diabetes Q & AQ & A: How many carbohydrates should you eat to control diabetes effectively?

Q: I have had diabetes for two years.  I am 6’3” and weight 215 pounds (having lost almost 100 pounds in the past 15 years).  I have never heard anyone tell me how many carbohydrates one should have to control their diabetes.  I talked with my doctors, but they seem more comfortable prescribing medications than giving me specific dietary recommendations.  Where can I find this information?
– David H.

Answer by: Gary Scheiner MS, CDE, Clinical Director of Integrated Diabetes Services

A: So glad to hear that you’ve managed to get your weight down!  What a difference that can make for your health.

bread and counting carbsYou raise a great question about the amount of carbs in your diet. Honestly, the nutrient composition of your diet needs to be individualized.  Carbohydrate, protein and fat all play a significant role in overall health maintenance, but we tend to become more carb centric when we live with diabetes since carbs affect blood sugar so quickly.  Unfortunately, this often means protein and fat content aren’t equally considered.

The breakdown of nutrients should be tailored to your personal lifestyle and preference, as well as how your blood sugar responds to different foods.  Blood sugar checks give us an inside look at how the body responds when carbohydrates are eaten. By doing a bit of food and blood glucose analysis, one might find that a certain amount of carb works best and/or specific carb-containing foods work better than others. It should also be considered combining carbohydrate with various amounts of protein and fat can have different effects on post meal blood sugars.

Other key factors to consider when determining carb requirements include lifestyle (how physically active you are), current weight, and whether you want to gain/lose/hold steady.   A good chart for estimating your needs can be found here: https://www.getfit.tn.gov/fitnesstracker/calorie_levels.pdf

How to determine how many carbs to eat

Once you have a rough idea of your total calorie requirements, then you can determine what percent should come from carbohydrates.  For most people, carbohydrates make up 40-50% of the day’s total calories.  This can be a bit lower if your blood sugar is very sensitive to small amounts of carb; a bit higher if you exercise a great deal.  For example, if you need 2000 calories per day and want 40% of the calories to come from carbohydrate, you would take 40% of 2000 (800) and divide by 4 since there are 4 calories per gram of carbohydrate.  This comes to 200g of carb per day.   The other 1200 calories then need to broken down into fat and protein calories to provide a balance of nutrients.

The distribution of those carbohydrates through the day makes can have a major impact on blood glucose levels. Eating all (or most) of the day’s carbohydrates in one sitting would be less effective than spreading the carbs throughout the day.  Distributing carbs throughout the day is also a better way to provide satiety and avoid intense hunger.  Similarly, having all of your carbs in the form of simple sugar and refined flour is not as beneficial as having carbs that come from whole grains, fruits, vegetables, legumes and dairy products.

Confused?  Don’t worry.  Most people are!

That’s why there are thousands of Registered Dietitians (RDs) available to work with people with diabetes.  Ideally, look for an RD who is also a Certified Diabetes Educator (CDE) so that they can work with you to optimize your blood sugar control while customizing your meal plan.