Ask the Registered Dietitian Archives
Here is an archive nutrition and food-related questions and answers.
- When shopping, should I look for sugar or carbs? Do you have other grocery shopping tips?
- What foods have the most starch and sugar?
- What artificial sweetener is best for diabetics to use and where does "Splenda" fall?
- Is the diet for prediabetes the same as the diet for actual diabetes?
- Is it safe to use agave if I have type 2 diabetes?
- How do alcoholic beverages affect my blood sugar with type 2 diabetes?
- Are sugar-free products safe to eat?
- Can one eat a banana a day on a diabetic diet?
- Do you have any travel advice? I'm traveling over seas to Asia.
- How do meal replacement products control diabetes?
- How many carbohydrates would be in a salami and cheese sandwich?
- How much fruit can you eat if you have diabetes?
- What is the maximum amount of daily carbohydrates and sugar that is safe for someone with type 2 diabetes?
- Which squash is better for you - spaghetti squash or butternut squash?
- My husband was just diagnosed with type 2 diabetes. Can he have soda or does he have to have diet?
I have type 2 diabetes. When shopping, should I look for sugar or carbs? What can I do to shop in a healthier manner?
Navigating the grocery store can be tough – there are so many brands and different foods to choose from! Looking at labels is a key strategy for making better decisions when grocery shopping.
When you look at a label, consider both the portion size and the total grams of carbohydrate listed. (Sugar is just one type of carbohydrate, but all types will raise blood glucose, so don’t just look at the grams of sugar!)
Also, keep your meal plan in mind. Do you have a range of carbohydrates that you shoot for at each meal? Will that food or meal fit easily into your meal plan? Or is it high in carbohydrates and unhealthy saturated fat? These are important things to consider before tossing something in your cart.
Here are some additional tips to help you shop healthier:
- Use a grocery list. Fill it with lots of vegetables and fruit, and include some whole grains, lean meats, and low-fat dairy. Make it a habit to stick to your list and resist grabbing that extra bag of cookies from the shelf.
- Get your produce first. Start your shopping trip with a visit to the produce section. Fruits and veggies should make up about half of what is in your cart.
- Don’t shop hungry. You’ll be more likely to splurge on less healthy choices that are not on your list if your stomach is rumbling. If you shop on a full stomach, cravings are less likely to occur, which will help you stick to your plan and make good choices.
- Choose healthy sources of carbohydrate. This includes whole grains, fruit, low- or non-fat dairy, beans, and starchy vegetables.
- Limit less nutritious sources of carbohydrate. This includes products made with refined grains (white bread, pastries, etc.), sweets (candy, baked goods, ice cream, etc.), and salty snacks like potato chips. Try to save these treats for special occasions. It’s probably not a good idea to keep foods around that you know will lead to overeating.
- Choose lean protein sources. This include chicken or turkey without the skin (breasts are the leanest part of the bird), 93% lean ground turkey or beef, vegetarian protein options like tofu and veggie burgers, and lean cuts of pork or beef such as sirloin or chuck roast. Stay away from highly-processed options like salami, hot dogs, and other higher-fat cuts of meat.
- Cut out sugar-sweetened beverages and buy less alcohol. This is not only a healthy choice, but will also save you money!
- Avoid aisles with junk food. Remember you don’t have to walk down every aisle – so why tempt yourself? Skip the aisles with the soda, chips, and candy.
For more information about the best choices from each food group, visit our What Can I Eat? section on diabetes.org. Use that information as a guide for choosing the healthiest options at the store!
What foods have the most starch and sugar?
Sugar and starch are two different types of carbohydrate but both will raise blood glucose. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels in your target range. In order to do so, you'll need to know which foods provide carbohydrate.
The main sources of starch in our diets are listed below:
- Grains like bread, pasta, rice, cereals, and crackers. *The best grain choices are whole grains rather than refined grains.
- Beans, legumes, and peas.
