Pasta is one of the most troublesome foods for people with diabetes. Traditional wheat noodles are almost pure, 100% carbohydrate, and even a modest portion can send your blood sugar skyrocketing upwards. Add in the lavish amounts of butter, olive oil, cheese, or cream that accompany most dishes of spaghetti or macaroni – fats that often cause late and unpredictable blood glucose rises – and it just gets even trickier, especially for those of us that require insulin with every meal.
How do you handle pasta? We’ve spent a long time grappling with this question, and more importantly, we’ve got the benefit our community of Diabetes Daily readers. We’ve reviewed hundreds of comments on our Facebook page and in our Forum on pasta strategies, all from the true world-experts on diabetes: the people living with it.
All in all, we’ve identified four major philosophies:
1. “Just Go For It”
Sure, pasta is a high-carb minefield. But many of our community members just lean in and go for it.
First, a warning: it is our job to remind you that high blood sugars are nothing to mess with. After all, they’re basically the root of long-term diabetes misery – hyperglycemia is the single most important modifiable factor in the progression of diabetes and its many tragic complications. And despite all the wonderful new medicines and technology we have to manage diabetes, most people still don’t hit the glucose management targets that their doctors set for them. One night of high blood sugars isn’t likely to do much harm, but many nights, over many years? That’s dangerous.
With that said, some people with diabetes have figured out a way to eat pasta while keeping blood sugar excursions and rollercoasters to an acceptable minimum.
Here are some approaches that people in the diabetes online community have had success with. Keep in mind that pasta lovers that require meal-time insulin have a bigger challenge ahead of them:
- Eat your protein and veggies first. The order in which you eat your food can have a big influence on how your blood sugar responds. Filling your belly first with lower glycemic index foods seems to mellow out the impact of the high-carb ingredients you eat next. For some patients with type 2 diabetes, this might be enough to keep a glucose spike with an acceptable post-prandial range.
- Simply pre-bolus for the carb total count. The flour used in pasta is a refined, high glycemic index starch, and some people will experience a fast and dramatic blood sugar rise. A single large bolus of rapid insulin may be the best way to counter it.
- Split your initial bolus – deliver a pre-bolus and then a second bolus some time after eating. If past pasta experiences have resulted in fast blood sugar drops and/or late blood sugar rises, it may be better to deliver the bulk of your insulin after you begin eating. This strategy may be especially useful for pasta with rich sauce.
- Others find that a pasta meal, just like pizza or sushi, takes such a long time to digest that it is hours before the peak glucose rise occurs. If pasta gives you sticky highs, or late peaks, consider splitting your insulin dose. Bolus 50-70% of your total insulin before the meal begins, and the rest an hour or two later. The more closely you can pay attention to your blood sugar – a continuous glucose monitor is key! – the easier this will be.
Insulin pump users have even better options:
- Try a dual bolus. Bolus for 50% of the meal as you begin eating, and then deliver the rest slowly over the next two or three hours.
- Try a square wave bolus. Release your mealtime bolus slowly over the next two or three hours.
Some people have such difficulty with late spikes that they end up with an initial bolus of only about 30% of the total carb count – they need most of their insulin an hour or more after they’ve finished eating.
No matter what strategy you’ve started out with, be prepared for hours of blood sugar uncertainty. Pasta is notorious for causing long, challenging rollercoasters and sticky highs. Check your blood sugar often, and be prepared to administer correction boluses (or consume some extra sugar) in case things look like they’re getting out of hand.
2. Try a Lower-Carb Noodle
If you can’t say no to your favorite pasta dishes, but also don’t want to deal with the blood sugar management headache every time, you should definitely look into the many lower-carb alternatives to noodles available today.
Here are some of the top options:
- Zucchini Noodles (“Zoodles”) – spiralized zucchini cooks in a flash and is a great way to get in some healthy veggies. We think it works best for lighter, summery sauces – think pesto, or even just butter and fresh basil. A serving of zoodles can have as few as 2 grams of carbs, 1g of which is fiber. Spaghetti squash is a similar option with a different flavor and texture. And there’s no rule against dressing broccoli in alfredo sauce!
