There are different ways to make sure you eat a consistent amount of carbohydrates throughout the day, including carbohydrate counting and exchange planning. Carbohydrate counting — A dietitian can help you figure out the number of carbohydrates you need each day based on your eating habits, weight, nutritional goals, and activity level.

The way carbohydrates are divided up for each meal or snack will depend on your personal preferences, the timing and spacing of your meals, and which diabetes medications you take table 1. However, even if you do not take insulin, carb counting can help you keep your blood sugar levels from getting too low or too high.

The number of carbohydrates in a particular food can be determined by reading the nutrition label, consulting a reference book, website, or smartphone app, or using the exchange system see 'Exchange planning' below. If you are eating out, restaurants usually have this information available upon request.

See 'Where to get more information' below. For example, some prepackaged snacks contain two or more servings. To calculate the carbohydrate content of the entire package, multiply the number of servings by the number of carbohydrates per serving.

This is because fiber slows the body's absorption of carbohydrates, so less insulin is required to manage blood sugar levels. Exchange planning — With exchange planning, all foods are categorized as either a carbohydrate, meat or meat substitute, or fat.

You can also easily determine the carbohydrate content of your meals and snacks using the exchange system. The table shows a sample daily meal plan based on this system table 2. A dietitian can give you a more complete list of foods to use for meal planning purposes. The exchange lists also identify foods that are good sources of fiber which can help keep blood sugar levels from getting too high and foods with a lot of sodium which should be limited.

A dietitian can help you determine how many servings of each group to eat at each meal and snack table 2 and the typical carbohydrate content of each meal and snack. Meal timing — Consistently eating at the same times every day is important for some people, especially those who take long-acting insulin or oral medications that decrease blood sugar levels sulfonylureas or meglitinides.

If a meal is skipped or delayed while on these regimens, you are at risk for developing low blood glucose. If you use "intensive" insulin therapy ie, if you give yourself multiple daily injections or use an insulin pump or take certain other types of oral diabetes medications eg, metformin , you may have more flexibility around meal timing.

With these regimens, skipping or delaying a meal will not usually increase your risk of low blood sugar. While foods that are high in fat eg, pizza are OK to eat occasionally, you will need to monitor your blood sugar levels more closely.

High-fat, high-protein meals are broken down more slowly than low-fat, lower-protein meals. When using rapid-acting insulin before a meal, your blood sugar level may become low shortly after eating a high-fat meal and then rise hours later.

If you eat meals that contain more protein or fat than usual, you may need to make meal-time insulin dose adjustments to manage this delayed rise in blood sugar. Intensive insulin therapy — If you take multiple injections of insulin per day or use an insulin pump, you can adjust your pre-meal insulin based on the number of carbohydrates you plan to eat and your pre-meal blood sugar, similar to patients with type 1 diabetes.

See "Patient education: Type 1 diabetes and diet Beyond the Basics ", section on 'Intensive insulin therapy'. There is not a single optimal diet or meal plan for people with diabetes. The best diet for you depends many different things, including your health concerns, weight-loss goals, and personal preferences.

General recommendations — To help manage the ABCs A 1C, B lood pressure, and C holesterol and promote good health, experts recommend that all people with diabetes aim to maintain a healthy weight by decreasing calorie intake and increasing physical activity and monitor their carbohydrate intake.

The following guidelines for a healthy diet are similar to the recommendations for adults without diabetes see "Patient education: Diet and health Beyond the Basics " :. People with diabetes are advised to avoid sugar-sweetened beverages including fruit juice.

The ideal amount of carbohydrate intake is uncertain. However, it's important for people with diabetes to monitor carbohydrate intake in order to manage their blood sugar levels and adjust insulin dosing as needed.

See 'Carbohydrate counting' above. Eating a healthy diet that contains a lot of the foods you like will make it easier to stick to your plan.

However, you should talk to your health care provider before starting any diet that involves extreme restriction such as a very low carb or "keto" diet. Depending on your situation, some diets may not be recommended.

