The two main types of carbohydrates

• Starchy foods: these include bread, pasta, potatoes, yams, breakfast cereals and couscous.
• Sugars: these can be divided into naturally occurring and added sugars:
  • Naturally occurring: sugars found in fruits (fructose) and some diary foods (lactose).
  • Added sugars: found in sweets, chocolate, sugary drinks and desserts.

Fibre

This is another type of carbohydrate, which you can’t digest.

• Insoluble fibre, such as is found in wholemeal bread, brown rice and wholegrain cereals, helps keep the digestive system healthy.
• Soluble fibre, such as bananas, apples, carrots, potatoes, oats and barley, helps to keep your blood glucose and cholesterol under control.

Make sure you eat both types of fibre regularly. Good sources of fibre include fruit and veg, nuts and seeds, oats, wholegrain breads and pulses.

How much?

Everyone needs some carbohydrate every day. The actual amount that you need to eat will depend on your age, activity levels and the goals you – and your family – are trying to achieve, for example trying to lose weight, improve blood glucose levels or improve sports performance. The total amount of carbohydrate eaten will have the biggest effect on your glucose levels.

Insulin and carb counting

If you’re living with diabetes, and take insulin, you’ll need to take that into account when eating carbs. Learn about which foods contain carbohydrates, how to estimate carbohydrate portions and how to monitor their effect on blood glucose levels.

There are special courses available, such as the DAFNE course, which your diabetes healthcare team can tell you about.

Our downloadable PDF e-book, Carbs Count, provides an introduction to carbohydrate counting and insulin dose adjustment. It takes you through the essential information, with practical examples and exercises. You candownload it for free through our online shop.

Three ways to include good carbohydrates in your diet

• Choose wholegrain breads and cereals.
• Have fruit whole, rather than as a juice. Eating an apple with the skin on, for example, will provide more fibre than drinking a glass of apple juice.
• Ring the changes with quinoa and couscous as an alternative to pasta.

How does carbohydrate affect anyone with Type 1 diabetes?

All carbohydrate is converted into glucose. In someone without diabetes, the body produces insulin automatically to deal with the glucose that enters the blood from the carbohydrate-containing food that we eat and drink.

In Type 1 diabetes the same principle applies but because your body doesn’t produce any insulin, you have to take insulin, either by injections or a pump. This will help to lower the glucose in the blood after eating carbohydrate-containing foods. Most people follow twice-daily or basal bolus insulin regimes.

• Twice-daily insulin

  If you are taking fixed amounts of insulin twice a day you may find it beneficial to have consistent amounts of carbohydrates on a day-to-day basis, and eat roughly the same amount of carbohydrate at similar times each day. More carbohydrate than usual can cause blood glucose levels to go too high, and less than usual can cause a hypo (low blood glucose levels).

• Basal bolus insulin

  If you are using a basal bolus insulin regime or pump you can be much more flexible in how much insulin you take and when you take it. Most people following this regimen will count carbohydrates that they eat and drink and then calculate how much insulin they need to take. The amount of insulin will change depending on how much carbohydrate they have eaten.

If you’re living with Type 1 diabetes, you might find that carbohydrate counting, or carb counting, is an effective way of managing your blood glucose levels – it means that your insulin dose can be individually matched to the amount of carbohydrate you eat and drink.

Being aware of the amount of carbs in food and drinks is important for everyone with diabetes, but carb counting is particularly helpful for those on basal-bolus insulin regimen. This is when the person with diabetes (mostly Type 1 diabetes) injects insulin with each meal or uses an insulin pump.

Although carb counting requires a great deal of time and effort, once mastered it can lead to better blood glucose control and greater flexibility in the times and amount of carbohydrate you eat. It doesn't mean total freedom to eat whatever you want in excess as this would be unhealthy for anyone, although special occasions and treats can be more easily incorporated and insulin adjusted to match.

Carbohydrates can be counted in two ways, in grams or as carbohydrate portions (CP). One CP is usually equal to 10g of carbohydrate. It is important that you find the method that works best for you.

Once you’ve got to grips with estimating the amount of carbohydrate you are going to eat and drink, the next key piece of information you need is your insulin-to-carbohydrate ratio. Insulin-to-carbohydrate ratios vary from person to person, so you will have your own personal ratio depending on your age, weight, activity levels and how sensitive you are to insulin. Your diabetes healthcare team will help you work it out and, eventually, you may even have a different insulin to carbohydrate ratio for each meal. They will usually estimate your starting insulin-to-carb ratio and subsequently fine-tune this based on your blood glucose control.

