Having Your Cake and Eating It Too: Fitting Sugar Into Your Meal Plan

The holidays are fast approaching, and visions of sugarplums are dancing in your head. But do the sugarplums really have to be just visions? What if you really could eat one of those tempting treats? Would your blood glucose skyrocket out of control? Not necessarily.


If you’ve had diabetes for more than a few years, you might remember being told that people with diabetes can’t eat sugar or foods that contain sugar. Sugar, along with honey, molasses, maple syrup, and other sweets, were thought to raise blood glucose levels higher and faster than other carbohydrate-containing foods, such as bread or pasta. In fact, sugar has received such a bad reputation over the years that many people still believe that eating sugar and sweet foods can actually cause diabetes.

Fortunately, thanks to the foresight of researchers who decided to challenge these theories, we now know, first of all, that sugar doesn’t cause diabetes, and second, that people with both Type 1 and Type 2 diabetes can fit sugar into their meal plans—as long as they account for it. We now know that, for the most part, it’s the total amount of carbohydrate, not the type of carbohydrate that you eat, that affects blood glucose levels. This means that the same amount of carbohydrate from any carbohydrate-containing food—including bread, cereal, milk, fruit, and desserts—affects blood glucose levels in pretty much the same way. (The one type of carbohydrate that doesn’t affect blood glucose levels is fiber, by the way.)

So, does that mean you can grab a handful of cookies or slice yourself a big piece of cake whenever you want? Not really. Remember that foods containing sugar, such as candy, cookies, and ice cream, are usually not exactly the most nutritious foods. They tend to contain a lot of calories and fat and not much else in terms of healthful ingredients. None of us, whether we have diabetes or not, should make a habit of eating sweets too often.

But, if you decide you’d like a piece of pumpkin pie on Thanksgiving, or even if you’re still polishing off Halloween candy, you need to think about how you’re fitting these foods into your eating plan. If you’re eating sweets in addition to your usual carbohydrate intake, you can definitely expect to see higher blood glucose readings (not to mention a few extra pounds). The key is to substitute sweets for other carbs in your meal plan.

Let’s take ice cream as an example. If you use the exchange system for meal planning (which you can read more about in my earlier blog entry), you would count ½ cup of ice cream as one starch or one fruit exchange (and don’t forget to consider the fat). If you go by carb counting, ½ cup of ice cream counts as one carbohydrate choice. If you count grams of carbohydrate, ½ cup of ice cream contains about 15 grams of carbohydrate. And if you use insulin and adjust your premeal insulin dose based on how much carbohydrate you plan to eat, you’d use your insulin-to-carbohydrate ratio to figure out how much insulin you need to take. By the way, if you do use a ratio, you need to look at the ice cream container label and go by the grams of carbohydrate listed there, rather than just round off to 15 grams.

What’s the tradeoff? Besides extra fat and calories, you might find that ½ cup of ice cream isn’t all that much (most people eat much more!), and that maybe a fiber-rich apple would be more filling. Because sweets are such a concentrated source of carbohydrate, the actual portion size that supplies 15 grams of carbohydrate (or one carbohydrate choice) is often quite small. But that might be fine for the person with a sweet tooth who is craving a taste of something sweet. The decision is yours. When the winter holidays roll around, you really can eat a piece of Aunt Wilma’s fruit cake (that is, if you really want to!).

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  • ephrenia

    My extended family tends to have get-togethers in restaurants for various family birthdays. These get-togethers almost invariably include birthday cakes. Since there are 2 of us with diabetes (myself and our Dad) and others with salt restrictions as well as those who eat any and everything, we tend to pick a restaurant with a varied menu.

    I know that if I want a piece of cake and NOT have a spike afterward – I can choose very low carb items (like steak and salad or chicken and turnip greens) then have a small piece of cake instead of bread or other starchy side dish. This works well for me without having to adjust my insulin dosage.

    I also tend to have a square of 60-70% dark chocolate most days. Its really good with nuts or cottage cheese as a snack!

    • gjm11653

      You win the best comment!

