Managing your blood sugar levels with diabetes can be quite challenging. Some people are prescribed insulin or medications to help them, but a proper diet should be the foundation for all diabetics. Paying attention to carbohydrates is generally recommended, since it is the nutrient that has the largest impact on blood sugar levels. This can be done by counting carbohydrates, either using grams or the exchange system.
Blood Sugar and Carbohydrates
Managing blood sugar levels with diabetes is not an easy task, mainly because the pancreas is not producing sufficient amounts of insulin and also because the cells have become less sensitive to its action. The main nutrient able to impact blood sugar levels significantly is carbohydrate. Once digested, it is converted to glucose, or sugar, and then enters the bloodstream quickly. Carbohydrates are found in most of the foods commonly consumed at every meal, including all types of bread, pasta, rice, potatoes, breakfast cereals, granola bars, fruits, milk, yogurt and sugar. The "2010 Dietary Guidelines for Americans" recommends consuming 45 to 65 percent of calories as carbohydrates, while most organizations and health care professionals suggest aiming for 45 to 60 g of carbohydrates each day, as explained by the American Diabetes Association. However, this approach may not be appropriate for all people with diabetes.
Counting Grams Vs. Exchange Lists
There are two main systems to help diabetics optimize their blood sugar levels by controlling their carbohydrate intake. The first one is to count grams of carbohydrates and the second is to to count carbohydrate choices. To count grams of carbohydrates in the food your eat, you can look at food labels or at a food composition table, to keep track of how many grams of carbohydrates you eat throughout the day. It is more accurate to count net carbs, which refers to the amount of digestible carbs, and can be calculated by subtracting fiber from total carbohydrates. In the exchange system, each carbohydrate choice is equivalent to 15 g of net carbs. The exchange system may make the math a little easier, but by rounding everything up and counting carbs with 15 g increment, this method is definitely less precise than counting net carbs directly.
Blood Sugar Control
Because carbohydrates constitute the main nutrient responsible for raising blood sugar levels, it would appear that consuming less of them would be beneficial. Many studies support this theory, although general recommendations advise people with diabetes to eat 45 to 60 g of carbohydrate per meal, which is the equivalent of at least 130 to 180 g of carbs a day. For example, a study published in the December 2008 issue of "Nutrition & Metabolism" compared the effect of a low-carb vs a low-glycemic index diet in individuals with type 2 diabetes. The low-carb diet comprised less than 20 g of net carbs a day, while 55 percent of the calories were from carbs in low-glycemic list. After 24 weeks, the low-carb group decreased their A1C, or average blood sugar levels, by 1.5 percent, compared to only 0.5 percent in the low-glycemic group. In addition, 95.2 percent of the diabetics in the low-carb group were able to significantly decrease, or even discontinue, diabetes medications, compared to only 62 percent of the subjects in the low-glycemic group. The authors of this study concluded that low-carb diets were better for diabetics than low glycemic index for diabetes control.
Considerations
There is abundant evidence in the scientific literature showing that diets with a lower carbohydrate intake can help diabetics better control their diabetes, not only because of the effect low-carb diets can have on blood sugar levels, but also because it can help achieve healthier weight, blood pressure and blood cholesterol levels. Although a very low carb diet with less than 30 g a day isn't currently recommended for diabetics, according to researcher Surender Arora, lowering your daily intake of carbohydrates below 100 g a day is probably the easiest and most effective way to improve your diabetes control and general health.
Getting Started
If you wish to experiment with the effect of a low-carb diet on your blood sugar levels, it is important to first talk with your doctor to ensure that you will be followed and that it will be done safely. Start tracking your carbohydrate intake at each meal, along with your blood sugar levels before eating and again two hours afterward to see the impact of what you eat on your blood sugar levels. Then, you can experiment with the effectiveness of low-carb diets by slowly lowering your carbohydrate intake to 30 g at each meal. Some diabetics will benefit more by further lowering their carbohydrate intake to 25, 20 or even 15 g of carbohydrates per meal. Everybody is different, but by keeping track of your net carbs and blood sugar levels, you will be able to determine what works best for your body.
References
- American Diabetes Association: Carbohydrate Counting
- "American Journal of Clinical Nutrition"; Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum; Alexandra M. Johnstone et al.; 2008
- "Nutrition & Metabolism"; The case for low carbohydrate diets in diabetes management; Surender K. Arora et al.; July 2005
- "Nutrition & Metabolism"; Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up; Jörgen V. Nielsen et al.; May 2008
- "Nutrition & Metabolism"; A low-carbohydrate, ketogenic diet to treat type 2 diabetes; William S. Yancy Jr. et al.; December 2005