If you know how many grams of carbohydrate are in a meal and your insulin-to-carb ratio then you can work out the number of units of bolus insulin you need to take for the meal. 

For example: if you are planning to eat 70g of carbohydrate at your meal and your insulin to carbohydrate ratio is 1 unit of bolus insulin for every 10g carbohydrate then you will need to take 7 units of bolus insulin.

The amount you actually take will also depend on other factors such as your blood glucose level, illness or planned activity.

How can I count the amount carbohydrate I am eating and drinking?

There are five ways you can count carbohydrate in food and drink.

1. Food labels – using the carbohydrate per portion value 

If you look at the labelling on the back of a ready-meal, you'll see something that looks like this:

If you ate all of this ready meal, the amount of carbohydrate you would count is 44.7g of carbohydrate. It is important to count the total amount of carbohydrate and not the 'of which sugars' value. When using the per portion value be sure that this is the actual portion you are planning to eat.

2. Food labels – using the carbohydrate per 100g value  

On the back of foods like pasta or, in this case, basmati rice, you'll see food labelling information like this:

When using the per 100g value, calculate the carbohydrate for the actual amount of the food or drink that you are going to have. For example, if you were planning to cook and eat 80g of this rice the amount of carbohydrate you would count is 61.9g of carbohydrate and not 77.4g. It is worthwhile investing in a good set of scales that are flat based, digital and can be zeroed. It is also important that your scales are accurate to within 5g. The cooked weight of foods like pasta, rice and potatoes will vary from the raw or pre-cooked weight, so check which values you are using. 

3. Reference lists and visual guides

What should you do when food doesn't carry a nutrition information label or you are eating out and don't have the recipe for what you are eating or a set of scales? Although these times can be more challenging, reference lists and visual guides, such as Carbs & Cals, will come to your rescue and help you estimate carbohydrate.  They list the amount of carbohydrate in handy measures, such as “1 bread roll “, “1 medium banana”, or “1 scoop of ice cream”. And some contain pictures for comparing, too.

4. Recipe nutrition information

Using the Diabetes UK recipe pages or cookbooks can take the hard work out of calculating the carbohydrate content of more that 250 recipes for you.

And there's no need to throw out your favourite recipes and cookbooks. Taking the time to work out the carbohydrate values of your day-to-day meals helps you build up a personal reference list that you can use again and again.

5. Restaurant and cafe nutrition information  

Many restaurants and cafes will now list nutritional information for their products online. You may find information that looks like this:

Bacon breakfast roll 

Many restaurants and snack bars are now providing nutrition information for their menus in a response to us all becoming more health aware. The nutrition information for this bacon breakfast roll was found in seconds after a quick search on the internet. Bear in mind that the values are average values and the dish that you are served may vary in size and content. You still need to use your judgement and experience

Three ways to start carbohydrate counting today

Ever heard the phrase “don't run before you can walk”? Well it's certainly true with carbohydrate counting.  Your first step has to be finding out more (see below). But there's no harm in the meantime putting down the foundations for building a new way to manage your diabetes.

1. Do you know which of your food and drink contain carbohydrate? Stop, think and make a mental note of which food and drink will need to be counted.
2. Get label savvy – scrutinise the nutrition labels. Pull the food and drink out of your kitchen cupboards and find out just how much information you have to hand.
3. Make carbohydrate your Mastermind specialist subject. Practise estimating the carbohydrate content of your meals – use reference lists to check your accuracy.

Interested and want to know more?

To carbohydrate count successfully you will need a whole lot more information than this article. You will need to learn all about carbohydrates, learn how to adjust your insulin and be dedicated to monitoring your blood glucose levels frequently. You will also need the support of professionals either in the form of your diabetes healthcare team or one of the structured diabetes education courses available. You can find out about courses available in your area from your diabetes healthcare team.

• The GI index runs from 0–100 and usually uses glucose, which has a GI of 100, as the reference. Slowly absorbed carbohydrates have a low GI rating (55 or below), and include most fruits and vegetables, milk, some wholegrain cereals and bread, pulses and basmati rice.
• Research has shown that choosing low-GI foods can particularly help manage glucose levels in people with Type 2 diabetes. There is less evidence to suggest it can help with blood glucose control in people with Type 1 diabetes.
• Not all low-GI foods are healthy choices – chocolate, for example, has a low-GI because of its fat content, which slows down the absorption of carbohydrate.
• Combining foods with different GIs alters the overall GI of a meal. You can maximize the benefit of GI by switching to a low GI option with each meal or snack. Go easy on lower GI foods like chocolate, which is high in fat and calories, especially if you are trying to lose weight. Save them for occasional treats.
• Eating to control your diabetes isn’t just about GI ratings. Think of the bigger picture and choose foods low in saturated fat, salt and sugar as part of a healthy, balanced diet.

