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Dear Diabetes: Why is Pizza So Difficult?

Tips for fitting pizza into a diabetes meal plan

Shortly after being diagnosed, there is a question that I believe most people living with diabetes – young and old, type 1 and type 2 – will eventually ask. It’s practical. It’s important. It’s “how can I eat pizza?”

Oh, pizza. The perfect marriage of cheese, bread, and tomatoes, pizza has become so much a part of our culture that, according to Alanna Moshfegh, supervisory nutritionist of the National Health and Nutrition Examination Survey, about thirteen percent of Americans report eating it each day. It pops up at office meetings; it’s a college staple. We throw parties in its name.

But for people living with diabetes, pizza is not always cause for celebration. Not only is it an inconsistent food – it comes so many sizes and thicknesses, with different toppings and varieties – but also its effects have a tendency to hit when one least expects it. Many people, like me, find that pizza may cause blood sugar to rise hours after they eat it. So why is pizza so difficult to fit into your meal plan? And what’s a person living with diabetes to do?

Unfortunately, the very ingredients that make pizza so delicious often contribute to its challenges. That tasty crust is primarily made of flour – usually white (without any of the fiber of whole grain) – and thus is nearly entirely carbohydrates. Many tomato sauces contain sugar, an additional source of possibly blood-sugar-raising carbohydrate. That beautiful layer of cheese can also be full of fat, which may slow down digestion and affect sensitivity to insulin – part of the reason pizza may cause blood sugar to spike hours after eating it. (The same is true of likely high-fat toppings like pepperoni or sausage.) Lastly, most people don’t stop at one slice; the sheer volume of pizza we usually consume in one sitting amplifies all these other issues.

The first step to fitting pizza into your meal plan is to estimate how much carbohydrate you’re actually eating. The USDA’s Food Nutrient Database for Standard Reference has some analyses for popular brands, which you can search here. Gary Scheiner, MS, CDE*, founder of Type 1 University, and author of Think Like a Pancreas, suggests one creative method: using your hand to estimate your serving size. Compare a pizza slice to your hand (with your fingers pressed together). “A hand-sized slice,” says Scheiner, “has roughly thirty grams of carbohydrate for a ‘normal,’ relatively thin-crust slice; something deep-dish or Sicilian is probably closer to forty-five. This is, of course a very rough guesstimate – and most slices of pizza will be bigger than a single hand, so be sure to be as honest as possible in your measuring.”

Scheiner has another carb-measuring method called the “carbohydrate factor,” which requires weighing your pizza. This simply means multiplying a food’s weight by the percentage of its weight that comes from carbohydrate. Roughly speaking, pizza is about 32% carbohydrate by weight, so if you multiply the weight of your pizza in grams by 0.32, you’ll have a sense of how many grams of carbohydrate it contains. (For example, if your pizza slice is 150 grams, you’d multiply it by 0.32 and get 48 grams of carb.)

Once you have a rough sense of how many grams of carbohydrate your pizza contains, you’ll need to figure out how to account for it. Work with your healthcare team to figure out a “pizza plan,” to potentially help put this American favorite on the menu.

Some other tips:

Read more about making pizza and other Italian favorites diabetes-friendlier.

Catherine Price is a freelance journalist and type 1 diabetic who has written for The New York Times, Slate, Popular Science, and O Magazine, among others. She blogs about diabetes at and you can follow her on Twitter @Catherine_Price. Price is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewee, and not of Sanofi US, its employees, agencies, or affiliates.

*“Certified Diabetes Educator” and “CDE” are certification marks owned and registered by the National Certification Board for Diabetes Educators (NCBDE). NCBDE is not affiliated in any way with Sanofi US. NCBDE does not sponsor or endorse any diabetes-related products or services.

© 2013 The DX: The Diabetes Experience


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