By now you know that carbohydrates affect your blood glucose levels. No, you do not have to avoid all sweets and starches, and yes, you can have fruit, carrots, and even sugar (in limited amounts)! You need to have a good understanding of what foods have carbohydrates, pay attention to the amount or portion size, select the healthiest carbohydrate foods that offer some fiber, and distribute your “carbs” evenly throughout the day.

What foods have carbohydrates?
- Grains : bread, crackers, rice, cereals, pretzels, pasta
- Starchy Vegetables : potatoes, peas, corn, legumes
- Fruit and fruit juices
- Milk and yogurt
- Sweets and desserts
- Non-starchy vegetables: broccoli, tomatoes, spinach, carrots etc., contain small amount s of carbohydrates and tend to not affect blood glucose unless large quantities are consumed.

The fiber and water content render the small amount of carbohydrate in these foods less available to impact blood glucose.

What are the best carbohydrate choices?
Various forms of carbohydrate affect your blood sugar differently. The same amount of carbohydrate from different foods will have a different effect on your blood sugar. A slice of white bread will raise blood sugar faster than one slice of whole grain bread. In this case, the difference is the fiber content. Foods that digest slowly will relase carbohydrate in the form of glucose into the blood stream more slowly.

Your goal is to eat carbohydrates in such a way that the foods cause a slow, steady release of glucose into your blood stream, so your body can effectively process it. Listed are some factors to keep in mind:

-Carbohydrate foods with fiber will slow digestion and release of glucose; Soluble fiber is particularly favored, such as oat bran, dried beans and peas, fruits, vegetables.
- The more refined the food, the faster the blood sugar rises. Even though fruit juice is healthy, because it is liquid and not solid like the fruit, the quicker the blood sugar will rise. Raw foods tend to be more slowly digested.
- Concentrated sweets such as simple sugar, will quickly raise blood sugar.
- Eating a carbohydrate food with fat, such as butter on the potato, will slow blood sugar rise.
- Adding protein will also slow the digestion - Have peanut butter with some crackers. This is called a combination snack (combines protein, fat and carb)

How much carbohydrate should I have?
There is no official perfect diet for diabetes. The best diabetic diet for you is one that keeps your blood glucose levels as close to target as possible, with the healthiest food choices. There are recommendations from low carbohydrate diets to the Mediterranean diet to vegetarian diets - you can create a personalized diet plan with your dietitian or certified diabetes educator.

Traditionally, diabetic diets are designed to start with this calorie distribution:

Protein: 15-25%
Carbohydrate: 40-55%
Fat: 25-35%

Based on your personal health, lifestyle and diet goals, you dietitian can calculate and educate you on the best diet design for you. Your dietitian will take into account your cholesterol levels, A1C, blood glucose patterns, kidney function, blood pressure, work and sleep habits, meal and snack patterns, and food likes and dislikes to create your unique meal plan.
Sample Calorie Distributions

15 %
20 %
20 %
25 %
50 %
50 %
45 %
40 %
35 %
30 %
35 %
100 %
100 %

Based on different calorie levels, you may be allowed from 120 gms to 330 grams of carbohydrate.

The amount of carbohydrate for each person varies with their calorie goals, exercise levels, blood glucose levels and male/female. A healthy diabetic meal plan includes:

Women : 45-60 grams of carbohydrate per meal (3-4 carb choices/meal)
Men: 60-75 grams per meal (4 to 5 carb choices/meal)

For snacks: 15-30 grams of carbohydrate per snack (1-2 carb choices/snack)

Here is a typical example:
1,500 calories - daily total carbohydrates 170 gm (45%). 40 grams (3 meals), 15 gram (3 snacks)

What is Glycemic Load?
Glycemic Index (GI) and Glycemic Load (GL) are terms you might here about carbohydrate foods. “Glycemic” means “sugar in the blood.” The GI and GL rank carbohydrates on a scale based on their immediate effect on the blood sugar after eating. This is called the glycemic response. Foods with a high GI/GL are rapidly digested and absorbed, raising the blood sugar quickly and high. A slower more gradual rise is preferred.

