Can diabetics eat pizza

How to Order Fast Food When You Have Diabetes

When you’re managing type 2 diabetes, making smart diet choices can help you lose weight and stabilize your blood sugar. It may even help you reduce your reliance on medication.

But when you’re in a hurry or on the road, fast food may be the only option available to you. For instance, you may work late hours or be pressed for time, and fast food might be the most convenient, or even the only, option available to you. There’s no denying that these quick-bite chains seem to be everywhere — the United States has about 7.52 fast-food restaurants per 100,000 residents, according to a study published in the journal Critical Public Health.

If you do find yourself needing to order at the drive-through, don’t fret. The key is knowing how to spot diabetes-friendly fare on the menu and get the nutrition you need without jeopardizing your health.

Type 2 Diabetes: Better Fast-Food Choices

Common sense says that fast food isn’t likely to be on the preferred-foods list for people with type 2 diabetes. After all, a typical fast-food breakfast can put you at or over your daily limit for fat, cholesterol, and carbohydrates. But many fast-food restaurants offer smart choices that can help you get the nutrition you need with the convenience you desire.

For starters, fast food doesn’t have to mean fat-laden fare. Planning ahead is key, says Jenny Dejesus, NP, CDE, a diabetes educator at Weill Cornell Medical Center in New York City. Many fast-food chains now feature healthier choices, and these are the restaurants you want to go to.

“If possible, look at the menu ahead of time. This way, you’ll have more time to make a healthier choice,” says Dejesus. Some chain restaurants give nutritional information for their food items online; you can find them by typing the chain name and the word “nutrition” into any search engine.

When trying to decide on the best fast-food cuisine, keep these ideas in mind:

  • Pizza may actually be a good choice for people with type 2 diabetes; just be sure to order the thin-crust type and top it with vegetables rather than high-fat meats and extra cheese. It’s also a good idea to watch portion sizes. Consider pairing a slice of pizza with a side salad for a more balanced meal that’s lower in carbohydrates, to help keep blood sugar levels more in line.
  • Tacos, burritos, and wraps can be tasty and permissible in your diet; when possible, ask for whole-wheat tortillas, and avoid any entrees that are fried. Add as many vegetables as you can on top and, if you can, add a small scoop of guacamole. The healthy fats from the avocado will help your body to absorb carbohydrates more slowly, leading to a more gradual rise and fall in blood sugar levels. Just remember that a little bit goes a long way, as guac is also high in calories.
  • Look for fast-food places that offer salad bars. These can be good for you, as long as you limit the amount of salad dressing you use and don’t load up on high-fat salad ingredients, like cheeses. Whenever possible, make your salad a more complete meal by adding a healthy protein source, such as a lean meat, fish, nuts, seeds, beans, hummus, or cottage cheese.

Keep an eye out for various healthy-diet special menu items. “Some restaurants offer foods lower in cholesterol, fat, and sodium, and higher in fiber. Many offer reduced-calorie salad dressings, low-fat or fat-free milk, and salt substitutes,” Dejesus says.

Type 2 Diabetes: Beware of Fast-Food Traps

One of the ways fast-food restaurants make money is by getting more customers to come through more quickly, pressuring you to make a fast ordering decision — and when you feel rushed, you may make the wrong choices.

Make smart rules and stick to them, like never ordering jumbo or super sizes. Keep in mind that you don’t have to eat the full portion of any food you order, especially if a chain’s “regular” portions are larger than you need. Cutting down on portion size can make a big dent in your caloric intake.

Try these additional tips when ordering:

  • Order single burgers, not double or triple patties, and go for chicken, turkey, or veggie burgers instead of beef burgers.
  • Avoid fried meats and even fried fish; instead, choose grilled or broiled sandwiches or platters.
  • Limit your toppings to vegetables, like a slice of tomato and lettuce or salsa, staying away from high-fat sauces, dressings, and mayonnaise.
  • Some restaurant items should be avoided, including croissants and croissant-based sandwiches, large muffins, and bagels, as well as ice cream and other desserts, especially pies.

Armed with information — and a super-size serving of willpower — you’ll be able to make better choices and take advantage of the convenience of fast food without it taking a toll on your health.

Pizza and Blood Sugar Control: (Not Quite) Easy as Pie

by gary scheiner, MS, CDE

Since the beginning of time, when cave people discovered the joys of combining cheese, sauce, and crust, people with diabetes have been perplexed on how to manage blood sugar levels when eating pizza. Things became even more complicated during the “toppings revolution” of the Renaissance, when folks started putting everything from salted fish to pineapple on their favorite pies.

