What should diabetics cut out of eating and should they avoid carbohydrates?

A fellow caregiver asked...

What should diabetics cut out of eating and should they avoid carbohydrates? My dad, recently diagnosed with type 2 diabetes, has very high blood sugar. Should he cut out carbs completely to try to get his numbers in the recommended range?

Expert Answer

Theresa Garnero is clinical nurse manager of Diabetes Services at California Pacific Medical Center in San Francisco.

No, definitely not. Carbohydrates, such as bread, rice, and pasta, are the body's main source of energy, and many carbohydrates, such as cereals, fruit, and dairy, contain nutrients essential to your father's good health. While it's true that carbs have a greater impact on your dad's blood glucose level than any other food, he may be able to make smarter choices about the kinds of carbs he's eating -- and how many -- to help keep his blood sugar in check. For instance, it's better for his body if he chooses complex carbohydrates that are also high in fiber, since this nutrient is less likely to cause blood sugar spikes. That means eating whole grain cereals, breads, pasta, and rice instead of white, processed ones. Likewise, whole fruit is a better bet than fruit juice. And simple carbohydrates, such as sugar, honey, and soda, are best kept for an occasional treat, as they can cause a sharp rise in blood sugar.

Since carbohydrates do raise blood sugar, your dad will want to balance out how much he eats. An easy way to do that is through what's called the plate method. If you think of a plate as a circle, divide it in half, and then divide one half in half again. On the full half of the plate goes vegetables and salads, one-fourth of the plate is reserved for protein, and the remaining one-fourth is for carbohydrates or starches.

To get a sense of how his body responds to carbohydrates, it's a good idea for him to test his blood glucose both before and after he eats. To learn more about carbohydrate counting he should talk with a dietician or his diabetes educator, who can help tailor a nutrition treatment plan to suit your father's particular needs.

As a general guide, men need 60 grams of carbohydrates per meal (women about 45 grams). That's about a cup of rice with a dinner of chicken breast and salad. Your dad can get creative about how he divvies up his carb count: For example, maybe for breakfast he'll have a piece of toast with a small glass of milk. For snacks, your dad should aim for around 15 grams of carbohydrates, roughly equivalent to a small piece of fruit or three graham crackers.

If your dad has a sweet tooth, you're unlikely to get him to lay off the carbohydrate-heavy cookies cold turkey. So when he just can't pass up a dessert, offer to split it with him or encourage him to increase his activity -- by taking a walk after dinner, for example -- to counteract the effects of the extra sugar on his blood glucose levels. At the very least, he should consume sweet treats at the end of a meal when his body is already busy digesting other food to help slow down the rise in his blood glucose. As in life, moderation is key.