Diabetes Nutrition Basics
for Optimal Health and Blood Glucose....................................................................
Dietary needs for children and adolescents withdiabetes are similar to those without diabetes.
There are 3 main nutrients in food: fats, proteins,and carbohydrates. These three main nutrients
have differing effects on blood glucose levels.
Your body needs all of these types of nutrients tobe healthy and strong. This book is yournutritional resource for creating a personalized,
healthy and well-balanced eating plan for your child.

This booklet
will cover thefollowing topics
in detail:basic food groups,
carb counting,eating out, FAQs,
resources,carbohydrate chart....................................................................
Santa Clara Pediatric Endocrinology Department

Basic Food Groups....................................................................................

Carbohydrates = Energy
Carbohydrates are one of three major nutrients in our diet. They provide fuelfor our brain and nervous system. Yet, not all carbohydrates are equally healthy.
After consuming a meal with carbohydrates, blood glucose levels will rise. During
digestion, 90-100% of carbohydrates convert into glucose. This glucose will enter
the blood stream 15 minutes to 2 hours after consumption. The dosing of insulin is
proportional to the amount of carbs consumed. Children need energy fromcarbohydrates in order to utilize proteins for optimal growth and development.

Carbohydrate-Containing Foods
Healthy Carbs
The following carb-containing foods also give yourchild important nutrients such as vitamins and minerals:- Breads and whole grains (100% whole grain bread,
100% whole wheat pasta, brown rice, quinoa, farro,bulgur, barley, millet)- Starchy and non-starchy vegetables (potatoes,
pumpkin squash, lima beans)- Fruits, milk, and yogurt- Dried beans, lentils, and peas>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Less Healthy Carbs

The following carb containing foods do not offer many nutrients and may make blood sugar management
more difficult-Sweets, desserts, candy, sugary beverages – Gatorade, juices,energy drinks, soda
- Processed packaged snack foods like pretzels, cookies, chips,
popcorn, crackers, cereal, energy bars, granola bars

2Protein and Fats...............................................................................................................
Protein and fats play an important role in many basic functions of the body including providing
energy, and helping cells and tissues function well.

Protein has minimal effects on blood glucose

levels if eaten as part of a meal. But protein will
have an effect on your blood glucose if eaten inlarger amounts. In most cases, your child needs
only 3 ounces (about the size of 1 deck of cards)
at each main meal. Choose a lean cut of protein(for example skinless poultry breast, tenderloin,
90% fat free meat, fish) to limit unhealthy fats inyour diet

Fats typically do not convert into blood sugar.

However, fat does slow down digestion, and thiscan cause your carbohydrates to be digested
more slowly overall. After consuming a high-fat
meal (examples: French fries, cheese burger,
pizza, Chinese food, pasta with cream sauce, orfried chicken), your child's blood glucose may
continue to rise up to 6-12 hours after the meal.
Since most of the insulin for the meal is used up
within 2-4 hours, there will be a risk of early low
blood glucose (BG) followed by sustained high
BG’s after fatty meals. Ask your endocrinologist
how to adjust insulin to handle these types of highfat meals.

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Carb Counting: Tools and Strategies....................................................................................

The basis of carbohydrate counting is knowing which foods containcarbohydrates. Remember, the quality of carbohydrate matters.
Use appropriate portion sizes for your child, and estimate carb counts
at each meal and snack. Estimating the amount of carbohydrates
in various foods may require practice. Here are some ideas.
.............................................................................................

Meal Planning

The first step in carb counting is to have a meal plan. The meal plan should guide you to decide how muchcarbohydrate, protein, and fat to eat at each meal and snack. Use the plate method and carb counting
strategies for meal planning. Consistency is the key to a successful meal plan. But the meal plan must be
flexible and realistic. Include favorite familiar meals, as most of us are creatures of habit when it comes tofood. Make a list of meals that your family enjoys to create a weekly menu plan, and consider writing carb
counts on your list for future reference.

