Pizza and Diabetes: Dietitian-approved tips for eating pizza with diabetes

Pizza and diabetes can be tricky to navigate, but it is possible to enjoy your favorite slice of pizza while managing your diabetes. 

Personally, pizza is one of my favorite foods, but it’s also quite difficult to enjoy and still maintain balanced blood sugars. Pizza and diabetes takes some planning and strategic thinking to navigate, but it is possible!

Can pizza raise your blood sugar?

Yes, pizza contains carbohydrate, and often a good deal of carbohydrates. So yes, it will raise your blood sugar. But, what we’re going to focus on in this article is how to tweak or manipulate that rise in blood sugar to happen at a speed that we’re comfortable with. In other words, we’ll focus on how to have a nice steady rise and then fall in blood sugar instead of a rapid spike or the dreaded “delayed spike”.

Pizza and diabetes and delayed blood sugar spikes

Remember, when we consume carbohydrates along with fat, fiber, and protein, we can slow down how quickly those carbohydrates raise blood sugar levels. But, with pizza, we also sometimes see a “delayed spike” because of the large amounts of fat in most pizza. The high fat content causes your GI tract to take an extra long time to digest pizza (also a reason you may feel sleepy after eating pizza), so blood sugars seem fine, or may even drop low, initially. But, a few hours later you see a large blood sugar spike. 

We’ll talk about different strategies to prevent initial spikes and/or delayed spikes, how to manipulate the fat and carbohydrate relationship, and most importantly, how to have confidence when it comes to eating pizza and diabetes. 

Pizza and diabetes: 3 main questions to ask

When thinking about enjoying pizza with diabetes, there’s a few things we want to keep top of mind.

1. How much pizza should you eat? 

This will depend on several factors:

• How much do you want to eat? Your hunger and satisfaction matters!
• How many carbohydrates at a meal does your body respond well to?
• Do your medications dictate how much carbohydrate you should have at a meal?
• How filling/satisfying is the pizza you’re having?

2. Are your macronutrients balanced?

Pizza has all of our macronutrients: fat, carbohydrates, and protein. But, there are things we can do to make sure we’re choosing blood sugar friendly versions of those macronutrients:

• Choose a crust that has fiber and protein
• Opt for toppings with fiber and lean protein
• Choose sauces that limit added sugar and fat
• Cheese is fine of course, but it’s usually best to only use a moderate amount

3. Do you want pizza?

If you want pizza, eat pizza. Anyone living with diabetes can tell you how judgmental other people can be about pizza and diabetes (and a lot of other foods quite honestly). But, remember that you can eat pizza if you want to, and you can eat it how you want to as well. You get to decide what is best for your body and your situation. Don’t let judgmental looks or comments from others deter you form enjoying your food.

Pizza and type 1 diabetes

I am a registered dietitian and have also been living with type 1 diabetes for 30 years, and I can honestly tell you I STILL have trouble dosing for pizza sometimes. It’s a hard food to figure out. That’s just a fact. But, it doesn’t mean you can’t enjoy it.

Most people with type 1 diabetes will struggle with the delayed spike phenomenon that we discussed previously, so let’s look at some ways to potentially avoid that. 

*Always with your doctor if you have specific questions, or before you make any changes to your insulin dosing schedule.*

Step 1: Divide your bolus into 2 or 3 parts

Many people choose to divide their total amount of insulin needed for the pizza into 2 to 3 parts and give it at different intervals. Any of these may be an option based on what you decide with your healthcare team:

• Pre-bolus (given 15-30 minutes before eating)
• While you’re eating your pizza
• Immediately after finishing the pizza
• Delayed bolus (given 1-2 hours after finishing your pizza)

Step 2: Decide how to divide up those boluses/injections and decide on your timing

What percentage of your total dose to give at what time will depend on many different factors, and I can’t ethically write an article saying give this amount at this time. We are all unique and different. But, just know that it’s perfectly normal to give multiple injections/boluses when managing pizza and diabetes.

Examples of Timing 

Here’s an example. Let’s say I’ve calculated that I need 5 units of insulin for the pizza I’m about to eat. I may choose to do any of the following:

Example	Before Eating	During Eating	After Eating
A	2 units 15 minutes before	–	1 unit when I’m finished eating Give 2 units an hour after finishing eating
B	1 unit 30 minutes before eating	Give 2 units while eating	Give 2 units 2 hours after eating
C	3 units when I start eating	–	Give 2 units 2 hours after eating

There are many other ways we could divide that dose of 5 units up. The three above are just examples. Again, how to divide the dose up and when to give it will depend on your unique needs.

Pizza and type 2 diabetes

With type 2 diabetes and pizza (non-insulin dependent), we don’t have quite as much timing and medication dosing to worry about, but it is still important to think about the potential impact on your blood sugar levels. 

For most people with type 2 diabetes, a 15-30 minute walk after eating pizza would likely be a great option to help prevent a blood sugar spike. And, I also highly encourage choosing your favorite vegetable or salad combination to enjoy alongside your pizza. I have a great list of options below. 