- Starchy vegetables like potatoes, corn, winter squash, and pumpkin.
Sources of sugar include:
- Foods that contain naturally-occurring sugars like milk or fruit.
- Foods with added sugars. Added sugars are added during processing. Examples include fruit canned in heavy syrup or sugar added to make a cookie.
Though these foods contain carbohydrate, many of them are also important to our diet and provide us with important nutrients. Plus, everyone - even people with diabetes - needs some carbohydrate in their diets.
We encourage people with diabetes to choose healthy sources of carbohydrate whenever possible over those that are less nutritious. Whole grains, beans, starchy vegetables, fruit without added sugar, and low-fat dairy are all great choices, while foods like sweets, salty snacks, and refined grains are less nutritious and should be limited.
To read more about the difference between starch and sugar, check out our page on Carbohydrates.
What artificial sweetener is best for diabetics to use and where does "Splenda" fall?
There are 5 artificial sweeteners that have been tested and approved by the FDA: acesulfame K, aspartame, sucralose (Splenda), saccharin, and neotame. These sweeteners are used by food companies to make diet drinks, baked goods, frozen desserts, candy, light yogurt, and chewing gum. You can also buy most of them as table top sweeteners.
Stevia is another common zero-calorie sweetener that people ask about. Stevia is also referred to as Rebaudioside A, Reb-A, or rebiana. Technically, Reb-A is a highly purified product that comes from the stevia plant and is several hundred times sweeter than sugar. According to the U.S. Food and Drug Administration (FDA), Reb-A is generally recognized as safe (GRAS) as a food additive and table top sweetener, but you’ll usually see it under the stevia name. When something is generally recognized as safe by the FDA, it means that experts have agreed that it is safe for use by the public in moderate amounts.
We do not recommend one of these sweeteners over another for people with diabetes. Some of the sweeteners have strong aftertastes, which you may or may not be sensitive to. So, go with whatever you prefer and use it in moderation.
Artificial sweeteners like Splenda can help you cut calories in your diet when you use them to replace regular sugar. These sweeteners are an option for people both with and without diabetes. Find more information right here on diabetes.org about artificial sweeteners, how to use them in the kitchen, and how they can work with your diabetes meal plan.
I was just diagnosed with prediabetes. Is the diet for prediabetes the same as the diet for actual diabetes?
Prediabetes is a condition where your blood glucose levels are higher than normal, but are not yet high enough to be diagnosed as full-blown diabetes. Many healthy eating recommendations are the same for people with diabetes and prediabetes. Both groups should focus on controlling portion sizes and including nutrient-rich grains, vegetables, fruits, low-fat dairy, and lean protein foods in their diets.
When you have prediabetes, your main goal is to prevent or delay the onset of type 2 diabetes. Research has shown that weight loss through increased activity and a healthy, reduced-calorie diet may help to do just that. Weight loss can also be helpful to people with type 2 diabetes, but there is also a big focus on meal planning to control carbohydrate intake and blood glucose. This is not as much a priority for prediabetes.
Some healthy eating tips that can help with weight loss are below:
- Control portion size. This can help you eat less calories all together, which can lead to weight loss. To keep portions in check, and try using measuring cups and spoons.
- Write down what you eat. Tracking your food intake can make you more accountable for your choices. After tracking what you eat for a few weeks, review your records and find places where you could improve.
- Incorporate more non-starchy vegetables into your diet. They are fat-free and very low in calories. Make an effort to have a vegetable side with dinner, a salad once a day, or make a veggie soup that you can pack for lunch during the week.
- Focus on including high-nutrient sources of carbohydrate such as whole grains, fruit, low-fat dairy, beans, and starchy vegetables. Choose these over less nutritious foods such as products made with refined grains, sweets, and salty snacks.
- Choose lean protein sources such as chicken breast, lean deli turkey, beans, tofu, and lean cuts of pork or beef such as sirloin or chuck roast.
