Diabetes & Food

Get to Know Carbs

Carbohydrates or “carbs” get a lot of attention these days and it’s no secret that carbs can affect your blood glucose (blood sugar). You might be wondering if you should eat less of them, or even eat them at all. You’re not alone!

Carbs come in many different forms, but the main three are starch, fiber, and sugar. When purchasing packaged food, the term “total carbohydrate” refers to all three of these types. Learn more about nutrition labels. So how much is the right amount?

Let’s start with the basics. All food is made up of three main nutrients: carbohydrates, protein and fat. You need all three to stay healthy, but each person needs a different amount. When choosing carbs, the key is choosing complex carbs—the ones that give you the most bang for your buck in terms of vitamins, minerals and fiber. Complex carbohydrates are digested slower, therefore they are less likely to cause a rapid spike in your blood sugar like refined carbohydrates. Examples are whole grains and legumes.

Processed foods tend to be high in carbs, especially refined carbohydrates, while also being very low in vitamins, minerals and fiber—giving carbs a bad rap. But choosing fewer processed carb foods and paying attention to how much you are eating can make a big difference in your blood sugar and overall health.

Now, let’s dig into the types of foods that have carbs—and how to choose higher quality sources.


Try to target whole, minimally processed carbohydrate foods. If you’re using the Plate Method, foods in this category should make up about a quarter of your plate. Foods high in starch include:

  • Starchy vegetables like corn, winter squash and potatoes
  • Legumes and pulses, including lentils, beans (like kidney beans, pinto beans and black beans) and peas (think split peas and black-eyed peas)
  • Grains including foods made from wheat like noodles and pasta, bread and crackers, as well as rice and others

Whole grains are just that: the whole plant that has been harvested and dried with little processing. They provide fiber as well as essential vitamins including B and E and other minerals needed for optimal health. Examples include oats, barley, bulgur, quinoa, brown rice, farro and amaranth. At least half of your daily grain intake should come from whole grains.

Wondering what the deal is with “refined grains”? Basically, these grains are processed to remove the outer layers and most nutritious parts of the grain, meaning that we’re missing out on all the beneficial fiber, vitamins and minerals that the whole grain would typically provide. To avoid diseases caused by vitamin and mineral deficiencies, there are laws in place to make sure that essential vitamins and minerals be added back in during processing—this is what “enriched” means when you see it on the label.

Bottom line: when reading the ingredient list, look for products that list “whole grain” or “whole wheat” as the first ingredient as opposed to “enriched.”


Fiber comes from plant-based foods, including fruits, vegetables and whole, intact grains. Fiber acts like your body’s natural scrub brush—it passes through your digestive tract, carrying a lot of bad stuff out with it. It also keeps us feeling full, and helps lower cholesterol. Those aren’t the only benefits: eating foods higher in fiber can also improve your digestion, help you manage your blood sugar and reduce your risk of heart disease.

People with diabetes and those at risk for diabetes are encouraged to eat at least the same amount of dietary fiber recommended for all Americans. The Dietary Guidelines for Americans (DGA) recommend a minimum of 14 grams of fiber per 1,000 calories. You can find specific recommendations for your age group and gender in the Dietary Guidelines for Americans.

Keep in mind that if you haven’t been eating a lot of foods high in fiber on a daily basis, it’s important to increase your intake slowly to allow your body to adjust. A sudden increase in eating foods high in fiber (especially foods with added fiber or when using supplements) can cause gas, bloating or constipation. Be sure you are drinking enough water too, because fiber needs water to move through your body!

Good sources of dietary fiber include:

  • Pulses (like lentils and peas) and beans and legumes (think navy beans, small white beans, split peas, chickpeas, lentils, pinto beans) 
  • Fruits and vegetables, especially those with edible skin (like pears and apples) and those with edible seeds (like berries)
  • Nuts—try different kinds (pumpkin seeds, almonds, sunflower seeds, pistachios and peanuts are a good source of fiber and healthy fats, but be mindful of portion sizes, because they also contain a lot of calories in a small amount!)
  • Whole grains such as:
    • Quinoa, barley, bulgur, oats, brown rice and farro
    • Whole wheat pasta
    • Whole grain cereals, including those made from whole wheat, wheat bran and oats

Foods that are naturally high in fiber and contain at least 2.5 grams are often labeled as a “good source,” and foods labeled as “excellent source” contain more than 5 grams of fiber per serving.