Today, even with an assortment of new tools and techniques for managing blood sugar, the “pizza effect” continues to elude the masses. Many find it nearly impossible to figure out the carbs-per-slice, whether it be thin-crust, hand-tossed, or deep-dish. For some, indulging in a few slices results in an inexplicable blood sugar drop after eating, followed by a momentous sugar surge. For others, the blood sugar doesn’t start to head skyward until many hours later, perhaps overnight.

For those who enjoy a slice (or two, or six…), here are three ideas that might help you find that delicate balance between the pizza you love and the healthy blood sugar you covet.

1. counting pizza carbs

To count the carbs in pizza, you’ll need a hand. Your hand, to be exact. You can estimate the number of carbs in pizza pretty well by using your hand as a measuring tool. A traditional, hand-tossed pizza that is the size of the average adult’s hand contains approximately 30g of carb. And don’t forget to include the corners!

A traditional, hand-tossed pizza that is the size of the average adult’s hand contains approximately 30g of carb. And don’t forget to include the corners! In this example, the slice of pizza is slightly larger than an adult woman’s hand, so we’ll call it 35g.

An adult’s hand-size slice of thin-crust? Go with 20g. Deep-dish, pan or Sicilian? Call it 45g. To see if your hand is larger or smaller than average, count the number of your “hands” in a frozen pizza that has a nutrient label or a slice from a restaurant or delivery company that provides nutrient listings for its food. Slice sizes can vary tremendously. I’ve seen pizza delivered by a national chain that was so small, the slices were barely half a hand, or 15g each. Then again, my favorite pizza shop on the boardwalk in Ocean City, NJ, is at least 2 ½ hands, or 75g carb.

2. delay the bolus

Sometimes, food doesn’t digest all that quickly. Especially when it contains a great deal of fat, or you consume a lot of it at one time. Fat slows the rate at which food empties from the stomach into the intestines, where it is then absorbed into the bloodstream. Likewise, large volumes of food take longer to pass through the stomach than smaller quantities. If you consume multiple slices of pizza, or the pizza is laden with fat-filled toppings like sausage or extra cheese, you can expect the carbs to take a few hours longer than usual to “kick in”.

When we give a bolus of rapid-acting insulin (either via injection or a pump), the insulin usually starts to work in about 15 minutes, peaks in 60-90 minutes, and finishes in about three to four hours. This activity profile works fine if the food you are eating digests fairly rapidly. When the food digests slowly, a normal meal bolus may peak too early – resulting in a blood sugar drop followed by a blood sugar rise a few hours later when the food is finally absorbed but the bolus is fading.

The solution is to delay or blunt the activity of the insulin. This can be accomplished a number of ways. The bolus could be taken after the meal instead of before. The dose can be split into two parts: half taken before eating, the other half taken an hour or two later (if you need a correction bolus for high blood sugar, always include all of it in the first injection). You could even use Regular (R) insulin instead of a rapid-acting analog. For those who use an insulin pump, the bolus can be delivered gradually over a few hours using the square/extended/dual/combination bolus feature. My personal preference is to give a third of the bolus normally (with the meal) and the other two thirds extended over the next two hours.

3. cover the fat

The final insult brought on by high-fat foods like pizza is the prolonged, gradual blood sugar rise that occurs many hours after eating. And guess what…it’s not carbs that are causing the rise. It’s the fat. But not directly. Here’s how.

High fat meals and snacks cause an increase in serum triglycerides for many hours. When the liver is confronted by large amounts of triglycerides, it becomes resistant to insulin. And that results in greater secretion of glucose by the liver. Without a concurrent increase in insulin, blood sugar levels are going to go up, up, up.

The solution involves taking extra basal/long-acting insulin after high-fat meals. Those who take injections can accomplish this by taking a small amount of NPH (intermediate-acting insulin) after eating. Those on insulin pumps can increase their basal rate for several hours after eating. I personally increase my basal by 60% for eight hours following high-fat meals, especially restaurant and take-out food or large portions of high-fat snacks.

So there you have it. It’s no wonder pizza is such a challenge when you have diabetes. It takes careful carb counting, attention to the timing of the bolus insulin, and often extra basal insulin. It’s a lot to think about and takes some practice to get it right. But anything worthwhile takes some effort.

And hey… this is PIZZA we’re talking about!

Visit for a free video course dedicated to the pizza/blood sugar connection.

Gary Scheiner MS, CDE is Owner and Clinical Director of Integrated Diabetes Services, a private consulting practice located near Philadelphia for people with diabetes who utilize intensive insulin therapy. He is the author of several books, including Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin. He and his team of Certified Diabetes Educators work with people throughout the world via phone and the internet. Gary is also “Dean” of Type-1 University (, an online school of higher learning for insulin users. See our Test Drive in diaTribe #29 for more information on this resource. Gary can be reached at [email protected], or toll-free at 877-735-3648

The Great Pizza and Diabetes Experiment

I hate pizza. Sure, it has that great smell. Yeah, it has an amazing look, as steam rises up over a landscape of melted cheeses dotted with toasted veggies and crisp meats. Oh, and the taste is wonderful, a molten fusion of flavors that rocks the taste buds.