- Use healthier cooking methods without added fat (i.e. broiling, baking, microwaving, grilling, roasting, etc.). Avoid frying foods.
- If you do add fat in cooking, do so in moderation and use an oil that is high in healthy fats such as canola, olive, peanut, corn, or safflower.
- If you drink alcohol, stick to the following guideline: no more than two drinks per day for men and no more than one drink per day for women. Choose lighter drinks like wine spritzers or light beer.
- Cut out soda and other sugar-sweetened drinks and choose zero-calorie drinks like water, unsweetened tea, or sugar-free lemonade.
- Want more ideas for small changes you can make? Check out our list of Ways to Cut 100 calories.
Is it safe to use agave if I have type 2 diabetes?
Agave nectar is a very popular sweetener right now. It is well-known for having a lower glycemic index (GI) than regular sugar, brown sugar, or honey. So, using it in place of one of these may cause a less severe blood glucose reaction. However, glycemic response can vary from person to person. It also depends on where the agave is from and the other foods you are eating at the time.
Furthermore, agave nectar still provides the body with the same amount of calories and carbohydrates as regular sugar, and it will raise blood glucose. When you include agave nectar in your meal plan, count it as you would regular sugar and remember to use it sparingly.
You can see a comparison of the calories and carbohydrates in a few popular sweeteners below:
1 tablespoon honey = about 64 calories, 17 grams of carbohydrate
1 tablespoon packed brown sugar = about 52 calories, 13 grams of carbohydrate
1 tablespoon white or granulated sugar = about 49 calories, 13 grams of carbohydrate
1 tablespoon maple syrup = about 52 calories, 13 grams of carbohydrate
1 tablespoon agave nectar = about 45 calories, 12 grams of carbohydrate
1 packet of artificial sweetener = about 4 calories,
How do alcoholic beverages affect my blood sugar with type 2 diabetes?
You can still drink alcohol when you have type 2 diabetes, but there are a few precautions that you should take.
If you choose to drink, we recommend that women have 1 or less drinks per day and men have 2 or less drinks per day. One drink is equal to 12 ounces of beer, 5 ounces of wine, or 1-1.5 ounces of hard liquor.
For people with diabetes, hypoglycemia or low blood glucose can be a reaction from drinking alcohol on an empty stomach. Hypoglycemia can occur right after drinking or up to 24 hours after drinking. This is most problematic for people taking certain diabetes medications (like sulfonylureas or meglitinides) or insulin.
To avoid a hypoglycemic reaction, eat a meal or snack with your alcoholic beverage. You should also check your blood glucose before drinking (if prescribed) and drink only if your levels are under control.
Note that wine and other alcoholic beverages also contribute extra calories to our diets, which can lead to weight gain. What’s more, alcohol can impair your judgment, making it less likely that you will stick to your usual eating plan and healthy habits. It’s okay to enjoy an alcoholic beverage, but make sure you drink in moderation and stay in control. For more tips on alcohol and diabetes, visit the Alcohol page on diabetes.org.
I was recently diagnosed with type 2 diabetes and am trying to control my diet. Are sugar-free products safe to eat?
Many people think that those with diabetes need to completely avoid sugar. Now experts agree that you can substitute a small amount of sugar for other carbohydrate-containing foods into your meal plan and still keep your blood glucose levels on track.
That doesn’t mean you can eat all of the sugar you want. Most sweets have a large amount of carbohydrate in a very small serving - including many sugar-free candies, cakes, etc. So, we suggest saving sweets for special occasions. When you decide to include a sweet treat, keep portion size in check and be sure to work it into your meal plan.
Many people think that foods labeled “sugar-free” are also carbohydrate-free and that they can have as much as they want. However, the sugar-free label does not automatically mean that a food has zero carbohydrates.
