Is a no-carb, low-carb, or moderate-carb diet the best choice for someone living with diabetes?
This is a question I’m asked almost daily, and today I will try to answer it by sharing my experiences with all three diet types.
What is the best diabetes diet?
Before I jump into the different diets, let’s get the obvious answer out of the way: It depends.
The diet that is best for you will always be determined by your health goals, activity level, weight, and other factors. The diet that works for you might not work for me, and vice versa.
For example, if you are trying to build strength and muscles, you shouldn’t follow the same diet as if you are trying to lose weight.
Similarly, someone who runs every day has different dietary requirements than someone who sits in an office all day and doesn’t exercise.
Your healthcare provider or a registered dietitian (RD) can help you determine what sort of dietary approach is best for you and your diabetes management.
Now that we have that out of the way, let’s get into the details of the different diets!
The “no-carb” (ketogenic) diet
The ketogenic diet (“keto”) is typically defined as including fewer than 50 grams of carbohydrate per day, with a focus on high-fat and moderate-protein foods.
The theory behind this eating approach is that by consuming very few carbs (contributing to around 5 to 10 percent of your total calories), your body will start converting fat into fatty acids and ketones.
Ketones can replace glucose as your body’s main energy source, meaning that your body mainly relies on fat for energy. In theory, this should make it very easy to lose excess body fat if you limit your calorie intake at the same time.
Because you eat almost no carbs, you also, in theory, need very little insulin, making blood sugar control easier. (Carbohydrate is the main nutrient that affects blood sugar levels.)
Foods recommended on the keto diet
Some sample foods recommended for this diet include:
- Meats (e.g., beef, pork, lamb, poultry, and game meats; preferably grass-fed and organic, if possible)
- Fatty fish (e.g., salmon, mackerel, sardines, trout, and other fish rich in omega-3 fatty acids)
- Eggs (preferably free-range or omega-3-enriched eggs)
- High-fat dairy (e.g., butter, cream, and certain cheeses)
- Nuts and seeds (e.g., almonds, walnuts, flaxseeds, pumpkin seeds, chia seeds)
- Healthy oils (primarily extra-virgin olive oil, coconut oil, and avocado oil)
- Avocados (whole avocados or freshly made guacamole)
- Low-carb vegetables (e.g., green veggies, tomatoes, onions, peppers)
- Condiments (e.g., vinegar, mustard, hot sauce, garlic, herbs, and spices)
- Beverages (e.g., water, unsweetened coffee and tea)
A registered dietitian can help you determine the best balance of foods to eat, taking into consideration your lifestyle and overall health goals.
My experience on the diet
So, what has my experience with the keto diet been? Unfortunately, it did not work for me at all! I only had 20 grams of carbs per day, and my insulin sensitivity went bonkers.
Since fat is released more slowly into the bloodstream than complex or refined carbs, I didn’t see any crazy blood sugar fluctuations, but my insulin needs increased dramatically compared to when I was eating a low-carb or moderate-carb diet.
Needless to say, my experience with the ketogenic diet was that I gained weight rapidly. Not really what I was going for.
My blood sugars were nice and stable, although often trending high. But since gaining fat isn’t part of my goal, I can honestly say that I will most likely never try a ketogenic diet again.
I know that some people successfully follow a ketogenic diet for diabetes management, so my experience may not be typical, but I cannot recommend a ketogenic diet at this point. You don’t need it for good blood sugar management, and the downsides can be serious.
(In addition to the issues I experienced, risks of this diet can include hypoglycemia [low blood sugar] for those on insulin or drugs that promote the release of insulin, nutrient deficiencies, kidney stones, acceleration of kidney damage for those with kidney disease, and constipation.)
The low-carb diet
There is currently no standard, universally accepted definition of a low-carb diet, but most resources define it as less than 26 percent of total calories daily or less than 130 grams of carbs daily
Foods recommended on a low-carb diet
Some sample foods recommended for this diet include:
- Non-starchy vegetables (e.g. leafy greens, broccoli, cauliflower, zucchini, bell peppers, cucumbers, asparagus)
- Lean proteins (e.g., chicken, turkey, lean cuts of beef and pork, fish [especially fatty fish like salmon], other seafood)
- Eggs (a great source of protein and nutrients)
- Dairy (e.g., unsweetened Greek yogurt, cheese [especially hard cheeses], cottage cheese)
- Nuts and seeds (e.g, almonds, walnuts, flaxseeds, chia seeds, pumpkin seeds)
- Healthy fats (e.g., olive oil, avocado oil, coconut oil, butter, ghee)
- Avocados (rich in healthy fats and very low in carbs)
- Berries, in moderation (e.g., strawberries, blueberries, raspberries, blackberries)
- Fruits, in moderation (e.g., watermelon, cantaloupe, peaches, plums, citrus fruits, preferably whole or minimally unprocessed)
- Whole grains, in moderation (e.g., wheat, quinoa, barley, oats)
- Legumes, in moderation (e.g., lentils, black beans, chickpeas)
- Beverages (e.g., water, unsweetened tea and coffee)
A registered dietitian can help you determine the best balance of foods to eat, taking into consideration your lifestyle and overall health goals.