But I still hate pizza.

Because no matter what I do, it effs up my blood sugar. Big time.

And I’m not alone.

The problem is that every pizza is two glucose highs waiting to happen. There are fast sugars in the crust and in the sauce, and there are slow carbs in the cheeses and meats. And pizza’s challenges for the pancreatically-challenged are everywhere.

  • Pan, hand-tossed, or thin crust?
  • What toppings?
  • How generous or stingy is the cook?
  • Does one brand have more sugar in their sauce than another?
  • And what about the slices? A “slice” of pizza has a published carb count in many cases, but rarely are pizzas cut uniformly. It’s a nightmare.

In wondering how on earth we’re supposed to deal with all of this, my solution has been to avoid pizza altogether.

So you can imagine how I felt when the ‘Mine team asked me to take on pizza as the next in our line of “great food experiments” that have included ketchup, coffee, and craft beer so far. Given that March is National Nutrition Month, it seemed like a perfect time for the so-called Great Diabetes and Pizza Experiment.

Know Thy Enemy

I started by studying the enemy. And there’s a lot of information out there, despite the fact that pizza sales are actually on the decline with only $38,504,164,116 in sales last year. For those of you who can’t count your commas, that’s $38 billion!

There are more than a dozen brands of pizza out there and they have a pretty big carb range. Or so it would appear at first glance. But something interesting is lurking in the math. As I compared products, I noticed that the serving sizes varied a lot, too, ranging from 85 grams up to 152 grams.

Digging deeper into the math, I divided the carbs into the serving sizes to find out the carb impact of each kind of pizza on a per-gram basis. And when I did, I was stunned. Pizza — regardless of crust or topping or brand — has a carb impact very close to 0.23 carbs per gram.

Could it be true? Was there, lurking in all the confusion of size and style and brand, a universal pizza bolus? Do we just need to weigh any piece of pizza and multiply the results by 0.23 to get the carb count? Could it really be that simple?

Time to find out…

Pizza Science in Action

I ran a small-scale scientific experiment. And to gain the most data beyond just myself, I recruited a second lab rat: a fellow T1D sister who is a pizza-lover and didn’t need much arm-twisting to join in on this experiment offering free pizza dinners.

Like me, she’s on insulin pens and CGM. We agreed we’d both do a fingerstick calibration as a baseline before the meal, then record the CGM readings at two and four hours.

In a perfect world, peak glucose would be in two hours, and at four hours we should be back to our normal fasting blood sugar levels.

Of course, a perfect world wouldn’t include a diabolical food like pizza.

Each of the pizza meals would be limited to two pieces of pizza, with no sides. I wanted my data to be as pure as parmesan. But to drink I selected low-carb dry red wine, because I love wine more than science.

Here’s my lab journal:

Experiment One: Pizza Hut

We opened the cardboard box and beheld the pizza. “You have a really tough job,” said my D-sis, “Having to eat pizza and all…” Then she pointed to a slice on the left, and then one across the pizza from it. “I’ll take this one, and that one.”

I transferred her choices to the waiting paper plate on my digital Salter kitchen scale. We had used the “tare” function to erase the weight of the plate before adding the pizza. Her two slices clocked in at 207 grams. I multiplied that by our theoretical universal constant of 0.23 and came up with a carb count of 47.61. “Round it up to 48,” I suggested, and she entered the figure into her RapidCalc app, along with her (grossly) above-target blood sugar, and took a combined pizza and correction bolus.

She said the carb count sounded waaaaaaay too low to her. I did the math on my two slices after weighing them, and the count sounded waaaaaaay too high to me.

What happened? Surprisingly, not much. I went up a bit, but not too badly. D-sis came down, but not as far as she would have liked. Here, check it out:

Base 2 HR 4 HR

Wil 137 193 235

D-sis 342 242 201

The glucose response to the pizza was better than either of us usually see with traditional carb counting, and we were amazed by how close our final sugars were, especially given how far apart they were at the start.

Experiment Two: Little Caesars

Much like KFC has fried chicken cooked and waiting, Little Caesars has cheese and pepperoni pizzas waiting for eager eaters at all hours. During the dinner rush, a wider array of options is available. Price-wise, they are about half the cost of Pizza Hut, and the flavor was great. How’d it work out blood sugar-wise?

I’m happy to report that, using the universal constant of 0.23 carbs per gram, the Little Caesars hand-tossed 3 Meat Treat treated my blood sugar similarly to the way that the Pizza Hut Pan Meat Lover’s did. Which is to say, hardly perfect, but better than I’ve ever experienced in the past.

