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[5 min read] Carbohydrates and diabetes

In the past, patients with diabetes were advised to avoid sugar and simple carbohydrates to control their blood sugar levels. However, research has shown that patients can enjoy moderate amounts of carbohydrates in the context of a healthy dietary pattern, and with awareness of the type, timing, and amount of carbs eaten (1).

diabetesPatients should no longer be simply advised to ‘quit eating sugar’ as a method to treat diabetes. With the evolution of medical nutrition therapy for diabetes management, patients now have tools and options, such as carbohydrate counting, to help manage their blood sugar levels (2).

What is the ideal amount of carbs?

Everyone needs some carbs in their diet, but the ideal amount remains unclear. Recent research has shown that low carb diets may result in improved blood glucose control, triglyceride levels, and insulin sensitivity for patients with diabetes, but these eating plans may be difficult to adhere to in the long-term (3).

It is recommended that patients work with their GP or a dietitian to develop an individualised eating plan with a focus on dietary quality and mealtime routine. Additionally, it is recommended that patients receive education on carbohydrate counting from a diabetes educator, who will teach them the number of carbs in a meal or snack and how to dose insulin based on that count.

What kind of carbs should patients eat?

There is increased focus on the quality rather than amount of carbs when it comes to general health (4). The glycaemic index (GI) is a useful way of categorising carbs according to their effect on blood sugar. Foods with a high GI, like white bread, are rapidly digested and cause significant fluctuations in blood sugar, while low GI foods like whole oats are digested more slowly, prompting a more gradual rise.

In general, patients should include lower-GI carbs that are higher in fibre, such as vegetables, fruits, whole grains, and dairy products. Eating carbs with foods that have protein and fat has also been shown to enhance glycaemic control (5).

What is the best eating plan or pattern for patients with diabetes?

There is no “one-size-fits-all” eating pattern for individuals with diabetes. To be effective, nutrition therapy recommendations should be tailored for each patient based on their personal health goals, cultural preferences, health literacy, and willingness to change.

Any advice should emphasise a variety of nutrient-dense foods in appropriate portion sizes as part of a healthful eating pattern, while the right amount of carb depends on medication, body size and physical activity levels.

Learn more about the role of carbohydrates in diabetes management in the online Professional Diploma Program in Medical Nutrition.


Lynette Law, Accredited Practising Dietitian

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  1. Sheard NF, Clark NG, Brand-Miller JC, Franz MJ, Pi-Sunyer FX, Mayer-Davis E, et al. Dietary Carbohydrate (Amount and Type) in the Prevention and Management of Diabetes. A statement by the American Diabetes Association. 2004;27(9):2266-71.
  2. Marcason W. What Is the Role of Carbohydrates in the Management of Diabetes? Journal of the Academy of Nutrition and Dietetics. 2014;114(10):1696.
  3. Goldenberg JZ, Day A, Brinkworth GD, Sato J, Yamada S, Jönsson T, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ. 2021;372:m4743.
  4. Ludwig DS, Hu FB, Tappy L, Brand-Miller J. Dietary carbohydrates: role of quality and quantity in chronic disease. BMJ. 2018;361:k2340-k.
  5. Bell KJ, Smart CE, Steil GM, Brand-Miller JC, King B, Wolpert HA. Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era. Diabetes Care. 2015;38(6):1008-1

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