By: Rosanne Rust, MS, RDN, LDN —

Diabetes affects approximately 30.3 million Americans, or 9.4% of the population, according to 2015 data from the American Diabetes Association. Of that 30 million, approximately 1.25 million American children and adults have type 1 diabetes, and another one million have pre-diabetes. It’s estimated that 1 million Americans are diagnosed with diabetes every year.

November is recognized in the United States Diabetes Month. November 14th is recognized around the globe as World Diabetes Day. And these statistics most certainly deserve attention when considering both the prevention and treatment of Type 1 and Type 2 diabetes. Read on to learn more about diabetes, and how carb counting can be used as a tool.

Diabetes Terms at a Glance

Pre-DiabetesAlso called impaired glucose tolerance, pre-diabetes is diagnosed when blood glucose levels are higher than optimal but not high enough to be diabetes. People with pre-diabetes are at higher risk for developing type 2 diabetes, and for heart disease and stroke.Type 1 DiabetesType 1 diabetes is usually, but not always, diagnosed in childhood. It is diagnosed when blood glucose and hemoglobin A1C (average blood sugar over the past 2 to 3 months) results are above normal range. In addition to high blood glucose levels in type 1 diabetes, there is also a lack of insulin produced in the body. Type 1 diabetes requires injecting insulin (using syringes, pens, or an insulin pump) and measuring blood sugar levels (using a glucometer or a wearable device called a Continuous Glucose Monitor (CGM)).Type 2 DiabetesType 2 diabetes occurs when blood sugars are consistently high, due to either insulin resistance or poor insulin response in the body. Type 2 diabetes typically presented in middle aged or older adults, but we are now seeing it diagnosed more in younger people. It sometimes requires insulin, but often is managed with oral medication, diet and lifestyle interventions. Measuring blood sugar levels is also essential for managing Type 2 Diabetes, although it is typically done so less frequently compared to Type 1.

Risk Factors

Risk factors for Type 2 diabetes include family history, being overweight, having high blood pressure, age (being over 45), and metabolic syndrome (overweight, low HDL, high triglycerides). A strong family history of diabetes increases risk as well. The good news is that both types of diabetes can be treated and controlled with lifestyle choices and medication.

Education and Treatment

Certified Diabetes Educators (CDE) are trained to help people with diabetes lead healthy lives by creating a blood sugar management plan and helping them stay on track with it. Registered Nurses and Registered Dietitians often pursue this credential. CDEs have comprehensive knowledge about diabetes prevention, pre-diabetes, diabetes, and diabetes management.

Once diagnosed, it’s recommended that patients meet with a dietitian and CDE who will review the physiology of the disease and its potential complications. They will also educate the patient about lifestyle change, diet, and blood glucose monitoring.

How Many Carbs?

Carbohydrates (carbs) have been blamed for weight gain and diabetes over the past few years, creating confusion over this important nutrient. In many cases, some individuals are avoiding carbohydrates for no reason. Carbohydrates provide energy and many carbohydrate foods deliver important vitamins, minerals, and fiber. In addition – these foods add flavor, texture, and enjoyment to the diet.

How many carbohydrates do people need? This depends on multiple factors and should be prescribed by the CDE. A 140 pound woman requires fewer carbs than a 200 pound man. Carbohydrate needs are calculated based on total energy needs required to maintain a healthy body weight. Depending on the person, their medical and diet history, and their weight and activity level, the carbohydrate prescription may be 40-50% of total recommended calories. For someone requiring 1,800 calories, this would be about 200-225 grams a day. For someone needing 2,200 calories, carbohydrate limits would be 250-275 grams per day. Ideally, these carbs are spaced out through the day (at about 15-65 grams per snack or meal), and also planned to match activity and glucose tolerance.

