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Carb Confused?

You’re not alone. We went to a nutrition expert to uncover the 7 essentials when it comes to carbs and diabetes.

You can’t escape them—they’re in your bread, milk, cereal, grapefruit, corn, and cookies. But that’s not a bad thing. After all, we all need carbs. “There’s so much hype about carbohydrates [carbs] that people get the impression they’re bad,” says Amy P. Campbell, RD, CDE, education program manager at Joslin Diabetes Center in Boston. Considering carbs is extra dizzying for people with diabetes, because eating carbs can mean a sharp rise in blood sugar. But carbs are important, providing energy to our bodies. Here’s what you need to know to make smart-and-easy carb choices.

Carbs are Best in Balance

In people with type 2 diabetes, insulin—the hormone that converts sugar into fuel—isn’t working properly. So if you suddenly overload your system with carbs, your body can’t convert them all into energy you can use. Instead, sugar gets dumped into your blood—and stays there. And with carbs, this process happens quickly. The result: high blood sugar levels. But you can’t just avoid carbs and the energy they provide. A better strategy: Balance your carb intake throughout the day. Many people with diabetes enjoy three or four carb servings (or 45–60g carb) at each meal and snacks. Work with your healthcare provider to find the numbers that are best for you.

It's NOT About the Sugar

Maybe you’ve heard diabetes referred to as “a touch of the sugar.” But sugar isn’t the enemy. Sugar is just one type of carb. It’s total carb count—not the type—that will have the most impact on your blood sugar levels. It’s okay to eat a small dish of ice cream on occasion—just count it as part of your total carb allowance. That said...

Carbs are Just One Part of the Picture

So sugar isn’t off-limits. Neither are french fries. But even if these indulgences fit into your carb allowance, they shouldn’t make regular appearances. After all, they take up space that should be reserved for more nutritious foods. While weighing the carbs in a food, don’t forget to factor in whether it’s providing any nutritional benefits. So if you’re longing for pizza, look for a choice with a fiber-rich crust. Other good choices: Whole-grain breads, pastas, and crackers, brown rice; high-fiber cereals; fruits and vegetables; and fat-free or low-fat milk and yogurt.

sugar isn’t the enemy—it’s just a type of carb

Learning the Lingo Can Help

There are lots of ways carbs are referenced. It’s common to see “carb choices” or “carb servings” instead of carbs measured in grams. To translate:


So if you eat something that has around 30 grams of carb, you’ve eaten 2 carb choices.

Keeping Tabs Doesn't Have to Be Torture

If carb counting seems complicated, rest assured that some tools can help make carb choices more clear.

  • First, take advantage of nutrition panels on packaged products. Zero in on total carbohydrate—and keep the listed serving size in mind, too.
  • What about foods without labels, like fruits and vegetables? In these cases, a carb counting guide is your best friend. Complete Guide to Carb Counting, 2nd Edition is published by the American Diabetes Association or 1-800-DIABETES (1-800-342-2383). And check out the back cover of this publication for a quick guide to some common foods and their carb choices.
  • Restaurants may supply nutritional information on their websites or upon request.

Portion Distortion is Common

Even if you’ve been living diabetes for years, check your portion know-how occasionally. Remember that carb choices are based on specific serving sizes. So measure a serving of cereal. Pour yourself a four-ounce glass of juice. “Most people eat much more than they realize,” says Campbell. And calories from all foods will affect blood sugar to some degree.

Sometimes Your Body is the Best Judge

No matter what your eating plan, test your blood sugar about two to three hours after a meal. “Generally, blood sugar should be below about 160 at that point,” says Campbell. “If it’s higher than that, it’s likely because you ate too much and/or didn’t have enough medication on board.” Watch for signs of high blood sugar: thirst, headache, frequent urination, and fatigue. If you experience any of them, check your blood sugar reading with your meter.

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