>>>>>>>>>>>>>>>>>>>>>>>>>>>
Meal Planning Strategies
1. Visualize your plate or bowl. Take the time to read food labels, anddiscover how many servings your bowl or plate hold.
2. Use your hand size to estimate a proper serving size

3. Contemplate balance: Your goal is to prepare balanced meals that
include carbohydrates, protein, and healthy fats.
4. Consider the source of your nutrients: Whole grains are healthier thanrefined grains. Refined grains include: white rice, white bread,breakfast cereal, crackers)- Whole fruits are healthier than fruit juices (see FAQs)- Choose lean meats like skinless poultry, lentils, fish, and eggs for protein- Limit fats from butter, cheese, red meat, skin of poultry, and fried foods
5. Smart Snacking: A snack is a small portion of food eaten between meals.
Eating a snack can prevent hunger between meals, aid in providing
adequate nutrition, and keep you energized and satisfied throughout theday. For better blood glucose control, we recommend that a snack should
consist of foods that contain less carbohydrates and more protein.
However, having diabetes does not mean you are required to have a snack.

Palm size = 3 to 4 ounces

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Use Measuring Cups

Measure food once a month to reinforce proper serving sizes and to re-gauge yourestimates. You can also place a typical portion on your child’s plate, then use a measuring cup or spoon
to quantify it.

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....................................................................................................................

....................................................................................................................

Use the Nutrition
Facts LabelBe sure to read nutrition labels very
carefully. Food labels help you identify
how many grams of carbohydrate arecontained in one serving of food. By
reviewing the ingredient list, you canevaluate the quality of carbohydrates
and the level of processing (examplesin FAQs). The total carbohydrate
amount includes dietary fiber andgrams of sugar. It is important to pay
attention to the serving size, as thenutrition facts pertain to just one
serving size.

....................................................................................................................

Example of Counting Carbs Using a Food Label (see label above)
1. Find the serving size
2. Find the grams of total carbs per serving
3. Determine how many servings your child will be eating

1/4 cup
15g
2 servings or 1/2 serving

For example:• for two servings, multiply the grams of total carbs by 2
• for a half serving, divide the grams of total carbs by 2

15g x 2 = 30g
15g / 2 = 7.5g

5....................................................................................................................

Invest in a Kitchen Scale
Many foods come in different shapes and sizes which can make carbohydrate counting more challenging.
Cooked food, such as rice and pasta, may be difficult to measure using measuring cups. Chips can also
be difficult to measure using cups, as the amount can vary significantly if the chips are intact vs crumbled
into small pieces. Weighing food in these situations is a more accurate method to count carbohydrates.
A kitchen scale is a handy tool.

>>>>>>>>>>>>>>>>>>>>>>

A “carbohydrate factor” is defined as a percentage of food that is carbohydrate.
How to figure out the carb factor:
1. Reference the USDA data base, Calorie King book, or the food label
2. Identify grams of carbohydrates and grams of food per serving
3. Use the following formula

Carb Factor =total carbs in one serving (grams)
Weight of one serving of food (grams)

For example: Breakfast Cereal
Weight of one serving of rice krispies = 30 gm
Total carbs in one serving (30 g) rice krispies = 26.1 gm
Carb Factor for rice krispies = 26.1/ 30 = 0.87
Therefore, there is 0.87 g carbohydrates in every 1 g of rice krispies....................................................................................................................
Now, using the carb factor, you can calculate the grams of carbs in any food item using a scale! Here’s how:

1. Measure the weight of the food in grams.
2. Use the following formula:
Food weight (grams) x carb factor for that food = grams of carbs in that foodSo, if you weigh out 70 grams of rice krispies on a food scale, using a carb factorof 0.87, you can easily determine that your cereal contains 60.9 grams of carbs.

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It may seem like a lot of work, but it can be simple!
Here are some helpful hints:
1. Make meals that your family enjoys
2. Create your own carb count database by writing down food items yourfamily regularly eats and typical portion sizes. If you are using a foodscale, then add a column for carb factors to this database.
3. Take a team approach to healthy eating within your family by ensuringthat all family members adhere to the same meal plan.
4. Try to create a schedule and menu of eating throughout the day andinclude 3 balanced meals and 2 snacks as needed for appetite
regulation.
5. Avoid using food as a reward or punishment for your child.