My experience on the diet
I’ve found the low carb diet to be the sweet spot for most women with type 1 diabetes (myself included) when dieting for weight management or fat loss. I only go this low on daily carbs when I want to slim down, like when I want to drop the last few pounds for a photo shoot or fitness competition.
An added benefit of a low-carb diet is that it makes blood sugar management easier. I divide my daily carbs between several meals and combine them with lean protein and good fats, so I hardly see any blood sugar fluctuations after meals.
That said — and I know that this will be controversial to a lot of people in the diabetes community — in general, I don’t recommend a low-carb diet as an optimal, everyday maintenance diet. It may support weight loss and blood sugar management but may also decrease your energy levels.
If you live an active lifestyle (and especially if you do resistance training), the moderate-carb diet provides you with the energy you need to fuel your workouts while still allowing for great blood sugar management.
The moderate-carb diet
A moderate-carbohydrate diet typically includes 26 to 44 percent of daily calories from carbohydrates. If you eat 2,000 calories per day, that’s between 130 and 220 grams of carbs per day.
For some people with diabetes, this may be too many carbs, though most research suggests moderate-carb diets are suitable for this population. Personally, I consume the higher end of this carb range when I exercise a lot and am trying to build muscle mass.
Foods recommended on a moderate-carb diet
Some sample foods recommended for this diet include:
- Whole grains (e.g., brown rice, whole-wheat pasta, quinoa, barley, whole-grain breads)
- Fruits (e.g., apples, oranges, pears, berries, peaches, preferably whole or minimally processed)
- Non-starchy vegetables (e.g., leafy greens, broccoli, cauliflower, bell peppers, and other colorful vegetables)
- Lean protein sources (e.g., chicken, turkey, lean beef, fish, tofu, legumes)
- Low-fat dairy (e.g., low-fat or fat-free milk, yogurt, cheese)
- Legumes (e.g., beans, lentils, chickpeas)
- Nuts and seeds (e.g., almonds, walnuts, chia seeds, flaxseeds)
- Starchy vegetables, in moderation (e.g., potatoes, sweet potatoes, corn)
- Healthy fats (e.g., olive oil, avocado, nuts)
- Beverages (e.g., water, unsweetened herbal teas and coffee)
A registered dietitian can help you determine the best balance of foods to eat, taking into consideration your lifestyle and overall health goals.
My experience on the diet
During my last muscle-building phase, I averaged about 200 to 250 grams of carbs a day, but I was also lifting heavy weights five to six days a week. As long as I stick to low-glycemic carbs (except right after my workout), I can eat that many carbs and still have very good blood sugar control.
The great thing about the moderate-carb diet (aside from eating lots of tasty carbs) was that I managed to “lean out,” slightly reducing my body fat percentage while adding some nice muscle mass.
For those who have weight loss goals, eating a moderate-carb, healthy diet like the Mediterranean diet, especially combined with regular exercise (doesn’t have to be competition level), has been shown to support weight loss in people with type 2 diabetes and type 1 diabetes.
You can see exactly what my typical diet is like in this post.
Foods to avoid
No matter how many carbs you’re targeting in your eating plan, certain foods are best limited or avoided for both blood sugar and general health. These include:
- Processed foods (prepackaged meals, baked goods, candy, potato chips, etc.)
- Foods high in sugar (sodas, juices, pastries, etc.)
- Refined starches (white bread, white rice, white pasta, etc.)
- High-sodium foods (fast foods, canned goods, frozen convenience meals, processed meats, etc.)
- Alcoholic beverages
What the American Diabetes Association recommends
As I noted above, there isn’t a universal approach to eating that’s appropriate for everyone with diabetes. This is reflected in the American Diabetes Association’s (ADA) nutrition guidelines.
Based on the current research, the Standards of Care in Diabetes — 2024 suggests that a variety of eating patterns can be appropriate, including the Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) diet, low-carbohydrate vegetarian, and plant-based.
The ADA also recommends limiting processed meats, animal fats, refined grains, and added sugars, and focusing on whole, plant-based foods.
Final thoughts
As I mentioned at the start, the best diabetes diet for you depends on your goals. Personally, I find a low-carb diet optimal for weight loss and a moderate-carb diet optimal for maintaining and building muscle mass.
(As a final note, some people with diabetes also follow an all-carb, all-fruit diet in which they eat as much as 600 grams of carbs a day or more and get great results. This is not something I would ever try and is not recommended by healthcare professionals, but it clearly shows that many different diets can work well for diabetes management.)
