Optimal diabetes management requires healthy, balanced eating, combined when necessary with insulin and/or medication, and blood glucose (sugar) control. The best way to manage your child's diet is to create a meal plan. Your child's meal plan provides the basis for healthy eating and safe blood sugar control. The meal plan discussed below features consistent carbohydrate intakes.
This approach to meal planning considers the total amount of carbohydrates eaten at each meal and snack and sets an amount of carbohydrates to be eaten in each meal and snack. After a careful review, the dietitian will recommend how much carbohydrates your child should eat at each meal and snack time. This amount stays the same every day until you, your child and your dietitian see a need for change.
This insulin regimen provides the same amount of insulin every day with some adjustments depending on blood sugar level. Some families find this regimen easier because they do not have to make significant adjustments to their child's insulin.
While on this type of insulin regimen, children must eat similar amounts and types of foods for meals and snacks at the same time each day. This will help them achieve and maintain the best possible control over their blood sugar levels.
If, for example, a child eats a huge dinner one night but skips dinner the next, it will be very difficult to adjust the insulin dose and prevent
hypoglycemic or hyperglycemic events.
Pino's story
Pino is 12 years old and was recently diagnosed with type 1 diabetes. He was started on a three-time-a-day (TID) insulin regimen, and follows a carbohydrate-consistent meal plan.
Pino's diabetes team considers his age, height, weight, meal diary and activity level, and decides that he will have 60 grams of carbohydrates at breakfast, 80 grams of carbohydrates at lunch, and 60 grams of carbohydrates at dinner, plus 15-20 grams carbohydrates during snacks.
Pino's meal variety with a fixed amount of carbohydrates
Pino's dietitian shows him and his family how to create meal plans based on these carbohydrate counts. The variations are endless, depending on what he wants to eat, so long as he remains within 5 to 10 grams of the total carbohydrates per meal.
An example of one of Pino's lunches:
- 2 slices whole wheat bread (30 grams carbohydrates)
- 2 oz chicken breast (0 grams carbohydrates)
- 1 tsp margarine (0 grams carbohydrates)
- 1/2 cup carrot sticks (10 grams carbohydrates)
- 25 grapes (25 grams carbohydrates)
- 1 cup (250 mL) milk (15 grams carbohydrates).
Total carbohydrates for lunch: 80 grams
Dinner for Pino usually has more variety. He likes to break his dinner down as follows:
- 2 grains and starches choices (30 grams carbohydrates)
- 1 fruit choice (15 grams carbohydrates)
- 1 milk and milk alternatives choice (15 grams carbohydrates)
- fats and meat (0 gram carbohydrates).
Total carbohydrates for supper: 60 grams
One option is for Pino to use all of his carbohydrates at dinner in the form of grains and starches; for example:
- 2 cups of cooked pasta (4 grains and starches choices for 60 grams of carbohydrates)
- 4 oz meat (0 gram carbohydrates)
- green salad with oil and vinegar (0 gram carbohydrates).
He might, however, opt to have a chocolate bar for dessert and reduce his carbohydrate consumption during his main meal; for example:
- 1 cup pasta (30 grams carbohydrate)
- 3 oz chicken (0 gram carbohydrates)
- green salad with oil and vinegar (0 gram carbohydrates)
- chocolate bar (30 grams carbohydrates).
The total carbohydrate count for both meal options is 60 grams.
Pino's meal plan is not a restrictive diet
Pino would have to make adjustments if he wanted to have his pasta with sauce (some store-bought pasta sauces contain added sugars), or if he wanted to have a glass of milk with his dinner or a piece of fruit instead of a chocolate bar for dessert. As a result, carbohydrate counting requires some math.
Carbohydrate counting may seem difficult at first, but it will get easier with practice.
The meal plan is not a diet. It is not meant to limit the amount a child can eat. Pino should feel satisfied, and his meal plan will change as he grows. He and his parents need to keep note of when his meal is no longer enough to satisfy his hunger. They should then let their dietitian know so they can help adjust the meal plan to allow for more food. The doctor or diabetes nurse will then adjust his insulin to balance his blood sugar levels.