These products do not have any added sugars and are usually sweetened with sugar alcohols and/or artificial sweeteners. However, most sugar-free foods have other ingredients in them that provide carbohydrates, so they will raise still blood glucose. As with any other food, always check the total carbohydrate listed on the nutrition label when deciding how these foods fit into your meal plan and remember to keep portion size in check. They are safe to eat, but don’t overindulge just because something is sugar-free!
Can one eat a banana a day on a diabetic diet? I have type 2 and I’m not on insulin.
Yes, you can still eat bananas – even if you have diabetes. Bananas are a good source of fiber, potassium, and vitamin C, but they do contain carbohydrates. In fact, all fruit has some carbohydrate, so you need to count it in your diabetes meal plan. If you want to include bananas in your meal plan, become familiar with portion sizes and the number of carbohydrates in each.
Bananas vary quite a bit in size, so counting the carbs that they provide can be difficult. Below are some estimates for different sizes.
Extra small banana (6 inches long or less) – about 18 grams of carbohydrate
Small banana (about 6-6 7/8 inches long) – about 23 grams of carbohydrate
Medium banana (7-7 7/8 inches long) – about 27 grams of carbohydrate
Large banana (8-8 7/8 inches long) – about 31 grams of carbohydrate
Extra large banana (9 inches or longer) – about 35 grams of carbohydrate
Be aware that blood glucose responses can vary from person to person. If you want to have a banana daily, you may need to make adjustments the portion size you eat depending on your how your blood glucose responds to eating bananas or other types of fruit.
I'm going on a 2-week business trip to Asia. This is my first international trip since I was diagnosed with type 2 diabetes in April. I control my blood sugar through diet and exercise, am at a healthy weight now, and stopped taking medications about 1 month ago b/c my glucose levels were dropping too low. I heard airline travel can affect glucose & obviously my schedule will be disrupted. I'm planning to take some foods with me for emergencies. Do you have any travel advice?
When you have diabetes, you can still go anywhere and do almost anything, but it requires a little extra planning. Before a long trip, visit your doctor and have a medical exam to see how you are doing with your diabetes management. During your visit, make sure you mention any issues you may be having currently with low’s or high’s. It is important to be in good control before leaving.
Before you leave, get two papers from your doctor: a letter and a prescription. The letter will list what you need to do for your diabetes and the supplies that you use. Always keep the letter with you in case of emergency or if you are questioned when going through airport security. The prescription should be used if you run out of medications you take in case you run out. Some other guidelines for traveling with diabetes are:
- Always wear a diabetes ID bracelet or necklace.
- Pack twice the medication or insulin (if you take them), and diabetes testing supplies as you think you will need in your “carry on” bag. Keep this bag with you at all times whether you travel by plane, car, boat, bike, or foot.
- Pack plenty of healthy snacks to carry with you on the plane and throughout the rest of the trip.
- Have some juice, glucose tablets, or hard candy on hand at all times to treat low blood glucose.
Since you are going out of the country, you should learn to say “I have diabetes” and “Sugar or orange juice please” in the language that the people speak there. You can also get a list of English-speaking doctors there from the International Association for Medical Assistance to Travelers (IAMAT). Go to their website (www.iamat.org) or call 716-754-4883.
Try to keep up your routine while you are on your trip.
- Sometimes, the stress and excitement of travel can affect your blood glucose. If prescribed, check your blood glucose regularly.
- Follow your usual meal plan and keep carbohydrate intake consistent, make healthy food choices, and control portion size.
- Be active on most days.
- Take your medications and/or insulin if prescribed by your doctor.
For more information, check out:
How do meal replacement products control diabetes?
Using meal replacements has been shown to be an effective strategy for weight loss. People with prediabetes and diabetes who are overweight can greatly benefit from weight loss. Losing just 5-10% of your weight (or 10-20 pounds for someone who weighs 200 pounds) can help you control your blood glucose levels and bring down your A1C. It can also improve your blood pressure and cholesterol levels.