Both of the test subjects started with respectable numbers this time. I stayed flat with a slight rise towards the end, but had no excursion whatsoever. My D-sister dropped a bit in the middle, and rose more sharply towards the end, but nothing to write home about — especially since this is pizza we’re talking about.

Here are our numbers:

Base 2 HR 4 HR

Wil 146 151 161

D-sis 134 106 186

Despite the fact that Little Caesars and Pizza Hut pizzas have radically different crust styles, the “universal” constant delivered similar results: Basically a fairly flat response, ending above target, but not hideously so.

Experiment Three: Totino’s Frozen Pizza

Science is a lot of work: Get the frozen pizzas out of the oven, cut them, weigh the servings for me and my D-sis on the scale, multiply the grams of weight by the universal bolus figure of 0.23 to get the carbs, enter the carb count and current blood sugar into RapidCalc, and record all the figures in my notes for this article—all before the damn pizza got cold!

Meanwhile my D-sis quickly turned her iPhone upside down after entering her blood sugar. I sighed. “How bad is it?” I asked her.

Four hundred and thirty-five fricken’ mg/dL. “What on earth did you do?” I asked, whereupon she admitted to eating “yummy” cake and forgetting to bolus for it. Naturally I read her the riot act about being an irresponsible D-person. Then I sat down to eat my pizza.

When the two-hour alarm went off I checked my CGM. I was at 276 with a quartering arrow up. What the f—?! How could that be?! That high… And still rising!

We put our heads together to figure out what went wrong. One idea was that the “universal bolus” didn’t work for frozen pizzas, as they have a higher crust-to-topping ratio than restaurant-type pizzas. While I could buy that, I just couldn’t reconcile it with an excursion that bad. “It almost looks like I didn’t take any insulin at all…” I started to say.

“That would be being an irresponsible D-person,” said my D-sis with a triumphant twinkle in her eye.

I activated my Echo pen and looked at the base. The last bolus was many, many, many hours before. Well, shit. I was so busy figuring out the bolus, that I had forgotten to take it.

Base 2 HR 4 HR

Wil 155 276 —

D-sis 435 — —

I terminated the experiment at two hours. Then I took a rage bolus, and ate the leftovers.

Experiment Four: Local Fare

Of course, none of this science does us any good if it only works for chain pizza. The real prize is having a method for taking on local mystery pizza. The final phase of our experiment was to apply the universal constant to local pizza and see if the numbers came out similar to the numbers we saw on the brand-name pizzas.

I packed my scale and we headed to J.C’s New York Pizza Department, a combination eatery and three-lane bowling alley on the Plaza in the heart of my town of Las Vegas, New Mexico — the Las Vegas you can’t see from space.

Did it “work”? Did we get readings similar to our first two experiments?

No. Damn it.

Base 2 HR 4 HR

Wil 127 128 263

D-sis 188 317 359

D-sis shot up crazy-high before the two-hour check and continued to drift up. Eight minutes short of the final check she bailed and took insulin. I stayed flat for the first two hours, then began a sharp rise.

So much for science.

D-Pizza Takeaways

What did I prove in the end?

Well, even if there may be a universal carb-count for pizza, navigating this using traditional insulin may not allow for steady numbers unless you can plan ahead and dose accurately each and every time.

In other words, Your Pizza May Vary (YPMV), just as Your Diabetes May Vary and everything under the sun plays into the Blood Sugar Effect you’ll experience when consuming this kind of pie.

For me in the end, the Great Pizza Experiment proved nothing… beyond the fact that I’m justified in really hating pizza.

Eating Out When You Have Diabetes

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Whether it’s the local pizza joint after a game, the food court at the mall, or barbecued ribs on your best friend’s back porch, eating out is probably a part of your social scene.

You don’t want to miss the fun just because you have to watch what you eat, and the good news is that you don’t have to. You can pretty much eat the same foods as your friends and family — you just have to keep track of what you eat and enjoy certain foods in moderation.

Which Restaurant Should I Choose?

If you’re choosing where to eat, think about the places that offer you the most options — even fast-food places have healthy choices on their menus. Whenever possible, look for nutritional facts on the meal you plan to order — like calorie, carbohydrate, and fat content. This information is available in many chain restaurants (you may need to ask for it) or online.

Don’t worry — you’re not limited to places that serve only soy burgers and carrot sticks. If you can order a meal that includes a good balance of proteins, fats, and carbohydrates, you’re doing OK. But if you find that certain restaurants don’t offer many vegetable choices or that they only serve fried food that’s covered in cheese, you might want to pick a place that offers more options.

You might find that there are more healthy breakfast choices — like yogurt, fresh fruit, and scrambled eggs — for you at the diner than at the coffeehouse, so convincing your friends to chow down on diner food is one option.