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EXAMPLE

Food Items

My child’s Serving
in grams

Carb Factor

Total Carb

2 Whole wheat toast

56

0.46

25.76 gm

1 Egg

0

0

0 gm

1 Apple120

0.14

16.8 gm

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EATING OUT...................................................................................................................
Home cooked meals are always the healthiest option, but
occasionally you may want to eat out. Here are some tips.

Choosing a Restaurant
Look for a restaurant which offers wide a variety of menu options.
Check an online menu (if available) for nutritional information.
Avoide eating at “all you can eat” buffet type restaurants as it
can be difficult to keep track of carb counts.

Ordering Your Meal (if frequently eating out)
Find a menu item which contains ingredients from all
major food groups. Try to picture your plate while ordering.
Avoid filling up on complimentary bread and butter orchips and salsa.
Always ask for dressing and sauce on the side.
Help your child pick a menu option by narrowing it down
to 2-3 healthy menu items and then allowing your child tochoose (if your child is less than 7 years old).
The entire family should follow similar guidelines wheneating out.

Portion Size Matters > > > > > > > > > > > > > > > > > > > > > > >Restaurants often serve 2-3 portions in a single meal.
To prevent overeating, try the following:
1. Consume salad or green vegetables first.
2. Request a take-out box and pack half of the meal in the box to take home.
3. If portion sizes are larger, you can order one meal to be split amongst
2-3 family members. Most restaurants will honor this request.

9What is Carbohydrate counting?
For people with diabetes who require insulin, carbohydrate counting is a method of matching an
insulin dose to the total grams of carbohydrates that you eat. This helps keep blood sugar
levels more stable after meals. Accurate carb counting is essential to calculate an optimal
insulin dose. Carb counting is something that takes time and patience to learn, but it is a skill
which is fundamental to care for your child’s diabetes.

What is the best carb counting method for my child?
There is no “best carb counting method”. The best carb counting method is simply one which
you can use effectively and consistently, which keeps your child’s blood glucose in a target
range.

What should my child eat?
•
•
•

•

•

Choose foods that are rich in nutrients
Focus on the quality of carbs
Healthy carbs are those which come in their natural form, such as whole grains,vegetables, and whole fruits. Such foods are minimally processed and containplenty of nutrients and fiber. Your body has to work harder to digest them andtherefore these foods can keep blood sugars more stable than processed foods
Limit packaged/processed foods such as crackers, cookies, and canned fruits insyrup, cakes, donuts, chips, and energy bars. These items will often spike blood
sugars. Such foods aren’t healthy.
Make sure the entire family follows the same diet so no one feels singled out or
deprived.

How many carbs should my child consume each day?
Carbohydrates play an important role in your child’s growth and development. Carbohydrates
should be a part of a healthy meal plan. How many carbohydrates your child needs depends on
your child’s age, activity level, weight, and appetite. There is no magic number. Your dietitiancan help to give you some rough guidelines. Be sure to include a wide variety of carbohydrates
from whole grains, fruits, vegetables, low-fat milk and yogurt.

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FAQs
What is fiber? How does it affect blood glucose levels?
Fiber is a non-digestible plant material. It is found in whole grains, dried beans, lentils, fruits,
vegetables, nuts, and seeds. There are two types of fiber; soluble and non-soluble.
Soluble fiber dissolves in water and delays release of glucose into the blood stream. Somesoluble fiber is fermentable which helps to maintain colon health.
Non-soluble fiber absorbs water, creates bulk, and prevents constipation but has no effect onblood glucose
Bottom line: fiber is a good and healthy addition to your diet.

