Quincie Grounds, RD/LD, CNSC, Nutrition Services Consultant, Hospital DivisionIf you have been diagnosed with pre-diabetes, Type 1 or 2 diabetes, or have a loved one with the disease, it is important for you to know the role nutrition plays in managing the disease. A balanced, healthy meal plan with emphasis on lean protein, low fat dairy, fruits, vegetables and whole grains is recommended. Many individuals with diabetes worry about the amount of carbohydrate they should take daily. The 2014 Standards of Medical Care for Diabetes state that there is not an ideal percentage of calories from carbohydrate. The amount should be based on individualized assessment of current eating patterns, personal preferences (e.g., tradition, culture, religion, health beliefs and economics), and blood glucose control goals. A dietitian can help you develop a meal plan to meet your needs. Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains a key strategy in achieving glycemic control.

Our bodies break down carbohydrates from foods into glucose for energy. The increase in blood glucose triggers the pancreas to release insulin, which helps the body use or store the glucose. People with diabetes may not make enough insulin, or their insulin may not work well. Treatments with lifestyle or medications help handle the glucose. When you live with diabetes, managing your diet, physical activity, medications, and insulin use helps keep blood sugar stable.

So is there a difference between carbohydrates?
The answer is yes. Simple carbs have only one or two sugars, so the body processes simple carbs quickly. These carbs – such as table sugar, the added sugars in processed foods, and the sugars found in fruits and milk – make blood sugar rise rapidly. Complex carbs contain three or more sugars. Your body has to work harder to break down complex carbs because the sugars take longer to digest. Examples of complex carbs include the whole grain cereals and breads, pastas, rice, vegetables, legumes and beans, and some fruits. Complex carbs may contain soluble or insoluble fiber, and both are good for you.

Should a diabetic limit the amount of “added sugar” in their diet?
The answer is yes. “People with diabetes and those at risk for diabetes should limit or avoid intake of sugar-sweetened beverages (from any caloric sweetener including high-fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiovascular disease” states the 2014 Standards of Medical Care for Diabetes. Limiting added sugar from processed foods is beneficial in controlling blood glucose levels.

How do you know how much carbohydrate is in a food?
Look for the amount of "total carbohydrate" grams on the food label. "Total carbohydrate" can also be broken down as "dietary fiber" and "sugars." But "sugars" won't tell the whole story. These include the natural sugars found in fruit and milk products as well as added sugars. A food label that lists a form of sugar as the first ingredient may be high in total sugars. There are books and websites that can help you determine the amount of carbohydrate in a serving of food.

Even though you might focus attention on counting carbs, you also need to eat enough protein and healthy fats. Don't skip meals, and eat healthy snacks to help keep blood sugar under control. And don’t forget a healthy dose of physical activity (recommend 150 minutes per week).