The best thing for you to do is to work with your healthcare team, experiment, take notes, learn from your mistakes, and find the diet that works for you and your body!
Recommended next post: How to Lose Weight When You Live With Diabetes.
Delaney
Hi Christel!
I just started resistance training 6 days a week and your website has been the biggest help!
I was hoping you could say more about the low carb diet. I’m planning on eating 1,380 calories a day but I was wondering what the macros would look like in a low carb diet.
Thank you so much!
Christel Oerum
So glad the website is a good resource for you!
As I mention in the article the “low carb” definition is fluid but I see it as 50-75 g carbs per day excluding veggie carbs. So that’s 200-300 calories from carbs a day (50-75 x 4), plus ~200 calories from veggies, meaning you have 980-880 calories left for fats and protein. Since I don’t know your details lets me give you an example of what that could look like.
Let’s say you weigh 140 lbs and decide on 0.8 g of protein per lbs. That would be 140 g of protein (x4) = 560 calories. You’d then have 420-320 calories left for fat. Where carbs and protein have 4 calories per gram fat has 9 calories meaning you’d eat (420-320 divided by 9) 46.7-35.6 g fat per day.
Natalie
Hi Christel,
I have type 1 diabetes and I’m on day 9 of the Keto diet. I’m about to give up because I feel terrible. My blood sugars have been perfect, but I think I’ve had the Keto flu for the past seven days. So, I’m curious, what percentage of macros work best for you? I’m interested in losing a little fat, but gaining muscle.
Thank you!
Natalie
Christel Oerum
If your goal is weight loss you have to be in a calorie deficit, just doing keto will not do it. You can lose weight on any diet as long as you can stick with it.
The right calorie level will depend on the individual (age, sex, activity level, fitness level, genetics, etc.) so you’ll have to determine that for you. You can start by using the calorie calculator (HERE) or even better, track what you eat and drink for a week in MyFitnessPal and then reduce that amount by 200-500 calories per day
Rob
Hi I’ve just discovered your website while looking for an explanation for high insulin resistance while on keto diet.
I’ve tried keto diet twice now and my experience both times was that for a first month or so, my BG levels would go down and stabilize between 4-7 mmol/l and my daily insulin needs would go down 30-50%. So far so good.
But after a month, my BG would start to rise and most of the time it would stay between 7-10 mmol/l. It was very difficult for me to get my BG levels to drop below 7 mmol/l. I started to pump more insulin into my body, but it seemed that to have little effect. Keto diet might not be for me, so I think I will rather stick to low-moderate carb intake.
Is there any explanation yet for this “problem”?
Thank and keep up the good work :).
Christel Oerum
I don’t have a scientific explanation, unfortunately. All I can say is that I had the same experience and did not enjoy it. One theory could be that the body becomes so used to / depended on using fat for fuel that it becomes inefficient at using glucose. But again, that’s just a theory
Jane
I am a type 1 LADA. Low carb has always worked for me. Because of my insulin to carb ratio, I would need too much insulin for 200-300 carbs. Keto did not work at all for me. I did not tolerate all the fat. My BS would spike overnight. So am tooling along at less than 70 carbs daily. Am active. I do weights and cardio. And still work as a nurse 2 days a week. Feel great for an old lady.
Rob
Dear Christel,
Thank you for this article. Cleared lot of my confusion on carb diets.
One question; I am looking to start low carb diet recipes can you help…
Christel Oerum
Hi Rob, glad you found it helpful. For low carb recipes you can filter for “Low carb recipes” in the recipe library here on the site:
Sachin malik
Hi Christel
Thank you for this great article.
Many people don’t have enough money to discuss everything with dr.
For those, your article is like a DR.
Thank you
Yilam
Dear Christal,
Really big thanks to you for this article. Save me from the confusion.
Now I have confidence to go moderate carb without feeling “wrong”.
One question:
Is moderate carb compatible with moderate/high fat diet?
I am 32 y o, 152cm and 44kg (BMI: 19). I have a high body fat ratio though, so I want to lower that.
As I am tiny, I think 100g carb daily is good for me (30% of daily caloric intake). 100g of proteins seem to be the upper limit too (30% also, plus I don’t exercise much). In this case, how much fat is a sensible proportion? Another 30%? Will that be too high?
I know low carb and high fat work together. High carb and high fat are plain old bad diet. How about moderate carb and (???) fat……?
Christel Oerum
Hi Yilam,
I’m glad you found this post useful. My goal is to convey that ultimately the right diet will depend on you and your goals. There is not a one-fits-all.
I suggest you start by calculating your daily calorie need: https://diabetesstrong.com/how-to-find-your-daily-calorie-need/
That will help you find your macros. If you decide on 100 g carb, that equates ~400 calories, 100 g protein will be ~400 calories as well.