Glycaemic index and diabetes – Q&A

What else affects GI?

• Cooking methods: frying, boiling and baking
• Processing and the ripeness of fruit and certain vegetables
• Fibre: wholegrains and high-fibre foods act as a physical barrier that slows down the absorption of carbohydrate. This is not the same as ‘wholemeal’, where, even though the whole of the grain is included, it has been ground up instead of left whole. For example, some mixed grain breads that include wholegrains have a lower GI than wholemeal or white bread.
• Fat lowers the GI of a food. For example, chocolate has a medium GI because of it’s fat content, and crisps will actually have a lower GI than potatoes cooked without fat.
• Protein lowers the GI of food. Milk and other diary products have a low GI because they are high in protein and contain fat.

Is it ok to only focus on GI?

If you focus only on the GI of foods, without looking at other aspects, your diet could be unbalanced and high in fat and calories, which could lead to weight gain (making it harder to control your blood glucose levels) and increase your risk of heart disease. It’s important to think about the balance of your meals, which should be low in saturated fat, salt and sugar and contain plenty of fruit and vegetables.

The amount of carbs you eat has a bigger effect on blood glucose levels than GI alone. For example, pasta has a lower GI than watermelon, but pasta has more carbs than watermelon, so if you eat similar amounts of either of these two foods, the pasta will have more of an impact on your blood glucose levels. The most important thing to do is get your portion size right – once you do this, you will get an added bonus for choosing low-GI alternatives. 

Low-GI foods in your healthy, balanced diet

It’s easy to include low-GI carbs in everyday meals:

• Choose basmati or easy cook rice, pasta or noodles. Or, try plantain, quinoa or bulgur wheat for a change.
• Eat wholemeal roti and include dhal in your meals.
• Use new potatoes instead of old potatoes – try sweet potatoes for a change.
• Instead of white and wholemeal bread, choose granary, pumpernickel or rye bread.
• Swap frozen chips for pasta or noodles.
• Try porridge, natural muesli or wholegrain breakfast cereals.

Educating yourself on GI

There are books that give a long list of GI values for many different foods. This kind of list does have its limitations. The GI value relates to the food eaten on its own and in practice we usually eat foods in combination as meals. Bread, for example is usually eaten with butter or margarine, and potatoes could be eaten with meat and vegetables.

An additional problem is that GI compares the glycaemic effect of an amount of food containing 50g of carbohydrate but in real life we eat different amounts of food containing different amounts of carbohydrate.

Note: The amount of carbohydrate you eat has a bigger effect on blood glucose levels than GI alone.

When it comes to your diet, you probably already know you need to eat less saturated fat, salt and sugar and at least five portions of fruit and vegetables a day. But did you know that wholegrains should also feature? As a nation, we are not eating enough of them.

What are wholegrains?

Wholegrains are the seeds of cereal plants such as wheat, maize, corn, rye, barley, oats, rice and quinoa. In their natural unprocessed state, grains consist of three parts:

• the endosperm
• the bran
• the germ

The endosperm is the central part of the grain and is a concentrated source of starch. The outer most layer, the bran, is a rich source of insoluble dietary fibre, B vitamins and phytochemicals. The germ is a concentrated source of protein, ‘healthy’ fats, B vitamins and vitamin E.

When wholegrains are refined, for instance to make white flour, most of the bran and germ are removed and with it most of the nutrients, dietary fibre and other protective components, which are concentrated in the bran and germ layers.

Wholegrain foods, retain all three parts of the grain. They may be eaten whole (eg brown rice and oats), cracked (eg bulgur wheat), or milled into flour and made into foods like bread and pasta. To qualify as a wholegrain, a food must contain 51 per cent or more wholegrain ingredients by weight per serving.

Why are wholegrains a healthy choice?

Wholegrains are a smart choice, not just for people with diabetes, but for the whole family. If you do have diabetes, wholegrain foods are usually better for managing blood glucose levels because they tend to have a lower glycaemic index (GI). This means they do not affect blood glucose levels as quickly as refined carbohydrate foods. However, since wholegrains are also carbohydrate foods, and all carbohydrates affect blood glucose levels, be mindful of your portion sizes.