But if your friends prefer the coffeehouse, one alternative is to buy something to drink and bring a snack in your backpack or purse that’s easy to eat discreetly, like pretzels or raisins. Some people may be embarrassed or worried that the manager might give them a hard time, though. If you think you might be in a situation like this, you can talk about what to do with your doctor or dietitian and how to adjust your meal plan or insulin doses.

What Should I Order?

When it’s time to order, follow the same rules for food content and portion sizes that you follow at home. Your meal plan probably calls for you to eat a good balance of proteins, fats, and carbs. Usually, you can get all of the nutrients you need at a restaurant, too.

These tips can help:

  • Change and rearrange. To get a well-balanced meal in a restaurant, feel free to substitute certain ingredients or side orders (for example, you could substitute salad for fries). Don’t feel weird about it — people ask for substitutions all the time. You can also ask for a different preparation, like having your chicken broiled instead of fried.
  • Watch the sides. Avoid foods with sauces or gravy, and ask for low-fat salad dressings on the side.
  • Pick your own portion. Restaurant portions often offer enough food to feed your entire crew, but try to eat the same portion of food that you’d eat at home. Either eat only part of your order and take the rest home or split it with a friend.
  • Master menu lingo. Watch out for words like “jumbo,” “supersize,” “deluxe,” or “value” when eating at your favorite fast-food joint or the food court at the mall. Instead, order junior- or regular-sized sandwiches and sides.
  • Split with a friend. Are you hungry for some fries? Order a healthy sandwich and side salad for yourself and sneak a few of your friend’s fries instead of ordering your own. And dividing an entrée or sandwich between friends also helps keep portion sizes under control.
  • Go light on buns and crusts. Choose thin-crust pizza over the deep-dish pie and skip double burgers and extra-long hot dogs to keep carb intake under control. And keep in mind that English muffins, bread, and small buns often contain fewer calories and fat than croissants and biscuits.

The same tips apply to eating at your school cafeteria. To be a healthy eater at school, make sure you pick a variety of healthy foods and stop to think about when you’re getting full.

What Should I Bring With Me?

When you go out to eat, bring the things you take with you everywhere, like testing supplies, snacks, and medicines. A quick-reference guide to food content and portions can make choosing healthy foods a little easier — ask your doctor or dietitian for one of these booklets. Or use your smartphone to pull up one of the many nutrition apps or websites. If you use things like artificial sweeteners or fat-free spreads, bring them along, too.

If you take insulin, there’s no need to stay home if you have to eat later than usual — in most cases you can just make a few simple adjustments to your medicine schedule.

Do you have questions about how to make eating out even easier? Talk to your doctor or dietitian.

Reviewed by: Steven Dowshen, MD Date reviewed: September 2016

There’s a month for everything, and this month, we celebrate the hamburger. The word “hamburger” comes from the German city Hamburg, and hamburger trivia tells us that the burger made its US debut (along with the ice cream cone) at the 1904 World’s Fair in St. Louis. Americans eat close to 40 million burgers every day, so it seems appropriate that this popular food should have its own month to give us another reason to celebrate.


But for those of us who are health-conscious, concerned about heart health, or watching our weight, can burgers really be part of a healthy eating plan? Sure. As with any food, it’s a matter of knowing how (and how much) to squeeze it in.

Burger Nutrition
Beef often gets a bad rap in terms of its health offerings. Sure, it tends to be higher in saturated fat than poultry or fish, and its higher fat content, overall, means that calories in a burger are higher than calories in, say, a skinless chicken breast. But there are some nutritional merits to ground beef: Beef is a source of high-quality protein, B vitamins, and minerals such as iron and zinc.

Burger “Bites”
Every now and then, I enjoy a juicy burger hot off the grill. I don’t indulge all that often, so I figure it’s OK to savor the moment. Of course, some people eat burgers more often than others. Is there a way to make burgers healthier without sacrificing flavor or moisture? Here are some burger “bites,” or facts to keep in mind as you ready your grill for the summer.

Go lean. Whenever possible, choose lean or extra lean ground beef. Lean hamburger can come from any number of cuts of beef, including top and bottom round, top sirloin, eye round, flank, tenderloin, top loin, and T-bone. According to the USDA, “lean” meat (also known as 10% or 90/10) is meat with less than 10 grams of total fat, 4.5 grams or less of saturated fat, and less than 95 milligrams of cholesterol per 3.5-ounce cooked serving. “Extra lean” (also known as 5% or 95/5) is meat that is less than 5 grams of total fat, less than 2 grams of saturated fat, and less than 95 mg of cholesterol per 3.5-ounce cooked serving.

