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DIETETIC AND CARBOHYDRATE COUNTING INFORMATION
For Children with Type 1 Diabetes
Patient Information Leaflet
July 2016
WHAT CAN I EXPECT FROM MY DIETITIAN?
In hospital (at diagnosis)
•
The Dietitian will to come and meet you and answer any questions during your hospital
admission.
•
We will provide simple diabetes related nutrition advice based on your individual needs,
and aim to put your mind at ease about eating, activity and the effect on blood glucose.
•
We will also start you on carbohydrate counting during your admission.
•
If the Dietician cannot come to see you during your first few days the Diabetes team will
explain basic dietary advice.
Back home:
We will offer
• the Dietitian to help support you as you settle in and start thinking about your normal diet.
•
Every 3 months the Paediatric Diabetes Team will offer you a review appointment, at
Tameside Hospital Paediatric Out-Patients with the Consultant, Specialist Nurse and
Dietitian.
•
Once a year we will offer for you to have an extra appointment with the Dietitian at
Tameside Hospital Paediatric Out-Patients Department, as part of your annual diabetes
review.
•
If you need extra support, we can arrange this also, usually at home, at scarbsol/day
care, in clinic or over the telephone.
What do I need to eat?
The important goals with your eating are:
1. Eat regularly – your Dietitian will tell you how often you need to eat.
2. Eat some food rich in starchy carbohydrates with each meal.
3. Reduce the amount of sugar in your food and drinks as this can cause high blood sugar
readings.
4. A diet with high fibre and at least five portions of fruit and veg is important to help keep
healthy blood sugar readings. A healthier diet can reduce the risk of heart problems and
other diabetes complications.
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What is carbohydrate?
¾ Often referred to as carbs
¾ A source of energy
¾ The only nutrient that affects blood glucose levels
¾ During digestion the carbohydrate foods you eat e.g. beans and toast, are broken
down into glucose (sugar).
¾ The glucose is then absorbed into the bloodstream causing a rise in your blood
glucose level.
Where can I find carbohydrate?
Starch
¾ Foods rich in starchy carbohydrate are generally a good source of fibre, vitamins and
minerals e.g. bread, pasta, rice, potatoes, cereal and pulses.
¾ Starchy foods take longer to break down and so will keep you feeling fuller for longer.
¾ Aim to include some starchy foods at each meal, limit high fat starchy foods e.g. crisps,
chips and pastries.
Sugars
Sucrose = table sugar
¾ Used to sweeten foods and drinks.
¾ Food and drinks that are high in sugar can cause weight gain and tooth decay.
¾ You don’t have to avoid sugar completely but try to limit foods and drinks with sugar as
the main ingredient.
Fructose = carbohydrate found in fruit.
¾ Fruit also contains fibre, vitamins and minerals.
¾ Aim to eat at least 5 portions of fruit and veg per day.
Lactose = carbohydrate found in milk.
¾ Provides energy, protein and calcium
¾ Try to have 3 portions of either: milk, cheese and/or yoghurt every day.
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Certain foods don’t contain any carbohydrate.
Such foods include:
¾ Plain cuts of meat and fish
¾ Eggs
¾ Hard cheeses
¾ Oils and fats
Carbohydrate counting
We count carbohydrates because it is the food/nutrient that affects the body’s blood glucose
levels. Once carbohydrate is eaten it usually appears in the blood as glucose (sugar) within 2
hours. Glucose is the body’s main energy source.
Insulin is needed to allow glucose to pass from the bloodstream into the cells of the body where
it is used for energy. Knowing the amount of carbohydrate in the food you eat allows you to
match the amount of fast acting insulin that you will need. Foods with a lot of carbohydrate will
need more insulin than those foods with less carbohydrate. Carb counting helps you to be more
flexible in managing your diabetes.
How we calculate the carbohydrate content in our food
We use a variety of resources or tools to help us calculate the carbohydrate content of different
types of food. These include:
¾ Carbs and Cals book
¾ Food labels
¾ Weighing scales
¾ Household measures such as spoons, jugs, cups etc
¾ Websites for restaurants or retailers
¾ Smartphone apps
Example of calculating carb content
To calculate the carb content of the food item you will need two pieces of information.
•
Firstly, the carbohydrate amount per 100 grams,
•
Secondly, the weight of the portion of food.
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The calculation is as follows:
Amount of carbs for serving = amount of carbs per 100 grams x serving size
100
Example
• A bowl of Rice Krispies cereal.
From the label on the cereal box the carbohydrate per 100 grams is 87grams. Having weighted
the Rice Krispies, the portion size is 55grams.
Amount of carbs per gram = 87grams = 0.87grams,
100
Amount of carbs per portion (55g) = 0.87grams x 55g = 48g of carbohydrate.