Meal replacements have a set number of calories which helps take the guesswork out meal planning. They come as a pre-packaged shake, bar, or main dish that can take the place of one or more of your meals during the day. Some companies offer low-glycemic meal replacements which can also be helpful for some people with diabetes.
If you are planning to start a weight loss program, talk to your doctor first. Your doctor can help you set up a plan that works for you. When you eat less and start losing weight, they may need to make adjustments to medications or insulin if you take them.
When it comes to weight loss, remember that you don’t have to lose it all at once. Slow, gradual weight loss (about ½ - 2 pounds per week) is the safest way to go. No matter which weight loss program or approach you use, be sure you are making changes you can stick to. Losing weight is the first step, but maintaining the healthy habits you learn is essential for keeping the weight off.
How many carbohydrates would be in a salami and cheese sandwich?
The major carbohydrate source in most sandwiches is the bread. If you pay attention to nutrition labels when you are picking out food in the store, you should know that the amount of carbohydrate in a piece of bread can vary quite a bit. You may buy bread that is lower-carb and has just 10 grams per slice, or you may opt for a denser bread with 25 grams per slice.
Thin sandwich bread is also available now, which is lower in calories and carbs. Either way, choose bread that is whole grain and will also work with your meal plan. The first ingredient on the ingredient list of the bread you buy should be whole wheat flour or another whole grain.
So, the total amount of carbohydrates your sandwich will depend on the bread you buy. The rest of a sandwich usually involves cheese, a meat, and perhaps some non-starchy veggies like lettuce and tomato – all foods that have minimal carbohydrates.
Here are some extra tips to help you build a healthier sandwich:
- Buy 100% whole grain bread.
- Add some leafy greens and other non-starchy veggies to your sandwich like cucumber, spinach, tomatoes, or bell peppers.
- Choose lean meats that are less processed with 3 grams of fat or less per ounce – salami, pastrami, bologna, and other highly processed meats are not the best choices.
- Better meat choices include low-sodium turkey breast, ham, roast beef, and chicken breast.
- Put just a few slices of deli meat on your sandwich (no more than 2 ounces worth) and fill the rest of the sandwich with fresh vegetables for more taste and texture.
- You can also cook fresh chicken or turkey breast on the weekends and use it on your sandwiches.
- Be careful not to go overboard on the condiments - use condiments and sauces that are low in saturated fat and be careful not to go overboard – because the calories can add up! Some good ideas are mustard, salsa, balsamic vinegar with a little bit of olive oil or hot sauce. You can also try a bit of barbeque sauce, a small amount of low-fat mayonnaise, fat-free salad dressing, hummus, or pesto.
- Some research has linked eating a lot of processed meat with a higher risk for diabetes, heart disease and certain cancers. So, add some variety to your lunch menu during the week. Try packing a peanut butter sandwich, tuna salad with whole wheat crackers, a salad, or healthy leftovers to mix it up.
- Instead of using processed deli meats, you can also try cooking fresh meats ahead of time (like chicken breast, turkey breast, or lean pork or beef cuts). Cook up fresh meat on the weekend and use it in your lunches throughout the week. Fresh meats do not contain all of the sodium, fat, and preservatives usually found in processed lunch meats.
How much fruit can you eat if you have diabetes?
Fruit is loaded with vitamins, minerals, antioxidants, and fiber, just like vegetables. It does contain carbohydrates, so you’ll need to work it into your meal plan. The actual amount you can have will depend on how many carbs you usually eat at each meal (or snack) and what else you are going to eat with it.
Fruit is a much healthier source of carbohydrate than some other carbohydrate choices like refined grains, cookies, cakes, pastries, processed snack foods, and candy. To help you with meal planning, the following portions of fruit have about 15 grams of carbohydrate:
- 1 small piece of whole fruit (about 4 oz)
- ½ cup of frozen or canned fruit
- ¾ - 1 cup of fresh berries or melon
- 1/3-1/2 cup fruit juice
- 2 tablespoons of dried fruit
- 12 small cherries
- 3 ounces or about 17 small grapes
- 1/3-1/2 cup 100% no sugar added fruit juice
What is the maximum amount of daily carbohydrates and sugar that is safe for someone with type 2 diabetes?
