Why Do People with Diabetes Count Carbs, Not Sugar?

Carbohydrates (carbs) are essential macronutrients for the body, just like fats and proteins. Diabetes stigmas and misconceptions might have you thinking that people with diabetes (PWD) should avoid them, but that couldn’t be further from the truth. People living with all types of diabetes require carbs for energy, just like people without! Your brain needs them for fuel.

Though eating too many high-carbohydrate foods may lead to diabetes challenges, including high blood sugar, eating the right amount for you can support nutritional balance and energy levels. Carbs aren’t the enemy! 

People with type 1 and type 2 diabetes are often taught to count carbohydrates rather than sugar. Estimating total carbohydrate intake rather than counting sugar intake alone is a better strategy because sugar is not the only component that can raise blood sugar. Other digestible carbohydrates that raise blood sugar include milk sugar, fruit sugar, natural starches (common in foods like potatoes and rice), and processed starches (like maltodextrin). Counting only the sugar in meals, snacks, and beverages would miss most of what raises blood glucose and lead to less accurate insulin dosing.

In this guide, we explain why that makes a difference.

What are carbohydrates?

At a foundational level, carbohydrates are essentially sugars. The body can use them right away for energy or store them in the liver and muscles as glycogen for later use. The type and amount of carbohydrate you eat can affect your blood sugar levels. 

Carbs are important macronutrients because they:

• Provide glucose (sugar) as the body’s main fuel
• Come from foods that also supply fiber,  vitamins, and minerals
•  Support balanced energy and growth in children

Not all carbohydrates are created equal—there are different kinds of carbs, and if you have diabetes, it’s important to know which carbs you’re eating and how they affect your blood sugar.

What are the different types of carbs?

There are three main types of carbohydrates. If you live with diabetes, it’s important to understand the difference between simple and complex carbohydrates.

The three main types of carbohydrates are:

• Sugars: simple carbs
• Starches: complex carbs
• Fiber: complex carbs

Examples of simple carbs (sugars) include:

• Fruit
• Fruit juice
• Milk
• Honey
• Regular soda
• Hard candies

Complex carbs contain more nutrients and enhance digestion. Examples include:

• Legumes: chickpeas, black beans, lentils
• Whole grains: oats, brown rice, quinoa.
• Starches: potatoes, sweet corn, plantains, squashes.
• Fiber-rich fruits: pears, apples, berries

The list goes on! Complex carbs are higher in nutrients and support digestion. They are made up of three or more carbohydrate units linked together, forming longer chains. These chains are longer than those of simple carbs, so they take more time to break down and digest which slows the impact on blood sugar. 

All three types of carbohydrates affect your blood sugar levels because they all break down into glucose, which enters your bloodstream. If you focus on counting the total carbohydrates you eat, it can help you dose insulin more precisely to make your blood sugar more predictable.

Complex carbs vs. simple carbs

The American Heart Association (AHA) suggests eating complex carbs day-to-day instead of simple carbs because they are broken down more slowly and give you energy over a longer time. The more complex the carb, the less it affects your blood sugar. The two main types of complex carbs are starches and fibers, found in foods like fruits, black beans, and brown rice.

If you have low blood sugar (hypoglycemia), simple carbs are better because they work faster to raise your blood sugar. Think hard candies, glucose gummies, powder or gels—not chocolates, breads or even some pastries. 

Starches: yes, you can eat them

Starches are complex carbohydrates and an important source of carbohydrate. Because they are complex carbs, they take longer for your body to digest. You can find starches in everyday foods like corn, potatoes, beans, pasta, bread and rice. 

These foods contain chains of glucose molecules that plants store for energy. When you eat these foods, your body breaks the chains apart to release glucose, which it uses for energy. 

Sugar: yes, you can eat this too

Sugar is a type of carbohydrate, but not the only one. There are several kinds of sugar. Other carbohydrates need to be broken down into glucose for the body to use them, but simple carbs like sugar are already in the form of one or two glucose molecules. Your body needs glucose for energy, and interestingly, the human brain uses about half of the glucose that your body needs.