Carbohydrate Counting

Carbohydrate counting (or carb counting) is a dietary strategy to help people with diabetes track their carbohydrate intake to keep blood sugar levels optimal. It involves tracking the grams of carbohydrates consumed through meals and snacks through the day. A registered dietitian (RDN) can determine how many carbohydrates are needed in the diet depending on calorie needs and activity levels. An RDN or CDE will also help patients plan the amounts needed at each meal or snack.

Carbohydrates are one of three macronutrients found in foods and beverages. The other two are protein and fat. Carbohydrates include sugars (simple carbs) and starches (complex carbs). Carbohydrates are found in many foods including breads, cereal, grains, pasta, fruit, vegetables, milk, yogurt, and of course sweets (candy, sugar-sweetened beverages, baked goods and desserts).  Foods such as whole grains, fresh fruits and vegetables are considered complex carbohydrates and contain more nutrients, but since carbohydrates increase blood sugar more rapidly than foods high in protein or and fat, it’s important for those with diabetes to keep track of all of them. Unless a patient is experiencing hypoglycemia, it is usually recommended that simple carbohydrates are avoided for the most part due to their higher glycemic effect.

Managing the amount of carbohydrates consumed at every meal results in better blood sugar management. Many types of foods containing carbohydrate can be included in the meal plan (such as special occasion foods). A unit (or carb-counting serving size) of carbohydrate is generally considered to be 15 grams, and a meal plan may limit carbs to 30-45 grams per meal, or 15-30 grams per snack.

How do Sweeteners Fit?

People with diabetes can still enjoy some foods containing sugar, but they have to be carefully planned into the diet. Overall, high sugar foods and beverages should be strictly limited (this is especially true with sugary drinks, since liquid sugar raises blood sugar levels rapidly). Low- and no-calorie sweeteners (LNCS) can help add sweetness to the diet without the unwanted glycemic effects of caloric sweeteners. For instance, aspartame has no effect on blood sugar, nor on body weight.

Substituting non-caloric sweeteners for caloric ones can also make the diet plan more enjoyable. These include diet soda in place of regular, lemonade or other drinks sweetened with a LNCS, light yogurt, sugar free frozen treats, or sugar free pudding. LNCS can also be used to sweeten tea or coffee.

Since LNCS don’t add to the total carbohydrate content of the food or beverage, they can be a very helpful tool for people with diabetes. A newly diagnosed patient who previously enjoyed drinking regular soda or sweet tea will be delighted to hear they can substitute a diet soda or a tea sweetened with a LNCS that can be integrated into blood sugar management programs.


Carbohydrate management is a key component of blood glucose management, and, therefore, it’s important that all carbohydrates are accounted for in a patient’s meal plan. Be sure to refer newly diagnosed patients to a registered dietitian and CDE so your patient will have a blood sugar and meal plan management strategy.  In addition, continue to encourage patients to touch base with their educator whenever they are struggling with their blood sugar levels. Keep in mind, achieving a desirable weight and including daily physical activity also play key roles in diabetes management. The more enjoyable and feasible a diet plan is, the more likely your patients will be able to adopt and adhere to it.

Rosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years experience. Rosanne is a paid contributor to As a Nutrition Communications Consultant  she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.

Neva Cochran, MS, RDN, LD –

November is a time to focus attention on diabetes, its prevention and treatment. About 30.3 million people or 9.4% of the U.S. population are living with diabetes while an estimated 84.1 million Americans 18 years or older have prediabetes.

Diet is an essential component of diabetes management. According to the position paper of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes, “medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs) is effective in improving medical outcomes and quality of life, and is cost-effective. MNT provided by RDNs is also successful and essential to preventing progression of prediabetes and obesity to type 2 diabetes.” (1)

While most individuals with diabetes have a moderate intake of about 45% of calories as carbohydrate, research on the ideal amount of carbohydrate for those with diabetes is still inconclusive. Monitoring carbohydrate intake and blood glucose is essential for maintaining glucose control. (2) Ideally, eating fewer foods with refined carbohydrates and added sugars and more carbohydrates from vegetables, fruits, dairy and whole grains is preferred.