Some studies have shown that healthy diets, rich in wholegrain foods, can reduce the risk of heart disease, stroke, certain types of cancer and Type 2 diabetes. The ways in which wholegrains help prevent these conditions are not fully understood. They can play a part in maintaining a healthy body weight over time as part of a healthy, balanced diet and help keep your gut healthy due to the compounds they contain called phytochemicals. Studies also suggest that wholegrain foods may be more filling than their refined counterparts, which may help reduce the urge for snacking between meals and help people manage their weight.

How much should we eat?

In the UK there are no official recommendations, but most experts recommend at least three servings a day. It’s important to replace refined products with wholegrain foods to help keep your blood glucose and weight in check in the long term.

1 serving of whole grains equals:

• 25g porridge oats
• 1 bowl (34g) muesli
• 1 bowl (30g) toasted wholegrain oat cereal
• 1 bowl of wheat-based breakfast cereal
• 1 bowl of breakfast cereal made from wholewheat
• 1 large slice (40g) multi-grain bread
• 23g (uncooked weight) brown rice
• 23g (uncooked weight) wholewheat pasta
• 3 Ryvitas
• 3 oatcakes
• 1 slice of rye bread
• 1 wholemeal pitta bread

Are there gluten-free wholegrains?

If you follow a gluten-free diet there are plenty of gluten-free wholegrains that you can enjoy such as brown rice, quinoa, uncontaminated oats, millet, sorghum, teff and buckwheat.

What’s the difference between wholemeal, wholewheat, wholegrain and granary bread?

Wholemeal, wholewheat and wholegrain bread are basically different terms for the same thing and all are wholegrain. However, granary bread is slightly different and refers to bread that contains malted wheat flakes that are added to give it a characteristic texture. This may or may not be made from wholemeal flour, so you will need to check the label. Wheat-germ bread is made from white flour to which a portion of wheat germ has been added back, it is not wholegrain.

How to eat more wholegrains

There are plenty of simple and tasty ways to introduce wholegrains into your diet.

• Choose a wholegrain cereal for breakfast.
• Swap white bread for wholemeal bread – look for the words ‘wholegrain’ or ‘wholemeal’ on the label.
• Choose brown rice instead of white – look out for brown basmati and quick-cook brown rice.
• Use wholemeal flour for baking – if you’re not used to baking with wholemeal flour start by substituting half the white flour with wholemeal. As you get used to cooking with wholemeal flour you can gradually increase the proportion.
• Choose oatcakes or Ryvita or wholemeal crackers instead of cream crackers.
• Swap couscous for bulgur wheat.
• Add barley to soups and stews.
• Popcorn in a wholegrain so as treat swap crisps or other savory for unsalted sugar-free popcorn.
• Corn on the cob is wholegrain, or you can add sweetcorn to recipes like spaghetti bolognese or chilli con carne.
• Use porridge oats in crumble toppings.

Everyone should eat some starchy  foods every day as part of a healthy, balanced diet.

Although your usual favourite carbohydrates, such as pasta, rice, noodles and potatoes are very popular, they’re not the only options. You could try grains like couscous, quinoa and barley to introduce a new flavour to your favourite dishes.

Barley and quinoa are both low-GI foods, and quinoa is also a source of protein and fibre, and works particularly well in salads.

The sweeter taste and creamy texture of sweet potatoes can make an interesting change from potatoes – they’re particularly delicious baked.

Or, you might want to try a new variation on rice. There are lots you could try, including brown rice, sticky rice, wild rice and fragrant rice, which are very popular in a range of dishes from around the world.

Alternatives to carbs

Instead of sticking to pasta and rice, try these recipes for vegetable alternatives to rice and pasta, which will help you to cut down on your carbohydrate portion sizes – if you need to – as well as adding to your five a day:

You could also try using slices of marrow in place of some of the pasta sheets when making lasagne. 

Sugars, sugar substitutes and sweeteners: natural and artificial

If you’re living with diabetes, or even if you’re not, you might think sweet foods are a barrier to your healthy, balanced diet. As a general rule, everyone should be eating less sugar – but sometimes, only something sweet will do.

If want to lose weight, or you’re trying to keep your blood glucose levels stable, you may want to know whether artificial sweeteners could help. If you browse around your local supermarket, you’ll see a huge range of sweeteners on offer, so it can be baffling to know which, if any, to go for.