Cook wisely. One of the drawbacks of using leaner hamburger is that its lower fat content can mean that the burger is drier and, well, chewier. Higher-fat beef yields those juicy, drippy burgers that make a mess but taste so good. But lean hamburger can still produce a tasty burger. Outdoor grilling, a griddle pan, and the oven broiler can also make a lean but juicy burger. The key is to not cook it at too high of a temperature. Using medium heat will let the beef brown and retain its moisture at the same time. Also, use a spatula to flip your burgers, rather than a knife or a fork, to help preserve its juiciness.

Beef it up. Another way to add moisture and nutrition to your burgers is to mix some of the following into the hamburger before cooking: chopped onions, green peppers, tomatoes, zucchini, carrots, mushrooms, leafy greens (like spinach), salsa, guacamole, or fruit. Of course, topping your burger with any of these foods can give your burger a (nutritional) boost, as well.

Keep portions in check. Going out for a burger means that you’ll likely be getting a hefty-sized burger. A hamburger from the chain “Five Guys” weighs about 9 ounces and contains about 700 calories. For comparison, a 4-ounce extra lean hamburger patty contains just 185 calories. If a 4-ounce burger seems meager, remember that you can bulk it up a bit by mixing vegetables, fruit, or whole-grain bread crumbs into your ground beef (see above).

Go half and half. A lot of people have switched over to using ground turkey in place of ground beef. Turkey, in general, is much leaner than beef. However, choose your ground turkey wisely. Look for the words “ground turkey breast” on the package. If you see “lean ground turkey,” you’ll likely end up with white and dark meat turkey, along with some turkey skin. That spells more fat and calories, similar to what you’d get in lean ground beef.

You can slash calories and fat by using a combo of ground turkey breast and lean (or extra lean) ground beef to make your burgers. You’ll notice that packages of meat and poultry in your supermarket now carry the Nutrition Facts label, thanks to a new USDA ruling. This will make it easier for you to know exactly what you’re getting, at least for packaged meat and poultry items.

Don’t get “side-swiped.” I know, I know — eating burgers without fries is like July 4 without fireworks. But it does bear thinking about. French fries, potato chips, and potato salad (which, I admit, go really well with burgers) add more calories, fat, and carbs. Think about ditching some of these higher-fat side items, at least once in a while, for oven-baked fries (you can even make these out of zucchini and carrots), garden salads, or fresh fruit. If you’re worried about too many carbs, eat just half of a hamburger bun, or try either a lower-carb bun or a wrap.

Any other ideas for making a better burger?

Healthy Pizza

Here is a healthy alternative to a standard pizza. We have used a plain tortilla wrap, added a small number of ingredients and within 15 minutes from start to finish have prepared a delicious meal.

Be adventurous – change up the toppings – once you have the wrap as a base and a tomato puree on top, the rest is up to you.

  • Try a wholemeal or seeded wrap
  • Have the kids make their own
  • What about some cooked ham, cherry tomatoes and finish with large handful of rocket as the pizza comes out of the ove
  • top with left-over roast chicken shredded finely with some sliced red onion

Whatever toppings you add, just remember to go use small amounts as the wrap won’t crisp on the base if the toppings are too heavy. Go easy on the cheese – use this recipe as a portion guideline.

Serve with a simple green salad which can be quickly put together while the pizza is in the oven.


1 Tortilla Wrap (medium size 64g)
10g Tomato puree
4 pieces chargrilled peppers in olive oil (or use thin slices of fresh peppers)
5 stoneless black olives halved
15g soft goat’s cheese, crumbled
20g grated mozzarella cheese
Freshly ground black pepper


  • Pre-heat oven to 200 degrees Celsius
  • Place a tortilla wrap onto baking parchment on a baking tray
  • Lightly spread the tomato puree over the wrap
  • Place toppings on, starting with peppers and olives and then soft goat’s cheese
  • Lastly sprinkle mozzarella cheese over the top
  • Bake in oven for 7-9 minutes until cheese is melted and wrap is crisp and lightly coloured.

This recipe serves 1 adult.

Pizza and Diabetes: How to Eat Pizza Without Sabotaging Your Blood Sugars

A Type 1 writer gives guidelines on how to dose insulin so you can occasionally indulge in high-carb/high-fat foods without making your blood sugars soar. Written by Ginger Vieira 13

Diabetes doesn’t have to end your love affair with pizza. If you’re going to occasionally indulge, do some experimenting and take good notes to figure out the right way to dose your insulin. Photo by Cel Lisboa on Unsplash

Just because you live with type 1 diabetes doesn’t mean you can’t enjoy a few slices of pizza, or lasagna, or Chinese food, or even…a cupcake with buttercream frosting!

(Note: If you’re a hardcore low-carber and you can willfully resist cake and pizza every day of the week, all year long, this article simply isn’t for you!)

