Does it sometimes seem like your child’s numbers go out of range after eating certain foods -- no matter how carefully you count the carbs? We asked moms to share their trickiest-to-dose-for foods and then asked Melissa Herrmann Dierks, R.D.N., L.D.N., C.D.E., a registered dietitian nutritionist and certified diabetes educator in Huntersville, N.C., for her expert tips for keeping blood sugars on an even keel. Do any of these foods sound familiar?
Tricky Food: Pizza
“My son loves pizza, but it can make his blood sugar high for hours, especially if it’s pepperoni!”
--Chelsea, Lehigh, Penn.
Tips: Pizza is rich in carbohydrate, thanks mainly to the crust, but it also tends to be a high-fat food item. “Fats can delay how quickly glucose enters the bloodstream,” explains Dierks. For your child’s numbers, this can mean that instead of the normal post-meal rise in blood sugars, you may see a delayed spike in blood sugar -- that is, rising numbers several hours later. Protein in foods can have a similar effect, so added meat toppings, including pepperoni (which also contains fat), may slow down carbohydrate metabolism even more.
For many kids with type 1 diabetes, thin-crust pizza topped with a moderate amount of cheese may not pose much of an issue, but a thick-crust, extra-loaded slice is another story. To have a better idea of how a child’s numbers could respond, Dierks recommends not only calculating the carbohydrate count of the pizza and pizza toppings the child will eat, but also looking up the meal’s fat and protein content. And then, “be prepared to experiment to find out what works” for your child and your family’s favorite pie, she recommends.
If your child uses an insulin pump, you can also reach out to your pump trainer to learn how to calculate a “dual wave” or “square wave” bolus, which can better match blood sugar patterns following a fatty meal. These alternate settings are not always taught at your initial training session, and your trainer will likely be excited that you want to learn more.
Tricky Food: Free Samples
“Handling smaller, on-the-fly treats like samples at the grocery store is always confusing. Do I cover these or not?”
--Shawna, San Diego, Calif.
Tips: Food samples can come in all shapes and sizes -- from slices of meat from the deli to cookies and bites of cake from the bakery. Whatever it is being offered, Dierks recommends parents take a minute to first calculate the food’s carbohydrate count. Some items, such as one strawberry, a cube of deli meat or cheese or other non-carbohydrate containing items will not require insulin to cover. Other foods, such as baked goods or some fresh fruits, may take a little more work to figure out. Carrying a calorie-counter book with you, using the data in your insulin pump or downloading a smart-phone app that offers carb-count information per serving can be helpful in these situations. As Dierks says, “Use your tools!” And when in doubt, ask. If the sample is a packaged food item, such as a pizza roll, the nutritional information is probably somewhere nearby. “Once you have collected this information, then you can decide whether or not insulin is needed,” says Dierks.
Tricky Food: Between-Meal Beverages
“Before diagnosis, my daughter carried a sippy cup of milk or diluted juice so she could drink whenever she felt like it. When we tried this after diagnosis, her numbers went haywire.”
--Joellen, Gainesville, Fla.
Tips: “When milk or juice is consumed as part of a meal or snack, it’s easy to simply calculate them as part of the meal’s total carbohydrate count,” says Dierks. Drinking milk or juice between meals or outside of snack time, however, can impact blood sugar if the serving is large enough. How to take the guesswork out of between-meal drinks? One alternative is to serve carbohydrate-free beverages (like sugar-free drink powders) when a child is craving something sweet; another is to stick to plain water. “We don’t want to restrict the calories of growing children, but we do want to keep blood sugar numbers in range,” says Dierks, who adds that if caloric beverages are reduced, calories (and carbohydrates) can be added to meals and snacks to make sure a child is getting enough during the day.
Tricky Food: Birthday Cake
“Party foods are the worst! I’ve calculated slices of birthday cake down to the last gram only to have my 8-year-old take two bites and then run off to play with his friends.”
--Amy, Jackson, Miss.
Tips: It can be a challenge to make sure that what you bolus or dose for is actually consumed. “If your child has insulin on board to cover a slice of cake but doesn’t eat it, he or she will need to take in carbohydrates in another form or run the risk of having a low,” says Dierks, who recommends drinking milk or juice as easy-to-consume choices to fill the carbohydrate gap. “Just make sure the carbohydrates in the amount you serve match the carbohydrates needed,” she adds. Dierks also recommends that parents talk to their child’s care team about how to adjust insulin doses for special events like birthdays and other food-centered celebrations.
Tricky Food: Ketchup (and Other “Free Foods”)
“Ketchup is on the list of free foods, but our son pours it on basically everything. When do free foods stop being free?”
-- Tamara, Chesapeake, Va.
Tips: According to the American Diabetes Association, free foods are food or drink choices that contains less than 20 calories and 5 grams of carbohydrate or less per serving. Free foods, because they contain very little carbohydrate, won’t do much to change blood sugar levels. So how much ketchup qualifies as a free food? A serving size of just one tablespoon. “When you think about the puddle of ketchup that most kids pour over their fries, this is probably much more than a tablespoon. At this point, ketchup is no longer a free food and will need to be calculated as part of the meal’s carbohydrates,” says Dierks. The sure-fire way to tell whether a food is truly free or not: “Get into the habit of measuring foods to make sure you have the correct serving size,” advises Dierks, who recommends having measuring spoons and measuring cups on hand to help with this task. Consider also investing in a food scale. “I can’t say enough good things about them,” says Dierks, who notes that a basic scale can run less than $10, while more high-tech scales -- that even provide carbohydrate-count readouts for common foods -- can run up to $100.
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the "typical" experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.
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