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Do I have to eat three meals a day with diabetes?

By Megrette Fletcher, M.Ed., R.D., C.D.E

Many people with diabetes ask, “Why am I supposed to eat three meals a day?” It’s a great question! Mindful eating isn’t about following rigid rules so let’s look at the reasons behind the three-meals-a-day suggestion for people with prediabetes and diabetes.

Eating-three-meals-a-day-with-diabetes

When a person has diabetes, he struggles to process carbohydrates because the body either isn’t making enough insulin, or the insulin that’s made isn’t effective—a condition called insulin resistance. This means that if a person eats too many carbohydrates at one time, their body isn’t able to process the carbohydrates, causing the blood sugar to rise (hyperglycemia).

However, carbohydrates are not a specific food, but a macronutrient. In fact, carbohydrates are found in many foods, many of which are full of other nutrients, vitamins, minerals, and fiber. For this reason, the Recommended Daily Allowance (RDA) which establishes the minimum intake necessary for health, recommends 130 grams of carbohydrate per day. However, if you have diabetes, eating 130 grams of carbohydrate at one meal may cause your blood sugars to rise above target. Therefore, most people with diabetes find it easier to keep their blood sugar in their target range by dividing their totally daily carbohydrates across several meals.

Key Point: The amount of carbohydrates consumed at one time (during a snack or meal) is important for someone with prediabetes or diabetes.

But I want to eat twice a day instead!

But what if you wanted to divide your carbohydrate intake into two meals instead of three? If you ate half of the 130 grams of carbohydrate at each meal, that would provide 65 grams of carbs each.

How would you know how your body handled this change? The answer is to test your blood sugar!

In Chapter 6 of Eat What You Love, Love What You Eat with Diabetes, we suggest creating little experiments to see how certain types and amounts of foods affect your blood sugar levels. The American Diabetes Association recommends that your blood sugar level two hours after the first bite of food be under 180 mg/dL. If you are considering eating two meals a day, blood sugar testing can help you learn if it is effective.

What if my blood sugar is in my target range?

So if your blood sugar is under 180 mg/dL two hours after your first bite of a meal containing 65 grams of carbohydrate, then it is likely that your body tolerates 65 grams of carbohydrates at a time. You may decide to experiment with other foods and amounts of carbohydrate to see what other foods help keep your blood sugar in a target range.

Key Point: Test your blood sugar two hours after eating to see if you are in your target range.

What if my blood sugar is higher than my target range?

If your blood sugar is over 180 mg/dL two hours after your first bite of a meal containing 65 grams of carbohydrate, you still have options. You could reduce your carbohydrates at each meal by having three meals instead of two. If you divided the minimum number of carbs per day (130) into three meals, it would be about 45 grams per meal (rounded for easier counting). Or you could continue to have two meals with fewer carbohydrates and add a small snack or two in order to consume the remainder of the recommended amount of carbohydrate.

What does a meal with 45 grams of carbohydrate look like? To help you imagine, think of 45 grams as a basic sandwich with two slices of bread eaten with a piece of fruit. Another example is 6 ounces of vanilla yogurt (~20 g of carbs), 1/2 cup of blueberries (10 g of carbs), and a slice of toast with margarine (15 g of carbs).

(We tried to make it as easy as possible to learn about carbohydrates in Chapter 7 of Eat What You Love, Love What You Eat with Diabetes!)

What if my blood sugar is still elevated?

Talk with your provider about your findings. Resist the desire to blame yourself or think that these elevated blood sugar are just because of something you ate. Diabetes is a progressive disease, and over time, the body loses the ability to make insulin.

Key Point: If your blood sugars are still elevated, don’t just stop checking! Talk with your provider to learn about other options for keeping your blood sugar on target.

So, the answer is no, you don’t have to eat three meals a day with diabetes! The only way to know is to check.

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About the author

Megrette Fletcher is a registered dietitian, certified diabetes educator, author, and co-founder of The Center for Mindful Eating. Megrette is the 2013-2014 president of The Center for Mindful Eating, a non-profit, organization to assist health professionals to explore the concepts of mindful eating. She has written articles for and has been quoted about mindful eating in Diabetes Self Management, Today’s Dietitian, Today’s Social Worker, Bariatric Times, Glamour, Family Circle, The Wall Street Journal, US News and World Report, Women’s Day, and Oxygen Magazine. Megrette currently works as a diabetes educator in Dover, New Hampshire.

2 Comments

  1. Andrew Morgera says:

    Trying to plan meals can be very difficult for me. I couldn’t imagine trying to doing so but having to divide my carbohydrate intake as well. Trying to do this on your own can be very hard and overwhelming. Do you have any recommendations to individuals with diabetes on how they can discuss this issue with their doctors?
    Thank you for your insight!

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