You can get naturally occurring sugars from foods like milk and fruit. However, there are also added sugars found in drinks like regular soda, candies, baked goods and many processed foods.

Fiber: yes, you need it

Fiber is a carbohydrate found in plant sources that doesn’t give your body usable energy because it’s not digested fully the way other carbs are. Instead, fiber helps with digestion, fullness and smoother blood sugar after meals.

Fiber-rich foods help keep your digestive system moving. Fiber can make you feel full and also helps keep your bathroom trips regular. You can find fiber in foods like lentils, peas, beans, nuts and whole grains.

When you count carbs, you include all sugars in the total, including starches and fiber.

Use your insulin-to-carb ratio for better blood sugar management

Managing diabetes involves understanding how to handle things like counting carbs, taking insulin and managing your blood sugar levels. One important tool is determining your insulin-to-carb ratio, which helps you figure out how much insulin to take based on the carbs you plan to eat during a meal or snack.

Carb-counting errors can happen, leading to unexpected high blood sugar. On the flip side, if you eat too few carbs and take more insulin than you may need, it might cause your blood sugar to drop too low. There’s a balance you have to figure out with your healthcare provider and, often, through trial and error. 

Diabetes requires experimentation. And knowing how to read a food label also helps.

How to count carbs on a food label

Reading a food (nutrition) label may feel tricky the first time you do it, but don’t worry. You’ll get the hang of it!

Here are some steps to get you started:

1. Locate the nutrition label on your food: If your food doesn’t have a food label, you’ll need to do some research. For example, an apple usually won’t come with a nutrition label. Diabetes management apps or food lists may be helpful when you run into this.
2. Find the total carbohydrates for that serving size: Yes, serving size matters for accurate insulin dosing! Investing in and using a food scale may also be helpful to ensure you get it right, just so long as it doesn’t become an obsessive tendency.
3. Multiply your carbs by the serving size: If you have 1.5 servings, for example, you’d multiply your carbohydrate amount by thenumber listed as the serving size.
4. Calculate net carbs, if advised: If your healthcare provider has recommended that you calculate net carbs, determine that by following this equation from the American Diabetes Association: “Net Carbs = Total Carbs – Fiber – Sugar Alcohols.”
5. Get your insulin dose prepped: Once you have your number, use it to calculate your insulin dose. For example, if your number is 50g of carbs and you take one unit of insulin for every 10g of carbs, you would take five units of insulin for the food or meal. 
6. Plan ahead: Your final carbohydrate count may need to be adjusted to account for exercise, insulin on board (the amount of insulin currently active in your body from a previous dose), environmental changes, hormone fluctuations or other rigorous activities. Always consult your healthcare provider if you’re unsure how to adjust your insulin dose to accommodate these factors.

How many carbs should you eat if you have diabetes?

If you’re unsure about how many carbohydrates you should eat or which types are best, don’t hesitate to ask your healthcare provider for advice. They can give you tips on counting carbs or choosing the right ones. Some books and apps provide nutritional information about common foods and can help you with carb counting.

When it comes to figuring out how many carbs to eat, it depends on your individual needs. Every person, with or without diabetes, needs balanced nutrition for overall wellness. 

Get support counting carbs + managing diabetes

Ask your healthcare team to help you determine the right carbohydrate (carb) ratio for your meals. If you need additional assistance with counting carbs, consider finding a diabetes education program in your area. You can also speak with your healthcare provider about diabetes self-management education and support (DSMES) services.

You might also be eligible to consult a certified diabetes care and education specialist (CDCES) through your insurance, who can offer personalized support for your carb-related challenges or goals. There are many resources available to help you develop an effective diabetes nutrition plan that includes carbohydrates!

Always remember: carbs aren’t the problem; the stigma behind them is! Carbs are an essential part of your body’s overall wellness and energy levels. 
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