Breakfast is the most important meal of the day — right? For people with type 1 diabetes, this statement couldn’t be more true. What we choose to eat for breakfast will likely impact our blood sugar levels for the entire day, setting us up for a tedious struggle or potentially a day of smooth sailing on the blood glucose front.

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While there’s always room for an indulgent day of pancakes or a cinnamon roll, the choices we make on a daily basis at breakfast are ideally made in the best interests of our diabetes (and therefore well-being).

Let’s take a look at breakfast goals, pitfalls, tips, and strategies to ensure that your breakfast does more than kick-start metabolism for the day — that it also sets you up for greater blood sugar management success.

 

What does a “balanced breakfast” with type 1 diabetes look like?

Overall, any balanced meal should contain a healthy mix of carbohydrates, fat, and protein. How much of each should you eat for breakfast? The answer to this question isn’t easy, because not only are there several schools of thought on nutrition here, but there are also variations in your body’s unique needs and reaction to foods.

Despite the recent low-carb craze, “it is actually important to ingest a small amount of carbohydrates in the morning,” says Jennifer Okemah, a Washington state-based dietitian, Diabetes Education and Care Specialist (DCES), and sports nutritionist. “The liver has been working overtime all night long, creating fuel for the body by breaking down stored glucose (glycogen) into glucose.”

By eating at least some carbohydrates for breakfast, you “break the fast” and this signals to the liver that it can settle down producing glucose, Okemah explains. This also explains why your blood sugar spikes when you skip breakfast altogether.

“When carbs are over-restricted in the morning, behaviorally, people tend to crave more carbs later on,” Okemah says. Adding protein and fat to the meal ensures it’s satisfying and slows down the digestion of the carbohydrates.

But how many grams of carbohydrates, fat, and protein should you aim for?

“High-carb/low-fat, or high-fat/low-carb are the ideal combinations for the sake of blood sugar management. Find the ratio that feels best for you and your body and your energy,” encourages Christel Oerum, founder of the diabetes fitness community DiabetesStrong, certified personal trainer, and book author. Oerum has also lived with type 1 diabetes herself for more than 20 years.

Okemah and Oerum both recommend a similar approach when it comes to breakfast:

  • 10 to 20 grams of net carbs (total carb – dietary fiber grams = net carbs)
  • Choosing foods with a low glycemic Index rating (less likely to spike blood sugar)
  • At least 10 grams of protein
  • At least 10 grams of fat

A few examples from Okemah and Oerum include:

  • Ezekiel muffin with egg whites and 1 slice of cheese
  • High-fiber toast with nut butter
  • High-fiber toast with avocado
  • High-fiber toast with an egg or soy cheese
  • ½ cup cottage cheese with 1 fruit
  • Plain Greek yogurt with added nuts or berries
  • Corn tortilla with scrambled egg whites and avocado

For some, a bowl of steel-cut oats might feel like a healthy, energizing, easy-to-manage blood sugar option. But for others, that bowl of oatmeal may lead to a lethargic feeling and a 6-hour assault on your diabetes that nearly ruins the rest of your day.

Oerum personally prefers to make protein the priority of her breakfast, with a combination that adds up to about 30 grams of protein, 15 grams of carbohydrates, and 10 grams of fat.

She warns that a breakfast high in both fat and carbohydrates will create the most difficulty when it comes to blood sugar management.

“When you combine high-fat and high-carb, the effects of that meal on your blood sugar will definitely linger longer because the fat slows down the digestion of carbs — and most of us are already more insulin-resistant in the morning due to hormones.”

“It also depends on your body and what you’re doing right after you eat,” Oerum adds. “For example, I eat breakfast, and then I go right to the gym.”

Regardless, Oerum recommends making consistency the biggest priority.

“The more consistency there is in the meals you eat, the easier blood sugar management becomes because you know exactly how much insulin you need for that meal. Choose three or four breakfast meals that you enjoy and rotate through them. You could eat one specific meal for a few weeks and then change it to something else.”

She also suggests learning how to swap different proteins or different carbs for added flexibility. If the overall macronutrient profile of carbs vs. protein vs. fat is the same, you’ll have a good idea of its impact on your diabetes while still enjoying some flexibility in food choices.