  • Marina Slaton

    I was diagnosed diabetic in August of 2003. Since I am allergic to artificial sweeteners, I had to figure sugar into my diet from day 1. It hasn’t always been easy, but I find that when I really crave something sweet, a very strong, rich, sweet candy or ice cream treat works very well. Most of the time a very small portion hits the taste buds like dynamite and the craving is satisfied. Those days when that doesn’t work requires a lot more self control, but then I think of the consequences–my sister-in-law now has diabetic dimentia because she was not taught how to deal with her dibetes, so continued to eat as she had before. When I think of her, I find it much easier to watch what I eat, and count EVERY carb.

  • Joan Russell

    In reading your article “Having your cake and Eating It Too! I disagree on one very important factor. To substitute sweets for good carbohydrates can do more harm in the long haul of living with diabetes!

    How can diabetics know that it takes the body TIME to adjust to every change that is made without someone explaining? When the high blood glucose comes with a piece of cake – then what do they do? Too many do not understand how to adjust their ratio or exchanges; a lot of available information differs!! Too many do not have medical assist that understands the many types of diabetes.

    Different methods are needed for each person. To speak generally is safe but does not cover the many factors of living with diabetes and can be very mis-leading.

    The exchange of nourishing carbs for a piece of pie will not support them well through the day and night. A healthy, active life is worth far more than a piece of fruit cake.

    • gjm11653

      I careless about nourishing carbs. A carb is a carb.I count carbs. But for lunch I may eat pie instead of a “lunch”. I am not into 4 squares. One meal may be nothing but green beans, and another a slice of chicken. Depends.

  • acampbell

    Hi Joan,

    I wanted to respond to your comment. I definitely agree with you that one shouldn’t frequently substitute sweets for healthier carb choices, and I did make that clear in my post. However, knowing that people with diabetes do occasionally enjoy something sweet, the point is that it’s okay, once in a while, to eat a small piece of cake, say, instead of a piece of fruit. Also, research has shown us that sweet foods don’t necessarily raise glucose levels any higher than other carb foods, such as bread or fruit. The key is watching portions and monitoring blood glucose to see how sweets (or any carb food, for that matter) affect blood glucose. People with diabetes have choices in what they eat. Enjoying a piece of pumpkin pie on Thanksgiving will not lead to any long-term damage. But it’s important to get back on track with healthier eating the day after!

  • Ekbigpanda

    This message is for Amy Campbell. Your recommendation for using Splenda is the same product touted by Dr. Mercola on his website about Splenda and other sweetners that can be used to kill ants and was originally discovered when research was being done in developing pesticides. I am a Type II diabetic and have been trying to manage the disease going on 25 years.
    Wouldn’t it be healthier to use sugar or fruit juices to sweeten deserts?

  • wkmmarfa

    I disagree with you comments regarding the eating of sugars “if you want to.” I find that it takes very little to make my blood sugars skyrocket. Also I feel like it similar to cheating on your wife or husband. Once you do it you will probably do it over and over again. You can do it “if you want to” but is really not a good idea. Adjsting my insulin does not give me the insurance to eat sugar. I simply don’t and cannot do it. Jan Chait has made the same comments and I am not sure how these comments can be justified in a diabetic magazine.

    • gjm11653

      Because it is your choice. Why do you want to take away my choice? You can choose not to eat sugar or anything you deem awful. I find your comment about eating sugar to be like cheating on a spouse to be so bizzare. Ask someone who has been cheated on if eating a slice of cake if diabetic is as devastating.You are not the food police.

  • gjm11653

    I intend to eat my usual foods at Holiday meals. I count carbs some and portion control too. I am new to this diabetes junk and for now will not eliminate any food I like. I do not cook right now since it is just me. I check my bs and it is low throughout the day. I am willing to substitute a slice of pie for lunch or cake for dinner. I do not eat meals as it is. I eat if hungry only. I am not into 3 squares a day since my kids grew up. So eating is hit and miss. But Holiday dinner is too good to miss.