What the Science Says

The American Diabetes Association supports the use of LNCS, stating “they may have the potential to reduce overall calorie and carbohydrate intake if substituted for caloric (sugar) sweeteners and without compensation by intake of additional calories from other food sources. Nonnutritive sweeteners are generally safe to use within the defined acceptable daily intake levels.” (2)

An international scientific panel of health experts met in Lisbon, Portugal in July 2017 to develop a consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. By analyzing the evidence related to the role of LNCS, their goal was to develop a useful, evidence-based reference to help reduce sugar consumption consistent with current international public health recommendations. They concluded that replacing caloric sweeteners with LNCS in weight loss plans might aid in weight loss. In addition, their use in diabetes management may contribute to better glycemic although results have been modest. The panel proposed that foods and beverages with LNCS could be included in dietary guidelines as alternatives to products sweetened with free sugars. (3)

In a 2013 scientific review of the role of LNCS in diabetes, the authors noted that research finds LNCS play an important role in diabetes prevention and management. Because added sugars are a source of increased carbohydrate intake, using LNCS is a safe and easy way to reduce carbohydrate consumption for those with type 2 diabetes so they can better manage blood glucose levels and lose weight. Substituting sugars with LCNS allows more flexibility in accommodating their health goals and personal dietary preferences. (4)

What a RD, CDE Recommends

In a recent article (5) by registered dietitian and certified diabetes educator, Kathy Warwick, she outlines the nutritional management of diabetes throughout the lifecycle. According to Warwick, there are a number of eating patterns that are acceptable for the management of type 2 diabetes. Nutrition therapy for adults involves meal planning that takes carbohydrates, fats, and protein into consideration. The amount of carbohydrate in meals can vary from 39% to 57% of energy without negatively affecting glucose control. As far as LNCS use, she suggests that FDA-approved nonnutritive sweeteners may be helpful for weight reduction and are safe to use within the acceptable daily intake range.

What Diabetes Organizations Advise

Leading diabetes centers and organizations all support the inclusion of LNCS as part of a healthful eating plan for diabetes management.

Sugar substitutes can be very useful to people with diabetes according to Gillian Arathuzik, RD, CDE with the Joslin Diabetes Center. In an article on the Joslin website, she recommends using either aspartame or sucralose in moderation depending on a person’s taste preference. (6)

Likewise, the American Diabetes Association confirms the safety and usefulness of LNCS for people with diabetes on their website. They support use of foods and drinks with LNCS as another option that may help curb cravings for something sweet. (7)

Finally, the American Association of Diabetes Educators has two LNCS tip sheets available on their website, one with frequently asked questions (8) and the other featuring a chart listing the amount of sweetener packets and cans of diet soda that can be consumed without exceeding the Acceptable Daily Intake. (9)

In summary, scientists, dietitians and noted diabetes organizations all support the use of low and no calorie sweeteners in moderation as part of a nutrient-rich eating plan for those living with diabetes. As health professionals it is reassuring to have options to recommend to clients to increase eating enjoyment and manage diabetes.


  1. Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 DiabetesJ Acad Nutr Diet 118:343, 2018
  2. Lifestyle Management: Standards of Medical Care in Diabetes – 2018Diabetes Care 41(Suppl. 1):S38, 2018
  3. Ibero–American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and BeveragesNutrients 10 818, 2018
  4. The Role of Low-calorie Sweeteners in DiabetesUS Endocrinology 9:13, 2013
  5. Diabetes Management & Nutrition Guide: Diabetes Nutrition Throughout the LifecycleToday’s Dietitian 20:33, 2018
  6. The ABC’s of Sugar Substitutes” Joslin Diabetes Center website accessed 10-18-18
  7. Low-Calorie Sweeteners” American Diabetes Association website accessed 10-18-18
  8. Translation of Research to Help Answer Patient Questions About Sweeteners” American Association of Diabetes Educators website accessed 10-18-18
  9. Acceptable Daily Intake (ADI) in Packs of Sweetener Compared to Cans of Diet Soda” American Association of Diabetes Educators website accessed 10-18-18

