Patient education: Carb counting for children with diabetes (The Basics)

What is carb counting?

Carb counting is a type of meal planning that many people with diabetes (or "diabetes mellitus") use. It is a way for people to figure out how many "carbs" they eat. "Carbs" is short for "carbohydrates."

The body breaks down the food we eat into 3 main types of nutrients: carbohydrates, proteins, and fats. Carbohydrates are sugars and starches that come from food. The body uses carbohydrates for energy.

People with diabetes need to watch how many carbs they eat, because carbs raise a person's blood sugar level.

Which foods have carbs?

Foods with a lot of carbs include:

Bread, pasta, rice, and cereal

Fruits and starchy vegetables

Milk and other dairy foods

Foods with added sugar (such as many cookies and cakes)

How is carb counting helpful?

Carb counting helps you:

Choose the right amount of insulin to give your child before meals and snacks – The insulin dose depends on different factors, including what your child eats (especially the amount of carbs) and how much they exercise.

Plan your child's meals and snacks for the day – You can use carb counting to figure out how many carbs your child should eat at each meal and snack.

Keep your child's blood sugar levels well managed – Spreading out the carbs your child eats over a whole day can help keep their blood sugar from getting too low or too high. Eating about the same amount of carbs every day also helps. This can help manage your child's diabetes better and prevent medical problems that diabetes can cause.

How do I count carbs?

To count carbs, look at the food's nutrition label (if it has a nutrition label). Look at the

"Total carbohydrate" number – This tells you how many carbs are in 1 serving size of the food. If your child eats 1 serving, the number of carbs your child eats is that number.

"Serving size" – This tells you how much food is in 1 serving. If your child eats 2 servings, the number of carbs is 2 times the number of carbs listed.

"Dietary fiber" – Fiber is a carb that is not digested and so does not raise blood sugar. Foods with a lot of fiber can help manage your child's blood sugar. If a food has more than 5 grams (g) of fiber, less insulin is needed for that food. So, only count the carbs that are not from fiber.

If your child's food doesn't have a nutrition label, talk with your dietitian (food expert), diabetes nurse, or doctor. They can give you information about the usual serving sizes of different foods and the number of carbs in 1 serving size.

How can I plan my child's meals?

Your child's dietitian will tell you how many carbs your child should eat in 1 day. It depends on your child's age and size, and how active they are.

You can spread out the total number of carbs over your child's meals and snacks for the day. That way, your child can eat some carbs at each meal or snack. Writing down the number of carbs your child eats at each meal and snack can help you keep track of the total number.

Does my child need special foods?

No. Your child can eat the same foods as your family. But, if possible, your family should eat a healthy diet with low-fat foods and lots of vegetables. It's best for your child to get carbs from fruits, vegetables, whole grains, and low-fat milk and dairy products. Whole grains are found in foods such as whole-wheat bread, whole-grain cereals, and brown rice.

What if my child is a picky eater?

If your child is a picky eater, try to be creative. Ask your dietitian, doctor, or nurse for ideas for new snacks. If your child refuses to eat at meal or snack time, try to have them eat or drink something else that has about the same amount of carbs. Otherwise, their blood sugar could get too low or too high.

Your diabetes team can also tell you how to adjust the timing and amount of your child's insulin dose when they are sick or their appetite changes.

What if my child eats food without telling me?

If your child eats extra snacks, remind them that eating extra food can raise their blood sugar level and lead to serious problems. Your child should always let you know if they want to eat extra food. That way, you can make sure that they get the right amount of insulin.