Carbohydrate issues: type and amount.

Both the type and amount of carbohydrate found in foods influence postprandial glucose levels and can also affect overall glycemic control in individuals with diabetes. This review, based on the American Diabetes Association's Nutrition Recommendations and Interventions for Diabetes, and the American Dietetic Association's Evidence Analysis Library (Diabetes 1 and 2), provides a description and interpretation of the clinical studies involving diabetes and type and amount of carbohydrate. Although the relationship between blood glucose and insulin is linear, not all types of carbohydrate are fully metabolized to blood glucose. Added sugars such as sucrose and high fructose corn syrup are digested, absorbed, and fully metabolized in a similar fashion to naturally occurring mono- and disaccharides. Only about half of the carbohydrate grams from sugar alcohols and half or less from dietary fiber are metabolized to glucose whereas almost all "other carbohydrate" (mainly starch such as amylose and amylopectin) becomes blood glucose. The percent of energy as carbohydrate indicated for people with diabetes depends on individual preference, diabetes medication, and weight management goals. Glycemic index/glycemic load concepts are attempts to use these carbohydrate availability and amount issues for controlling postprandial glycemia.