Pizza and gestational diabetes

Mamas with gestational diabetes can still enjoy pizza too! Prioritizing fiber and protein is key, and making sure to follow any carbohydrate guidelines given by the doctor or dietitian.

Best pizza crust for diabetes

So, the first thing to think about when navigating this whole pizza and diabetes dilemma is what type of crust do you go with? And, I hate to break it to you, but there is no one right or wrong answer. Just some things to consider… As long as you’re choosing a pizza crust that you actually enjoy eating, and that has protein and fiber, it should be a good option. 

Some diabetes-friendly pizza crust options include:

• Whole wheat
• Ancient whole grains
• Grain free
• Whole grain tortilla
• Cauliflower crust (see notes below)
• Egg white wraps/tortillas

Is gluten free pizza crust better for diabetes?

There is no data to support that a gluten free crust is better for your blood sugars than a crust that has gluten in it. If a blood sugar friendly crust is gluten free, I can assure you that the lack of gluten is not the reason it is blood sugar friendly.

One of my favorite frozen pizza crusts is made with whole ancient grains. So, it has more protein and fiber than a typical crust, but also happens to be gluten free. Again, the gluten (or lack thereof) has nothing to do with it, but rather the presence of protein and fiber.

Whole wheat pizza for diabetes 

Whole wheat pizza crust will have slightly more fiber and protein than traditional white flour pizza crust, but I’m going to be honest… it isn’t all that much. To really make a difference in fiber and protein content, we usually need to add some other whole grains, or additional ingredients. 

Cauliflower pizza and diabetes

The idea of adding some veggies into your pizza crust is great! But, be careful. A lot of “veggie” based crusts are often made primarily with a rice-based flour which is not very blood sugar friendly. If you opt for a cauliflower crust, check to see what other flours are used as well.

Best diabetes-friendly pizza toppings

Some of my favorite protein and/or fiber rich toppings include:

• Bell peppers
• Onions
• Mushrooms
• Olives
• Spinach
• Tomatoes
• Chicken
• Lean sausage
• Fried egg

Obviously, this is not an exhaustive list, but simply some of my favorites.

Best frozen pizza for diabetes

Next time you head to the grocery store, check out these frozen pizza options…

1. Amy’s Cheese Pizza Snacks: Imagine a blood sugar friendly pizza pocket and that’s what you have with Amy’s Cheese Pizza snacks! Each serving has 9g protein and 25 Total carbohydrate.
2. Cappello’s Grain Free Pizzas: Cappello’s offers a delicious pizza crust option made from almond flour. It crisps up well in the oven and can handle lots of toppings unlike some other grain free crusts I’ve tried.
3. Smart Flour Foods Ancient Grains Pizza Crusts: Smart Flour Foods is hands down my favorite blood sugar friendly pizza crust option. It is lower in carbohydrate than standard pizza crusts and tastes delicious!
4. Urban Pie Pizza Co. Spinach & Roasted Mushrooms Thin Hemp Seed Crust Pizza: Urban Pie offers some amazing ready to cook frozen pizza options. They add nuts and seeds to their crusts and pile on the veggies too.

And, make sure to check out over 30 more frozen dinner ideas that are perfect for people with diabetes.

Best take out pizza for diabetes

So, maybe you’re not making your own pizza but just want to order one. Choosing the best pizza option at a restaurant comes down to the type of crust and the toppings you choose. And, you also want to try to find nutritional information ahead of time online if you can.

Diabetes friendly pizza restaurants

Pizza and diabetes is already a bit tricky to navigate, and throwing in a restaurant experience can be even more complicated. So, I like to be as prepared as possible. Check out my Best Fast Food For Diabetes recommendations post for my favorite pizza delivery options… There’s a whole section in that post about “Can people with diabetes eat pizza?” and I list my go-to delivery options. 

1. Blaze Pizza allows you to build your own pizza and customize your toppings. This means we can add more veggies and lean proteins than we would get at other restaurants. I also love their half pizza and salad combo option. Research has shown that eating non-starchy veggies (like greens in a salad) and protein before a higher carb food item (like pizza) may help promote more stable blood sugars.
2. MOD Pizza also offers a customizable pizza experience. For most of their 11-inch crusts, a whole pizza will run about 80-90g carbohydrate. This includes the cauliflower crust as well. But, they do offer a 6-inch pizza crust that has 38g carbohydrate and can be loaded up with veggies and lean proteins. And, you can even pair it with one of their delicious salads!

Best pizza side dishes for diabetes

Part of increasing the protein and fiber in a meal with pizza, also involves what we eat along with the pizza. And while you can certainly just eat the pizza itself, if you want something else, try to include an additional fiber source like veggies or a delicious salad, like some of these:

• Low Carb Broccoli Ranch Salad with Bacon
• Easy Air Fryer Carrot Fries
• Creamy Dijon Spinach Artichoke Dip
• Basic Balsamic Green Beans

For those days when pizza isn’t on the menu, grab a copy of my cookbook The Easy Diabetes Cookbook for quick, simple, blood sugar friendly meals and snacks!

This post was updated from its original publish date in July 2021.