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Recently my doctor put me on insulin. My sugar was going up and down and out of control no matter how hard I tried to control my diet. He told me to eat no more that 30 grams of carbs a day. I can do that, and I have been doing it, but I need to know if I should eat most of my carbs at dinner, or distribute them equally during the day. I am still going up and down in my count. I have been eating 10 carbs for breakfast and lunch combined, and then having the rest for dinner and going to bed. Is that to much at one time?


Unfortunately, we have a difficult time answering your question with certainty without more information. It would be necessary to know if you are on oral medications in addition to insulin, as there are new and effective medications that target insulin resistance and assist with post meal glucose elevations. Education regarding carbohydrate counting and the effects of exercise and activity on glucose levels is necessary in your case. Thirty grams of carbohydrate per day is very low. A more reasonable amount of carbohydrate to consume is ~30-45 grams per meal, combined with protein, healthy fats and fiber. By keeping the carbohydrate consistent at each meal and eating a well balanced meal, you will help to avoid post meal blood sugar spikes. When we see large fluctuations in blood glucoses, it is largely the result of dietary excesses or the consumption of too little carbohydrates; the other possibility is the failure of the medical regimen to safely and effectively match with your lifestyle, diet and activity. Your glucose lowering regimen must be individualized and the need for diabetic education and nutrition therapy is essential and they must be coordinated. The vast majority of patients can be managed quite effectively in the hands of a solid team of diabetes specialists.

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Response by:

Connie A Gottfried, MPH, RD, LD, CDE Connie A Gottfried, MPH, RD, LD, CDE
Case Western Reserve University