. If this is a person who isn’t expected to survive their cancer, there is no reason to have them suffer further by limiting carb intake. In such situations, I am most guided by the cancer doctor who can tell me the patient’s chances of survival.

Can I Go With No Carbs To Cure My Diabetes?

A no-carb or very low-carb diet can help put diabetes in remission or mask it but will not cure diabetes in the long term. There are other things you should do to help put your diabetes into remission besides cutting carbs completely.

Exercise, for example, also has many benefits. If you are going to have regular exercise, you have to have some healthy carbs in your diet to ensure that you have enough fuel for your muscles during exercise. When it comes to managing diabetes and diabetic diet there is no one-size-fits-all approach. However, cutting carbs can be an effective way to lower blood sugar levels and put diabetes into remission.

A no-carb or very low-carb diet can help to mask the symptoms of diabetes, but it will not cure the condition in the long term. In addition to limiting carbs, there are a few other things you can do to help put your diabetes into remission. These include exercising regularly, maintaining a healthy weight, and managing stress levels. Making these lifestyle changes can be difficult, but they are essential for putting diabetes into remission and keeping it under control in the long term.   

About the author

Dr. Ahmet Ergin is the author of The Ultimate Diabetes Book and the Founder of the SugarMD youtube channel. He practices in Port Saint Lucie, FL as an endocrinologist physician.