Personally, I make sure that most of my diet (80 to 90%) consists of real food, and is generally very low-carb, too. And then that leaves room for the occasional gluten-free carb-loaded dessert (I love baking!) or one of my favorite gluten-free pizzas (white pizza with lots of cheese and red onions…please!).

But managing your blood sugar around those luxury items that are both loaded with carbs and loaded with fat means your usual insulin dosing protocol isn’t going to work. This applies to foods including:

  • Pizza
  • Chinese food
  • Lasagna (most cheese & pasta Italian dishes, actually)
  • Cakes & Cupcakes with buttercream frosting
  • Ben & Jerry’s ice cream

Surprisingly, there are foods that you would think should be on this list that I’ve found simply don’t qualify because they do digest at a more normal rate, like cheesecake! So you really need to take good notes when indulging to figure out what other foods should be on this list for you.

Mostly, I think you’ll find that the 5 listed above are absolutely the biggest troublemakers.

Why You Can’t Take Your Insulin All At Once

When you eat pizza—or anything else in the list above–you’re not just eating a good serving of fat and a good serving of carbs, you’re eating a lot of fat and a lot of carbs. Even if you’re enjoying only one slice of pizza or one cupcake, taking all of your estimated insulin dose before or even during the meal is going to lead to severely low blood sugars.

(If you currently don’t know how to consistently calculate your “estimated insulin dose” for meals based on your insulin-to-carbohydrate ratio, you need to read Gary Scheiner’s book, Think Like a Pancreas ASAP. This is a critical part of diabetes management with insulin.)


Because all that fat is going to dramatically slow down the digestion process of all those carbs.

Here’s what happens if you take all your fast or rapid-acting insulin at once for these types of foods:

  1. Within 45 minutes to 90 minutes, you will experience a quickly plummeting low blood sugar
  2. Next, you’ll treat that low blood sugar with at least 15 grams of carbs, like you normally would. And you’ll wonder how on earth pizza could be involved in a low blood sugar.
  3. Also, you’ll want to treat it again and again because there is so much “extra” insulin on board from the dose you took for that pizza. While still full of pizza, you’ll feel sickened by the idea of having to eat more but instinctively panicked because your blood sugar is dropping so rapidly.
  4. Then about 3 to 4-hours later, you’ll find that your blood sugar is insanely high, because not only did you eat carbs to treat the low after your meal, the rest of that original meal is finally being digested without any recently-bolused insulin around to help make use of all those carbs. Oy vey!
  5. Then you take a monster-sized correction bolus, and swear to never eat pizza again! You vow to hate diabetes forever because it’s impossible, and it just doesn’t make any sense! You tell yourself you’re a “bad diabetic” for trying to enjoy pizza once every few weeks. Frustration and rage and guilt ensues. And a few weeks later, the cycle repeats itself.

Enjoying Pizza Without Sabotaging Blood Sugars

It’s actually pretty simple, and you can easily determine your own process following the same guidelines if you take good notes next time you have some pizza or a couple of cupcakes!

Example: One entire small gluten-free pizza from Mimmo’s:

  1. I do not pre-bolus. I repeat: I do not pre-bolus any of my insulin. (Pre-bolusing is the act of taking your insulin about 15 minutes prior to eating to ensure that it’s taking action in your blood sugar by the time an ordinary meal starts to digest. But this is no ordinary meal.)
  2. Right as I sit down to eat, I take 4 or 5 units of my rapid-acting insulin. If my pre-meal blood sugar was below 100 mg/dL, I’d probably only take 4 units. If I was starting out with a slightly higher blood sugar, I’d take 5.
  3. Then, I eat my beautiful gluten-free white pizza covered in cheese and red onions, dipping it occasionally in Tiger Sauce!
  4. I make a note of when I finished eating that pizza—assuming that most pizza meals are easily finished within 1 hour. If I really extended my meal over the course of a couple hours, I would pick a time in the middle of that period to note.
  5. About 2 hours from the time I finished eating the pizza—and 3 hours from the time I took my first insulin dose for the team—I will check my blood sugar, and take another 5 units of insulin to cover the rest of the pizza that will start to be digested in the hours to come.
  6. And then, I check my blood sugar again 2 hours after that to see that all is well.

I must add, though, that if I make a homemade gluten-free pizza or I bake one of the frozen, gluten-free pizzas from Costco, I need twice the amount of insulin. Not all pizzas are created equal! And this may be more of an issue with gluten-free pizzas because crust ingredients can vary significantly, but either way: be aware of the differences between your pizzas if you’re applying one pizza’s dosing approach to a pizza from a different place.

The same dosing strategy applies to cake with buttercream frosting (the frosting being the real issue, not the cake), Chinese food, lasagna, and dense ice cream like Ben & Jerry’s.