Neva Cochran, MS, RDN, LD is a registered dietitian nutritionist based in Dallas. She serves as a nutrition communications consultant to a variety of food and nutrition organizations, including the Calorie Control Council. She is passionate about promoting fact-based food and nutrition information to help people enjoy nutritious eating. Follow her on Twitter @NevaRDLD and check out her blog at

Blood glucose is primarily impacted by the carbohydrates in the foods and beverages consumed. Here are some steps to help prevent and manage diabetes through the diet.

  • As a first step, understand what carbohydrates are and where they are most commonly found.
  • Next, learn how to count carbohydrates. This entails counting the number of grams of carbohydrates in a meal and matching that to your dose of insulin.
  • More broadly, understand how to make sense of Nutrition Facts labels and make informed dietary decisions.
  • Strategize and execute your eating plans. This could mean looking up recipes with nutrition information needed to count carbohydrates, meal planning to help time your meals to keep blood sugars balanced, or seeking out smart substitutions to prevent blood glucose spikes, such as replacing sweetened foods and beverages with low- and no-sugar alternatives.
  • The inclusion of naturally high fiber or fiber-enriched foods in your diet could aid in the management of blood glucose levels, as they have been shown to slow the absorption of carbohydrates. As a result, the rise in post-meal glucose and insulin levels are minimized.
  • Take advantage of online tools such as CCC’s Food Calorie Calculator, which allows users to choose from thousands of foods and brands, and see nutrition facts including calories and carbohydrates.
  • Understand that there are more options than ever before for foods and beverages often labeled as “lite”, “reduced-calorie”, “reduced-sugar”, or “diet” that can help you minimize spikes in blood glucose levels. Those products are typically sweetened with low- or no-calorie sweeteners (LNCS). Learn more about utilize LNCS to manage diabetes here.

By: Jessica Levinson, MS, RDN, CDN —The kids are back in school, after-school activities are in full swing, and before you know it the holiday season will be here. It’s not so easy to get a healthy meal on the table when there’s so much going on in the household, especially when you’re shuttling the kids around town.

Early mornings and late nights at soccer practice and dance class may lead your family to stop for take out more often than you’d like, which means your family is likely eating larger portion sizes and more calories, sodium, saturated fat, and sugar than they would be if eating home cooked meals. But that doesn’t have to be the case. With a little bit of planning, cooking at home can become a reality. If you spend some time over the weekend planning for the week ahead, it will be much easier to implement this change for the family.

For breakfast, stock the fridge with hard-boiled eggs and individual containers of low-fat yogurt or cottage cheese. Don’t be afraid of fruit-flavored yogurts that are made with sweeteners – the nutritional benefits of yogurt (i.e. calcium, vitamin D, protein) are worth a few extra calories and increased palatability, especially for kids. You can even prepare smoothies the night before and quickly re-blend in the morning. This Blueberry Pomegranate Smoothie is a good source of protein and antioxidants and the pretty color will certainly excite the kids first thing in the morning.

Whole grain frozen waffles or pancakes spread with nut butter and topped with fresh fruit are another quick and easy breakfast the kids will love. You can also make a batch of egg muffins over the weekend, store them in the freezer, and defrost in the microwave in the morning. Overnight oats are another popular timesaving breakfast option.

If you’re packing lunch for the kids or yourself, keep it simple and balanced by filling bento-style lunchboxes with a protein, whole grain, vegetables, and fruit. Or put reheated leftover pasta dishes or hearty soups like lentil or chicken noodle in a thermos, which will keep it warm until lunchtime. Think outside the box when it comes to sandwiches – use romaine lettuce leaves as a sandwich wrap or use two cucumber rounds as the “bread” for mini sandwich bites. Fill them with tuna, chicken, or salmon salad. And don’t forget to pack a bottle of water to stay hydrated without the extra calories of soda or juice.

