Diabetes: Carbohydrate Counting Meal Plan

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KEY POINTS

• Carbohydrate counting is a food plan that adjusts your child’s insulin dose based on the amount of carbohydrates your child plans to eat. With the carbohydrate counting meal plan, your child’s insulin dosage and amount of carbohydrates are not always the same every day.
• Carbohydrates, also called carbs, are a source of energy for the body. Carbs are found in foods such as fruit, soft drinks, candy, pasta, bread, cereals, rice, potatoes, beans, peas, leafy vegetables, and fruits.
• Your healthcare provider and dietitian will help you create a schedule for your child’s meals and insulin doses. They can also give you guidelines for adjusting your child’s insulin dose.

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Carbohydrate counting is a food plan that adjusts your child’s insulin dose based on the amount of carbohydrates your child plans to eat. With the carbohydrate counting meal plan, your child’s insulin dosage and amount of carbohydrates are not always the same every day. This plan is more flexible than some other meal plans. It is usually started after you have learned how your child’s body responds to food choices and insulin.

What are carbohydrates?

Carbohydrates, also called carbs, are a source of energy for the body. There are three basic types of carbs: starches, sugars, and dietary fiber.

• Sugars such as glucose and fructose raise blood glucose very quickly. Sugar is found in foods such as fruit, milk, soft drinks, baked goods, and candy.
• Starches are found in plant-based foods such as pasta, bread, cereals, rice, potatoes, beans, and corn. Some starches are converted to energy very quickly, but others, such as whole grains, are converted more slowly.
• Dietary fiber is the part of plants that cannot be digested. Fiber is found in whole-grain bread and pasta, beans, peas, leafy vegetables, raisins, prunes, apples, and berries. Fiber can help control blood glucose by slowing how quickly your body absorbs sugar from foods.

You can find nutrition facts on the food label, in nutrition books or apps for your smartphone or computer, or on the Internet. Fifteen grams of carbs equals 1 carb choice. A gram is a way to measure how much something weighs.

Carbs affect your child’s blood glucose level more than protein or fat. If your child uses insulin, you need to balance how much insulin your child takes with the amount of carbs he eats. This helps keep your child’s blood glucose at a healthy level and helps prevent many health problems.

How does the carbohydrate counting meal plan work?

The main goal of this meal plan is to balance insulin with the carbs your child eats during the day. If your child is taking long and short -acting insulins, you will be adjusting only the short-acting insulin doses.

First, your healthcare provider needs to figure out how much insulin your child needs to take for the amount of carbs your child plans to eat. There are 2 ways to figure this out:

• I/C ratio: Most people use the insulin-to-carbohydrate ratio (I/C ratio). Your child’s healthcare provider or diabetes educator will help you figure out what your child’s I/C ratio should be. You then multiply the I/C ratio by the number of grams of carbs your child plans to eat. The I/C ratio multiplied by the grams of carb equals the units of insulin your child needs.

  An example of an I/C ratio is 1 unit of insulin for every 10 grams of carbs. If your child’s I/C ratio is 1/10 and he plans to eat 60 grams of carbohydrate, then your child needs 6 units of insulin.

• Units per carb choice (exchange): You can also count carbs in serving sizes of 15 grams. This is called a carb choice or an exchange. Your provider will tell you how many units of insulin your child needs for every carb choice that he eats. Units of insulin per carb choice multiplied by the number of carb choices equals the total units of insulin your child needs.

  You will adjust the units of short-acting insulin for every meal to match the number of carb choices your child eats. For example, if your child needs 1 unit of insulin for every carb choice, then for 3 carb choices, your child needs 3 units of insulin.

Your child’s insulin dose also depends on exercise, blood glucose levels, illness, and stress. In general, your child should take insulin at a time that allows the insulin to start working as his blood glucose starts to get higher. Sugar is absorbed into the blood about 10 minutes after your child eats. The peak in blood glucose from food usually happens about 60 minutes after he eats.

Your healthcare provider and dietitian will help you create a schedule for your child’s meals and insulin doses. They can also give you guidelines for adjusting your child’s insulin dose.

Which foods have carbohydrates?

Food groups that have carbohydrates include:

• Starchy foods (breads, cereals, rice, pasta, and starchy vegetables such as corn and potatoes)
• Fruits
• Milk and yogurt
• Sugary foods

Your child should eat only small amounts of sugary foods for a healthy diet. Serving sizes depend on the food. One tablespoon of sugar equals 1 carb choice. A sweetened drink may equal 2 or more carb choices. Check the nutrition facts label on the package to see how many grams of carbohydrate are in a serving.

Meat, fats, and vegetables do not affect your child’s blood glucose in the same way as carbs. However, these foods do count toward your child’s daily calories. Choose healthy kinds of meat and fat, and plenty of nonstarchy vegetables.

• Meats are protein. Your child should eat lean meat and not eat too much meat.
• Your child should not eat a lot of fats such as butter, oils, salad dressing, mayonnaise, bacon, and cream cheese.
• Your child should eat nonstarchy vegetables such as lettuce, broccoli, cauliflower, carrots, cucumbers, and celery. These vegetables do not count toward daily carbs.

How do I get started?

1. Before you start counting carbs, keep a careful record of your child’s food, insulin, blood glucose level, and exercise for at least 3 days. Measure and record your child’s blood glucose before meals and 2 hours after meals. Record all doses of insulin or oral medicines your child takes.
2. Your dietitian will review your records and work with your healthcare provider to decide how much insulin your child needs to take for the amount of carbs he eats.
3. Start counting carbs and adjust your child’s insulin dose. For the first 1 to 2 weeks carefully record the following:
   • The number of carbs your child eats at each meal or snack
   • Your child’s insulin doses
   • Your child’s blood glucose levels, especially 2 hours after meals
4. After a week or two, review your records with your dietitian or diabetes educator to see if any changes need to be made.

For books that help you with carb choices, exchange food groups, and other information to help manage diabetes, contact:

• The American Diabetes Association
  http://www.shopdiabetes.org/Categories/8-Diabetes-Books.aspx
  800-232-6455