Carbohydrate counting

Healthy eating for diabetes is the same healthy eating advice for the general population. You need to have a healthy balanced diet and we base this around the Eat Well guide.

What are carbohydrates?

Carbohydrate foods that we eat are broken down into glucose by the body and therefore raise the blood glucose levels after a meal. Carbohydrate is the name given to both starches and sugars.

Starchy foods

• Bread and other foods made from flour such as chapattis, crackers, pitta bread, sauces and soups, pastry and Yorkshire puddings
• Potatoes, crisps and chips
• Rice pasta, noodles, couscous, and bulgar wheat
• Breakfast cereals, and oats
• Starchy vegetables such as sweetcorn, plantain, yam and sweet potato, squash and parsnip.

Wholegrain and wholemeal varieties are healthier.

Some starchy foods such as beans, lentils and dhal contain very slow release carbohydrate that can have less of an effect on your blood glucose. It is best to see how they affect you and we can help you to adjust your insulin. For now we will only count baked beans if you eat more than half a tin.

Naturally sweet foods

All fruit contains fructose (fruit sugar) and needs to be counted. In the same way milk and milk products contain lactose (milk sugar) and this also needs to be counted.

• Fruit including fresh, tinned and dried
• Milk
• Yoghurt, fromage frais, yogurt drinks, milk shake
• Custard, rice pudding

If you drink unsweetened fruit juice remember to count it.

Sugary foods

• Sugar, sugary drinks, Chocolate, sweets, toffees and mints
• Jam, marmalade, honey
• Cakes, biscuits, desserts, sweet puddings and ice cream.

There are also many other foods that contain very little or no carbohydrate at all.

Foods containing very little or no carbohydrate

These foods will not affect your blood glucose. However, if you eat too much of certain foods they may affect your health in other ways. For example, eating too many high fat foods can cause weight gain and an increase in blood cholesterol levels.

• Meat, fish, eggs, cheese and nuts
• Fats such as cream, butter, margarine and oils
• Mayonnaise and salad dressings
• Most vegetables and salads
• Pickles such as pickled onions
• Flavourings such as salt, pepper, soy sauce, herbs and spices
• Water tea and coffee
• ‘Diet’ and sugar free drinks
• Artificial sweeteners such as saccharin, aspartame, acesulfame K, Splenda, and Stevia

You will be shown how to recognise the carbohydrates you are eating and how to adjust your insulin dose for them.

The aim is to help your child grow properly, to feel well, have blood glucose levels within range and be symptom free.

Do we count all carbohydrate containing foods?

Yes. We do not carbohydrate count meat, fish, eggs, cheese or vegetables.

Are there any foods I should avoid?

Yes. We will advise you avoid sugary drinks including juice, fizzy drinks, milkshakes, tea or coffee with sugar or flavoured syrup, slush puppy or other ice drinks. We will also advise you avoid sweets including boiled sweets, chewy sweets, Haribo, lollypops, toffee, fudge.

The reason for this is that these all makes blood glucose levels rise very quickly and we are unable to match the insulin injected to the food making blood glucose levels high.

How do we quantify the carbohydrate foods?

We use the actual weight of a food and various sources to work out how much carbohydrate is in food. If something does not come in a measured quantity you will need to weigh it.

What kind of scales should I use?

Digital scales work best. Make sure you zero the scales after putting on a plate or bowl to make sure you only weigh the food.

How do I read food labels?

To read a food label you will need to locate the total amount of carbohydrate which is written carbohydrate: this includes starches and sugars (not just the ‘of which sugars’).

Nutrition

You will also need to work out what amount of the food you are eating:

Using ‘Carbs and Cals’ book

You will no doubt be shown this book during your admission to hospital. If a food does not come with a label such as cooked pasta, rice, potatoes, in store baked goods or fruit this is the place to look.

You need to check what weight of food you have to work out for your portion how much carbohydrate the food has. This is shown in the green circle which says Carbs.

This book is also available as an app and we will recommend that you download this before you leave hospital as it is very useful.

Meal times

What happens at breakfast?

When you wake in the morning you will need to test your blood glucose level before you eat or drink so it may be easiest to decide what you are going to eat in advance and work out the carbohydrate content of this.

If you are having breakfast in hospital there will be cereals, ready-brek and toast on offer as well as milk and fruit.

If you are having a bowl of corn flakes with milk, a banana and a slice of brown toast with butter you will need to work out how much cereal you are having by weighing it, measuring the volume of milk and use the ‘Carbs and cals’ book to work out how many carbs are in a banana and the slice of bread. You will not need to work out the butter as it does not contain any carbohydrate.

You will need to add the values from all the foods together to work out the carbohydrate value for the meal and after testing blood glucose you can work out how much insulin to give 15 minutes before this meal.

What happens at lunch and tea?

This is the same process as breakfast. You will need to test your blood glucose level before you eat or drink, so it may be easiest to decide what you are going to eat in advance and work out the carbohydrate content of this. Usually the hospital menus for lunch and evening meal are given out the night before.

You need to work out the carbohydrate content of the meal and give insulin 15 minutes before a meal.

For main meals you will need to add up the carbohydrate values of any carbohydrate containing foods as well as puddings and drinks.

Remember if you give insulin for a meal you need to finish eating it.

Can I have snacks and supper?

Please avoid having snacks between meals while you are in hospital as this helps us to stabilise your blood glucose levels sooner. You can however have snacks and supper if this has been discussed with the team and will certainly be discussed before you go home.

If you do really want supper this must be at least 2 hours after your evening meal and in hospital you will be offered a similar menu to breakfast time.

Should we avoid carbohydrate foods?

We do not advise that you avoid carbohydrate containing foods as these are important sources of energy and essential nutrients for growth.

Is there a limit to the amount of carbohydrates and insulin my child can have?

There is not normally a limit to the amount of carbohydrate you can have or insulin. Everybody has individual requirements for insulin and this will vary from day to day and week to week as your diabetes stabilises and as you grow.

We will give advice if we think your portions of carbohydrate are not age appropriate or if you are overweight or gaining weight too quickly as this can have very negative effects on your diabetes and long term health.

You will have a practical session on the ward with the following:

• Weighing and measuring foods
• Calculating the portion of carbs in your child’s diet
• Reading a label and making sense of it
• What is an insulin carbohydrate ratio
• What is a correction dose of insulin

At every meal time

• Make sure blood glucose checks are done pre meal and rapid insulin is given at least 15 minutes before the meal according to the meal being eaten
• Identify the foods containing carbohydrates
• Weigh the food and be able to work out how much carbohydrate there is in the food from either the ward food tables or ‘Carbs and Cals’ book
• To know the importance of a balanced meal and that omission of carbohydrate is not a heathy choice
• Be able to use the portion and weight of the foods to be eaten to work out the grams and amount of carbohydrate for the meal and add up to give a total amount of carbohydrate. We will continue this learning and build on it pre-discharge
• Using the insulin carbohydrate ratio for your child work out the actual dose of rapid insulin needed for the meal
• You then need to check if the blood glucose level is in range and if it is not and higher than the target then use correction chart to decide the extra insulin required and add to the meal bolus
• If a significant amount of the carbohydrate food in the meal is not eaten be aware you may need to offer an alternative within the next hour. Suitable items include bread, toast or cereal and milk, yogurt or fruit. Do not offer preferred or treat foods.

If a child is reported to be a picky eater or known to struggle to eat all on their plate then you can consider giving a smaller bolus before eating but the insulin should not be omitted and simply given at the end of the meal.