If you have type 1 diabetes, carbohydrates are probably the trickiest part of your diet. All carbohydrate sources — including both healthy carbs like whole grains and unhealthy carbs like added sugar — raise your blood sugar. Eating with type 1 means being perpetually aware of carbohydrates, counting carbs and adjusting your insulin use multiple times per day.
Finding the right balance takes some experimentation. While eating fewer carbs usually allows you to use less insulin and achieve lower blood sugar levels, a low-carb diet isn’t right for everyone.
Ultimately, your carb intake is something you need to discuss with your medical team to find what best fits your lifestyle, preferences, and health goals.
Diabetes authorities today are reluctant to broadly recommend an exact level of carbohydrate intake. In recent years, experts have come to recognize that it's possible to achieve good health and good diabetes control by following a wide variety of diets, from very low carb to high-carb.
Toby Smithson, RDN, CDCES, the senior manager of nutrition and wellness at the American Diabetes Association, says that the organization’s most important science-based statements on diabetes management, the Nutrition Consensus Report and the official standards of care, “state that there is not an exact percentage of calories that should come from carbohydrate, protein, or fat.” There is no evidence supporting the idea that there is a “perfect” amount of carbohydrates to consume.
In short, the American Diabetes Association doesn’t recommend a specific amount of carbohydrates for someone with diabetes.
Your ideal carbohydrate intake is unique to you. “It is quite individualized, but there are certain factors that matter, like a patient’s goals and lifestyle,” says Rekha Kumar, MD, an endocrinologist at NewYork-Presbyterian and Weill Cornell Medicine in New York City.
How much do you exercise? What type of foods do you prefer? How comfortable are you carb counting and changing insulin doses for every meal? The answers to questions like this will help you and your doctor collaborate on an approach that can work for you.
It seems natural: If carbohydrates are the most problematic part of your diet, and the component that most raises your blood sugar, should you just eat less of them?
The science shows that a diet lower in carbohydrates definitely has benefits, including:
- A1C reduction
- Weight loss
- Improved blood pressure
- Increased HDL (“good cholesterol”)
- Lower triglycerides
Carbohydrate restriction, whether moderate or extreme, can also help increase
time in range and lower the amount of insulin you need, often without increasing the risk of
hypoglycemia.
Eating fewer carbs can reduce the risk of the frustrating
blood sugar roller coasters that can so easily ruin your day when you have type 1 diabetes.
It’s not all good news. Dr. Kumar points to a few downsides of carbohydrate restriction.
Long-Term Health Unknowns The fewer carbs you eat, the more protein and fat you’ll find yourself eating. For many people, that means more red meat, and many experts are worried that low-carb diets create heart health risks. Unfortunately, the science is still unsettled.
“There's not a ton of long-term research on low-carb diets in type 1,” says Kumar.
Sustainability Some people find low-carb diets a struggle to stick to. “It's just a really small group of people that can adhere to these things for a long period practically speaking,” says Kumar. “There are people with type 1 that do really well on low-carb diets, but these are people that are choosing that and it works for their lifestyle,” she says.
Insulin Changes A low-carb diet can significantly change your insulin requirements. Navigating this change can be tricky, and, if done without care, could be dangerous. “There's such a low margin for error,” says Kumar, “because the lower carbs that someone's eating, it means the lower insulin doses they need, and small miscalculations can cause disproportionate low blood sugar.”
Age Kumar doesn’t think a low-carb diet is appropriate for children: “Restricting carbs isn't considered safe in the pediatric type 1 population because of the risk of low blood sugar and, in the long-term, affecting growth and brain development.” Experts recommend only adopting this restricted diet in collaboration with a doctor who can provide enhanced monitoring of your child’s growth and health.
Yes. Some people find diabetes management success while eating a large amount of carbohydrates.
For example, “athletes and super active people need a decent amount of carbohydrates to fuel performance and to prevent a post-exercise drop in blood sugar,” says Kumar.
Even if you’re not running marathons, you may simply prefer a healthy eating pattern that tends to be higher in carbohydrates, such as a vegetarian diet.
“The Mediterranean style, Dietary Approaches to Stop Hypertension (DASH), vegetarian or vegan, and low-fat eating patterns are higher in carbohydrate than the low-carb eating patterns and can be options for people managing diabetes,” says Smithson.
It also helps if you’re eating the right kind of carbs. A study in children and adolescents with type 1 diabetes found that following the Mediterranean diet could help improve both time in range and A1C.
Kumar says that the Mediterranean diet “actually can be higher in carbs, but they're from whole grains, legumes, fruits, vegetables, and not necessarily from white flour or simple sugars.”
It’s important to consider carbohydrate quality rather than just focusing on quantity.
You should be limiting highly processed and refined carbohydrates such as those found in white bread, pasta, and packaged snacks. Kumar says that these carbs lead to the most rapid blood sugar spikes and, because they are inflammatory, have the worst effect on your long-term metabolic health.
High-quality carbs, on the other hand, are digested more slowly, leading to slower blood glucose rises, and are strongly associated with good long-term health.
“‘Quality carbs’ are those in vegetables, beans, lentils, fruit, whole grains, milk, and yogurt. They break down slowly and have key nutrients like fiber or protein, vitamins, and minerals that provide many health benefits,” says Smithson.
Ultimately, it’s your results that matter most. Can you achieve good health and good blood sugar control on your current eating pattern?
Not every ingredient affects everyone with type 1 in the same way. Instead of assuming all carbs are identical, pay attention to how your blood sugar responds to different meals. You may find out that you can tolerate some carbohydrates better than others.
“There are individual variations,” says Kumar. “I've heard certain patients with type 1 say, ‘I can eat a bagel, but I can't eat white bread.’ It sounds like it should be the same, but individuals will say different things about pasta versus pizza and the way their own bodies respond.”
Smithson recommends checking your levels before and after a meal: “You can see how different foods or combinations of food work best for you by checking your blood glucose before a meal or snack and then two hours after. As you continue to make changes, watch for blood glucose trends to help guide the best choices for you,” she says.
It might take some experimentation and effort, and the collaboration of your diabetes care team, to determine the best amount of carbs for you to eat. It’s also wise to discuss any interest you have in specific diets and discuss how to incorporate them safely.
“Everyone's health journey is unique, so eating patterns need to be individualized to include other health conditions (like heart, kidney, or liver disease), food preferences, cultural foods, cooking skills, and accessibility to healthy food choices,” says Smithson.
It’s also possible for your carbohydrate needs to change with time. “There are many life scenarios that would change the amount of recommended carbs or the amount of recommended insulin per carbohydrate,” says Kumar. For example, “if somebody develops more muscle mass, and they're more fit, their insulin sensitivity will improve, and their blood sugar spikes less in response to carbohydrates.”
Based on changes that can happen, Kumar says that the relationship between patients and specialists remains important over time. “Having a good diabetes team, like a nutritionist and a diabetes educator is important, even if patients only check in once every several years when something changes.”
- There is no single recommended amount of carbohydrates for people with type 1 diabetes, as the ideal intake varies based on individual factors like activity level, food preferences, and lifestyle.
- A diet with fewer carbs can improve blood sugar control, reduce insulin needs, and increase time in range, but very low carb diets may not be sustainable for everyone and lack long-term safety research.
- Focusing on high-quality carbohydrates from whole grains, vegetables, fruits, and legumes rather than refined carbs can lead to better blood sugar control and long-term health outcomes.
- Work with your diabetes care team to find the right carbohydrate balance for you, and monitor your blood sugar responses to different foods to understand how your own body reacts.