Sugar, sweets and most refined foods have high glycemic loads. Some surprises, such as cereals and potatoes, also have relatively higher GI-GL. However, when you eat these foods with milk containing protein or a potato with butter and steak and broccoli, the GI-GL changes. Also, the cooking method and food particle size can alter the values. So, GI-GL is a source of controversy because this method is not predictably consistent. It can shed light on why your blood glucose goes so high at times.

Understanding the Food Groups, or Exchange Lists
The Academy of Nutrition and Dietetics, in collaboration with other health associations, created The Exchange System. This system was designed to make meal planning easier for people with diabetes and offer health educators a common and consistent way to instruct them. Foods are categorized together into six groups that are commonly alike - like all fruits - and portions into amounts that are the same composition. For example, all the servings of fruit are 60 calories and 15 grams of carbohydrate. So, each fruit can be “exchanged” for another and the amount of calories and carbohydrate consumed remains the same.

Using Carbohydrate “Choices” to Carb Count
Carbohydrate counting is a useful tool to plan your meals, especially to balance with your diabetes medication and insulin. A carbohydrate “choice” is a portion of food that has 15 grams of carbohydrate.

The fruit group, the starch group, and the milk group all have 15 grams of carbohydrate per portion as described. So, if you are planning on having 45 grams of carbs at lunch, you could have one serving of milk, one serving of fruit and one serving of starch. Another 45 gram example for lunch - two starches (30 grams) and one fruit (15 grams).

1 carbohydrate choice=15 grams of carbohydrate

Samples of one carb choice or 15 grams of carbohydrates:
½ cup oatmeal
1 slice of bread
½ English muffin
1 6-inch tortilla
4-6 crackers
½ cup peas
½ cup potatoes
1/3 cup rice or pasta
1 8oz. glass skim milk
2 small cookies
1 medium apple
¾ cup blueberries
1/2 grapefruit

Using Carb Choice to Meal Plan - How This Works
Sample Meal Plan: 1,800 calories 206 gram Carb, 60 grams Fat, 112 gm Protein (45%-30%-25%)
3 meals= 60 grams carbs; one snack 15 grams carbs
1,800 calorie food Exchange Plan
3 Milk, 4 Veg, 2 Fruit, 8 Starches, 8 Meat, 4 Fat - 13 carb choices

Distribute the 13 carb choices evenly throughout the day. A choice can be a milk, a starch or a fruit. So, if you happen to not have enough fruit (15 grams) in a day, you can switch a fruit choice for a starch (15 grams) choice (hopefully it has fiber!).

Carb Goal
Sample Menu
60 grams
(4 choices)
4 Carbohydrate Group
2 Starch
1 Fruit
1 Dairy
1 Protein
1 Fats
2 slices toast
¾ cup blueberries
Low sugar low fat yogurt
1 scrambled egg
1 tsp margarine
60 grams (4 choices)
4 Carbohydrate Group
2 Starch
1 Fruit
1 Dairy
1 Non-starchy vegetable
3oz. Protein
1 Fats
2 slices bread
½ cup fruit cocktail
8 oz. milk
Raw carrots
¾ cup tuna
1 tsp. mayonnaise
60 grams
(4 choices)
4 Carbohydrate Group
3+1 Starch
2 Non-starchy vegetable
4 oz. Protein
2 Fats
1 cup brown rice
½ cup peas
Salad with raw veggies
4 oz. grilled chicken
1 tsp. marg, 1 tbsp. salad dressing
15 grams
(1 choice)
1 Carbohydrate Group
1 Starch
Non-starchy vegetable
1 oz. pretzels

Using the Food Label to Carb Count

Suppose you are eating a frozen dinner meal, or a combination meal of fish, pasta and vegetables. You can use the food label to find the carbohydrate content. Find the total carbohydrates (in one serving or the entire meal - see sample nutrition label below). Fiber and sugars and sugar alcohols are sub-listed there also. If there is more than 5 grams of fiber, subtract half the fiber from the total carbohydrates. This is your amount of carb grams. Divide this number by 15 grams to find the number of carb choices you are using for this food item.

Counting Carb Grams
Counting Carb Choices
What is Carbohydrate Counting?


Reviewed by Clara Schneider MS, RD, RN, CDE, LDN - 05/13