If you have type 1 diabetes, it is important to know how many carbohydrates you eat at a meal. This information helps you determine how much insulin you should take with your meal to maintain blood sugar (glucose) control.
Carbohydrates are the main type of food that raises blood sugar. The starch, fruit and milk groups of the Food Group Pyramid for Diabetes are high in carbs. Foods in the Other Carbohydrates and Combination Food groups are also high in carbs. The vegetable group has a small amount of carbohydrates. The meat and fat groups have few or no carbs. The amount of carbohydrates you eat at each meal will determine how high your blood sugar rises after the meal. The other two major nutrients, protein and fat ,also have an effect on blood glucose levels, though it is not as rapid or great as carbohydrates.
Most people with diabetes can control their blood sugar by limiting carbohydrate servings to 2-4 per meal and 1-2 per snack.
A delicate balance of carbohydrate intake, insulin, and physical activity is necessary for the best blood sugar (glucose) levels. Eating carbohydrates increases your blood sugar (glucose) level. Exercise tends to decrease it (although not always). If the three factors are not in balance, you can have wide swings in blood sugar (glucose) levels.
If you have type 1 diabetes and take a fixed dose of insulin, the carbohydrate content of your meals and snacks should be consistent from day to day.
Children and Diabetes
Weight and growth patterns can help determine if a child with type 1 diabetes is getting enough nutrition.
Changes in eating habits and more physical activity help improve blood sugar (glucose) control. For children with diabetes, special occasions (like birthdays or Halloween) require additional planning because of the extra sweets. You may allow your child to eat sugary foods, but then have fewer carbohydrates during other parts of that day. For example, if child eats birthday cake, Halloween candy, or other sweets, they should NOT have the usual daily amount of potatoes, pasta, or rice. This substitution helps keep calories and carbohydrates in better balance.
One of the most challenging aspects of managing diabetes is meal planning. Work closely with your doctor and dietitian to design a meal plan that maintains near-normal blood sugar (glucose) levels. The meal plan should give you or your child the proper amount of calories to maintain a healthy body weight.
The food you eat increases the amount of glucose in your blood. Insulin decreases blood sugar (glucose). By balancing food and insulin together, you can keep your blood sugar (glucose) within a normal range. Keep these points in mind:
- Your doctor or dietitian should review the types of food you or your child usually eats and build a meal plan from there. Insulin use should be a part of the meal plan. Understand how to time meals for when insulin will start to work in your the body.
- Be consistent. Meals and snacks should be eaten at the same times each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) consistent from day to day.
- Learn how to read food labels to help plan you or your child’s carbohydrate intake.
- Use insulin at the same time each day, as directed by the doctor.
Monitor blood sugar (glucose) levels. The doctor will tell you if you need to adjust insulin doses based on blood sugar (glucose) levels and the amount of food eaten.
Having diabetes does not mean you or your child must completely give up any specific food, but it does change the kinds of foods one should eat routinely. Choose foods that keep blood sugar (glucose) levels in good control. Foods should also provide enough calories to maintain a healthy weight.
The amount of each type of food you should eat depends on your diet, your weight, how often you exercise, and other existing health risks. Everyone has individual needs, which is why you should work with your doctor and, possibly, a dietitian to develop a meal plan that works for you.
But there are some reliable general recommendations to guide you. The Diabetes Food Pyramid, which resembles the old USDA food guide pyramid, splits foods into six groups in a range of serving sizes. In the Diabetes Food Pyramid, food groups are based on carbohydrate and protein content instead of their food classification type. A person with diabetes should eat more of the foods in the bottom of the pyramid (grains, beans, vegetables) than those on the top (fats and sweets). This diet will help keep your heart and body systems healthy.
Grains, Beans, and Starchy Vegetables
(6 or more servings a day)
Foods like bread, grains, beans, rice, pasta, and starchy vegetables are at the bottom of the pyramid because they should serve as the foundation of your diet. As a group, these foods are loaded with vitamins, minerals, fiber, and healthy carbohydrates.