 

Why breakfast with type 1 diabetes can be tricky...

For people with type 1 diabetes, morning can be the most insulin resistant time of day, for a few reasons. People with T2 diabetes can also experience insulin resistance and higher blood sugars in the morning for the same reasons, but it’s less common compared to those with T1.

Let’s take a closer look.

Cortisol

As soon as your feet hit the floor in the morning, your body releases a surge of hormones — especially cortisol. This creates temporary insulin resistance, which means your blood sugar can be more difficult to manage in the morning and around breakfast if you don’t increase your insulin doses.

While cortisol is often discussed in a negative light, it’s a critical part of your body’s ability to handle stress — even good stress like excitement and moments of joy!

There is such a thing as too much cortisol, but on a daily basis cortisol helps to keep you alive.

“Blood levels of cortisol vary throughout the day, but generally are higher in the morning when we wake up, and then fall throughout the day,” according to the Society for Endocrinology.

“This is called a diurnal rhythm. In people that work at night, this pattern is reversed, so the timing of cortisol release is clearly linked to daily activity patterns. In addition, in response to stress, extra cortisol is released to help the body to respond appropriately.”

The Dawn Phenomenon

The Dawn Phenomenon refers to rising blood sugar levels generally between 2 a.m. and 8 a.m. that are the result of cortisol, glucagon, growth hormone, and adrenaline (a.k.a. epinephrine).

Glycogen is essentially stored glucose released by your liver. Because you’ve been “fasting” all night while asleep, your liver releases glucagon which is then converted back into glucose and serves as a fuel source your body’s energy needs until you eat breakfast. If you’ve ever tried intermittent fasting and struggled with spiking blood sugars while skipping breakfast, glucagon is likely a big part of that spike.

Adrenaline also increases blood sugar levels by signaling to your liver to release glucose.

Growth hormone increases blood sugar levels by making your body’s muscle and fat tissues less sensitive to insulin, thus requiring more to get the job done. (This is also why growing teenagers need significantly more insulin during these years when growth hormone levels are surging.)

The Somogyi Effect

The Somogyi Effect refers to severe low blood sugar that might occur while you’re sleeping, followed by your liver releasing glucagon in order to bring you up to a safe level. However, that release of glucagon can lead to a rebound high blood sugar. Since this is happening while you sleep, you may not be aware of the severe low and think that you need more insulin to correct the high.

Waking up a few nights in a row to check your blood sugar, and then working with your healthcare team, can help identify if this is the cause of your morning highs. With the increased prevalence of continuous glucose monitors this is also easier to identify.

Adjusting insulin doses to compensate for these morning hormones

In terms of blood sugar management, it simply requires an increase in your insulin doses, but where and when to increase your insulin can be tricky.

“I check my blood sugar as soon as I wake up, and I take a full unit of insulin, walk the dogs, and then go home and eat breakfast,” explained Oerum. Her approach is common — many with type 1 diabetes (including myself) find they need 1 unit of insulin immediately upon waking to prevent morning blood sugar spikes.

“You could change your basal rates in your insulin pump to address dawn phenomenon, but it’s not always 100 percent consistent so it can be helpful to actually just wake up, check your blood sugar, and take that small bolus of insulin unless you woke up with a low blood sugar.”

If your blood sugars tend to rise earlier — while you’re still sleeping — that would be a good reason to adjust your background insulin doses via your basal rate or long-acting insulin dose, with the support of your healthcare team.

All of this will help you stay in a healthy blood sugar range heading into breakfast.

 

Foods to avoid at breakfast

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There are quite a few popular foods these days that are touted as healthy breakfast options, but for a person with type 1 diabetes these foods can be nothing but trouble.

Smoothies

There’s a big difference between the high-protein/low-carb protein smoothie you might make at home and the smoothies you’ll find at Jamba Juice, Smoothie King, Grabbagreen, and others.

The typical fruit smoothie can easily contain anywhere from 50 to 100 grams of carbohydrates and more than 600 calories. And you didn’t even chew those calories!

While it may be advertised as “no sugar,” it likely still contains high-glycemic sweeteners like honey or agave nectar, along with pure juice, and some actual fruit.

