Oftentimes I will have patients with diabetes whose blood sugars are high, and they think, logically, that if they eat very few (or no) carbohydrates, that will help. Unfortunately, they are working against themselves, and here’s why:

The body has what I like to refer to as a savings account of glucose in the liver. When the cells in the body aren’t getting the glucose they need for energy (like when someone skips a meal or when their cells are resistant to insulin), they start complaining all over the body trying to get someone to fix their problem. Word gets to the liver that the cells are starving and he wants to help. The trouble is, liver is a busy guy. He’s got many, many jobs. I often joke that managing this savings account is his “side gig.” He’s not particularly good at it.

In people with diabetes, liver sometimes starts dumping glucose from his savings account into the blood when he doesn’t really need to, and also he doesn’t know when to stop. He just keeps pouring and pouring sugar into the blood and before you know it, this poor person who is trying their darnedest to avoid eating carbs in order to get their blood sugars down has a sky-high blood sugar because they haven’t eaten!

It’s the most frustrating thing in the world because it’s totally backwards to what we would naturally think.

Moral of the story: don’t skip meals, and don’t over-restrict carbohydrates! It’s just as important to eat enough as it is to not eat too much to manage blood sugars in diabetes (side note: that’s true for weight loss as well!).

Bonus sub-moral of the story: If you have something frustrating going on with your blood sugars or your weight that you can’t explain, seek out a Registered Dietitian or a Certified Diabetes Educator to help explain all the funky things that your body might be doing without your realizing it! You don’t have to be frustrated and helpless. You can be empowered to better understand your body!

Carb Counting How Your Body Works

What a great question. I get asked about sugar alternatives all the time and it is one of the more frustrating areas of nutrition for me.

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As a dietitian, I am held to practice evidence-based nutrition, which means providing recommendations to patients based on the information that research provides. The tricky part with research is that, darn it, it doesn’t always agree with itself. One study will say something is fine, another will say it will cause you cancer (a great reason not to change your eating habits based on one single news clip, health news article, or Dr. Oz show).

We are only as good as the research that we have, and when it comes to sugar alternatives, I don’t feel that what we have is great. We have a lot of research in some areas, and not as much in others, but I struggle with the research we have because some of it is funded by industries that have a financial stake in the results (think sugar companies or artificial sweetener companies) and the methods aren’t always great assessments of real-life application.

So what I end up giving my patients is the information that we do have on all of their choices, and advise them to make a personal decision. Here is what we have so far:

Artificial sweeteners like sucralose (Splenda®), aspartame (Equal®, Nutrasweet), and saccharin (Sweet‘N Low®)

  • Pros: Do not raise blood sugar significantly (1, 2) do not provide calories. (3, 4)
  • Cons: Do not occur naturally, some have an unpleasant aftertaste, sucralose may worsen insulin resistance. (5)
  • What is unclear: conflicting research on whether artificial sweeteners may increase hunger (the first two references say it does, the latter four found it did not) (6, 7, 8, 9, 10, 11), aspartame has been linked to increased occurrence of cancer, though in the spirit of full disclosure the methods of this study have been debated. (12)

Stevia (Truvia®)

  • Pros: Does not raise blood sugar, provide calories, or increase hunger (13), some researchers claim it may have anti-hypertensive, anti-inflammatory, and anti-carcinogenic benefits (14), comes from a leaf that grows naturally.
  • Cons: The safety of consuming stevia in large amounts has not been well-studied, though preliminary reviews have considered it safe (15).

Agave Nectar

    • Pros: May have a lower glucose and insulin response than sugar and cause less weight gain than sugar (16), occurs naturally.
    • Cons: Provides calories, raises blood sugar and can lead to insulin spikes in large amounts, causes inflammation, contains high levels of fructose which may increase BP (17) and worsen insulin sensitivity (18).


    • Pros: Unprocessed raw local honey is generally easy to find (albeit expensive), has higher antioxidant content than other sweeteners including sugar (19), occurs naturally.
    • Cons: Provides calories, raises blood sugar and can lead to insulin spikes in large amounts, causes inflammation.

