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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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

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