Controlling Carbs

As we have explored in previous Diabetes Flashpoints posts, there is ongoing debate in the diabetes community over whether a following a low-carb diet is the best way to achieve good blood-glucose control and to avoid diabetic complications. But among those people who eat more than a few grams of carbohydrate each day — the vast majority of people with diabetes — there are different methods for keeping track of, and restricting, carbohydrate in the diet. Is there any way to tell which is best?


Not surprisingly, it appears that for people with diabetes who take insulin, counting carbs can be helpful. A study published last month in the journal Diabetes Care, which tracked 61 adults with Type 1 diabetes who used insulin pumps, assigned each participant either to learn how to count carbs — which became the basis for mealtime insulin doses — or to learn how to estimate mealtime insulin doses without counting carbs. After 24 weeks, participants in the carb-counting group had a lower body-mass index and waist circumference than those in the non-counting group. Overall there was no significant difference in HbA1c level between the two groups. However, as a Reuters article notes, this changed when researchers looked at those in the carb-counting group who reported counting carbs consistently and using their insulin pump as directed. This segment of participants had a 0.35% lower HbA1c level, on average, than the non-counting group.

Another method of regulating carbohydrate in the diet is the glycemic index (GI) — a system that rates carbohydrate-containing foods according to how quickly they raise the blood glucose level. A 2008 study, published in the journal Nutrition, compared a low-GI diet with receiving dietary education based on American Diabetes Association guidelines in people with poorly controlled Type 2 diabetes. It found that although both groups saw similar reductions in HbA1c after 12 months, members of the low-GI group were 74% less likely than those in the education group to have had diabetes drugs added to their regimen, or doses of current drugs increased, over the course of the study. A 2003 meta-analysis (combined analysis of several studies) on low-GI diets — published in the journal Diabetes Care — did, however, find an average HbA1c reduction of 0.43% associated with such diets.

What do you think — have you tried counting carbs as part of your diabetes meal plan? Or using the diabetic exchange system, which takes food groups and nutrients other than carbohydrate into account? Following a low-GI diet? Which system have you found to work best — or is low-carb the only way to go? Leave a comment below!

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  • M. B.

    Carbs are not my friend. I use Humulin N in mornings to regulate my insulin levels throughout the day and get 70/30 mix at meal times. If I happen to eat rice for let’s say dinner, the next morning, my meter tells me about it. I can not drink milk even though I love it. I had to resort to the carb-countdown version. Ice cream is another weakness of mine. Only type I can consume with less guilt is carb-smart variety. So, in short, if you are not controlling your carbs, you will know.

  • FEL

    I did not know not counting carbs was ever an option! That has been drilled into my head by my endo, diabetes educator, etc. My numbers are much better if I am diligent about counting and not eating bad carbs at all.

  • Steve Parker, M.D.

    Type 2 diabetes is a disorder of carbohydrate metabolism. The body cannot process dietary carbs to the same capacity as seen in non-diabetics.

    A helpful analogy is lactose intolerance. People with insufficient enzyme to digest lactose can manage the condition easily by avoiding lactose-containing products. Some need to avoid all lactose, others can tolerate small amounts.

    In the field of nutrition, “essential” means necessary to life and health. There are essential amino acids (in proteins) and essential fatty acids, but there are no essential carbohydrates.

    The average diabetic eating 250 g of carb daily would see no deterioration in health or longevity by reducing carb consumption by 80 or 90%. I think the opposite is true: they’d see an improvement. (Diabetics should not undertake major carb restriction without consulting their healthcare provider first.)

    Or they can continue high carb consumption and take drugs to counteract the hyperglycemia. Unfortunately, we don’t know the long-term consequences of many of the drugs we use. They gain FDA approval based on short-term studies. Note that usage of rosiglitazone was recently severely restricted due to adverse cardiac events. Europeans took it off the market entirely. Which drug is next?