Sugar (including raw sugar/turbinado sugar, cane sugar, and brown sugar)

  • Pros: Tasty – that’s about it. Raw sugar and brown sugar have slightly more antioxidants than refined sugar (19).
  • Cons: Provides calories, raises blood sugar and can lead to insulin spikes in large amounts, causes inflammation, offers empty calories without micronutrient value (20).

So there you have it. It’s unfortunately not as simple as “which is the best sweetener to use?” Your goals, personal convictions, and body all play in to that choice.

Other tips: work on decreasing your use of sweetening agents in general, and don’t put all your sweetener eggs in one basket. In other words, moderate. Small amounts of a few different kinds of sweeteners in your diet is less likely to cause the damage that might occur from getting all your sweetening from one particular source.

Sources (Yes, I know – lazy, linked sources without full citations):

  20. Gropper, S. A. S., Smith, J. L., & Groff, J. L. (2009). Advanced nutrition and human metabolism. Australia: Wadsworth/Cengage Learning.

Carb Counting How Your Body Works

Many recommendations have come out in recent years discussing the benefits of avoiding long periods of sitting. For those of us who work at a desk, that can be tough! While working, it can be difficult to 1) remember to get up, 2) realize how much time has passed since you got up, or 3) get up at all, depending on what your job is!

To help with this conundrum – I tracked down two apps designed to promote movement while I was on my carb counting stent (people with diabetes are recommended to get up and move for 3 minutes out of every 30!). Check out my assessment of these apps:

Move – Daily Activity to Stay Healthy
(free from the Apple app store)

This one allows you to customize the frequency which you wish to be reminded to exercise, as well as the time frame in which you want reminders (like 8 am to 5 pm, for example). The app sends you an encouraging and/or Jillian Michaels-like reminder (“Don’t you dare think about skipping this one!” or “Come on, no excuses!”) to get up and move on the schedule you set. The app contains a list of exercise suggestions that you can tailor to your preferences. If you choose to do the exercise it suggests, you click a button that says “I did it!” and it will tack it onto an ongoing list of the exercises you have completed that day, complete with estimated calories burned. If you don’t want reminders on certain days, you can skip them for a day.

  • Pros: Easy to use, customizable exercises/schedule, exercise suggestions, accumulating list of exercises throughout the day is motivating.
  • Cons: Reminders could be a little less cheesy/condescending, several of the exercises would not be discreet in certain office settings (think jumping jacks and side-lying leg lifts – they have an “Office” exercise pack you can purchase that is supposed to remedy this).

Overall: I enjoyed this app – I liked that it gave suggestions for exercises because, even as an exercise physiologist, I do better with direction. Particularly when I’m in the middle of the work day – I don’t have to come up with exercises on my own!

Stand Up! The Work Break Timer (free from the Apple app store)

This app also allows you to customize it with a daily schedule and frequency of reminders. You can skip days as needed. On schedule, the app pops up a reminder that states, “Time to stand up. We want you to live longer!” If you go to the app at that time, you can select between options to skip that particular reminder or to acknowledge that you got up, which the app will track.

  • Pros: Easy to use, customizable schedule, tracks the number of times  and when you get up throughout the day.
  • Cons: Reminder is the same every time, no exercise suggestions.

Overall: It worked. I enjoyed the other app more, but they both will get the job done!


_export-4I wrapped up carb counting yesterday, and I would be lying if I said I wasn’t relieved that I don’t have to poke my fingers anymore. I’m glad I did it – I got some good ideas for tips on how to make it hurt less (the side of the finger is the spot!). I did miss my insulin one day – I was on an overnight girls’ trip and thought I brought everything (got my meter, lancets, blood sugar log, and vitamin) but I somehow managed to leave my syringe behind. Phooey. There goes my perfect record.

As far as carb counting goes, it’s not awful. It gets tiresome and Halloween was definitely tough, but it wasn’t the hardest part. Getting the 30 minutes of activity 5 days per week was a challenge, but not the end of the world. Now, getting the 3 minutes of activity per every 30 of sitting – that was the sticker. Fortunately, the apps I discussed in this post made it easier. I’ll be writing a post reviewing the two apps soon! Even with the apps, it was downright impossible to do that every single thirty minutes. You know, I have 60-minute appointments and on girls’ day I drove for two hours there and two hours back. No exercise there. But I did the best I could and honestly, it really felt good to get up and get the blood flowing and joints moving on a regular basis.

