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Where Health Care Professionals
Go for Information
Carbs Are the Key:
Current Nutrition
for Diabetes
Contributed by Karen Auwaerter, RD
Updated by Nutrition411.com staff
Review Date 8/12
D-0556
Remember when…
• No sugar or sugary foods
• More complex carbohydrates, because they are
digested more slowly and will not increase blood
sugar as rapidly
Remember when (cont’d)
• American Diabetes Association (ADA): Nutrition
Recommendations and Principles for People With
Diabetes Mellitus, 1986:
 People with diabetes can safely incorporate
1 teaspoon of sugar into a meal, as long as blood
sugar is under good control
Remember when (cont’d)
• Patients followed rigid meal plans and could not
request any foods high in concentrated
carbohydrates
• Calories were calculated to within 100 calories of the
diet prescription (ie, 1800 ADA diet)
• Patients were told: “I am sorry, but that is not on
your diet.”
Remember when (cont’d)
• House snack was automatic
• Snacks included protein, because it helped “regulate”
blood sugar
• Patients typically were on NPH insulin or sulfonylureas
(Diabinese®, Glucotrol®, Micronase®)
The new research says…
• Postprandial glucose levels and insulin responses to a
variety of starches and sucrose are similar if the
amount of carbohydrate is constant
• Day-to-day variations in energy and protein or fat
intake are not significantly related to A1c
ADA Guidelines changed in
1995 to reflect new science
• “Sugars” and concentrated sweets are allowed as
part of a healthy eating pattern for all persons with
diabetes
• Sweets can replace other forms of carbohydrates in a
meal pattern
• Most carbohydrates should come from nutritious
sources, such as fruits and vegetables, grains, and
low-fat or fat-free dairy foods
The evidence says…
• Foods containing carbohydrates (CHO) from whole
grains, fruits, vegetables, and low-fat milk are
important components—include them in a healthy
diet
• The total amount of CHO in meals or snacks is more
important than the source or type
The evidence says…
(cont’d)
• Because sucrose does not increase glycemia to a
greater extent than isocaloric amounts of starch, it is
not necessary to restrict sucrose and sucrosecontaining foods
• However, you must substitute sucrose and sucrosecontaining foods for other CHO sources or cover
them with insulin or other glucose-lowering
medication
ADA Position Statement,
2008
• Implementation of a “consistent carbohydrate”
diabetes meal plan at health care facilities
• Elimination of the name ADA diet and no
concentrated sweets (NCS) diet
• CHO content comparable from day to day at each
breakfast, lunch, and dinner
• Diet approximately 50% CHO, 20% protein, 30% fat
Source: American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the
American Diabetes Association. Diabetes Care [serial online]. 2008;31(suppl 1):S61-S78. Available at:
http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf. Accessed August 5, 2012.
ADA Position Statement,
2008 (cont’d)
• Patients requiring clear or full liquids should receive
approximately 200 grams (g) CHO daily
• Sugar-free liquids are not appropriate
• After surgery, initiate food intake as quickly as
possible
Source: American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations and interventions for diabetes: a position statement of the
American Diabetes Association. Diabetes Care [serial online]. 2008;31(suppl 1):S61-S78. Available at:
http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf. Accessed August 5, 2012.
Consistent CHO diet
• Typically 60 g CHO at each meal
• Occasional sweets counted into the total CHO (coffee
cake, Fig Newtons)
• Increased amount of fresh vegetables, fresh fruit, and
whole grains
• 60 g CHO in all liquid diets
Patient and staff
education is key
• The “old” ADA diet no longer exists
• Artificial sweeteners are allowed to help reduce total
carbohydrate intake of a meal
• Foods with “added sugars” are acceptable, as long as
they do not affect the overall carbohydrate balance of
a meal
References
Academy of Nutrition and Dietetics. Nutrition Care Manual®. Available at:
http://www.nutritioncaremanual.org/auth.cfm?p=%2Findex.cfm%3F. Accessed August 5,
2012
American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes
Care [serial online]. 2012;35(suppl 1):S11-S59. Available at:
http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.pdf+html. Accessed
August 5, 2012.
American Diabetes Association, Bantle JP, Wylie-Rosett J, et al. Nutrition recommendations
and interventions for diabetes: a position statement of the American Diabetes Association.
Diabetes Care [serial online]. 2008;31(suppl 1):S61-S78. Available at:
http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf. Accessed August 5,
2012.
Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and
recommendations for the treatment and prevention of diabetes and related complications.
Diabetes Care [serial online]. 2002;25:148-198. Available at:
http://care.diabetesjournals.org/content/25/1/148.full.pdf+html. Accessed August 5, 2012.