So in this section we'll take you through:

• What are sweeteners
• Types of sweeteners
• Sweeteners and cooking
• Sweeteners and safety

What are sweeteners?

Sweeteners are ingredients that are added to food to enhance sweetness. They can be grouped in different ways: One way is to loosely group sweeteners as: sugar or sugar substitutes.Another way to group sweeteners is whether the sweetener is: natural or artificial. 

Types of sweeteners

One of the most useful ways of grouping sweeteners is to look at those that have nutritive value, ie nutritive sweeteners, and those without nutritive value, ie non-nutritive or ‘low-calorie’ sweeteners. 

Nutritive sweeteners

There are different types of nutritive sweeteners, but they all contain carbohydrate and provide calories. They are usually referred to as ‘sugars’ or ‘added sugar’, but they can also appear in the ingredient list of food packaging as:

• glucose
• fructose
• sucrose
• maltose
• honey and syrup, etc.

Polyols

One group of nutritive sweeteners is polyols, which are sugar alcohols, and include:

• erythritol
• isomalt
• maltitol
• mannitol
• sorbitol
• xylitol. 

They can be natural or artificially produced. Polyols contain carbohydrates and calories, but they have fewer calories and less of an effect on blood glucose levels than sucrose (sugar). 

Polyols and diabetes

It’s not exactly clear how the polyols should be ‘counted’ by people who are adjusting their insulin dose according to the carbohydrate they consume, as not all of the carbohydrate from polyols is absorbed. The amount of calories provided by polyols varies, as the amount of carbohydrate digested or absorbed by the body varies, depending on the type of polyol. People with diabetes should speak to their healthcare team for individual advice about this.  

Polyols and ‘diabetic’ foods

Polyols are usually used in products marketed as ‘diabetic’ or ‘suitable for diabetics’ and, as these products can be as high in fat and calories as standard products, Diabetes UK and the European Commission Regulations don’t recommend them. Consuming large amounts of polyols can have a laxative effect, causing bloating, flatulence and diarrhoea. 

Non-nutritive or artificial sweeteners 

Non-nutritive sweeteners can be one way of reducing your overall carbohydrate and calorie intake if you substitute it for nutritive sweeteners like sugar.These are sometimes called ‘artificial sweeteners’ and are usually found in:

• ‘sugar-free’ or ‘diet’ foods and drinks
• fizzy drinks
• fruit juices
• jellies
• yogurts
• chewing gums, etc.

The terms ‘non-nutritive’ and ‘artificial’ sweeteners are used interchangeably. 

Types of artificial sweeteners 

There are various artificial sweeteners licensed for use in the UK. These include: 

• aspartame, used in Canderel, Hermesetas granulated  
• saccharin, used in Hermesetas mini sweeteners 
• sucralose, used in Splenda 
• acesulfame potassium (acesulfame-K), used in Hermesetas Gold sweetener  
• cyclamate, used in Hermesetas liquid.

Some products are made from a combination of two artificial sweeteners. For example, Hermesetas Gold sweetener is made from a blend of aspartame and acesulfame-K.

Sweeteners and cooking

Why use sweeteners in cooking?

They can give you a burst of sweetness, while reducing your sugar and calorie intake because they contain little or no calories or carbohydrates and don’t affect blood glucose levels.

Which sweeteners are best for cooking?

Artificial sweeteners come in granules, tablets or liquid form. Most of them can be used in cold and hot foods, but not all can be used for cooking: 

• Aspartame (used in Canderel) loses some sweetness at a high temperature.
• sucralose (used in Splenda) and acesulfame-K (used in Hermesetas Gold sweetener) can be used in cooking and baking. 

Only small amounts of artificial sweeteners are needed as they are intensely sweet.

Sweeteners from the stevia plant

A relatively new group of non-nutritive sweeteners include naturally sourced, calorie-free sweeteners made from the stevia plant, eg Truvia and Stevia. They are 200–300 times sweeter than sucrose (sugar) and are heat stable, so can be used in cooking and baking. 

Natural and artificial sweeteners

It can be confusing to group together sweeteners as the terminologies are open to interpretation. For instance, some products from the stevia plant are marketed as ‘natural’, even though they’re processed and refined. Yet, some of the other products marketed as artificial sweeteners may be derived from naturally occurring substances. For example, sucralose, which is used in Splenda, is derived from sugar (sucrose). Whatever the name, grouping or terminology, it’s important to ask what is in the particular sweetener and whether the sweetener or product has carbohydrate or calories, and how that fits into your individual goals for healthy eating.