Let’s say your calorie need is 1800 (again, you’d have to calculate that) and you decide on a 500 calorie deficit. Then you’d want to eat 1300 calories a day. 800 of that would be from carbs and protein so you’d have 500 calories left, which equates 55 g fat/day since fat has approximately 9 calories per gram.
As with all meal plans / macro splits this would be a start and you’d evaluate progress after (optimally) 4 weeks and consider making changes
Yilam
Dear Christel,
Thank you for such a quick reply!!
And thanks for the link for calculating caloric need! Very useful!
I have done that and my daily caloric need is 1160 (43.5*0.9*24*0.95*1.3).
I am not planning to lose weight (just want to adjust the body composition), so I will keep my intake at 1160kcal.
In this case, 30% (348kcal) carb is 87g and 30% (348kcal) protein is also 87g. The 464kcal remaining would be equivalent to 51g fat.
My concern is…… would 87g carb + 87 g protein + 51g fat very imbalanced? As many of my friends tell me that, if I am not on a low carb diet, high fat will lead to all sort of problems……
Yes I am very willing to try first and evaluate. Just want to make sure it is not faulty in the first place to start 🙂
Thanks a lot!!!
Christel Oerum
Sure,
I generally don’t recommend going below 1200 calories/day. And you might benefit from going a little higher some days.
Why not stick with the 100 g carbs, 100 g protein and then do 44 g fat? I would consider that a good starting point. But again, I don’t know you, your goals or activity level well enough to give a straight up recommendation. If you ever need more in debt guidance I can offer that as 1:1 coaching
https://diabetesstrong.com/online-personal-training/
Yilam
Oh thanks so much Christal!! I thought my reply failed because it didn’t show. How glad to find it actually didn’t disappear and with your reply!! Thanksssss 🙂
You are right I don’t want to go under 1200 either. I will try 100g carb (33%) + 100g protein (33%) + 44g fat (33%).
Planning to start, I realise it needs vast research on nutrition data and enormous time to learn about each food item. I will try to get familiar and adjust my current diet to the planned diet gradually.
Will definitely tell you how it goes…… if I manage to go that far. 🙂 but really thank you for helping me start!!
Christel Oerum
You got it!
Joel
I know this is an older blog but, I have to say I’m having the same experience with keto. I’ve been keto (and yes…blood testing over .5 mmol most of the time, I stopped cause it’s expensive) for over a year and my belly fat is increasing! I’ve been so sold on the science behind it, I’m in denial. It was refreshing to see someone else with the same issues. Why is that and what is going on!?!? I’m switching back to your moderate carb idea.
Thanks!
Joel
Christel Oerum
You and I are not alone in having a bad experience with keto, not that many talks about it though. I believe it’s fantastic for some, but we are not all the same.
I don’t know the exact science, I’ve been told it can mess with your hormones and others told me that if it’s not done “right” (for example too much protein) it can have a negative effect on your metabolism. All in all, I haven’t seen any science on it, so it’s anecdotal. My advice is to do what feels right, and you can afford and don’t buy into the “one fits all” paradigm
Brooke Bomleny
Hi I am a mom to a newly diagnosed Type 1 three year old girl. I have started researching carb approaches, and any kind of “plan” in general is hard with a toddler…but wondering what approach you recommend for kids? Or any references to plans for them? Wanting the best blood sugars for my baby and am so overwhelmed! Thanks so happy to have found your blog!
Christel Oerum
Hi Brooke,
Unfortunately, I don’t really have any experience with kids that age. I would love to help you, but I don’t want to give any advice when I’m not sure what the right approach is. Do you have a local JDRF chapter you can contact? They have great support and events for parents and children in most cities.
Please tell your daughter from me that there is nothing she can’t do with diabetes and that I wish her (and you) all the best.
– Christel
Ashley
This was a great blog! Defiantely gave insight into each diabetic diet type.
I always have great ideas to start the low carb diet but when it comes down to it I really dont know where to start, substitutions etc. A ‘sample’ menu, I think, would be very beneficial. Do you know where I could find one OR if you would like to write one?! 😀
Love the blog!
Christel Oerum
Hi Ashley, thanks for the positive feedback! We will be starting a new challenge on TheFitBlog in January (be on the look out for the sign up form) and that will actually have weekly meal plan suggestions. So you’ll actually get 4 ‘sample’ menus in the next month. I hope you like them.
Christel
Ruby McGill
Fantastic blog! Im interested to see how a low carb diet affects my diabetes, but was never really sure where to start. This has provided an awesome insight and i will be sure to experiment and find out what works best for me.
Thanks heaps.
Christel Oerum
Hi Ruby – thanks you 🙂
You have the right approach, it’s all about testing things out and find what works for you. Be on the lookout for sample menus in the new year.
Christel