Confused about carbs

Are you confused about carbs?

Carbs can confuse many people. To be able to follow a good diet for gestational diabetes you need to understand a bit about carbohydrates and where you’ll find them.

Not knowing which foods and drinks are high in carbs can be detrimental to trying to control your blood sugar levels and whilst most know that sugar should be cut out of the diet with gestational diabetes, many do not realise that carbohydrates are a problem too.

Carbohydrates turn into glucose in the bloodstream (therefore carbs are pretty much sugar as far as we’re concerned) and eating anything high in carbs will raise blood sugar levels. The other problem is that certain carbs can turn into glucose in the bloodstream very quickly. This can be seen as the red line in the diagram below…

Macronutrients impact on blood glucose

If carbs raise blood sugar levels why can’t we just cut them out completely?

ketonesCutting carbohydrates out of the diet, or restricting them very low will lower blood sugar levels, but the problem with doing this is that it causes the body to go into a state of ketosis, burning fat for energy instead of glucose. It can also make you feel lethargic too.

The problem with burning fat instead of glucose is that when you are pregnant, the acid that is produced as a result of the body doing this, called ketones, can be harmful to the growing baby if ketones are produced in very high amounts.

Therefore it is important to continue to eat small amounts of carbohydrates at each meal where possible and to stay well hydrated. You can read more about ketosis on our ketones page.

Different types of carbs

Carbohydrates can be found in most foods and drinks. Carbs are made up of three different things: sugar, starch and fibre.

There are different types of carbs and this is where it can get very confusing as many may just think of carbs like bread, pasta and rice e.t.c but carbs can also be found in the following items:-

  • sugarsugary drinks
  • sugary foods e.g. cakes and pastries
  • sweets
  • sugars, jams, honey and syrups
  • dairy products e.g. milk, yoghurt
  • fruit and fruit juices
  • vegetables
  • nuts
  • seeds
  • grains and flours
  • sweeteners

Simple carbs

Simple carbs are broken down and digested very quickly meaning they can spike blood sugar levels very quickly and are often the things that taste sweet. Simple carbs are naturally occurring in many foods:

  • fructose in fruit
  • lactose in milk and yoghurt
  • sucrose in table sugar

Simple carbs are also found in sweets and sugary treats.

Complex carbs

Starch is a complex carbohydrate made of sugar units bonded together.  Starch occurs naturally in vegetables, grains, and cooked dried beans and peas.  Complex carbs come in two types:-

Refined complex carbs – When a complex carb is refined, it is processed and much of the fibre and goodness is stripped away e.g. white flour

Unrefined complex carbs  – Unrefined carbs are, therefore, carbs that are in their natural state and contain much more goodness e.g. wholemeal flour


Comparing refined and unrefined complex carbs

Golden rule#5. Low amounts of unrefined complex starchy carbs at every meal

When selecting carbs for our meals and snacks, we are talking about the complex starchy carbs like bread, pasta or rice.

For better blood sugar levels we need to select unrefined complex carbs which have more goodness like brown and wholegrain varieties…

Refined complex carb × Unrefined complex carb 
White flour Wholemeal flour
White bread Granary or wholemeal bread
White pasta Whole wheat pasta
White rice Brown or whole grain rice
Breakfast cereals Steel-cut/pinhead porridge oats

Fibrous complex carbs

Golden rule#6. Bulk up meals with lots of vegetables and salad

fibrous complex carbsVegetables contain fibrous complex carbs, but they also contain lots of vitamins and minerals.

The amount of carbs found in vegetables varies, with sweeter, starchy veg like carrots and sweetcorn being higher in carbs and green leafy vegetables having the least amount of carbs in them.

It is for this reason that we advise bulking your meals with plenty of salad and green vegetables.

 A mixture of macronutrients, carbs everywhere?!

Fage Total Greek yoghurtMacronutrients are the food groups: carbohydrates, fat and protein.

Many foods and drinks are a mixture of macronutrients and so this can also be confusing. For example, yoghurt has carbohydrates from the lactose, fat and protein in it.

The best products to help with a gestational diabetes diet and for lowering blood sugar levels will be low in carbohydrates and high in fat and protein.

You can view the best yoghurts I have found on my best yogurts page.

Why am I getting high levels with good, advised breakfasts???

cereal and bananaWe often see mothers confused as to why their recommended breakfasts of cereal, skimmed milk and banana with a small glass of orange juice has caused them to have high blood sugar levels. So let’s look at this advice…

Cereal = complex carb (could be refined or unrefined depending on the cereal)

Skimmed milk = simple carb (from the lactose in the milk)

Banana = simple carb (from the fructose in the fruit)

Orange juice = simple carb (from the fructose in the fruit, juicing also means the fruit is broken down even more and the sugars will be more easily absorbed).

Carbs turn into glucose in the bloodstream, so you are effectively eating sugar + sugar + sugar, with a drink of pure sugar = an almighty spike in blood sugar levels! Or you may see a crash in levels dropping very low which could be a sign that you’ve spiked and crashed.


Carb counting

carb countingOne method that is used a lot with diabetes dietary advice is carb counting. This is where a measured amount of carbs is eaten for each meal and snack.