This is a very common question among people with diabetes. The American Diabetes Association recommends following a meal plan that works for you and helps you meet your diabetes goals. Your healthcare provider can help you set these goals, which might include losing weight, improving your A1C, lowering your blood pressure and/or lowering cholesterol levels.
Your meal plan should take your goals and preferences into account. Discuss with your provider how many carbohydrates to include at each meal and whether or not to include snacks. Your provider may suggest just using the diabetes plate method to start or they may have you try carbohydrate counting. A registered dietitian or certified diabetes educator can be especially helpful when you are first learning to plan meals.
If you haven’t set up an individualized meal plan yet, we suggest including about 45-60 grams of carbohydrate per meal to start. If you follow that recommendation, you would be eating a total of 135-180 grams of carbohydrate throughout the day. However, some people may need more and some people may need less, so set up a plan that works for you soon!
When counting carbohydrates, remember that all foods containing carbohydrate will raise blood glucose. There are several different types of carbohydrate out there, and sugar is just one of them. So, we suggest focusing first on the amount of total carbohydrate in a food and making sure it fits with your meal plan. That means looking at the total carbohydrate grams listed on the nutrition label, not just the grams of sugar.
We do not have a specific recommendation in terms of how many grams of sugar to have per day. However, we encourage you to make good choices at meal time. This means choosing healthier carbohydrate choices with less added sugar like fruit, vegetables, whole grains, beans, and low-fat dairy instead of sugary cereals, soda, sweets, pastries, and the like.
How many carbs and calories are there in butternut squash? Is spaghetti squash any better or worse?
Either type of squash is a great choice! Both of these veggies are packed with important nutrients like certain vitamins, minerals, and fiber – a great addition to your meal plan! The major difference between the two is that butternut squash is classified as a starchy vegetable, while spaghetti squash is classified as a non-starchy vegetable. So, you can have more spaghetti squash for less carbohydrates.
Butternut squash is denser in calories and carbohydrates, so you need to be careful of portion sizes and work it into your meal plan. If you use our diabetes plate method to plan meals, you would put the butternut squash in the small starchy portion of the plate and spaghetti squash would go with the non-starchy vegetables, which should fill up half of the plate.
See a comparison of the two squashes below:
½ cup cooked butternut squash = 40 calories + 11 grams of carbohydrate
½ cup cooked spaghetti squash = 20 calories + 5 grams of carbohydrate
Note: Most of the carbohydrate in non-starchy vegetables is fiber, so unless you eat more than 1 cup cooked spaghetti squash, you may not need to count the carbohydrates.
You can work both of these easily into your meal plan! Though butternut squash is high in carbohydrates, it is still a very healthy food that is packed with nutrients including iron, fiber, vitamin A and vitamin C. Spaghetti squash also provides vitamin C, B vitamins, and fiber. Both are very low in fat, sodium, and have no cholesterol.
My husband was just diagnosed with type 2 diabetes. Can he have soda or does he have to have diet?
The American Diabetes Association recommends drinking zero-calorie or very low-calorie beverages like water, unsweetened teas (hot or cold), black coffee, and diet soda. There are other options too, such as low-calorie drinks and drink mixes which can be found in most grocery stores.
You can also try flavoring your water with a squeeze of lemon or lime juice for a refreshing drink with some flavor. These drinks are all great thirst-quenchers and provide almost no calories or carbohydrates.
We suggest that those with diabetes limit regular soda, fruit punch, energy drinks, juice drinks, and other sugary drinks. So regular soda is something your husband will want to avoid.
For more information about what to drink with diabetes, visit: What Can I Drink?
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