- Hearts of Palm – Now available at Trader Joe’s and elsewhere, these noodles are cut from the mild and slightly fruity heart of palm vegetable. You can soak them in milk to remove some of the flavor, but may find that they taste better in Asian dishes than Italian ones. The texture isn’t quite like pasta, of course, but the good news is that they don’t need to be cooked at all: just drain and add to your warm sauce. The popular Palmini brand has 4g total carbs per serving, 2g of which is fiber.
- Soybean / Edamame Pasta – Often called a superfood, the soybean makes a nice green dried pasta with a slight vegetal flavor. The texture is pretty good, and the fiber counts can be incredible. Explore Cuisine, one common brand, offers only 7g of net carbs per serving (20g total, of which 13g is fiber).
- Low-Carb Egg Noodles – The low-carb recipe blog world has dozens of recipes for making your own low-carb or keto egg noodles at home, like this one from Wholesome Yum using lupin flour. You can also find some storebought options, like Carba-Nada’s fettuccine, which is made with some traditional durum wheat, but has extra eggs and soy protein too. A serving totals 24g of total carbs with 6g of fiber, for 18g net carbs.
- Chickpea Noodles – There are now several brands of chickpea noodles in US grocery stores. These hearty noodles have a good whole grain sort of flavor, and unlike some of the other options in this list, they come in thicker, short-cut shapes, such as rotini and penne, which stand up so well to heavier meat sauces. The carb count may be too high to work with a truly low-carb diet, but all the protein and fiber might result in less spikey glucose lines. A full dinner serving of the popular Banza brand has 60g of total carbohydrate, but 8g of it is fiber, and it adds 20g of protein.
Read 6 Great Low-Carb Pastas (and 1 to Avoid!) for more details and opinions.
3. Use Moderation
It sounds simple: just eat less pasta. Have a half-portion, or a quarter-portion, or even just a forkful off of your partner’s plate. Enjoy the flavor, but don’t have enough to cause blood sugar mayhem.
Will it work for you? Maybe, maybe not.
There’s a theory out there that we are all either abstainers or moderators. Moderators thrive when they allow themselves small amounts of something – whether that’s pasta, ice cream, alcohol, or anything else that we humans tend to get carried away with. Abstainers, by contrast, are all-or-nothing: they find it much easier to go 100% without something than 99% without it. As the author Gretchen Rubin has explained it:
You’re a moderator if you…
– find that occasional indulgence heightens your pleasure–and strengthens your resolve
– get panicky at the thought of “never” getting or doing something
You’re an abstainer if you…
– have trouble stopping something once you’ve started
– aren’t tempted by things that you’ve decided are off-limits
Are you a moderator? Maybe small portions of pasta are all you need to keep you happy. Fill most of your plate with veggies and protein – or treat pasta as a rare special-occasion meal.
But if you’re an abstainer, small portions of pasta might just drive you crazy. In that case, you might consider the final pasta philosophy…
4. Just Don’t Eat Pasta
Health authorities differ on the wisdom of low-carb diets: there is plenty of evidence that it’s a great way to treat diabetes, but the American Diabetes Association and its peers are reluctant to give it a full endorsement. Nevertheless, abstinence is almost undoubtedly the best way to ensure a night of steady blood sugars. Just don’t eat any pasta.
A large number of Diabetes Daily readers and community members have decided that pasta just isn’t worth it. Some of them have adopted low-carbohydrate diets to help manage their diabetes. Some haven’t – they’ve just determined that pasta is too problematic to bother with.
As tasty and as satisfying as pasta is, nobody enjoys watching their blood sugars climb up to the stratosphere, especially when hyperglycemia is accompanied by that awful, sticky, brain-foggy feeling. For people that require insulin before every meal, the challenge is even greater, because those big doses of fast-acting insulin are so tricky to time well; a big plate of pasta can result in devastating blood sugar lows as easily as it can frustrating blood sugar highs.
If you pass on pasta, try and fill your plate with plenty of vegetables and leaner protein, such as poultry, tofu, or seafood. That’s a meal that most nutritionists and doctors would happily get behind that should also mean smooth blood sugar sailing.
Read more about American Diabetes Association (ADA), insulin, insulin pumps, Intensive management, low-carb diet, noodles, pasta, pre-bolus.