How to Eat Pizza When You Have Diabetes

It may be delicious, but pizza can be a challenge for people who have diabetes. A pizza crust is full of carbs, and because of the high fat and protein content in cheese and meaty toppings, blood sugar may stay higher for hours after eating it, says Heather Howard, RD, a registered dietician with Kaiser Permanente Northern California in Sacramento, California. This, in turn, can make it difficult to determine insulin dosing and lead to a blood sugar roller coaster.

Fortunately, with a little planning and flexibility on toppings, pizza can be part of a healthy diabetes menu. If you take insulin, talk to your doctor or nutritionist to learn how to properly dose for it.

And even the sauce can be problematic. “Pizza sauce is also made with added sugars, which adds extra carbs,” says Howard.

Because of these factors, pizza probably should not be a staple of your diet if you have diabetes. But Howard says it can be eaten in moderation — after you discuss how to enjoy it in a healthy way with your healthcare provider.

“The combination of the carbs in the pizza crust and the high-fat cheese or meat toppings requires a delayed bolus of insulin because this combo of carbs, protein, and fats will have a delayed rise in blood glucose,” says Toby Smithson, RDN, the senior manager of nutrition and wellness at the American Diabetes Association.

Howard adds: “I have seen patients require more units of insulin that cover the same carb amount with the high fat and protein content.”

“Consider delivering a portion of your bolus dose before eating and the remaining portion over a few hours to account for the slow-digesting fat and protein,” says Howard. This method is sometimes called an extended bolus.

“The extended bolus is a setting on an insulin pump that will give insulin in two doses — an initial dose before eating the meal and then the rest of the dose over a designated period,” says Smithson. She adds that this method is designed to mimic a functioning pancreas that releases insulin as needed.

If you use insulin injections with a syringe or insulin pen rather than a pump, you may be able to use multiple injections instead of just one.

“People who inject insulin can manually use the extended bolus by taking a dose of insulin before eating to cover the carbohydrate in the pizza and a second dose two to four hours after eating to cover the fat and protein in the pizza,” says Smithson.

The exact timing will depend on your own situation, and blood sugar monitoring remains critically important.

“To understand how pizza affects your blood glucose, check it before eating any type of pizza, and then check three to six hours after eating,” Smithson says. A continuous glucose monitor (CGM), which updates with new blood sugar measurements as often as every 60 seconds, is especially useful to learn how your body responds to high-fat and high-protein meals.

The best way to make pizza healthier is to simply eat less of it. It’s not always easy to stick to one slice on pizza night, but there are some practical strategies to help you stay within your healthy limits.

“Eating high-fiber foods first can help you feel fuller quicker, which might help with portion control of the pizza,” says Howard. “It may also slow down glucose absorption, allowing your daily activity to burn the extra calories and glucose.”

Low-carb pizza options can be a great way to enjoy pizza without spiking your blood sugar, and there are several ways to make that happen.

• Make Your Own at Home Creating your own custom pizzas allows you to have full control over the ingredients, so you can top it with more veggies than cheese and pepperoni. Plus, making your own pizza can lower your sodium intake and avoid other unhealthy food additives.

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• Find a Restaurant With Low-Carb Options Driven by the popularity of low-carb diets like keto, many restaurants now offer low-carb pizza options.

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   “Prioritize veggies over higher-fat meats on the pizza, and ask for thinner whole-grain crust with light cheese,” says Howard. Choosing crusts made with more whole grains, for example, may help to minimize blood sugar increases after meals.

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• Try Frozen Varieties Many grocery stores now stock frozen low-carb crusts and pizzas. But be sure to read the label before putting it in your cart. “There is no FDA definition for low-carb pizza, so the consumer should read the nutrition facts panel on packaged pizza to find out how many grams of carbs are in a pizza serving,” says Smithson.
• Experiment With a Cauliflower or a Gluten-Free Crust Some cauliflower pizza crusts have fewer carbohydrates, but this isn’t always the case,

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   and some gluten-free bread is low glycemic index, meaning it might make blood sugar rise less quickly.

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   However, gluten-free products can still have carbohydrates — sometimes even more than items with gluten.

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   Again, it’s always a good idea to read the nutrition labels.

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You can’t always know how low-carb crusts will affect your blood sugar. After trying a low-carb option, “be mindful and do more blood sugar checks to see how your body reacts,” says Howard. “Each person is very different.”

• When you have diabetes, enjoying pizza requires a bit of strategy and planning because the combination of high carbohydrates with fat and protein can lead to delayed blood sugar rises.
• Monitor your blood sugar levels carefully after eating and adjust your insulin doses as needed to help manage post-meal blood sugar spikes.
• For people who take insulin, you may need to consider extended bolus dosing with an insulin pump or timing injections to better handle pizza’s delayed impact on blood sugar.
• Practice moderation and experiment with low-carb pizza options to aid your blood sugar management.