While it’s best to get your fiber from food, talk to your diabetes care team to determine if you should consider a fiber supplement.


Sugar is another source of carbs. There are two main types:

  • Naturally occurring sugars like those in milk or fruit
  • Added sugars, which are added during processing, like in regular soda, sweets and baked goods

Added sugars, when consumed with solid fats and excess energy intake, have been linked to health concerns, including overweight and obesity, type 2 diabetes or prediabetes, inflammation and cardiovascular disease. You may have heard added sugars referred to by other names—or seen one of these listed in the ingredients in a food label. Dextrose, fructose, lactose, table sugar, beet sugar, honey, corn syrup, turbinado and agave are just some of the many names for added sugars.

Finding the amount of sugar

Did you know that you can find the amount of both added and naturally occurring sugars listed in the new nutrition facts label? Learn how to decode the label.

Sugar Alcohols

Another item you may find on some foods’ nutrition facts label under total carbohydrates are sugar alcohols. Sugar alcohols are sweeteners that have about half the calories of regular sugar. Despite their name, they are neither a sugar nor and alcohol. They occur naturally in certain fruits and vegetables, but some are man-made and are added to processed foods. Many foods labeled "sugar free" or "no sugar added" have sugar alcohols in them

Sugar Substitutes
There are so many products on the market now that are referred to as sugar substitutes. Most of these are nonnutritive sweeteners, which means that one serving of the product contains little or no calories or impact on blood glucose. Because these sweeteners are sweeter than sugar, they can be used in smaller amounts. The U.S. Food and Drug Administration (FDA) has reviewed several sugar substitutes and has approved or recognized them as safe for the public, including people with diabetes. These are:

  • Saccharin (Sweet’n low)
  • Neotame (Newtame)
  • AcesulfameK (Sunett, Sweet One)
  • Aspartame (NutraSweet, Equal, Sugar Twin)
  • Sucralose (Splenda)
  • Advantame
  • Stevia
  • Luo han guo (monk fruit)

Most of these products are not broken down by the body; this means they pass through our system without providing calories. For some people, using these products are great alternatives to sugar. The potential decrease in calories and carbs could lead to better long-term blood sugar, weight and/or cardiometabolic health (think: heart and metabolism).

A word of caution—claims like "sugar-free," "reduced sugar" or "no sugar added" are not necessarily carbohydrate-free or lower in carbohydrate than the original version of the food. We recommend that you read the Nutrition Facts label to understand how many carbs and calories you are eating.

It’s also important to know that at this time, there is no clear evidence to suggest that using sugar substitutes will help with managing blood sugar or weight or improving cardiometabolic health in the long run. So here’s the bottom line:

  • Sugar substitutes are effective alternatives to sugar for some people, but not a perfect fit for all—it’s a personal choice.
  • If you’re looking to reduce your intake of sugar or sugar substitutes, start slowly. For example, start by replacing one soda or juice with water or a no-calorie drink at a time.
  • Water will always be a great choice! If you start feeling yourself get bored with just water, you can always spruce it up with fruits or herbs like this sparkling strawberry mint infused water.

What are “Net Carbs?”

While you might see it on some food packaging, the term “net carbs” does not have a legal definition and is not used by the Food and Drug Administration or recognized by American Diabetes Association. The FDA recommends using total carbohydrates on the nutrition facts label.

“Net carbs” are determined by subtracting any fiber or sugar alcohols on the label from the total carbohydrates. This is assuming that fiber and sugar alcohols are not absorbed or metabolized, but this is not always true, and some are partially digested and therefore still provide calories as well as impact blood sugar. The equation used to calculate net carbs is not entirely accurate because the contribution of fiber and sugar alcohols to total carbohydrates depends on the types present. The type of fiber or sugar alcohols used is not indicated on the nutrition facts label, therefore the effect on blood glucose and possible insulin therapy adjustments cannot be determined precisely.

For this reason, we recommend using the total grams of carbohydrate and closely monitoring your blood sugar when consuming foods high in fiber or sugar alcohol to determine how they affect your body. Learn more about “net carbs” and other nutrient claims you might find on the nutrition facts label.