Carb counting works to a point and can give good guides to portion sizes for carb amounts, but it can also mean that you over-restrict certain carbs and force yourself to tolerate others which could mean being medicated or doses increased to allow you to eat ‘set amounts’ of carbs.

Type 1 diabetics use carb counting to work out insulin doses versus the carbs eaten, but as gestational diabetes insulin resistance fluctuates with hormones in pregnancy, it can make judging insulin doses more difficult. This can lead to unstable blood sugar levels and more hypos.

You will find starchy complex carbs which YOU tolerate better than others

The main reason we do not advocate carb counting is that each person is different as to which starchy complex carbohydrates they tolerate best.

One person will tolerate wholegrain rice better than wholemeal bread or wholewheat pasta. Another person may tolerate potatoes better than whole grain rice.

When diagnosed with gestational diabetes, start by trying different starchy complex carbs at different meals to see what readings you get. It is advisable to keep a food diary alongside your readings to refer back to.


Starchy complex carb amounts?

carbsTrial and error with starchy complex carbs is the best approach at the start, so try different ones and keep a food diary alongside your readings.

Start with small amounts:-

  • 3 egg-sized new potatoes
  • 3 tbsp of cooked rice, pasta, or couscous
  • one slice of 800g loaf bread or 2 x  400g loaf slices

Depending on your readings increase the carbs in small amounts so that you are comfortably within your test target for blood sugar levels and reduce or eliminate carbs that you don’t tolerate so well.

starting point for starchy carbs

tweaking carbs

If you cannot tolerate ANY starchy complex carbs then you should contact your diabetes team as it may mean that you require help with medication or increased doses.

Never eat a ‘naked’ carb!

Golden rule#2. ‘Food pairing’

never eat a naked carbThere is something you can do to slow down the release of glucose from the carbohydrates into your bloodstream. You can ‘pair‘ carbs to make them more tolerable.

Eating carbohydrates with protein and natural fats will slow down gastric emptying and the release of glucose meaning you are less likely to spike blood sugar levels too high.

Making sure you “never eat a naked carb” means that you always add protein and natural fats e.g. a slice of Burgen soya & linseed bread toast (one of our better-recommended breads) will give higher blood sugar levels if only eaten with butter. Adding peanut butter or eggs the protein and natural fats will slow down the absorption of glucose and will give better blood sugar levels.

Another example is an apple. A Granny Smith apple is better for blood sugar levels as it is less sweet than other varieties. On its own, it is just a simple carb that could spike blood sugar levels. Dip the apple in peanut or nut butter and you have a much better snack!

The Glycaemic Index

Different types of carbohydrates are digested at different rates in the body and this has an effect on your blood glucose levels. The Glycaemic Index (GI), is a system of ranking used to understand how quickly these foods make your blood glucose levels rise after eating them (or spike).

Low GI foods should be used to help make better choices when selecting which carbohydrates to eat, so we advise swapping high GI foods for low GI instead for a better gestational diabetes diet.


A list of better options and quick swaps for a gestational diabetes diet
Carbohydrate food Better options for GD
Breads Burgen soya & linseed, multigrain, rye, pumpernickel bread, Hi-Lo, wholemeal sandwich thins, Lidl high protein rolls or low GI bread, 400g slices of wholemeal/granary bread see my post on best bread here
Crackers Oatcakes, Ryvita, whole wheat crackers & wholegrain crispbreads
Potatoes new potatoes, sweet potatoes small or half a jacket potato and mash may be tolerable but they must be paired with protein & natural fats – add cheese, butter and cream
Pasta and noodles wholewheat pasta & noodles cooked until al dente
Rice Basmati or brown wholegrain rice
Grains Quinoa, wholegrain couscous
Breakfast cereals Pinhead porridge oats (not rolled oats – these are still not tolerable to many)
Fruit Tart/sharp berries, Granny Smith apple, kiwi, small sharp citrus fruit
Fruit juices & carbonated drinks Water, no added sugar squash, diet/zero drinks. See our drinks information
Sugars, syrups, honey Sweeteners, agave nectar
Cakes, biscuits & pastries Nairn’s oat biscuits, hobnobs, digestives, rich tea
Jams & preserves (avoid even diabetic jams) Peanut butter (<7g total carb per 100g), marmite, cheese spread
Desserts Sugar-free or no added sugar jelly, no added sugar angel delight/shops own brand no added sugar ‘delight’
Sweets & chocolate Dark chocolate, ½ Kinder Bueno, Cadbury’s Freddo, treat size chocolate buttons. See our chocolate post
Milk Whole (full fat) milk, soy milk, almond milk, coconut milk, Lacto free milk
Yoghurts Coconut milk yoghurt, full-fat Greek yoghurt, soya yoghurt See our posts on the best brands of yoghurt here
‘Carb Hacks’:

Gestational Diabetes Diet

For information on the whole gestational diabetes diet that I advocate, please see my main Gestational Diabetes Diet page. I also have an example meal plan and membership options for those who would like detailed lists of foods and meal ideas and 7-day food plans to follow in the Silver membership.