  Carb Counting Goal Week #1 Week #2 Week #3
# of days nutrition recommendations met 7 7 6 6
Average carbohydrate intake per meal 45-60 grams 52.4 55.2 50.4
Weight change   -2 lb +1 lb -2 lb
Waist change   -.5″ 0” +.5″
Grocery Budget Change   +18% 0% -2%


As a special treat, my husband and I completed the #DiabetesDanceDare for Diabetes Awareness. Enjoy!

Carb Counting

Managing diabetes is a struggle. It can be overwhelming and exhausting to try to keep your blood sugar under control. Here are 7 reasons I think people find it challenging to do the things they know would be good for them:

  1. They are confusing. Nobody can agree. You get one recommendation from your doctor, one from an article you read online, one from a library book, and three others from your friends with diabetes. So who’s right? Sometimes no one, sometimes all of them. Diabetes recommendations (and bodies!) are so, so individual. Just because something is recommended for your friend or even the general public, doesn’t necessarily mean it’s right for you. Discuss your questions with your doctor and your dietitian. They should be able to help you weed out what’s right for you.
  2. They are overwhelming. So much to do, so little time: checking blood sugars (sometimes 4-6 times a day!), taking medications, dosing insulin, watching your diet, and staying active. I get it – I’m living it temporarily and I’m already starting to wonder how people do this all the time. Managing diabetes is no joke. Sometimes I feel like, as health professionals, we throw too many tasks at patients at one time. Be sure to communicate what’s realistic for you and tell your care team if you need to prioritize changes into smaller steps.
  3. Presentation is key. Along the same lines, nutrition information for diabetes is often presented in a tsunami of recommendations to idealize someone’s diet and prevent every chronic condition under the sun. I have sat in on and (I hate to say it) helped teach classes that covered carbohydrates, proteins, portion control, fiber, saturated fat, unsaturated fat, heart healthy recommendations, exercise, and mental and sexual health in one mind-numbing three hour stint. How likely is it that those poor people are going to retain anything useful? In fact, I meet with patients on a weekly basis who have attended those types of classes and flat out told me, “I didn’t learn anything. There was way too much information.” My plea to my profession: BREAK IT UP, PRIORITIZE, and EMPATHIZE.
  4. Portion does not mean portion. This is a big one. Diabetes educators and dietitians have adopted a term called “diabetes portion” or “carbohydrate portion.” This amount of a food has about 15 grams of carbohydrate and is intended to make carb counting easier. After learning the portions, someone can simply choose 3-4 per meal, 5-7 per meal, or however many their dietitian recommends, rather than track and count grams of carbohydrate. The unfortunate reality is that the word “portion” sends the message that that amount of carbohydrate is all they can have at once. I can’t tell you how many people I’ve worked with who say dejectedly, “So-and-so told me I could only ever have 1/3 cup rice at a time and that’s just never going to happen.” This misconception is suuuuuuper defeating for people who want to manage their diabetes, because they think they have to starve to do it. My solution? Change “carbohydrate portions” to “carbohydrate choices” or something less confusing so people know they can still eat!
  5. It’s not black and white. Eating for diabetes is not a list of “good foods” and “bad foods,” which can be confusing. Carbs are not bad and they give us energy, but people with diabetes simply can’t process too many carbs at one time. It’s not total avoidance, it’s moderation. Sometimes that’s hard to grasp.
  6. The media. Ohhhhhh the media…so useful in some ways, so full of garbage information in others.
  7. It’s a moving target. Recommendations for managing blood sugar are based on a conglomeration of research in the field. You know what that means? New research = new recommendations. Every few years, the recommendations change a bit based on new information. That’s why it’s important, even if you’ve had nutrition education before, to meet with your doctor regularly and a dietitian at least once a year to keep up on what’s new.

Carb Counting

For me, snacks are key to carb counting survival. In general, I feel satisfied after eating a carb-controlled meal but I’m finding myself hungry 2-3 hours after the meal. Snack time!