Are sugar substitutes safe to use?
Artificial sweeteners contain zero calories and do not affect blood sugar levels. They are often
found in beverages. They are safe if used in very small amounts; however the best andhealthiest choice of beverage for your child is fresh clean water. Artificial sweeteners include:saccharine (Sweet’N Low, Sugar Twin), sucralose (Splenda), aspartame (Equal), and extract of
the Stevia Rebaudiana plant (Stevia, Truvia, Purevia)

Which foods can spike blood glucose levels?
Blood glucose levels rise after consuming carbohydrates. Small temporary increases in blood
glucose levels are normal after eating a meal. Carbohydrates are found in a wide variety of both
healthy and unhealthy foods. Unprocessed or minimally processed carbohydrates–wholegrains, whole fruit, cooked beans—tend to raise blood glucose slowly. Processedcarbohydrates—breakfast cereal (cold), instant oatmeal, white bread, sugary beverages, fruit
juices, white rice, and potatoes—contain rapidly digestible carbohydrates and tend to spikeblood sugar quickly and higher than average.

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FAQs
What are sugar alcohols? Do they affect my carb count?
Low calorie or reduced calorie sweeteners are sugar alcohols (erythritol, sorbitol, xylitol,
mannitol, isomalt, maltitol). They have about half the sugar from the sugar alcohol and can raise
blood sugar but to a lesser degree. Many food products contain sugar alcohols, such as sugar
free candies, gums and other sugar free desserts.

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FAQs
I counted the carbs perfectly (weighed and measured everything) and mychild’s blood sugar went high afterwards. Why did this happen?
Keeping your child’s blood glucose levels stable can be challenging. There are many reasonsfor having high blood glucose levels despite counting your carbs accurately.
•
•
•
•
•
•

Breakfast cereals and other highly processed foods can spike blood glucose
levels despite measuring or even weighing the cereal
High fat/high carb foods can cause late rises in glucose levels as they take longer
to digest, long after the Humalog insulin has worn out
On a relatively inactive day for your child, such as an all-day car ride, you may
see high blood glucose levels after a meal
Insulin requirements increase with puberty
Physical and emotional stress, lack of sleep, illness or even hot weather can also
cause high blood glucose levels
BG spikes can happen if insulin is not timed correctly with respect to a meal. For
best outcomes, give insulin prior to eating. A higher pre-meal BG may require alonger wait time.

If high BG trends are persistent after taking into account the above factors, please contact yourdiabetes healthcare team.

The restaurant website gave me the carb count and I used it to calculate theinsulin dose but my child’s blood sugar went high afterwards.
For the most part, when we eat out, fat in the meal is contributing to the high blood glucose. A
high fat meal (especially high in saturated fats) makes our body insulin resistant. That means
more insulin is needed to keep blood glucose in range. Fat slows down the digestion ofcarbohydrates, which can cause rise in blood glucose levels for up to 4-6 hours after a meal.
Occasionally a high fat meal is okay, but frequent meals with high fat/saturated fat can behealthy for everyone and can make it challenging to manage blood glucose levels. If after using
the restaurant’s carb count, you get a high number, please adjust up on the carb count for next
time.

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FAQs
Is there anything my child can’t eat?
It is recommended that everyone, with or without diabetes, should limit foods that contain highamounts of saturated and Trans fats, sodium, and unhealthy carbs. The following are someexamples of the food that should be limited.
Any sugary beverages including juices, sport drinks, lemonade, freshly squeezed juice at home,
100% fruit juices (except for treating hypoglycemia), any deep fried foods, highly processed
foods such as frozen pizza, frozen dinners, cookies, any concentrated sweets, including
granola bars, protein or energy bars. If these are readily available in your household, yourchild/teen will consume it.

Why are whole fruits better than fruit juice?
Whole fruits come in a package of antioxidants, other nutrients, and fiber. Fiber makes us feelfull and also slows absorption of fruit sugars. Fruit juices are stripped of fiber and contain mostly
sugar that raises blood sugar fast. Therefore drinking fruit juice is one of the recommended
treatments for hypoglycemia. However, daily consumption of juice or any sugary beverages are
not recommended as they will spike blood glucose levels.

What is processed food?
Almost all foods are processed to varying degrees. To avoid confusion, focus on consuming
whole foods, which generally have no to minimal processing. Flavor added to foods like sauces,salad dressings, canned or frozen fruits, vegetables, and fish have all gone through some kindof processing to preserve the freshness and taste. Ready to eat food like crackers, granola
bars, and deli meat are heavily processed. Things like frozen pizza and microwavable frozen
dinners are even more heavily processed.