Eating dinner as a family is the biggest challenge of all for many families. To ease the burden, start with a small goal of cooking at home once or twice a week and work up to more as the schedule permits. Remember the MyPlate graphic when choosing what to make: lean protein, whole grains, vegetables, healthy fats, and a serving of dairy is all you need. Make big batches of soups and stews, which can be frozen and saved for a busy weeknight when you don’t have time to cook.

Get more recipes and tips in this guide to back to school meal planning.

Jessica Levinson, MS, RDN, CDN is a registered dietitian nutritionist and culinary nutrition expert. She has extensive experience as a recipe developer, writer, editor, and speaker. She is the co-author of We Can Cook: Introduce Your Child to the Joy of Cooking with 75 Simple Recipes and Activities (Barron’s, 2011), past columnist for the Culinary Corner column in Today’s Dietitian Magazine, and maintains a popular blog at Jessica is an active member of the Academy of Nutrition and Dietetics (AND) and various Dietetic Practice Groups of the AND, including Nutrition Entrepreneurs, Food and Culinary Professionals, and Dietitians in Business and Communications. Follow her out on Twitter, Facebook, Instagram, and Pinterest.

By: Jill Weisenberger, MS, RDN, CDE, FAND —

Yes, it’s true! When families eat together, they eat better. Specifically, kids who eat with their families eat more fruits and vegetables. Plus, they’re more likely to be at a healthful weight and less likely to engage in disordered eating. But that’s not all. Meal time is an important time for the entire family to connect. Research tells us that when teens eat regularly with their families, the teens are at lower risk of using drugs, have better mental health and feel more connected at home. Kids tend to do better in school too!

As hard as it was to put a family dinner on the table most nights, I wouldn’t have traded this important time for anything. It brought my family closer together, and it helped shape my girls’ values. They also learned about good basic nutrition. Today they know that fruits and vegetables are part of a balanced meal, that they should eat only until they are no longer hungry, and that it’s fun to try new foods and recipes.

Have More Family Meals

  • Get everyone onboard. Talk to your family about the obstacles that get in the way of having more family meals. For some families, it’s as simple as clearing the kitchen table of papers and mail.
  • Be organized. Plan a meal and shop for groceries.
  • Make it fun. Keep the TV off. Have a theme night now and then. Try Taco Tuesday, or have an indoor picnic on the floor. Practice using chopsticks with Asian food, and light candles for a fancy meal.
  • Strike up a conversation. Once a week or so, ask everyone to be prepared to share the highlight of their day, or a worry, a wish they have for the future, or something funny that happened.
  • Get everyone involved. Plan the menu together, or let family members take turns picking recipes. Let older kids shop for groceries and younger ones set the table or count out the right number of forks, napkins or ingredients for a recipe.

Collect Recipes

You may already have favorite recipes passed down through the generations. If you do, keep adding to this collection. If not, start collecting right away. Here are a few that your family is sure to love.

Sharing a meal together is a sure way to bring your family closer together and to instill good eating habits. It’s worth the effort. I promise.

Jill Weisenberger, MS, RDN, CDE, FAND has worked as both a nutrition counselor and a diabetes educator in the hospital and research settings, and now in private practice in Newport News, VA. Jill is the author of Diabetes Weight Loss – Week by Week and two upcoming books, The Overworked Person’s Guide to Better Nutrition and 21 Things You Need to Know about Diabetes and Your Heart. She is a member of the Academy of Nutrition and Dietetics, the American Association of Diabetes Educators and the American Diabetes Association. Jill is a paid advisor for the Calorie Control Council. Follow Jill on Twitter @NutritionJill and find more at