Ideally, a carb-controlled snack for my plan would have 15-20 grams carbohydrate and some protein (even better if it adds in fiber too!). The carbohydrates keep my energy up while protein helps keep the carbohydrates from raising blood sugar too quickly. My struggle is I’m finding the protein portion tough for some reason. Some of my favorite example snacks include:

  • 6-8 whole grain crackers with cheese
  • ¼ cup unsalted nuts with 2 Tablespoons dried fruit
  • 1 small apple with 2 Tbsp peanut or almond butter
  • 3 cups popcorn with a drizzle of olive oil, dash of salt, and garlic powder, rosemary, and thyme (it’s delicious – and even though this one doesn’t have much protein, it’s a whole grain, it’s high in fiber, and the portion is no joke)

My challenge is that often snack time ends up being on my breaks at work, and proteins are either tough to pack or they need preparation and/or refrigeration. I did a stint with mozzarella cheese sticks and they worked out really well but I got a little bored with them. I haven’t been able to make it to Winco to get the bulk mixed nuts at a decent price (I refuse to pay the prices at most grocery stores), and I’ll be honest, I’ve been too lazy to get a little container to put peanut or almond butter in. I could hard boil a bunch of eggs to have ready and take with me, but here again – too lazy, too busy. Gah.

Many times this last week, my snack has ended up being 15-20 grams carb only, without the protein. That’s less than ideal because besides regulating blood sugar, protein helps a snack be more satisfying for longer.

As I gradually add in diabetes recommendations to follow, I have to say that there is a LOT to it. I hear that from my patients all the time, and they aren’t kidding. Remembering to pack a lunch is pretty much habit, but the snacks are often a last-minute afterthought and making sure there’s protein with them seems like a nice idea that only happens when the planets align just right.

Anyway, this is all good experience for me as an RD and it backs up what I hope I communicate to my patients: do the best you can, take one step at a time, and be prepared that life is going to push you back. Life happens. Life gets crazy. Motivation comes and goes. Just be steady and do your best. After all, your life is worth fighting for!

Carb Counting


I gotta tell ya folks, sticking to the diabetes recommendations is exhausting, especially when life gets busy. With Halloween festivities and a rapidly filling schedule I’ve found it tougher to stick with the recommendations this week.

I did overdo my official dinner carb budget on Halloween, but I did it in a planned and intentional way. I spread my carbs out throughout the evening and only exceeded my carb budget by 15 grams. And that’s okay. It’s another case against the “diet mindset”: the recommendations are not hard and fast rules and it’s ultimately your life – you get to decide when to push on the guardrails, how often, and how far. The results are yours to own.

It’s going to be particularly tough this upcoming week, as I’m adding in goals to move for 3 minutes for every 30 minutes of sitting, check blood sugars daily, give myself a syringe poke daily (to simulate an insulin injection), and take a daily vitamin (to simulate taking oral medication for diabetes). It is definitely feeling a bit daunting, and I am only committed to this for another week!

The mental and emotional burden of managing diabetes is very, very real and goes far beyond what I’m facing here. When I don’t meet the recommendations, my body compensates and I chalk it up as a “Whoopsie, I’ll do better next time.” While that mindset applies for someone who has diabetes, they have the additional awareness that ongoing “whoopsies” can really do them harm.

For all those with diabetes, I salute you. Your road is not an easy one to walk. The obstacles and struggles on your journey can lead to diabetes burnout , which happens to everyone with diabetes from time to time.

 If you do feel lost, overwhelmed, or depressed (people with diabetes are more likely to be depressed, and depression worsens control of diabetes), please seek out some support and resources. A great care team, support group, dietitian, or even resources at can really help bolster your spirit and help you navigate all those tough barriers. You are not alone!


  Carb Counting Goal Week #1 Week #2 Week #3
# of days nutrition recommendations met 7 7 6  
Average carbohydrate intake per meal 45-60 grams 52.4 55.2  
Weight change   -2 lb +1 lb  
Waist change   -.5″ 0”  
Grocery Budget Change   +18% 0%

Carb Counting