Does my child need to follow a specific “diabetic diet”?
Kids with diabetes do not have to follow a specific diet. Your child will benefit from a healthy dietthat includes whole grains, lean protein, whole fruits, vegetables, a small amount of healthyfats, and water to drink with meals. The goal is to understand the carbohydrate content in foodand count all carbs with insulin. Consuming 3 meals and snacks as needed may help withappetite regulation. The entire household should follow the same diet to sustain it and to build
healthy habits together as a family. Following a healthy diet can help prevent long-term
diabetes related health problems.

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FAQs
Should my child/teen eat a low carb diet to more easily manage blood
glucose?
The goal for diabetes nutrition management is to maintain a target blood glucose by balancing
food, insulin and physical activity. Low carb diets continue to be popular but there is no formal
definition of a low carb diet. People who are following low carb diet plans, often control or
eliminate whole grains, fruits, milk, some vegetables, and legumes. Your child/teen’s nutritionneeds are different than adults. Decreasing or cutting back on healthy carbohydrates may invite
nutrient deficiencies, including fiber and some B- vitamins. Experts recommend thatapproximately half of the calories we consume come from healthy carbohydrates, ascarbohydrates are the body’s preferred energy source.

What about sugar free foods?
Carbohydrates have the greatest effect on blood glucose levels. When a food package
indicates, “sugar free”, it does not necessarily mean that it is “carbohydrate free.” In “sugar free”
products, food manufacturers replace sugar with sugar substitutes, such as aspartame,saccharin, sucralose, acesulfamet-k, and neotame. Some sugar free foods contain sugar
alcohols, such as sorbitol, xylitol, mannitol, and isomalt. However, these sweeteners actuallycontain carbohydrates. Therefore, it is important to check the food label for how many grams ofcarbohydrates are contained in one serving, whether or not the food is labeled “sugar free.”15

