Best Diet for Type 2 Diabetes: How Low-Carb Do You Actually Need to Go?
Unfortunately, there is no “best” diabetes diet.
The American Diabetes Association does not prescribe one specific diet or carbohydrate target for everyone with type 2 diabetes.
Instead, the 2026 ADA Standards of Care recommends individualized nutrition therapy built around minimally processed foods, including nonstarchy vegetables, whole fruits, legumes, lean proteins, whole grains, nuts and seeds, and other nutrient-dense foods.
The ADA also specifically recommends considering a reduction in total carbohydrate intake for some adults with diabetes to improve blood sugar.
But they don't tell you exactly how much carbohydrate to eat, which creates a practical question the guidelines can't answer for you: How low-carb do you need to go?
“Eat Low-Carb” Isn't a Prescription
I think about carbohydrate restriction differently when I'm using diet to treat type 2 diabetes.
It's a therapeutic diet because it has a specific job, which means it needs a specific dose.
If a medication wasn't lowering your blood sugar enough, your doctor wouldn't simply tell you to “take more metformin.” They'd prescribe a dose, measure your response, and adjust it if necessary.
Nutrition can be approached in a similar way.
“Eat fewer carbs” isn't much of a prescription because it's vague.
Eating 150 grams of carbohydrate per day is very different from eating 100 grams, 75 grams, or 30 grams. Each represents a different nutritional intervention and requires a different amount of restriction.
Despite what you read online, lower isn't automatically better. A very-low-carb or ketogenic diet requires more restriction and effort, and you may not need that level of change to get the result you want.
The goal is to find the least restrictive dietary approach that produces the health result you're trying to achieve.
The Right Diet Depends on the Goal
This is where generic dietary advice stops being very helpful.
Someone with an A1c of 6.6% who wants to improve their blood sugar may need a very different approach from someone with an A1c of 11% who wants to rapidly lower their glucose, avoid insulin, lose 50 pounds, and eventually pursue diabetes remission.
The appropriate intervention depends on where you're starting and where you're trying to go.
Your glucose and A1c, medications, degree of insulin resistance, body composition, weight-loss goals, activity level, food preferences, and ability to consistently follow the diet all matter.
So does your desired outcome.
The diet should match the job you're asking it to do.
Think of Carbohydrate Restriction as a Dose
When you're actively trying to change a metabolic problem like high blood sugar, it can be useful to stop thinking about diets primarily as labels—Mediterranean, low-carb, keto, etc.—and start thinking about them as different doses of a tool.
A moderate reduction may be enough.
If it isn't, you can reduce carbohydrates further and measure what happens.
A very-low-carbohydrate or ketogenic diet is simply a more aggressive version of that tool. Research suggests ketogenic diets can substantially improve glycemic control and may also improve weight and waist circumference in people with type 2 diabetes.
But greater restriction also comes with greater tradeoffs, and it may not be necessary—or appropriate—for everyone.
So instead, ask yourself this:
“How much do I actually need to change my diet to get the result I want?”
To be clear, carbohydrate restriction exists on a spectrum so there’s plenty of room for moderation. There isn't one universally accepted definition, but you'll commonly see diets described roughly as:
Moderate carbohydrate: more than about 130 grams per day
Low carbohydrate: less than about 130 grams per day
Very low carbohydrate: often less than 10–26% of total calories
Ketogenic: typically around 20–50 grams of carbohydrate per day, depending on how it is defined and measured
Again, these aren't prescriptions. They're useful descriptions of increasingly restrictive way of navigating your diet.
And importantly, you don't earn bonus health points for eating fewer carbohydrates.
If 100 grams per day gets your A1c, weight, and glucose where you want them, there may be little reason to eat 30.
If 100 grams isn't getting you there, that's when a more aggressive approach becomes worth considering.
Start With the Least Restrictive Effective Diet
If your doctor told you to “eat better” or “eat low-carb” without giving you much more direction, start by defining what you're actually trying to accomplish.
Are you trying to lower your A1c below 7%?
Get your fasting glucose below 100 mg/dL?
Lose 30 pounds?
Reduce medication?
Pursue type 2 diabetes remission?
Those aren't necessarily the same goal, and they don't necessarily require the same strict diet.
Then establish a starting point, follow it consistently enough to evaluate it, and measure the response.
If it's working, you may not need to make the diet more restrictive.
If it isn't working, that's useful information too. You can adjust the dose rather than abandoning the entire diet approach, or assuming you somehow “failed” the diet.
Start → Measure → Adjust
That's much more useful than arguing about whether Mediterranean, low-carb, or keto is the “best” diabetes diet.
The truth is, there probably isn't one. I've seen each of those approaches work when people commit to them for at least 3 months.
There is, however, a dietary strategy that is appropriate for your current metabolic health, your goals, and what you're willing and able to do consistently.
So if you're trying to decide what to eat after being diagnosed with type 2 diabetes, I would use the ADA recommendations as a starting point, then work with a diabetes specialist to determine the least restrictive diet that gets your blood sugar where you want it to go.
— Dr. Adam
Want help figuring out the right approach for your type 2 diabetes?
I’m a naturopathic physician accepting new patients in Montana and offering type 2 diabetes consultations and coaching outside of Montana.
If you're trying to lower your blood sugar, reduce medication, or determine whether remission is realistic, book a consultation and we'll figure out what makes sense for your goals.
Prefer to schedule over the phone?
Call 406-546-2164
References
American Diabetes Association Professional Practice Committee for Diabetes*; 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S89–S131. https://doi.org/10.2337/dc26-S005
Gong D, Lai W-F. Dietary patterns and type 2 diabetes: A narrative review. Nutrition. 2025;140:112905. doi:10.1016/j.nut.2025.112905. 10.1016/j.nut.2025.112905
Kilian J, Szlęzak D, Tyszka-Czochara M, Filipowicz-Popielarska E, Bronowicka-Adamska P. The Ketogenic Diet in Type 2 Diabetes and Obesity: A Narrative Review of Clinical Evidence. Nutrients. 2026 Jan 25;18(3):397. doi: 10.3390/nu18030397