If you wear a CGM, you can actually see that your blood sugar will remain stable with only half of your meal’s insulin dose, and then, suddenly, around that 2 to 3-hour mark after eating, your blood sugar starts to rapidly rise.

Unless of course, you’ve timed that second dose of insulin to prevent that delayed rapid rise.

What If I Wear an Insulin Pump?

There are a variety of ways you can manage this on an insulin pump.

However, if you’re watching your CGM, you’ll likely find that you don’t actually need a fancy Dual-Wave bolus. This is a bolus-option on your insulin pump that allows you to program a dose of insulin to be delivered immediately, and then another dose of insulin that is delivered gradually over the course of a set number of hours or minutes.

The reason I think this can cause trouble is that you inevitably still get too much insulin in those first 2 to 3 hours after you started eating when you really need that second dose of insulin to be delivered 3 hours after you started eating. It’s just too much insulin too soon.

How to Apply This to Your Diabetes

Whether you’re experimenting with your blood sugar around a new exercise routine or cake, the idea is to take very good notes on what you ate, when you ate it, how much insulin you took, when you took it, and how your blood sugar reacted…and what you need to do differently to get a different result.

Diabetes isn’t actually random. The problem is that it’s just affected by so many different variables. Many of which we can’t control–but we can predict.

Don’t give in to the “This sucks, I can never get this right,” mentality…and instead, strive to simply better understand what is causing those unwanted and often frustrating fluctuations in your blood sugar.

When it comes to eating, certainly, I’m a big advocate of eating mostly low-carb most of the time, but I really believe in dessert and treats, too. You’ll enjoy those treats far more if you have a better understanding of what your diabetes needs in order to manage your blood sugars around them. Do a little self-studying and enjoy!

Updated on: October 4, 2018 Continue Reading 5 Tips for Lowering Your A1C


Is eating pizza incompatible with diabetes?


Absolutely not. The real question is how do I manage to incorporate pizza into my diet without experiencing marked hyperglycemia? My answer: experiment!

The “pizza” food group is often a staple in the lives of many children and adolescents. Some of my colleagues have even referred to it as evil! However, I prefer to refer to pizza management as a challenge and thus try to include it in meal planning in moderation. Pizza is a complex assortment of fat, protein, and carbohydrates (carbs). As such, despite coverage with either fast or rapid acting insulin, blood sugars are often elevated several hours after pizza parties. The goal is to perform “damage control” in order to avoid having high blood sugars all day or night.

Suggestions for pizza strategies

  1. All pizzas are not equal! It is important to realize that different brands have differing combinations of fat, protein and carbohydrates. Indeed, apps that can be downloaded to computers and mobile devices such as Calorie King can provide carbohydrate counts for major pizza chains (e.g. Domino’s and Pizza Hut). Use this information to help you estimate as best as possible the number of carbs per slice, etc.
  1. There are many algorithms for estimating carbs based on thickness of the pizza crust. Ask your diabetes team for their favorite.
  1. Match your insulin regimen to accommodate the pizza.

For those patients on conventional split mixed insulin with NPH/Regular or rapid acting (such as humalog or novolog) 2 or 3 injections/ day, time your slice(s) with a meal such that the rapid or fast acting insulin will coincide with the carbohydrate excursion. However, be prepared for higher blood sugars even 3-4 hours later due to the fat content slowing digestion. Be prepared to possibly require more rapid or fast acting insulin later to lower blood sugars.

For those patients on basal/bolus insulin via multiple injections, one might try to use a combination of rapid and fast acting insulin (analog plus regular) in order to cover the immediate rise of blood sugar after pizza ingestion and then the slow rise in glucose several hours later.

Patients using insulin pump therapy may employ the same strategy as those that are on basal/bolus therapy by using a “combo” or extended bolus feature of the pump. This strategy allows you to give a certain amount of insulin up-front and the remainder over 2-4 hours based on what actually works. Many choose to determine the amount of rapid acting insulin required based on carb counting and give 50 percent up front and the remainder over 2-4 hours. The key is to experiment with varying percentages and hours to extend based on experience with different pizza brands. (33 percent up front and 66 percent over 2- 4 hours is another popular stratagy.) Keep trying to see what is most effective.

  • Keep in mind that it is still likely that you may have to give another correction bolus 3-4 hours after enjoying that pizza!
  • Keep records of the different combinations employed with the varying pizza brands so you do not forget.
  • Moderation is essential.
  • Ask your diabetes team for other ideas and share them with one another. Indeed, I continue to learn new successful strategies from my own patients who like to experiment. And there are more pizza options today (such as gluten-free and cauliflower crust varieties) that may have significantly less carbohydrates per serving.

See more helpful articles:

The 10 Best Apps for Diabetes Management

Keto Diet Recipes for Diabetes

The Best Vinegars for Diabetes

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