Sweeteners and safety

A major question that often comes up is how safe sweeteners are. There has been, and continues to be, some bad publicity and controversies about certain artificial sweeteners. 

All non-nutritive sweeteners used in foods in the EU have to undergo rigorous safety testing before being approved by the European Commission.

Food ingredient manufacturers have to provide evidence from safety studies showing that the sweetener in question:

• doesn’t cause any adverse effects, including cancer
• doesn’t affect reproduction
• doesn’t cause allergic reactions
• isn’t stored within the body, or metabolised into other potentially unsafe products.

What amount of sweetener is safe to eat?

As part of the approval process for each non-nutritive sweetener, an Acceptable Daily Intake (ADI) level is set. The ADI is the estimated amount per kilogram of body weight that a person can consume, on average, every day, over a lifetime without risk. ADIs are set 100 times less than the smallest amount that may cause health concerns, so it’s extremely difficult for most people to reach the ADI. With these checks, the current levels of intake of artificial sweeteners in the UK are safe, although people with phenylketonuria (a rare metabolic disorder) are advised to avoid sweeteners containing aspartame.

Should I eat sweeteners?

It’s a personal choice whether you decide to use sweeteners or not. If you decide to use sweeteners, but you’re unsure, speak to your diabetes healthcare team for individual advice, and check labels and ingredients on food packaging, as this can help you to make informed choices.

Should I avoid sugar altogether?

We all know we need to eat a healthy, balanced diet that’s low in saturated fat, sugar and salt to keep our weight, cholesterol, blood glucose and blood pressure in check. Sugar is a type of carbohydrate and because all carbohydrates affect blood glucose levels, reducing your sugar intake can help to keep blood glucose levels under control. As sugar contributes no nutritive value, apart from carbohydrates and calories, it has ‘empty calories’ and so is not good if you’re looking to manage your weight. This doesn’t mean that people with diabetes should have a sugar-free diet. In fact, it’s almost impossible to have a sugar-free diet in the long term. And, it’s also worth remembering that products labelled ‘sugar-free’ aren’t necessarily low-calorie.

Added sugar is the sugar we add to our food and drink. This includes the sugar we stir in our tea or the caster sugar we add to our baking. However, most of the sugar we eat is ‘hidden’ as food manufacturers have put it into a lot of the food and drinks we buy. It’s very easy to be unaware that the amount of sugar you’re consuming is reaching unhealthy levels because it comes in so many forms and in so many products. 

Sugar...by any other name

Even if we don’t see the word 'sugar' listed in the ingredients, it’s often there, but under a different name. Look for any of the following words, which indicate that sugar has been added.

Although honey, agave nectar and maple syrup are marketed as healthier alternatives to sugar, they’re really just other forms of sugar. 

What's the limit? 

Our intake of ‘free sugars’ should not be more than 5 per cent of our daily energy intake.

In other words, the maximum daily sugar intake for:

• children (aged 4 to 7) is 19g, equal to 5 cubes or 5 tsp of sugar
• children aged (7 to 10) is 24g, equal to 6 cubes or 6 tsp of sugar
• children (over 11) and adults is 30g, equal to 7 cubes or 7 tsp of sugar

Where sugar lurks

Apart from the obvious places like cakes, biscuits, chocolates, sweets and fizzy drinks, sugar is lurking where we wouldn’t expect it – such as in sauces, ready meals, bread and even bottled flavoured water.

Look at how many teaspoons of sugar are in these products: 

• 330ml bottle of pure orange juice = 7
• 500g jar of pasta sauce = 8
• 2 scoops of low-fat ice cream = 3
• 500ml flavoured mineral water = 6
• coffee shop standard hot chocolate and cream = 10
• skinny blueberry muffin = 6

(Key: Measurement of of sugar varies; 1 sugar cube or 1 tsp is estimated to be equal to 4g sugar)

The easiest way to cut down on sugar is to swap sugary drinks, including fruit juices and smoothies, to water, lower-fat milks, sugar-free and no-added sugar drinks. In the case of fruit juices and smoothies – it’s better to eat the whole fruit itself because we’re then getting the benefits of eating fibre, and the sugar in the fruit is absorbed more slowly in our bodies. 

Sugar shockers 

Check the labels...

Try to reduce the sugar you're adding yourself and look more closely at food labels for all that ‘hidden’ sugar.

Does low fat mean high sugar? 