To be accurate with you carb counting you need to weigh your portions.
Using the per 100g value will give you the most accurate results.
Certain Foods will need tobe weighed , here are a few
•
Breakfast cereals
•
Cooked rice
•
Cooked pasta
•
Mashed potatoes
•
Chips
•
Bolied/Baked potato
Calculating your insulin to carbohydrate ratio
Your diabetes nurse or doctors with prescribe your insulin to carbohydrate ratio. The ratio
means the amount of insulin you will need for the amount of carbohydrate in your meal. For
example, you may be prescribed 1 unit of fast acting insulin per 15 grams of carbohydrate.
In the above example, for Rice Krispies, the total carbohydrate for the 55gram portion was
48grams. With a ratio of 1 unit of insulin to 15 grams of carbs you would need 48/15 = 3units of
insulin. Depending on your insulin pen you can round to the nearest half or full unit.
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Example.
Please complete the following worksheet
Jamie is 8 years old and has type 1 diabetes mellitus for the past 3 years. Along
with this parents he adjusts his insulin dose for the carbohydrate that he eats in
his meals and snack. His insulin to carbohydrate ratio (ICR) is as follows.
Breakfast
Lunch
Dinner
Supper
Jamie’s Breakfast
Bowl of Rice Krispies
(55g)
1 unit for 7g of carbs
1 unit for 10g of carbs
1 unit for 15g of carbs
1 unit for 20g of carbs
Carbohydrate in the food
portion
87.4g of carbs per 100g
= 87.4g carbs ÷100g of rice
Krispies
= 0.874g carbs per gram of
rice Krispies
Carbs &
Cals
book
Food
Label
Food
APP
Total
9
48g of carbs
55x 0.874 = 48g carbs
And milk (150ml)
5g CARBS per 100ml milk
= 0.05g CARBS ÷ 100ml milk
= 0.05x 150 =7.5g cards
9
Toast (Thick slice)
1 slice = 20.8g cards
9
Total carbohydrate
76.5g carbs
Total Insulin
ICR: 1 unit for 7g carbs
= (76.5 ÷ 7) x 1
= 10.9 units (round up to
nearest whole number)
7.5g of carbs
21g carbs
76.5g carbs
11 units
TAMESIDE HOSPITAL NHS FOUNDATION TRUST
Aim
to finish Jamie’s lunch and complete your own lunch
Carbohydrate in the food portion
Jamie’s Lunch
Tuna Sandwich:
2 slices of bread
Tuna
mayonnaise
Slices of Cucumber
And Yoghurt (150g pot)
And Banana (medium)
Total Carbohydrates
Total Insulin
20.8g CARBS per slice
No carbs in tuna
No carbs in mayo}
-
Carbs &
Cals
book
Food
Label
9
9
Food
APP
TAMESIDE HOSPITAL NHS FOUNDATION TRUST
Now try and fill in your typical breakfast, lunch and tea.
My Insulin to carbohydrate ratio: Breakfast
Lunch
Teatime
Supper
1 unit of insulin for ……….g of carbs
1 unit of insulin for ……….g of carbs
1 unit of insulin for ……….g of carbs
1 unit of insulin for ……….g of carbs
My Breakfast Carbohydrate in the food portion Total Carbohydrate Total Insulin Carbs & Cals book Food Label Food APP Total TAMESIDE HOSPITAL NHS FOUNDATION TRUST
Your lunch
Carbohydrate in the food portion
My Lunch
Total
carbohydrates
Total Insulin
Carbs &
Cals book
Food
Label
Food
APP
TAMESIDE HOSPITAL NHS FOUNDATION TRUST
Your evening meal
My Evening Meal
Total carbohydrates
Total Insulin
Carbohydrate in the food portion
Carbs &
Cals
book
Food
Label
Food
APP
TAMESIDE HOSPITAL NHS FOUNDATION TRUST
Snacking
Try not to have too many extra snacks, however if you do occasionally want something more,
the list below provides ideas which contain little or no carbohydrate and therefore will not affect
your blood glucose level:
•
Raw vegetables e.g. cherry
•
Sugar free jelly
tomatoes, celery, carrot, cucumber
•
Sugar free ice pops or lollies
and red pepper sticks
•
Cheese, cheese strings and mini
•
Olives
•
Nuts and seeds, e.g. sunflower or
pumpkin
cheeses
•
Cold meat e.g. chicken, ham and
salami
Some snacks contain higher amounts of fat and salt, for example cheese, smoked ham and
salami. Try to limit these snacks to keep your diet healthy.
Snacking on vegetables counts towards your 5 a day fruit and vegetables!
What about food shopping?
•
Planning the first food shop with diabetes may seem scary. The following tips are based
on comments that other families have made.