Saturated fats eg, in meats, cheese, ice cream can be replaced with monounsaturated and polyunsaturated fatty acids eg, in fish, olive oil, nuts. Trans fatty acid consumption should be kept as low as possible.

Trans fats are banned from processed foods in the United States. Although very small amounts of trans fats are naturally present in meats, poultry and dairy products, the amount is too small for concern.

As diabetes increases your risk of heart disease and stroke, eating a diet low in saturated and trans fats and cholesterol can help to reduce your cholesterol levels and decrease these risks. In general, it's a good idea to get protein from lean meats, fish eggs, beans, soy, and nuts, and to limit the amount of red meat you eat.

See "Patient education: High-fiber diet Beyond the Basics ". See "Patient education: Low-sodium diet Beyond the Basics ". If you consume sugar-sweetened beverages regularly, a beverage containing artificial sweeteners such as diet soda can be a good short-term replacement strategy.

However, the best approach is to avoid both sugar-sweetened and artificially sweetened beverages, and try to drink more water. This is no longer recommended, although it's important to limit sugar intake.

If you take insulin, you should calculate each pre-meal dose based upon the total number of carbohydrates in the food, which includes the sugar content. Read all nutrition labels carefully and compare with other similar products to determine which has the best balance of serving size and number of calories, carbohydrates, fat, and fiber.

Some sugar-free foods, such as sugar-free gelatin and sugar-free gum, do not have a significant number of calories or carbohydrates and are considered "free foods. The American Diabetes Association ADA has a website called Diabetes Food Hub www.

org that many people find useful. The site has tools to help you manage your diabetes, including nutrition information and customizable recipes you can use in meal planning.

It can be challenging and sometimes overwhelming to figure out how to manage your diet in order to control your diabetes. But with time, practice, and support, most people are able to get used to it and make it a part of their daily life. Is it safe to drink alcohol?

People who take oral diabetes medications do not usually need to adjust their medication doses, as long as the alcohol is consumed in moderation and with food.

Alcohol may cause a slight rise in blood sugar, followed hours later by a decrease in the blood sugar level. As a result, it is important to monitor your blood sugar response to alcohol, especially if you use insulin.

Your provider can help you to determine if any changes in insulin doses are needed. Mixers, such as fruit juice or regular cola, can increase blood glucose levels and increase the number of calories consumed in a day. Also, calories from alcohol have little nutritional value and may contribute to weight gain or make it harder to lose weight.

Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available.

Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.

These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 2 diabetes The Basics Patient education: Diabetes and diet The Basics Patient education: Diet and health The Basics Patient education: High-fiber diet The Basics Patient education: Carb counting for adults with diabetes The Basics Patient education: Treatment for type 2 diabetes The Basics Patient education: The ABCs of diabetes The Basics Patient education: Preparing for pregnancy when you have diabetes The Basics Patient education: Lowering your risk of prediabetes and type 2 diabetes The Basics.

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: High blood pressure, diet, and weight Beyond the Basics Patient education: High cholesterol and lipids Beyond the Basics Patient education: Type 2 diabetes: Overview Beyond the Basics Patient education: Type 2 diabetes: Insulin treatment Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics Patient education: Exercise and medical care for people with type 2 diabetes Beyond the Basics Patient education: Preventing complications from diabetes Beyond the Basics Patient education: Losing weight Beyond the Basics Patient education: Exercise Beyond the Basics Patient education: Chronic kidney disease Beyond the Basics Patient education: High-fiber diet Beyond the Basics Patient education: Low-sodium diet Beyond the Basics.

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based.

Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Alpha-glucosidase inhibitors for treatment of diabetes mellitus Exercise guidance in adults with diabetes mellitus Measurements of chronic glycemia in diabetes mellitus Glycemic control and vascular complications in type 2 diabetes mellitus Initial management of hyperglycemia in adults with type 2 diabetes mellitus Insulin therapy in type 2 diabetes mellitus Management of persistent hyperglycemia in type 2 diabetes mellitus Metformin in the treatment of adults with type 2 diabetes mellitus Nutritional considerations in type 2 diabetes mellitus Overview of general medical care in nonpregnant adults with diabetes mellitus Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus Thiazolidinediones in the treatment of type 2 diabetes mellitus.

org , available in English and Spanish. The following reference books are a good source of information regarding diabetes and diet and carbohydrate counting. Contributor disclosures are reviewed for conflicts of interest by the editorial group.

When found, these are addressed by vetting through a multi-level review process, and through requirements for references to be provided to support the content. Appropriately referenced content is required of all authors and must conform to UpToDate standards of evidence.

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Patient education: Type 2 diabetes and diet Beyond the Basics. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. Official reprint from UpToDate ® www. com © UpToDate, Inc.

All Rights Reserved. Author: Linda M Delahanty, MS, RD Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD. All topics are updated as new evidence becomes available and our peer review process is complete.

Literature review current through: Jan This topic last updated: Jan 19, TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus is a disorder that is known for disrupting the way your body uses glucose sugar ; it also causes other problems with the way your body stores and processes other forms of energy, including fat.

Actions such as exercising regularly and eating more fiber and probiotics, among others, may help lower your blood sugar levels.

High blood sugar, also known as hyperglycemia, is associated with diabetes and prediabetes. Prediabetes is when your blood sugar is high, but not high enough to be classified as diabetes.

Your body usually manages your blood sugar levels by producing insulin, a hormone that allows your cells to use the circulating sugar in your blood. As such, insulin is the most important regulator of blood sugar levels 1. The latter is known as insulin resistance 1.

External factors include dietary choices, certain medications, a sedentary lifestyle, and stress 1 , 2. adults live with diabetes and that another adults have diabetes or prediabetes 3. Blood sugar management is especially important for people with diabetes, as chronically high blood sugar levels can lead to limb and life threatening complications 1.

Regular exercise can help you reach and maintain a moderate weight and increase insulin sensitivity 4. Increased insulin sensitivity means your cells can more effectively use the available sugar in your bloodstream. Exercise also helps your muscles use blood sugar for energy and muscle contraction 4.

If you have problems with blood sugar management, consider routinely checking your levels before and after exercising. This will help you learn how you respond to different activities and keep your blood sugar levels from getting too high or low 5.

Exercise snacks simply mean that you break up your sitting time every 30 minutes for just a few minutes throughout the day. Some of the recommended exercises include light walking or simple resistance exercises like squats or leg raises.

Other useful forms of exercise include weightlifting, brisk walking, running, biking, dancing, hiking, swimming, and more. In fact, any activity that regularly gets you up and moving — regardless of the intensity — beats a sedentary lifestyle.

Plus, know that if you have trouble dedicating longer periods to exercise throughout the week, you can still gain many benefits by doing shorter sessions.

For example, try aiming for minute exercise sessions 3 times a day for 5 days, with the goal of minutes per week.

Exercise increases insulin sensitivity and helps your muscles use blood sugar for movement. This can lead to reduced blood sugar levels. Your carb intake strongly influences your blood sugar levels 7.

Your body breaks carbs down into sugars, mainly glucose. Then, insulin helps your body use and store it for energy. When you eat too many carbs or have insulin-function problems, this process fails, and blood glucose levels can rise.

Some studies find that this can help you plan your meals appropriately, further improving blood sugar management 9 , Many studies also show that eating a low carb diet helps reduce blood sugar levels and prevent blood sugar spikes 11 , 12 , You can still eat some carbs when monitoring your blood sugar.

However, prioritizing whole grains over processed ones and refined carbs provides greater nutritional value while helping decrease your blood sugar levels Your body breaks down the carbs you eat into glucose, which then raises your blood sugar levels.

As such, reducing your carb intake can aid blood sugar regulation. Fiber slows carb digestion and sugar absorption, thereby promoting a more gradual rise in blood sugar levels There are two types of fiber — insoluble and soluble.

