Patient Guide to Managing Your Child's Type 1 Diabetes

Meal Planning for Children with Type 1 Diabetes

Understanding Carbohydrates for Optimal Blood Glucose Management

When you have a child with type 1 diabetes, it's easy to get carried away with the notion of a diabetic diet. But in reality, your child's dietary needs are no different from a child who doesn't have diabetes. Of course, there are certain considerations you need to be aware of, and understanding the carbohydrate content in food is arguably the most important. In this article, you will learn about the importance of carb counting, with a special emphasis on how fiber and sugar alcohols may also affect your child's blood glucose (blood sugar) levels.

Nutrition Basics
There's really no such thing as a diabetic diet. That's why you should focus instead on providing your child with balanced nutrition. A good nutritional resource to consult is the Food Pyramid. In recent years, the United States Department of Agriculture has made some updates to the standard Food Pyramid that most of us grew up knowing. Instead of being a set-in-stone guideline, now you can create personalized eating plans that are flexible and balanced. To refresh your memory on healthy eating, visit ChooseMyPlate.gov.

There are 3 main nutrients in foods—fats, proteins, and carbohydrates. These essential nutrients affect blood glucose in different ways.

  • Fats: Fat typically doesn't break down into sugar in your blood, and in small amounts, it doesn't affect your blood glucose levels. But fat does slow down digestion, and this can cause your blood glucose to rise slower than it normally would. After a high-fat meal, your child's blood glucose may be elevated up to 12 hours after the meal.
  • Proteins: Protein doesn't affect blood glucose unless you eat more than your body needs. In most cases, you need only about 6 ounces or less (which is about the size of 2 decks of cards) at each meal.
  • Carbohydrates: Carbohydrates affect your blood glucose more than any other nutrient. All of the carbohydrates in food turn into sugar in the blood, and they get into the blood at a much quicker rate than fats and proteins. Carbs usually enter the blood stream an hour after consumption and are usually out of the blood stream in 2 hours. That's why you should check your child's blood glucose levels before he or she eats, and then again 2 hours later. Ideally, the measurement after the meal should be within 30-50 points of the pre-meal levels. If it's not, you will need to adjust the carb content of the meal or adjust your child's insulin dosage.

Carb Counting, Meal Plans, and Insulin Adjustment
For people with type 1 diabetes, knowing the amount of carbohydrates in the food you eat is essential. The reason carb counting is so important is that the amount of carbohydrates in your child's meals determines his or her insulin dosage. Unfortunately, a one-size-fits-all insulin regimen doesn't exist. Your doctor will determine the appropriate dose for your child. To learn more, read our Patients' Guide to Insulin.

It's fairly easy to determine the total amount of carbohydrates in the food your child eats. All packaged foods contain a Nutrition Facts label, and that contains the total carbohydrates in each serving size. If the food doesn't have a label, your dietitian can give you resources that contain the carbohydrate count of common foods.

Everyone responds differently to carbohydrates. That's why working with a registered dietitian or certified diabetes educator (CDE) is so important. He or she will develop a balanced meal plan especially for your child that is based on your child's food preferences, nutritional needs, and medication (some insulin medications require that you eat a set number of carbohydrates in each meal, while others allow for more flexibility). The meal plan will contain the right amount of carbohydrates for your child.

Meal plans aren't strict in the sense that they outline specific foods to eat at any given meal; rather, they help you pick from specific food groups. This will help you manage the amount of carbohydrates in each meal, while still offering your child a balanced selection of food. Meal plans are also flexible in that they can accommodate to special events, such as birthday parties.

For healthy growth, it is important that your child follows his or her meal plan. Not only should your child eat from the food groups outlined in the plan, but he or she should also eat them at a specific time. Eating meals and scheduling insulin injections at the same time every day helps prevent blood glucose levels from getting out of control. Parents with younger children may find this aspect of type 1 diabetes management somewhat easier than parents who have teenagers. Not only are teens busier with activities and social schedules, but they are also transitioning to managing their diabetes without the help of their parents.

Fiber and the Type 1 Diabetes Diet
Fiber is important to any diet. Found primarily in fruits, vegetables, beans, and whole grains, fiber may reduce blood cholesterol, aid in weight management, and improve blood sugar levels by slowing the absorption of sugar.

When it comes to fitting fiber into your child's type 1 diabetes meal plan, you need to understand how fiber affects a food's true carbohydrate count. Fortunately, it's a very simple formula.

If the food contains at least 5 grams of dietary fiber, simply subtract half the grams of dietary fiber from the total carbohydrate grams (you can easily find this information on the Nutrition Facts label on packaged foods). The total equals the net carbohydrate count in the food. For example, if a food contains 10 grams of total carbohydrates and 5 grams of dietary fiber, the amount of carbs that will affect your child's blood glucose is 7.5 grams.

Dietary fiber may have less impact on blood glucose since it is not absorbed 100% and releases glucose into the cells more slowly. The American Diabetes Association recommends that if a food has more than 5 grams of fiber per serving, you can subtract the amount of dietary fiber from the total carbohydrate. However, synthetic forms of fiber are being added to many processed foods, which may not provide the same benefit as natural foods. You may want to initially subtract only half of the fiber and check your glucose level after meals containing high-fiber foods.

A Special Note about Sugar Alcohols
Foods with sugar alcohols (sorbitol, isomalt, xylitol, etc.) on the ingredient list are popular with people with diabetes. Many sugar-free products, such as candies, chewing gums, and dessert items, contain sugar alcohols.

Sugar alcohols are artificial sweeteners. Unlike regular sugar, sugar alcohols don't need insulin to be metabolized and won't cause your blood glucose to spike. They also contain fewer calories than pure sugar.

Products made with sugar alcohols are often geared toward people with diabetes, but understand that these foods should be eaten in moderation. When consumed in controlled amounts, sugar alcohols won't cause blood glucose to rise. But if eaten in excess, these products will raise blood glucose in people with type 1 diabetes. It's also important to remember that foods made with sugar alcohols still contain carbohydrates. Always make sure to check the total carbohydrates listed on the Nutrition Facts. This will help you better understand how to fit them into your child's meal plan.

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Managing Type 1 Diabetes at School
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