Diabetes and Diet: Your Questions Answered


Even if you think you’ve got the hang of counting carbs, there are always surprises.  In my own experience, carbohydrates can be frustrating, confusing, and they get the better of me more often than I’d like.  Understanding more about carbohydrates, instead of just getting angry at them (what good does it do to shout at an unresponsive bowl of pasta?) can help you avoid blood sugar spikes and dips.  We’re lucky to have Certified Diabetes Educator and nutritionist Marlee Zweifach here to answer readers’ questions and explain things like usable carbohydrates, non-nutritive sweeteners, fructans, and more.

Does eating food that contains sugar cause blood glucose levels to rise more quickly than eating bread or potatoes?

Eating foods with sugar do not necessarily cause blood glucose levels to rise more quickly than eating starches. Although there are many factors that influence how fast and how high a person’s blood sugar increases in response to a food, the most important factor is the amount of usable carbohydrate which exists is in that food. The usable carbohydrate can be determined from a food label and is usually equal to the “Total Carbohydrate” listed in grams on the food label. If the food contains fiber or sugar alcohols, you simply subtract ½ of the grams of these from the “Total Carbohydrate” to determine the usable carbohydrate. If the food does not contain a food label, I recommend using this website: Calorieking.com to find the “Total Carbohydrate” in the food item and determine the usable carbohydrate. Be sure that the portion size you plan to eat matches the portion size that you are using to determine the usable carbohydrate in the food. Foods that contain sugar may actually contain less usable carbohydrate than foods that do not, and could actually produce a smaller rise in your blood sugar.

Are sugar substitutes considered carbohydrates? Do they raise blood sugar?

Non-nutritive sweeteners or sugar substitutes are not considered carbohydrates because they do not enter your blood as sugar and do not raise your blood sugar.  Examples of non-nutritive sweeteners are aspartame, asulfameK, sucralose, stevia, and saccharine. Sugar alcohols are often contained in “sugar-free” products, and are considered carbohydrate because a portion of what is in the product does enter your blood as sugar.  Examples of sugar alcohols are Xylitol, Sorbitol, and Mannitol.

Which is better for me, a cookie with sugar or a cookie with artificial sweetener?

The important thing for you to consider when choosing a cookie is the amount of usable sugar it contains.  The amount of usable sugar in the food you eat has the most impact on your blood sugar. The usable sugar is determined by looking at the food label.  The “Total Carbohydrate” on the food lable refers to the grams of usable sugar + the grams of sugar that do not go into your blood (fiber and sugar alcohols). Sugar free cookies may contain sugar substitute which may or may not be usable sugar. Sugar alcohols are a sugar substitute that is only partially usable, while non-nutritive sweeteners such as saccharine or aspartame are not usable.   The amount of sugar alcohol a cookie contains is included in the “Total Carbohydrate” on the food label as well as listed under it.  To calculate the usable sugar in a cookie with sugar alcohols, you subtract ½ of the grams of sugar alcohols from the grams of total carbohydrate.  Then you can compare the usable sugar in this cookie with the usable sugar in another.  In your question, the cookie that has sugar must have a “Total Carbohydrate” on the food label of 9 grams, and assuming no fiber or sugar alcohol, the usable sugar is 9 – 0 or 9 grams.  The cookie with artificial sweetener would have a “Total Carbohydrate” of 12 grams and may have no fiber or sugar alcohols then the usable sugar would be 12 – 0 or 12 grams ( 3 grams more than the cookie with sugar).  If this cookie does contain sugar alcohols, you would subtract ½ of the grams of sugar alcohols from 12 to determine the usable sugar. In any case, there is not much difference between the usable sugar in either cookie, and both would have about the same effect on your blood sugar.

I know that nuts are heavy in fat. What is their effect on blood glucose?

Nuts have little or no carbohydrate, so they do not raise your immediate blood sugar, and are good to snack on unless you need to lose weight.  Because nuts are heavy in fat, they contain a lot of calories.  A handful of nuts could easily contain as many calories as a meal, so over time, it is easy to see how a person who snacks on nuts could gain weight. Weight gain will increase your blood sugars in general and if you require insulin, weight gain will increase your insulin needs.  I usually recommend that people who need to gain weight add nuts to their foods and snack on nuts because they can do so without increasing their immediate blood sugar results, however, if you are trying to lose weight, count out your nuts carefully (a serving would be about 6) and use them as a garnish to what you are eating.

Is Jerusalem artichoke a carbohydrate? Do I need to take insulin when I eat it?

The carbohydrate content of Jerusalem artichokes is about 17%, but the type of carbohydrate found in this food is not absorbed into the blood as well as other carbohydrates, so it should not require as much insulin as other carbohydrate sources. Jerusalem artichokes contain a complex carbohydrate called fructans which are composed of fructose units which are attached to each other in a way that makes it difficult for people to absorb them into the bloodstream.  Many other foods contain small amounts of fructans, but Jerusalem Artichokes contain mostly fructans as their carbohydrate source so that is why the soup did not effect your blood sugar.

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Lalit J Jhaveri
Lalit J Jhaveri
10 years ago

since my sugar levels remain high and all due to negligence for which I paid a price, since past fortnight I’ve been able to bring them closer to normal levels after I stopped intake of fruits except for Grapefruit which I consume. Pls suggest how to bring Albumin levels to normal (discharge of proteins form urine, all due to high sugar levels)
Thanks in advance, Rgds, Lalit J Jhaveri, Mumbai

Colorado Springs
Colorado Springs
12 years ago

“Sugar alcohols are often contained in “sugar-free” products, and are considered carbohydrate…”  I believe this is false.  Please site your sources for this statement.

Jessica Apple
13 years ago

Hi Gary,
The US FDA has concluded there is no basis to object to the use of certain refined Stevia preparations in food.  I don’t have much personal experience with Stevia, but it’s probably a good alternative to non-natural sweeteners.

Gary Brenner
13 years ago

I am interested in your opinion as a natural sweetener, alternative to sugar and to non-natural ones?  Some functional food companies are asking me about Stevia, and I am not sure what to answer.
Gary Brenner

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