For good health, and to keep our weight in check, it is not advisable to eat too much fat, especially the saturated fat found in butter, ghee, lard, pastries, cakes and processed meats.

Food manufacturers have created hundreds of low-fat products and marketed them to us as ‘healthy’. However, the taste of many of these products was altered by the removal of most of the fat, so sugar was added to the food to compensate. But what we're eating is still high in calories and not much healthier. 

 Porridge is a good source of fibre 

Increasing the amount of fibre in your diet can help you manage your diabetes. It also helps keep your gut healthy and can reduce your blood cholesterol, which lowers your risk of cardiovascular disease. If you are trying to maintain a healthy weight, it can also help you. 

The Scientific Advisory Committee on Nutrition (SACN), looked at the role of fibre in maintaining good health, published these new recommendations in July 2015:

• adults 16 years and over: 30g per day
• 11-16 years: 25g per day 
• 5-11 years: 20g per day 
• 2-5 years: 15g per day 

Currently, the average adult in the UK consumes only around 19g per day.

Here we’ll help you identify foods that are high in fibre and simple ways you can increase your intake. Remember that you’ll also need to increase the amount you drink. If you have diabetes, or are just managing your weight, the best options for drinks are water, no-calorie/low-calorie sugar-free drinks, unsweetened tea or coffee with milk. 

What is fibre?

Dietary fibre is a type of carbohydrate that’s found in plant-based foods. It’s not absorbed or digested by the body, but plays an important role in maintaining good health. There are two types of dietary fibre – soluble and insoluble. Most foods contain both types, but are usually richer in one type than the other. 

Soluble fibre

Found in oat, oat bran, linseeds, barley, fruit and vegetable, nuts, beans, pulses, soya and lentils. 

Insoluble fibre

Good sources include: wholemeal bread, bran, wholegrain cereals, nuts, seeds and the skin of some fruit and vegetables. 

Why is fibre important?

Having diabetes can increase your risk of cardiovascular disease. Evidence shows that increasing your intake of fibre, especially cereal and wholegrains, can help reduce the risk of cardio-metabolic diseases (this includes cardiovascular disease, insulin resistance and obesity) and colo-rectal cancer.

Higher intake of oat bran also leads to lower cholesterol levels and lower blood pressure.

Dietary fibre absorbs fluid and increases the bulk of waste matter, making your stools softer and easier to pass. Foods higher in soluble fibre have a particular role in reducing blood cholesterol. Increasing your dietary fibre can also help with managing your weight. These foods are filling and most are lower in glycaemic index (GI), which can help to control your appetite and have less of an effect on blood glucose levels.

How to increase your daily intake of fibre

To achieve the new SACN guidelines, we need to aim for at least five portions of fruit and vegetables a day. We need to try to base our meals around starchy carbohydrates, choosing wholegrain varieties, and include high-fibre snacks.

Here are some ideas, along with their fibre and carb content, to get you started:

To increase your fibre intake even further, add salad or vegetables to your lunch or main meal.

 High-fibre snacks

• Plain oat cakes
• Fruits
• Nuts
• Dried fruit
• Yogurt with berries and pumpkin seeds

Keep an eye on the portion sizes when you are eating these snacks, especially if you are watching your weight. 

Children and fibre

You can help your children to increase their fibre intake with the following ideas:

• Offer fruits or a small portion of dried fruit as a snack. 
• Blitz vegetables in a tomato sauce and serve with pasta. Why not introduce them to wholewheat pasta? Perhaps start with a mixture of white and wholewheat.
• Offer wholegrain cereals for breakfast, or even add some high-fibre bran based cereal to their favourite choices.
• A smoothie made with milk and frozen berries as a snack or try frozen yogurt with berries as a sweet treat.

Shopping tips

You can compare the back of pack nutritional labels on pre-packed foods and choose the food with the higher amount of fibre. At times this information may not be available but there are other ways of choosing foods high in dietary fibre:

• Look for words such as ‘wholemeal’, ‘wholewheat’ and ‘wholegrain’ on labels. Wholegrain carbohydrates tend to be higher in fibre and lower in GI, which means they have less of an effect on your blood glucose levels.
• Choose wholemeal, seeded or multi-grain bread  – these are higher in fibre than white varieties. Brown bread is not as high in fibre as wholemeal.
• Instead of white pasta or rice choose the brown/wholewheat type.
• Go for beans, pulses and lentils – buy tinned to save on cooking time and add to casseroles, soups, salads and curries.
• Choose oat-based, bran or wholegrain breakfast cereals.
• Buy a selection of interesting and seasonal fruit and vegetables to help you aim for your five-a-day target.
• Couscous and quinoa, which are wholegrains, are a great source of fibre.