Food Items

Weight ingrams

Commonmeasures

Grams ofcarbohydrates

Carb factors for foodscale

Bagel, plain

894” bagel

47.17

0.53

Bread, raisin

28.35

1 slice

14.83

0.52

Bread, wheat28

1 slice

12.91

0.46

Bread, white22

1 slice

11.97

0.54

Chapatti

38

1

20

0.52

Hamburger bun

54

One bun24

0.44

Naan, refrigerated

90

1 piece

45.39

0.50

Pancake, plain, drymix. Complete
prepared

38

1

13.95

0.37

Pita bread

28 gm

4” small

15.60

0.55

Tortilla, corn

26

1 tortilla

12.12

0.46

Tortilla, flour

32

1 tortilla

17.79

0.55

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Food Items

Weight ingrams

Commonmeasures

Grams ofcarbohydrates

Carb factors forfood scale

Apples138

1 apple

19.06

0.14

Apricots

35

1 apricot

3.89

0.11

Bananas118

1 banana

26.95

0.23

Blueberries

145

1 cup

21.01

0.14

Cherries

68

10 cherries

10.89

0.16

Grapes

168

1 cup

30.67

0.18

Kiwi

186

1 cup sliced

26.47

0.16

Mango, fresh

165

1 cup

24.72

0.15

Melon, cantaloupe,
honeydew

165

1 cup

14.25

0.09

Nectarines

136

1 nectarine

14.35

0.10

Orange131

1 orange

15.39

0.12

Papaya140

1 cup cubed

13.73

0.10

Peach

98

1 peach

9.35

0.10

Pear

166

1 pear

25.66

0.15

Persimmons,Japanese100

1 persimmon

18.5

0.18

Pineapples

165

1 cup

22.28

0.13

Pomegranates87

1/2 a cup

16.26

0.18

Strawberries

166

1 cup

12.75

0.08

Watermelon

152

1 cup

11.48

0.08

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Food Items

Weight ingrams

Commonmeasures

Grams ofcarbohydrates

Carb factors for foodscale

Barley cooked

150

1 cup

34.26

0.23

Malt O Meal cookedwith water

240

1 cup

25.68

0.11

Oats cooked with
water

234

1 cup

25.27

0.11

Pasta cooked

140

1 cup

39.68

0.28

Quinoa cooked

185

1 cup

39.40

0.21

Rice white cooked

158

1 cup

44.51

0.28

Rice brown cooked

195

1 cup

44.77

0.23

Food Items

Weight ingrams

Commonmeasures

Grams ofcarbohydrates

Carb factors for foodscaleBlack beans

172

1 cup

40.78

0.23

Garbanzo beans

165

1 cup

44.97

0.27

Kidney beans

177

1 cup

40.36

0.23

Lentil, green, brown

198

1 cup

39.86

0.28

Peas, split, dried,
cooked

196

1 cup

40.20

0.20

Pinto beans

171

1 cup

42.49

0.25

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Food Items

Weight ingrams

Commonmeasures

Grams ofcarbohydrates

Carb factors for foodscale

Asparagus,
cooked, drained

90

1/2 a cup

3.70

0.04

Baby corn

138.1

1 cup

32.3

0.23

Green beans

135

1 cup

8

0.06

Beets

42.5

1 each4

0.09

Brussels sprouts 156

1 cup

11.08

0.07

Broccoli, cooked 156

1 cup

11.20

0.07

Cabbage,shredded,cooked

150

1 cup

8.27

0.05

Cactus, cooked

149

1 cup

4.89

0.03

Carrots,
fresh

78

1 each7.0

0.09

Cauliflower,
cooked

124

1 cup

5.10

0.04

Cucumber300

1 each9.09

0.03

Edamame

118

1 cup

10.12

0.08

Spinach, cooked

190

1 cup

9.12

0.048

Tomatoes148

1 each

7.0

0.047

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Food Items

Weight ingrams

Commonmeasures

Grams ofcarbohydrates

Carb factors for food
scale

Corn

77

1 ear

19.33

0.25

Corn, frozen,
cooked

164

1 cup

31.65

0.19

Baby lima beans

180

1 cup

35.01

0.19

Mixed vegetables

64

1/2 a cup

10.31

0.16

Parsnips, cooked

156

1 cup

26.54

0.17

Peas, green

160

1 cup

22.82

0.14

Plantain, cooked

154

1 cup

47.97

0.31

Potato, skinless,cooked

156

1 cup

31.22

0.20

Winter squash,
baked

205

1 cup

18.14

0.9

Yams, cooked136

1 cup cubed

36.71

0.27

Food Items

Weight ingrams

Common measures

Grams ofcarbohydrates

Carb factors forfood scale

Brownie60

1 piece (2” square)

38.97

0.65

Chocolate cake71.87

1 piece41

0.57

Yellow cake withchocolate frosting144

1 piece

79.72

0.55

Donut, glazed

49

1 each21

0.42Apple pie155

1 slice

57.50

0.37

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Additional Resources

The websites listed below are a good places to start learning about diabetes and nutrition.
Living healthier with diabetes
www.kp.org/diabetes

Community Resources
carbDM.org
Carb DM has play dates for children with diabetes, monthly gatherings for adults with type 1
diabetes, workshops and lectures with topics relevant to type 1 diabetes, mentoring,
advocacy, and more.
www.carbDM.org
Contact Tamar Sofer-Geri at 650-464-4236
Diabetes Youth Foundation (DYF)
Summer camps & year round programs
dyf.org925-680-4994
Juvenile Diabetes Research Foundation (JDRF)
Greater Bay Area Chapter
121 Second St., 2nd Floor
San Francisco, CA 94105
jdrf.org
415-977-0360

References
1. American Diabetes Association
2. Academy of Nutrition and Dietetics
3. Juvenile Diabetes Research Foundation
4. American Association of Diabetes Educators
5. Today’s Dietitian
6. Pediatric Diabetes –Alison B. Evert, RD, CDE and Amy Hess-Fischl, MS, RD, BC-ADM,
CDE – American Dietetic Association (ADA)
7. U.S. Department of Agriculture Database© 2017, The Permanente Medical Group, Inc. All rights reserved.
Santa Clara Health Education. Department of Pediatric Endocrinology.

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