This could help you better manage type 1 diabetes The recommended daily intake of fiber is about 25 grams for women and 35 grams for men. Eating plenty of fiber can aid blood sugar management. Soluble dietary fiber appears to be more effective than insoluble fiber for this purpose.

In addition to preventing dehydration, it helps your kidneys flush out any excess sugar through urine. One review of observational studies showed that those who drank more water had a lower risk of developing high blood sugar levels Drinking water regularly may rehydrate the blood, lower blood sugar levels, and reduce diabetes risk 20 , Keep in mind that water and other zero-calorie drinks are best.

Avoid sugar-sweetened options, as these can raise blood glucose, drive weight gain, and increase diabetes risk 22 , Staying hydrated can reduce blood sugar levels and diabetes risk.

Choose water and zero-calorie drinks and avoid sugar-sweetened beverages. Portion control can help you regulate your calorie intake and maintain a moderate weight 24 , Consequently, weight management promotes healthy blood sugar levels and has been shown to reduce the risk of developing type 2 diabetes 1 , 26 , Monitoring your serving sizes also helps prevent blood sugar spikes 2.

The glycemic index GI measures how quickly carbs break down during digestion and how rapidly your body absorbs them. This affects how quickly your blood sugar levels rise The GI divides foods into low, medium, and high GI and ranks them on a scale of 0— Low GI foods have a ranking of 55 or less 15 , Both the amount and type of carbs you eat determine how a food affects your blood sugar levels.

Specifically, eating low GI foods has been shown to reduce blood sugar levels in people with diabetes 15 , Furthermore, adding protein or healthy fats helps minimize blood sugar spikes after a meal Stress can affect your blood sugar levels When stressed, your body secretes hormones called glucagon and cortisol, which cause blood sugar levels to rise 29 , One study including a group of students showed that exercise, relaxation, and meditation significantly reduced stress and lowered blood sugar levels Exercises and relaxation methods like yoga and mindfulness-based stress reduction may also help correct insulin secretion problems among people with chronic diabetes 31 , 32 , Managing your stress levels through exercise or relaxation methods like yoga may help you regulate blood sugar levels.

Monitoring blood glucose levels can help you better manage them You can do so at home using a portable blood glucose meter, which is known as a glucometer.

You can discuss this option with your doctor. Keeping track allows you to determine whether you need to adjust your meals or medications. It also helps you learn how your body reacts to certain foods 2.

Try measuring your levels regularly every day and keeping track of the numbers in a log. Also, it may be more helpful to track your blood sugar in pairs — for example, before and after exercise or before and 2 hours after a meal.

This can show you whether you need to make small changes to a meal if it spikes your blood sugar, rather than avoiding your favorite meals altogether. Some adjustments include swapping a starchy side for non-starchy veggies or limiting them to a handful.

Checking your blood glucose and maintaining a daily log enables you to adjust foods and medications when necessary to better manage your blood sugar levels. Getting enough sleep feels excellent and is necessary for good health In fact, poor sleeping habits and a lack of rest can affect blood sugar levels and insulin sensitivity, increasing the risk of developing type 2 diabetes.

They can also increase appetite and promote weight gain 36 , 37 , Additionally, sleep deprivation raises levels of the hormone cortisol, which, as explained, plays an essential role in blood sugar management 29 , Adequate sleep is about both quantity and quality. The National Sleep Foundation recommends that adults get at least 7—8 hours of high quality sleep per night To improve the quality of your sleep , try to:.

Good sleep helps maintain your blood sugar levels and promotes a healthy weight. On the other hand, poor sleep can disrupt critical metabolic hormones. High blood sugar levels and diabetes have been linked to micronutrient deficiencies.

Some examples include deficiencies in the minerals chromium and magnesium Chromium is involved in carb and fat metabolism.

It may potentiate the action of insulin, thus aiding blood sugar regulation 41 , 42 , 43 , Chromium-rich foods include:. However, the mechanisms behind this proposed connection are not entirely known, and studies report mixed findings.