Aiming for 30g a day may feel like a lot. As long as you try to increase your intake aiming to meet the recommendation slowly, you will be on the right path. Always speak to your healthcare professional before changing your diet. 

Gone are the days when all you can find in your supermarket is white, ready-sliced bread. There are so many different types of breads available now, so your choice really is only limited by your imagination. And, if you’ve got diabetes, you may also want to think about other factors, such as carbohydrate content and how much fat and how many calories are in the bread you’re eating.

Bread is a source of carbohydrate. During digestion, carbohydrate is broken down into glucose, which is used by the cells of the body as their main source of energy. There are two types of carbohydrate: starchy carbohydrates and sugars. Bread falls into the starchy carbohydrate category. All carbohydrates affect blood glucose levels.

Carbohydrate requirements vary between individuals and depend on age, gender, weight and physical activity. The Reference Intake (RI) of carbohydrate is 230g for women and 300g for men. These figures are just a guide and are based on the requirements of an average woman and man. Depending on your nutritional goals, you may require less.

Most supermarkets and local markets contain different types of bread. Here’s what you need to know next time you’re choosing a loaf.

White bread, tiger bread, pumpernickel bread, granary bread, flat bread, seeded and pitta bread

Serve with:

• lean chicken, ham, turkey or beef plus chopped tomatoes, grated carrot and cucumber
• egg and cress, with a little reduced-fat mayo and black pepper
• cottage cheese mixed with salsa and sweetcorn
• reduced-fat cheddar with grated carrot and sultanas
• Tabasco sauce, horseradish, mustard and chili sauce for a real fiery kick in jazzed-up sandwiches.

Per slice:

• White: 79Kcal – 16.6g carbs – 0.6g fat
• Tiger: 97Kcal – 17g carbs – 0.83g fat
• Granary: 85Kcal – 17g carbs – 0.8g fat
• Pumpernickel: 76Kcal – 14.5g carbs – 0.5g fat
• Pitta: 244Kcal – 18.5g carbs – 1.2g fat
• Seeded: 174Kcal – 29.6g carbs – 4.8g fat
• Bagel: 230Kcal – 44g carbs – 1.2g fat

Sourdough, rye and soda bread

Great served with turkey, chicken or Swiss cheese with shredded lettuce, tomatoes and reduced-fat mayo. Or, try smoked salmon and reduced-fat cream cheese.
Per slice:

• Sourdough: 79Kcal – 15.7g carbs – 0.2g fat
• Soda bread: 104Kcal – 21.9g carbs – 0.96g fat
• Rye bread: 55Kcal – 11.5g carbs – 0.4g fat

Brioche

Serve warm with jam or pure fruit spread for an indulgent treat.
Per individual brioche (45g):

• Brioche: 167Kcal – 23.3g carbs – 6.3g fat

Garlic and ciabatta bread

Serve with your favourite Italian dishes, and try to buy ready sliced so you can control your portion sizes and freeze the rest. This way, you won’t be too tempted to polish off the whole loaf. Look out for reduced-fat garlic bread, but bear in mind it's still fairly high in fat and calories.
Per slice:

• Garlic bread: 71Kcal – 9.4g carbs – 3g fat
• Reduced-fat garlic bread: 54Kcal – 8.98g carbs – 1.2g fat
• Ciabatta: 75Kcal – 12.4g carbs – 1.4g fat

Naan and chapatti

Serve with vegetable and meat curries. Try to avoid adding extra butter, margarine or ghee.

• Chapatti made with fat: 111Kcal – 24g carbs – 0.55g fat
• Chapatti made without fat: 197Kcal – 13.9g carbs – 7.7g fat
• Naan: 474Kcal – 79g carbs – 10g fat

Pasta, potatoes and rice... are all carbohydrates that cause a surge in blood glucose levels as they are broken down. For people with diabetes, these surges in glucose can be tricky to manage and cause problems over time. But what if simply changing the way these foods were prepared and cooked meant this was less likely to happen?

 

An experiment on the BBC TV show Trust me, I’m a Doctor, led by Dr Denise Robertson (senior nutrition scientist at the University of Surrey), showed that eating cooled or reheated pasta – turning it into ‘resistant starch’ – could help to reduce the rise of blood glucose levels.

 

Though further studies are needed, findings could have long-term benefits for people with diabetes...