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Chapter 5


Carbohydrate Carbohydrate and Diabetes


• The ADA states that monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains a key strategy in achieving glyce- mic control. (ADA, B)5


• For individuals on multiple daily insulin injections or insulin pump therapy, carbohydrate counting using insulin-to-carbohydrate ratios based on their abilities, preferences, and management goals is recommended. (DB, Strong)4


• For individuals on fixed insulin doses or on insulin secretagogues or on MNT alone, based on their abili- ties, preferences, and management goals, carbohydrate consistency (timing and amount) using carbohydrate counting; plate method, portion control, or a simplified meal plan; or food lists is recommended. (DB, Fair)4


Nutritive Sweeteners


• Intake of nutritive sweeteners, when substituted iso- calorically for other carbohydrates, will not have a significant effect on hemoglobin A1c (HbA1c) or insu- lin levels. (DB, Fair)4


• Intake of nutritive sweeteners should not be excessive to avoid displacing nutrient-dense foods and to avoid excessive caloric and carbohydrate intake. (DB, Fair)4


• People with diabetes should limit or avoid intake of sugar-sweetened beverages (from any caloric sweet- ener, including high-fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of car- diometabolic risk profile. (ADA, B)5


Fiber


• A cardioprotective eating pattern should include 25 to 30 g fiber from food per day, with special emphasis on


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