- βConfirms that carb counting difficulty is common β affecting 1 in 2 adults with T1D
- βIdentifies that most patients use unreliable visual estimation rather than measuring tools
- βHighlights a clear gap in dietitian support that patients and advocates can act on
| Journal | BMJ open |
| Year | 2025 |
| Authors | Sterner Isaksson, Hellman, Wijkman |
| PMID | 41320210 |
What Was Studied and Why It Matters
Researchers in Sweden wanted to understand how adults with type 1 diabetes (T1D) actually eat, what food-related challenges they face, and whether they feel supported by their healthcare teams. Managing blood sugar in T1D is deeply tied to what you eat β especially carbohydrates β so understanding real-world struggles is essential to improving care.
The study surveyed 191 adults with T1D across three diabetes clinics, asking about their daily food intake, carbohydrate counting habits, and how confident they felt about managing meals.
What the Study Found
The results painted a relatable but concerning picture for many people living with T1D:
- Carb counting is genuinely difficult: About 51% of participants said they found carbohydrate counting challenging. Most (53%) relied on visual guessing rather than measuring, and only 18% used more reliable methods like apps or food scales.
- Food avoidance is common: 61% said they avoided certain carbohydrate-rich foods entirely β not because of preference, but because those foods made blood sugar control too unpredictable.
- Diet quality needs improvement: On average, participants ate less fiber than recommended and more saturated fat than guidelines suggest β patterns linked to higher cardiovascular risk over time.
- Many feel under-supported: Around 40% said they hadn't received enough dietary guidance since their diagnosis. One in three wanted more support from a registered dietitian, and 39% believed changing their diet could meaningfully improve their glucose control.
What This Means for Real Patients
If you've ever stared at a plate of pasta and felt uncertain about how much insulin to take, you're not alone β and this research confirms that experience is widespread, not a personal failing.
The findings suggest that carbohydrate counting, while a cornerstone of T1D management, is something many people need more practical help with. Visual estimation leads to errors, which can cause unexpected highs and lows. Simple tools β like a food scale, measuring cups, or a carb-counting app β can make a meaningful difference in time-in-range.
For those using continuous glucose monitors (CGMs) or insulin pumps, pairing accurate carb counting with reliable diabetes supplies from a trusted source like MDS Diabetes can help you get the most from your technology. The more accurate your carb estimates, the better your devices can do their job.
Talk to Your Care Team
If you feel like your dietary questions aren't being answered at appointments, this study backs you up β many patients feel the same way. Ask specifically for a referral to a diabetes dietitian. Tailored meal counseling, not generic advice, is what tends to make a real difference.
Bottom Line
Half of adults with type 1 diabetes struggle to count carbohydrates accurately, and many avoid whole food groups out of fear of blood sugar spikes. Most participants weren't eating enough fiber or limiting saturated fat as recommended. A significant number felt their healthcare teams hadn't given them enough dietary guidance. The takeaway is clear: better access to personalized nutrition support should be a standard part of T1D care β and patients should feel empowered to ask for it.