When your child is first diagnosed with type 1 diabetes, suddenly having to track and count everything she eats in order to calculate insulin doses can feel overwhelming. But you will get the hang of it! Read on for some new and time-honored tricks to get you started.
Why Carbs Count
Carbohydrates in the foods we eat break down into glucose, our body’s main source of energy. The hormone insulin helps transport glucose into cells once it is broken down, which helps cells fuel up.
For most of us, this conversion of carbs into energy requires no conscious effort on our part. It’s different for people with type 1 diabetes, however. Because their bodies don’t produce enough insulin, people with T1D are required to “think like a pancreas” and balance the number of carbohydrates in their foods with the right dosage of insulin.
This is where carb counting comes in.
To calculate your child’s insulin dose accurately, you need to know how many carbs are in the foods your child eats — and this means quickly becoming an expert in food label reading, measuring portion sizes of foods, and estimating carbs in foods that don’t come with a label.
The Lowdown on Food Labels
To figure out your child’s insulin needs for foods with nutrition labels, there are two key nutrient facts to zero in on: serving size and carbohydrate grams.
The food’s “serving size” is listed near the top of the label; the rest of the nutrition information, including carb count, is based on this amount of food. The serving size may be half a cup or multiple cups, half a bottle or the whole container, or a number of ounces. Read carefully.
Carbohydrates are listed a little further down the label as “Total Carbohydrates” and are counted in grams. Since kids don’t always eat a full serving size, you may need to do some extra math to figure out how many carb grams will be in their portion.
As New Jersey-based dietitian Erin Palinski-Wade, R.D., C.D.C.E.S. explains, “If your child will only be eating one-half of the serving size listed on the label, you then count only one-half of the carbs.” For example, if the label on your can of soup says that a 1-cup serving contains 10 grams of carbohydrates, and you know your child will only eat about a ½-cup portion, cut the number of carbs in half, to 5 grams, as you calculate insulin needs.
Under Total Carbohydrates, your food label will also contain additional information about carbohydrates called “Total Sugar” and “Dietary Fiber.” These additional counts can sometimes cause confusion — what are they used for?
According to Palinski-Wade, “Total Carbohydrates is the amount of all carbohydrate in the food [and is the amount used for calculations]. Total Sugar indicates how much of this carbohydrate is actual sugar. The more carbohydrate from sugar, generally the faster the food will be digested and the quicker it will impact blood glucose levels.”
New food labels break down Total Sugar further to list “Added Sugars.” As Palinski-Wade explains, “If a food contains 10 grams of total sugar with 0 grams of added sugar, this indicates all the sugar in the food is naturally occurring, as you might see in a fruit [e.g., unsweetened applesauce].” Healthier foods generally contain very little or no added sugar.
On the flip side, food labels also indicate how much fiber (in grams) the serving contains. Fiber generally slows down glucose entering the bloodstream, because it takes longer for the food to break down during digestion. In some situations and for some foods, your care team may advise that you subtract grams of insoluble fiber from the total carb count when making calculations. You can ask your child’s provider which foods could prompt this exception.
Food labels also provide information about calories, fats, protein, and other nutrient facts. Your care team can help you understand how to use these nutrition facts to plan a healthy, balanced diet for your child.
Getting Comfortable With Carb Counts
To grow your skills in the fine art of carb counting, Laura Cipullo, R.D., C.D.C.E.S., C.E.D.R.N., a dietitian in private practice in New York and New Jersey, recommends going through a carb-counting resource guide to familiarize yourself with the carbohydrate grams found in common foods, and their serving sizes. For example, one medium banana contains approximately 27 grams of carbs; the typical turkey sandwich contains around 35 grams.
Most carb-counting guides provide information on everything from restaurant foods to home-baked casseroles and other foods that don’t come with a label. Familiarize yourself with different serving sizes; for more accurate carb counts, use measuring cups when serving sizes are given in volume (cups, milliliters) and a food scale to help count carbs by ounces or grams.
As you educate yourself about foods, include your child in this process as a first step towards taking more ownership of their diabetes. Kids just learning how to read may not be comfortable extracting information from food labels or carb guides, but there are other ways to help them quickly master this information.
“Teach to the eye,” recommends Cipullo. “You can educate your child on what a serving size of a favorite food looks like and how many carb grams it contains by taking pictures of meal and snack choices in the appropriate sizes and keeping these within easy access on a phone or printed out.” It’s also helpful to show kids what servings of “free foods” (generally defined as foods under 5 grams of carbs per serving) look like, so take pictures of those too.
Another estimation trick is to pre-measure snacks into small portion-size bags labeled with the carb grams. If you know that a good target for your child’s snack is around 30 to 45 grams of carbs total, your child can mix and match bags to meet that carb goal. Learning what these serving sizes look like can help kids better estimate when pouring out a snack from the original container later on.