•
Plan ahead
•
Write a list out before you go to the shops.
•
This makes it easier to focus on the things you need.
•
This also gives you the chance to look through the leaflets you have been given by the
diabetes team and clarify anything that you may be uncertain about.
• Remember to buy items for hypo treatment for at home and at school
Set time aside
•
Although you don’t have to spend a long time studying food labels, it is good to be able to
take your time going around the shop, as you may need to think about buying extra items
e.g. for hypo treatment.
•
Allow plenty of time so that you don’t feel under pressure to finish quickly.
Think about who is going
•
Could a relative or friend look after younger children?
•
Older teenagers are likely to want a say in food shopping.
Don’t try to read all of the food labels
¾ Remember diabetes doesn’t mean that any food will be harmful to your child
¾ If you want to know more about reading and understanding food labels ask your Dietitian.
Don’t buy diabetic products
¾ They can be expensive.
¾ They are higher in fat to make up for the reduced sugar
¾ They can even cause a laxative effect.
Sport and Exercise
I have diabetes can I still take part in sport and exercise?
¾ YES! Physical activity is important for everybody and can help lower your blood glucose
levels.
¾ Children and young people are recommended to do 1 hour each day at least 5 days each
week.
¾ There is no exercise you can’t do just because you have diabetes.
Exercise helps you to:
¾ Feel good
¾ Have a healthy weight
¾ Have a healthy heart
¾ Have lowered blood fats
¾ Have improved circulation
¾ Have improved insulin sensitivity
¾ Socialise with friends and family
How much extra carbohydrate will I need?
¾
•The amount and type of carbohydrate (carbs) that you will need depends on the type of
exercise, its intensity and how long it will last.
¾
•Your activity could be planned like swimming or gym class or unpredictable like playing
at the park on the way home from scarbsol.
¾
•Your diabities team will advise you on managing your insulin doses for any planned
exercise activities.
¾
•If you spend lots of time waiting around for your turn e.g. in some PE classes, it’s
unlikely you will need extra carbs. So make sure you aren’t having extra carbs if you don’t
need them; just have your normal drinks, meals and snacks.
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The following is some guidance on how your blood sugar levels
should read prior to exercise.
¾ Aim to start exercise with blood glucose levels between 5-8 mmol/l.
¾ If your blood glucose level is between 4 – 5 mmol/l you may need to eat an
extra snack of approximately 10grams of carbohydrate.
¾ If your blood glucose level is between 8-15 mmol/l you may not need extra
carbohydrates.
¾ If your blood glucose level is ≥15mmol/l, check for ketones.
It is
recommended that you don’t exercise if your blood glucose is ≥15mmol/l with
ketones and/or you feel unwell.
During a particularly strenuous activity such as football training or dance class,
additional carbohydrates may be needed dependant on the time of your last meal
eaten and how much insulin you had.
An individual exercise plan can be devised by your diabetes team. It is important to
complete blood glucose checks before, during and after exercise to understand what
is happening and then to tailor a plan for each individual person.
What about after exercise?
•
Your blood glucose can drop up to 18 hours after exercise.
•
This is because your muscles need to replenish the energy/glucose used
during exercise.
•
It is often a good idea to have an extra carb containing snack, perhaps before
bed, particularly if the exercise was strenuous but this will be considered as
part of your individual plan.
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TAMESIDE HOSPITAL NHS FOUNDATION TRUST
Who to contact for advice
Paediatric Diabetes Nurse Specialists during office hours 08.30- 16.30
•
Office: 0161 922 5262 (Mon-Wed)
•
Karen Wright 0161 922 4844 (Mon-Thur)
•
Jenny Butterworth 0161 922 5433 (Tues-Fri)
•
Paediatric Dietitian 0161 331 5165 (Wed-Thurs)
Mobile:
07760991621(Karen), 07775032136 (Jenny)
Out of hours: 0161 922 6000 - hospital switchboard and ask for on-call paediatric
registrar
Other Useful Contacts or Information
NHS Direct
Patient Information Centre
Diabetes UK
Hanas, Ragnar (2004) Type 1 Diabetes in children, adolescents and young adults:
How to become an expert on your own diabetes. Class Publishing, London.
References accessed:
http://www.ndr-uk.org/Diabetes/Diabetes-Explained.html
Clinical Paediatric Dietetics, 4th Edition, Vanessa Shaw/
If you have any questions you want to ask, you can use this space below to remind you
If you have a visual impairment this leaflet can be made available in bigger print or on audiotape. If you require either of these
options please contact the Patient Information Centre on 0161 922 5332
Author: Rosemarie McCarthy (Dietitian)
Division/Department:
Date Created:
Reference Number:
Version:
Paediatric Diabetes Team
July 2016
1.0
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