About 5% of people with diabetes have type 1 diabetes. Type 1 diabetes is an autoimmune disease where the pancreas makes not enough or no insulin. Nutrition recommendations are different for people with type 1 diabetes because insulin is required for every meal in addition to a basal insulin.
Thanks to technology, there are helpful tools including diabetes apps, insulin pumps, and continuous glucose monitoring (CGM). Some insulin pumps include CGM and help to deliver the correct amount of insulin by recognizing glucose patterns. There is one thing all this technology can’t do-estimate the food you are about to eat. Most people with type 1 diabetes base their mealtime insulin dose on the amount of carbohydrates they plan to eat. The glucose rise after eating is primarily due to the carb content of the meal. Carbohydrate counting is critical for people with type 1 diabetes, but it’s also good to consider what else is on your plate.
Carbohydrates have the greatest impact on glucose levels. Carbohydrate foods are sugars, starches, grains, vegetables, fruits, and milk and yogurt. To get started counting carbs, read the food label for serving size and total carbohydrates. The food label contains the exact carb amount for that food according to the serving size. The serving size is listed in volume (cups or tablespoons) and weight (grams). To accurately count carbs, you will need measuring cups and/or a food scale. If you want to try an experiment, plate your food and then measure it to see if you were correct with carb counting. If you don’t have a food label, look up a similar food online, or use the diabetes food lists and carbohydrate choices to estimate carbs.
Fiber is a complex carbohydrate that doesn’t raise glucose because it isn’t fully digested. Fiber is found in whole grains, legumes, fruits, vegetables, nuts, and seeds, and sometimes added to other food products. On the food label, fiber is listed under total carbohydrates. Fiber doesn’t raise glucose, so a general recommendation is to subtract all or half of the fiber content when the serving of food contains more than 5 grams of fiber. Glycemic response to fiber is individual and based on what other foods you are eating. Eating more fiber will benefit your digestion, gut, and glucose.
Sugar alcohols aren’t sugar or alcohol-they are named for their chemical structure. They are sweeter carbohydrates found naturally in some foods and used as food additives. Sugar alcohols include names such as sorbitol, maltitol, erythritol, xylitol-notice they are easy to recognize with the “ol” ending. These are commonly used as sweeteners found in food products that advertise “no added sugar” or “sugar free”. Sugar alcohols do impact glucose levels but not as much as sugar. Just like fiber, a general recommendation is to subtract all or half of the sugar alcohol content when the food contains more than 5 grams of sugar alcohols. Just a word of caution-sugar alcohols in larger amounts can cause some gastrointestinal distress including bloating, gas, and diarrhea.
While protein and fat don’t contain carbs, they can affect glucose after a meal. When consumed with carbs, protein and fat slow digestion and can cause a later rise in glucose. So instead of glucose peaking 2 hours after eating, the peak glucose could be 4-5 hours after eating. This is typically seen with higher fat and protein meals-think pizza or a cheeseburger and fries. A general guide for higher fat and protein meals is greater than 40 grams fat and 30 grams protein. More insulin may be needed to cover this type of meal as well. It’s important to seek individualized advice from your healthcare team for insulin adjustments. Using CGM is valuable to learn your glycemic response to meals.
Don’t forget that glucose is affected by many factors including stress, exercise, sickness, hormones, sleep, dehydration and certain medications. Glycemic response even to the same foods is different for people. Work with your healthcare team to find the best technology and meal plan that works for you.
by Christine McKinney, RD LDN CDE