In today’s world, there’s a smartphone app for just about everything, including counting carbs in foods. When you’re eating out, or whenever you come across a food that doesn’t come with a food label, carb-counting apps offer you the ability to swipe and tap your way to instantly locate the nutritional info you need for an almost limitless assortment of foods.
Amazing, right? It is, but apps for carb counting do come with some traps that you’ll want to avoid.
As North Carolina dietitian Julie Cunningham, M.P.H., R.D.N., L.D.N., C.D.C.E.S., notes, “Food labels come straight from the manufacturer, so if the ingredients change, the food label should change too. The companies that program carb-counting apps may not always be aware of changes in food composition right off the bat, so it’s possible that carb counting info on the app might not be up-to-date.”
Palinski-Wade shares this concern. “If you use a carb-counting app, be sure the nutrition information it pulls in is from a trusted source, like the USDA database. Apps that use self-reported nutritional information can provide inaccuracies. For foods that contain a food label, I would always opt to use the label to track carbohydrate intake to be as accurate as possible.”
Still, families have busy lives, “and it’s a lot easier to carry a smartphone around than it is every box of food in your pantry, so by all means, use the app,” says Cunningham. If a carb count from an app seems “off,” double-check it using a food label before you dose. If you are using an app to look up restaurant foods, keep in mind that you can also often visit the restaurant’s website for up-to-date nutrition information, or call ahead to the restaurant.
Besides ease of looking up foods, another main pro to using a carb-counting app is the ability to change the serving size of the food and let the app instantly recalculate the carbs for you. “With a food label, the portion size may be unrealistic, and you’ll have to do the math yourself. If you’re not a math whiz, apps make life easier,” says Cunningham.
Sometimes the choices the app has for serving sizes don’t quite match how much your child is eating, or the type of food. If you’re trying to quickly figure out how many carbs are in the homemade brownies that a parent brought for a surprise celebration after the last soccer game of the season, for example, you’ll need to do a little guesstimating.
If your app lists serving size in ounces, and you don’t have a scale handy, a good rule of thumb for foods like brownies and similar baked goods is that a 1-inch square of the food equals about 1 ounce. If your app tells you that a 1-ounce brownie has about 18 carb grams, do your best to visually measure the size of the brownie being portioned out. Is it more like 2 inches square, or 2.5? You can simply multiply the carbs to get a reasonable estimation.
Some apps are also equipped to provide an accurate carb count of “complex foods” like a homemade casserole made from a recipe. You simply copy and paste the recipe into the app, and it produces a carb count per serving (for example, ⅛ of a tray of homemade lasagna).
Hidden Carbs and Tricky-to-Count Foods
Unfortunately, it’s easy to overlook “hidden carbs” in certain foods that just don’t seem like they would contain many carbs, but in fact pack in a pretty significant number of them.
“In my experience some of the tricky foods can be salad dressings and barbecue sauce [which both can contain added sugar], and even vegetables. Many people might not even count veggies, but 1 cup of cooked broccoli can yield 7 to 10 carb grams, which might make a difference in insulin dosing for some kids,” says Marina Chaparro, M.P.H., R.D.N., C.D.C.E.S., a dietitian from El Paso, Texas. So check those food labels carefully! Even something like a simple vinaigrette salad dressing can come with significant amounts of added sugar.
Speaking of sneaky carbs, how about some of those classic kid situations like licking the spoon after you’ve just whipped up a batch of cookies, or even sampling a few pieces of the cat’s food? In general, say dietitians, don’t worry about factoring in these tinier doses of carbs.
Probably the most notorious food for tricky carb-counting is pizza. You may have the number of carbohydrate grams exactly right, but as Chaparro explains, “the addition of extra fat [from cheese, meats, and other ingredients] can delay the absorption of carbohydrates, which will ultimately affect blood sugars.” Figuring out how to cover pizza with insulin is something you may need to work on with your child’s care team if difficulties arise. It’s something that challenges even veteran D-parents, so don’t be discouraged if it takes a while to master!
Double-Checking Your Work
One way to gauge if your carb-counting skills are on point is to monitor your child’s blood sugar after meals. Is it falling within the expected range? Or is it trending high or low? Using this kind of information can help you verify the accuracy of your carb counting and show you which foods you may need to recalculate.
It’s also important to keep carb counting in perspective. As Cipullo has found, “while grams of carbs are helpful when balancing blood sugar, kids will always face hypo- and hyperglycemia challenges due to changes in sleep, exercise, hormones, and seasons.” In other words, an out-of-range blood sugar reading may have nothing to do with how accurate your calculation was.
If your child is trying a new food, Cipullo suggests choosing a smaller portion of the food and pairing it with protein and fat. “Keep a blood glucose and food diary to observe how your child’s body responds.” Some kids may encounter certain foods that seem to defy the rules of carb-to-insulin ratios, so take note of those and modify as needed.
“Carb counting is an art and a science,” says Chaparro. “Knowing the basics like reading a label and determining portion sizes can go a long way, but practice makes perfect!”
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.