You may ask yourself essential questions: How is the meal plan developed? How do I set the timing of meals and snacks? How much food should I provide? A registered dietitian (RD) will help create a meal plan to meet the needs of your child and family. The dietitian is experienced in nutrition planning for children and adolescents. The dietitian is a key member of your diabetes team.
The meal plan should be based on what and how much food your child normally eats. As such, food intake records (a "meal diary") help the dietitian figure out how much food your child typically eats. To create food records specific to your family, you and your family will be asked to record the amount and types of food eaten at each meal and snack over a period of about three days.
Your dietitian will review these records and calculate the average amount of carbohydrates, protein, and fat eaten at each meal and snack. This forms the basis of the meal plan and can also inform the insulin regimen. The timing of meals and snacks can be somewhat flexible, to work with the family’s routines as best as possible. As the child grows and daily routines change (for example, going to school, extracurricular activities, increased activity), the meal plan evolves accordingly.
Carbohydrate counting
People with diabetes have to plan their meals in order to manage their blood glucose (sugar) levels and stay healthy. People with type 1 and type 2 diabetes need to follow healthy eating guidelines — there is no specific "diabetic" diet.
Carbohydrate counting is an approach to meal planning that considers total amount of carbohydrates at a meal or snack. Carbohydrate counting will allow for more control, consistency, and flexibility with foods. You can match the amount of insulin with the amount of carbohydrates your child eats. It may also be used to control portions of carbohydrates.
What is a serving or carbohydrate choice?
The Canadian Diabetes Association has a food choice system, called Beyond the Basics: Meal Planning for Healthy Eating and Diabetes Management. It organizes food into seven groups, based on protein, fats, and carbohydrate content. Carbohydrates are further divided into grains and starches, fruits, milk and alternatives, and other choices.
- Food groups that contain carbohydrates and raise your blood sugars are:
- grains and starches
- fruits
- milk and milk alternatives
- some vegetables such as potatoes, sweet potato, carrots, peas, and corn
- other choices such as cookies, muffins, chocolate, candy, chips.
One serving of carbohydrates contains 15 grams of available carbohydrates (the equivalent of three teaspoons of sugar). A "serving" can also be referred to as "one carbohydrate choice" or "one exchange".
The following table provides carbohydrate content (in grams) for each food group.
| Food group |
One serving of carbohydrates (grams) |
|---|---|
| Grains and starches |
15 |
| Fruit | 15 |
| Vegetables | <5> |
| Meat | 0 |
| Fats | 0 |
| Milk and milk alternatives (8 oz or 250 mL) |
15 |
| Examples of one carbohydrate serving (15 g) | |
|---|---|
| Food group |
Example |
| Starch |
1 slice bread |
| ½ cup (125 mL) unsweetened cereal | |
| ½ hamburger bun or hot dog bun | |
| 3 cups (750 mL) popped popcorn | |
| 1/3 cup (80 mL) cooked rice | |
| ½ cup (125 mL) kernel corn (frozen or canned with no sugar added) or half a cob |
|
| ½ medium potato 75g | |
| 3 arrowroot cookies | |
| ½ cup cooked spaghetti | |
| 7 soda crackers | |
| 1 cup (250 mL) thick blended soup | |
| Fruit and vegetables | 1 medium apple |
| ½ banana | |
| 1 cup (250 mL) blueberries | |
| 1 cup (250 mL) watermelon | |
| 1 medium orange | |
| 2 cups (500 mL) strawberries | |
| Milk | 1 cup (250 mL) milk |
| 3/4 cup (180 mL) yogurt | |
The dietitian will teach you about healthy food choices, portion sizes, and carbohydrate counting.
It may seem difficult at first, but weighing and measuring food will help you learn to figure out what a carbohydrate choice and portion size look like. After a while, you will no longer need to double-check every measurement.
However, it is a good idea to go back to weighing and measuring foods from time to time. This helps you be sure that your estimates are still correct.
Health Canada maintains a list of foods with their nutritional analysis, including details about carbohydrate content. It is called the Canadian Nutrient File and can be helpful for foods that come without nutritional information.
Maintaining a healthy diet
Along with carbohydrate counting, you should consider food quality. Choose nutritious carbohydrates. "Wasting" carbohydrates on carbohydrate-rich but nutritionally empty foods can lead to poor growth and development. Therefore, it is better to choose an apple over a cookie, even if the sugar content in both is the same.
There are two methods of meal planning using carbohydrate counting
Method 1 is following a meal plan with a consistent amount of carbohydrates and insulin. With this method of meal planning, your child eats a set amount of carbohydrates at each meal and snack, and takes a set amount of insulin. Many families start with this method of meal planning.
Method 2 is following a meal plan with a fluctuating carbohydrate count per meal. With this method, your dietitian helps you decide how much rapid-acting insulin your child needs to cover a certain amount of carbohydrates; it is the insulin-to-carbohydrate ratio (I:C).
Choosing a meal planning method
Learn how to follow a consistent-carbohydrate meal plan or adjust insulin for carbohydrates to help keep your child’s blood glucose close to target levels. Your dietitian can help you decide which meal planning method is best for your family.