“At Jamba Juice, you’re ordering a large dessert,” says Oerum. “A lot of the smoothies remove the pulp and fiber — which helps you feel full — and it’s just a sugary substance. If you insist on finding a store-bought smoothie, ask to see all of the ingredients and make changes where you can, like removing the honey. Realistically, you’d be better off making your own at home instead.”

Make your own low-carb protein smoothie instead!

Using a “Vitamix” or “Nutribullet” or any other at-home mini-blender kitchen device, you can easily make your own high-protein, low(er) carb breakfast smoothie.

Here’s what you’ll need:

  • protein powder (whey, egg-white, collagen, vegan, etc.)
  • unsweetened milk (almond, cashew, flax, rice)
  • 1 cup of fresh or frozen low-glycemic fruit (blueberries, strawberries, etc.)
  • 1 tablespoon of a fat source (chia seeds, peanut butter, etc.)
  • Optional: 1 to 2 teaspoons of psyllium husk (corn husk fiber) for bulk and healthy bowels

Mix it up:

Use 2 scoops of Orgain protein powder, 1 cup of fresh blueberries, 1 tablespoon of peanut butter, 1 teaspoon of psyllium husk, and fill the rest with unsweetened almond milk.

Nutrition info per 16-ounce serving:

  • 337 calories
  • 23 grams net carb
  • 12 grams fat
  • 25 grams protein

If you feel better with a higher-fat breakfast, you can reduce the fruit quantity and increase the fat quantity.

Traditional cereal, granola, and oatmeal

Boxed cereal is one of the most highly processed, starchy products you could choose that will surely send your blood sugar skyrocketing. And while the carbohydrate count may say it contains 30 grams per 1 cup, it’ll likely impact your blood sugar as if the carb-content is twice as much.

“Those processed grains in cereal are already so broken down that your body really doesn’t have to do much during digestion, which means all the resulting glucose will hit your bloodstream fast,” says Mara Schwartz, RN, DCES, and coordinator of the Diabetes Prevention Program at Self Regional Healthcare in Greenwood, South Carolina.

“When it comes to oats, if you’re buying the right kind — steel cut whole oats instead of instant oatmeal — it can work for some people, but in my experience, not for most,” said Schwartz. “It’s still a very high-glycemic, starchy grain. And the slow rate of digestion for oats can make blood sugar management tricky.”

And granola, added Schwartz, is basically whole oats painted in some type of high-carb sweetener along with a lot of fat.

“The other problem with these pure-carb choices, like cereal, at breakfast is that you’re often hungry again just an hour or two later, and then you crave more starchy, processed carbs,” Schwartz told DiabetesMine.

Toast, muffins, pancakes, and more...

When it comes to toast, pancakes, muffins, and other breakfast baked goods, Schwartz said these should be considered a luxury indulgence, like a cupcake.

Schwartz recommends reading the book “Bright Line Eating” by Susan Peirce Thompson, who says that ingredients like highly processed white flour should be considered as addictive as cocaine and sugar — both of which are also plants.

“It doesn’t matter if it’s whole grain flour or white flour, traditional muffins, pancakes, scones, and breads are made with heavily processed starch. They are dessert. If you’re consistently choosing these types of things for breakfast, you’re going to struggle with your blood sugars, your energy, and your weight.”

“Don’t fall for ‘whole-grain’ labeling,” she warned. “Unless you’re looking at actual chunks of whole grain, it’s still just as processed as white flour.”

 

Foods to focus on at breakfast

Eating a low(er)-carb meal at breakfast will not only make diabetes management easier, it’ll likely leave you feeling more energized and satiated because you won’t have large amounts of insulin in your system or big swings in your blood sugars.

But remember, bacon on its own is not a breakfast nor a healthy diet. The more you can strive to get plenty of plants into your breakfast, too, the better off you’ll be. Recent research has found a link between strict ketogenic diets and cardiovascular issues. Instead of focusing on simply avoiding carbs, the goal could be to get more vegetables into your diet along with high-quality sources of protein and fat.

Low-carb sources of protein and fat

 

Low-carb breakfast recipes we love

Easy ways to eat more vegetables at breakfast

Getting a low-carb, veggie-packed breakfast every morning doesn’t require exceptional cooking skills or even fresh vegetables! Make things as simple as you need to so a healthier breakfast can be made in 5 minutes or less.

