Diabetes Health Center

Carbohydrate counting is a skill that can help you and your child plan his or her meals to manage diabetes and control blood sugar. Carbohydrate counting also can allow your child to eat a variety of foods, just like other kids, and to increase his or her sense of control and confidence in managing diabetes.

When you and your child know how much carbohydrate is in food, you can spread it throughout the day and control portion sizes. This helps to keep your child's blood sugar in his or her target range after meals. High blood sugar can make your child feel tired and thirsty and, over time, can damage many body organs and tissues.

Key points

• Carbohydrate is the nutrient that makes blood sugar rise the most.
• Using this method to provide consistent carbohydrate at each meal helps a child maintain blood sugar at his or her target level.
• You should consult a registered dietitian or certified diabetes educator to help you and your child understand and use carbohydrate counting.

• Type 1 Diabetes: Recently Diagnosed
• Type 1 Diabetes: Children Living With the Disease
• Type 2 Diabetes in Children

Carbohydrate counting is the recommended method of meal planning for people who have diabetes. It involves adding up the amount of carbohydrate in the foods you eat. Spreading carbohydrate evenly throughout the day helps prevent high blood sugar after eating, because carbohydrate affects blood sugar more than other nutrients. Within 2 hours after a person eats any kind of carbohydrate, most of it has changed to blood sugar. Foods that contain carbohydrate include:

• Fruits and vegetables.
• Milk and yogurt.
• Starchy foods (such as breads, cereals, vegetables such as potatoes and corn, and dry beans such as kidney beans and lentils).
• Sugary foods (such as candy and cakes).

Foods that contain sugar usually have more total carbohydrate in a serving than foods that contain starch. Contrary to what you may have heard, your child can eat foods that contain sugar, such as cookies. But if foods that are high in sugar make up a large part of your child's meals and snacks, he or she is probably getting too much carbohydrate and is not eating enough of other, more nutritious foods.

Carbohydrate counting helps you know how much carbohydrate your child is eating during a meal or snack to provide a more accurate estimate of how much his or her blood sugar will rise after eating. The more carbohydrate he or she eats at one time, the higher the blood sugar level will rise. Carbohydrate counting also helps if:

• Your child takes insulin before meals and his or her doctor wants to vary the dose according to the amount of carbohydrate in the meal. Even if your child doesn't take insulin, carbohydrate counting will help keep his or her blood sugar in a target range. Often your child's doctor may suggest that your child take one unit of fast-acting insulin for every 10 to 15 grams of carbohydrate in a meal. This insulin-to-carbohydrate ratio is not the same for every person and will be decided by you and your child's doctor. For more information on carbohydrate counting when using insulin, see:

  Diabetes: Counting carbs if you use insulin.

• Your child wants to eat a high-sugar food, such as a piece of birthday cake. You can substitute the piece of cake for a serving of other carbohydrate food in your child's meal plan. If your child takes insulin, you can adjust the insulin dose to cover the extra carbohydrate. Your doctor or certified diabetes educator can teach you how to do this.

Spreading your child's carbohydrates throughout the day will help keep his or her blood sugar levels within a target range, preventing low or high blood sugar. Both low and high blood sugar levels can cause emergency situations. Over time, high blood sugar levels can damage many body tissues and organs.

Here are some ways to help you and your child count the carbohydrate content of his or her food and spread the amount throughout the day. Your child will have the best chance of success if you and other members of the family also eat a balanced diet. If your child has type 2 diabetes, an added benefit of a balanced diet is that the whole family's risk for the disease will decrease.

Establish a meal plan

• Talk with a registered dietitian or certified diabetes educator to help you plan the amount of carbohydrate to include in your child's meals and snacks. You can show the number of servings of each food group for each meal by using the meal plan form(What is a PDF document?).
• Learn what makes a standard portion of carbohydrate foods. Each serving size or standard portion contains about 15 grams of carbohydrate.
• Learn how to count either grams or servings of carbohydrate.
• Learn the standard portions of foods that contain protein. Protein foods, such as meat and cheese, are an important part of a balanced diet.
• Limit saturated fat. Talk with a registered dietitian about how much fat to include in your child's meals.

Start counting

• Use the meal plan to select food for your child's meals and snacks. Remember, high-sugar foods or sweets should be eaten only sometimes and in smaller servings than starches, fruits, and milk.
• Serve standard portions. You don't have to weigh and measure your child's food. But that may help keep carbohydrate amounts consistent when you are first learning what makes up a standard portion.
• Check your child's blood sugar level often. If you check it before and 1 to 2 hours after a meal, you will be able to see how the food your child eats affects his or her blood sugar.
• Record what your child eats and his or her blood sugar results in a food record. At each regular visit with a certified diabetes educator or a registered dietitian, or whenever you think the meal plan needs a change, you can review the food record(What is a PDF document?).

Other helpful suggestions

• Read food labels for carbohydrate and calorie content. Notice the serving size on the package. See a picture of a food label .
• Get more help. The American Diabetes Association offers booklets that can help you learn how to count carbohydrates, measure and weigh food, and read food labels. See the Where to Go From Here section below for the address and phone number of the American Diabetes Association. You will still need to talk with a registered dietitian or a certified diabetes educator to make a plan that fits your child's needs.

Now that you have read this information, you are ready to plan regular meals and snacks and calculate the amount of carbohydrate in your child's diet.

Talk with your child's doctor

If you have questions about this information, take it with you and discuss it with your child's doctor. You may want to mark areas or make notes in the margins of the pages where you have questions.

If you and your child need help with carbohydrate counting or meal planning, ask to speak with a registered dietitian or certified diabetes educator. If you have been keeping a food diary for your child, take it with you when you visit the diabetes educator or registered dietitian.

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