Diabetes: Carbohydrate Counting Meal Plan

________________________________________________________________________

KEY POINTS

• Carbohydrate (carb) counting is a meal plan that adjusts your child’s insulin dose based on the amount of carbohydrates your child plans to eat and drink. With the carbohydrate counting meal plan, your child’s insulin dosage and amount of carbohydrates are not always the same every day.
• Carbs are a source of energy for the body. Carbs are found in foods such as pasta, bread, cereals, rice, potatoes, beans, peas, starchy vegetables, fruits, sugary drinks, and candy.
• 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.

________________________________________________________________________

Carbohydrate (carb) counting is a meal plan that adjusts your child’s insulin dose based on the amount of carb your child plans to eat and drink. With the carbohydrate counting meal plan, your child’s insulin dosage and amount of carbs 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?

Carbs are a source of energy for the body. There are 3 basic types of carbs: sugars, starches, and dietary fiber.

• Sugars such as glucose and fructose raise blood glucose quickly. Sugar is found in foods such as fruit, milk, sugary 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 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, pears, apples, and berries. Fiber can help control blood glucose by slowing how quickly your body absorbs sugar from foods.

You can tell how much carb is in a food by reading the Nutrition Facts Label on food packages. You can also find the carb content of food in nutrition books, apps for your smartphone or computer, or on the Internet. Fifteen grams of carbs equals 1 carb choice. A gram is a measure of 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 or she eats and drinks. 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 and drinks each day. If your child is taking long and short -acting insulins or rapid-acting insulins, you will be adjusting only the short-acting or rapid-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 and drink. There are 2 ways to figure this out:

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

  An example of an ICR is 1 unit of insulin for every 10 grams of carb. If your child’s ICR is 1/10 and he or she plans to have 60 grams of carb, 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 or she eats or drinks. 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 has. 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 physical activity, 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 or her blood glucose starts to get higher. Sugar is absorbed into the blood about 10 minutes after your child has it. The peak in blood glucose usually happens about 60 minutes after eating or drinking.

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 carbs?

Food groups that have carbs include:

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

Focus on feeding your child nutrition-rich, whole foods. Examples include vegetables, fruits, dried beans, peas, whole grains, and dairy products. Your child should eat only small amounts of sugary foods. 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 food packages to see how many grams of carbohydrate are in a serving.

Meat, fats, and some 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 carb choices.

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 physical activity 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 child’s records and work with the healthcare provider to decide how much insulin your child needs to take for the amount of carbs he or she eats and drinks.
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 and drinks 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 2, review your records with your child’s dietitian or certified diabetes educator to see if any changes need to be made.

To learn more about carb choices and other information to help manage diabetes, contact:

• American Diabetes Association
  https://shopdiabetes.org/collections/diabetes-books
  800-232-6455
• American Diabetes Association, Diabetes Food Hub
  https://www.diabetesfoodhub.org/?loc=ff-slabnav
  800-342-2383