It is important, however, to eat foods with plenty of fiber. Choose whole-grain foods such as whole-grain bread or crackers, tortillas, bran cereal, brown rice, or beans. Use whole-wheat or other whole-grain flours in cooking and baking. Choose low-fat breads, such as bagels, tortillas, English muffins, and pita bread.
(3 – 5 servings a day)
Choose fresh or frozen vegetables without added sauces, fats, or salt. You should opt for more dark green and deep yellow vegetables, such as spinach, broccoli, romaine, carrots, and peppers.
(2 – 4 servings a day)
Choose whole fruits more often than juices. Fruits have more fiber. Citrus fruits, such as oranges, grapefruits, and tangerines, are best. Drink fruit juices that do NOT have added sweeteners or syrups.
(2 – 3 servings a day)
Choose low-fat or nonfat milk or yogurt. Yogurt has natural sugar in it, but it can also contain added sugar or artificial sweeteners. Yogurt with artificial sweeteners has fewer calories than yogurt with added sugar.
Meat and Fish
(2 – 3 servings a day)
Eat fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal, pork, or wild game. Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.
Fats, Alcohols, and Sweets
In general, you should limit your intake of fatty foods, especially those high in saturated fat, such as hamburger, cheese, bacon, and butter.
If you choose to drink alcohol, limit the amount and have it with a meal. Check with your health care provider about a safe amount for you.
Sweets are high in fat and sugar, so keep portion sizes small. Other tips to avoid eating too many sweets:
- Ask for extra spoons and forks and split your dessert with others.
- Eat sweets that are sugar-free.
- Always ask for the small serving size.
New data suggests the ketogenic diet may aid in diabetes management. Keto is a low carb (less than 50g daily) diet with high amounts of healthy fats. The goal is to enter ketosis, a state where fat is the body’s main source of fuel. In type 1 diabetes, a survey on low carb diets showed less complications and good blood sugar control. In type 2 diabetes, a keto diet showed less insulin use and improved HbA1c (a marker for diabetes)1.
Intermittent fasting is an approach that limits when you eat, not what you eat. How it’s practiced varies greatly. Some may only eat within an 8-hour window or fast (not eat) every other day. Thus, results can vary. One study showed that alternate day fasting had no metabolic benefits2, while another showed only eating early in the day was beneficial for men with prediabetes3. And while animal studies have also shown improvements in diabetes, more work remains to be done in humans.
Disclosures: Long-term results and health risks of keto and intermittent fasting are unknown. Please speak with your doctor or dietician before modifying your diet. You should also know how to read food labels, and consult them when making food decisions. Your meal plan is for you only. Each person with diabetes may have a slightly different meal plan. Talk to your Registered Dietitian or Certified Diabetes Educator to help you plan your meals.
Ludwig, D. S., Willett, W. C., Volek, J. S., & Neuhouser, M. L. (2018). Dietary fat: From foe to friend? Science, 362(6416), 764–770. https://doi.org/10.1126/science.aau2096
Trepanowski, J. F., Kroeger, C. M., Barnosky, A., Klempel, M. C., Bhutani, S., Hoddy, K. K., Gabel, K., Freels, S., Rigdon, J., Rood, J., Ravussin, E., & Varady, K. A. (2017). Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese Adults: A Randomized Clinical Trial. JAMA Internal Medicine, 177(7), 930. https://doi.org/10.1001/jamainternmed.2017.0936
Sutton, E. F., Beyl, R., Early, K. S., Cefalu, W. T., Ravussin, E., & Peterson, C. M. (2018). Early Time-Restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even without Weight Loss in Men with Prediabetes. Cell Metabolism, 27(6), 1212-1221.e3. https://doi.org/10.1016/j.cmet.2018.04.010
American Diabetes Association. Standards of medical care in diabetes–2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 Diabetes Mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.
American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31:S61-S78.