Sometimes that means preparing chopped veggies for the week or putting frozen things into the microwave. It’s all worth it versus stopping at Starbucks for a sugar-laden scone and a coffee drink containing 60 grams of sugar.

Make your breakfast choices count!

Some ideas you can try:

  • The quickie salad: A salad doesn’t have to be beautiful or contain 8 different veggies. Pack a bowl full of “power greens” from the grocery store (or Costco), add a handful of pre-shredded carrots, drizzle a little of your favorite salad dressing, and eat it up along with some breakfast sausage or a few eggs!
  • Microwave veggie medley: Scoop 1 to 2 cups of your preferred frozen vegetable medley into a small bowl, microwave for 3 minutes, add a little sea salt, and pair it with a bowl full of Greek yogurt and blueberries. Easy.
  • Eggs and veggies: While sautéing two eggs, throw a handful of chopped onion, bell pepper, and broccoli into the pan!
  • Raw veggies while you drive: Every Sunday, buy a few cucumbers, bell pepper, and carrots. Chop them all into finger-food size. Put them into single serving Ziplock bags (or something more reusable) and eat a bag every morning on your way to work.
  • Easy cabbage “coleslaw”: At the start of the week, put half a cabbage into a food processor for a light shredding. (Don’t turn it into sawdust!) Put shredded cabbage into a big tupperware container, add a bag of shredded rainbow carrots and chopped cucumber. Every morning, fill a small bowl with your cabbage coleslaw and a light layer of your favorite salad dressing paired with your favorite protein source and some fruit.

 

What about your coffee?

Coffee can definitely raise your blood sugar by signaling to your liver to release more stored glycogen and breaking it down into glucose for fuel.

But Okemah warned that drinking coffee without breakfast will not only likely raise your blood sugar — and require a bolus of insulin even when your coffee is black — it can also create a “crash and burn” effect that comes with a big craving for carbohydrates.

“Caffeine shuts off the mechanism that makes us feel hunger. This is a great thing... until it wears off!” said Okemah. “That’s when people tend to overdo carbohydrates.”

Okemah recommends eating something with your morning coffee whether or not you feel “hungry” to help prevent this messy cycle that could likely lead you to impulsively eating a doughnut from the breakroom you’ve been resisting all morning.

 

Dosing insulin for breakfast

You’ll likely need more insulin at breakfast than other meals: “If you use the same carb ratio all day long, you probably need a different one for breakfast,” said Oerum. “In the morning, you’ll likely need more insulin often because of those early hormone surges.”

High-fat meals: Oerum and Schwartz agree that higher-fat breakfast choices likely need a split insulin dose, taking part of your dose when you start eating, and the rest of it an hour or two later. (Although some people may find this is the case for oatmeal, too.) For those on insulin pumps, this could be done with a dual-wave bolus.

High-carb meals: For higher-carb choices, a pre-bolus is going to make a big difference. This means taking your insulin dose about 15 minutes before eating to ensure that your insulin is active by the time those carbohydrates are being digested.

High-protein meals: And don’t forget, just because your meal is mostly protein doesn’t mean you don’t need insulin.

 “The reason we dose for carbs is because carbs impact our blood sugars most aggressively, but fats and proteins impact your blood sugars but less aggressively and in a different way in terms of units of insulin. All food that turns into energy will impact your blood sugar to some extent.”

Protein powders, for example, are already so broken down that they are digested very quickly, and large quantities of protein will be partially converted into glucose. You’ll have to experiment closely to see if your body needs, for example, 1 unit of insulin for 2 small scoops of Orgain’s vegan protein or 1 big scoop of whey protein.

Skipping breakfast altogether? Intermittent fasting is quite trendy these days, but it’s not for everyone. Read this Guide to Intermittent Fasting with Type 1 Diabetes, but keep in mind that people with a history of eating disorders or other related stomach health issues should probably avoid fasting or consult their healthcare team before starting.

Above all else, don’t give up! Check your blood sugar often, consider the variables at play, and take good notes. If you ate a certain meal, took your insulin, and your blood sugar was lower or higher than your goal range, that gives you information to apply to the next time you eat that meal.

 

This article has been medically reviewed by Maria S. Prelipcean, MD, on 9/16/2019.