Meal Plans and Diabetes

Food Labels

You need to know what's in the foods you're serving and eating. It's easy to guess what some foods contain, but others are more of a challenge. So look to food labels to find a food's ingredients, nutritional information, and calories.

Be sure to look for information on carbs, which can affect blood sugar levels. Usually, they're clearly listed on food labels in grams. The two main forms of carbs are sugars and starches. Types of sugars include fructose (sugar found in fruit and some baked goods), glucose (the main sugar in our bodies that's also found in foods like cake, cookies, and soft drinks), and lactose (sugar found in milk and yogurt). Starches include vegetables like potatoes, corn, and peas; grains, rice, and cereals; and breads.

The body breaks down or converts most carbs into glucose, which is absorbed into the bloodstream. As the glucose level rises in the blood, the pancreas releases the hormone insulin, which is needed to move glucose from the blood into the cells to be used as a source of energy.

Regardless of the specific meal plan that your doctor recommends, it's important to be aware of the carbs in foods so you can learn to balance carbohydrate intake, activity levels, and insulin to achieve the best possible diabetes control.

You can figure out your child's carbohydrate intake by checking the serving size and the amount of carbs per serving on the food label and determining how many servings your child eats.

Here's an example:

• serving size: 1/2 cup (120 milliliters)
• carbohydrates per serving: 7 grams
• amount of food eaten: 1 cup (240 milliliters)
• grams of carbohydrates eaten: 14 grams (7 grams per serving x 2 servings)

The "Right" Amount?

There is no one right amount of carbohydrates that your child should eat. The carbs that kids need per day will depend on many things, including the child's age, size, weight goal, exercise level, medications, and other medical issues. The recommended carbohydrate intake is different for each child and can even differ in the same child from day to day. The diabetes health care team will provide guidelines as part of the meal plan.

Also look at the sodium (salt) content on food labels. Eating too much sodium is linked to the development of high blood pressure, or hypertension. Because some kids with diabetes have hypertension, they may need to keep sodium intake within doctor-recommended levels to reduce the risk of high blood pressure problems. It's always wise to go easy on sodium, even if your child doesn't have hypertension.

Also pay attention to the amount of fat and the type of fat. Saturated fats, cholesterol, and trans fats can contribute to the development of heart disease. People with diabetes are at greater risk of developing heart disease, especially if they have abnormal blood lipid levels. Ask your doctor or dietitian whether your child needs to have limits on fat intake.

Aside from these considerations, parents might check food labels for the same reasons they do for themselves or other kids. For example, watching calories helps a person maintain a healthy weight. It's also important to make sure that your family gets enough vitamins, minerals, and fiber and eats a well-balanced diet in general.

Meal Planning

Helping your child balance carbohydrate intake, physical activity, and insulin to maintain good blood sugar control starts with nutritious foods. Try to make each meal a good balance of carbs and other nutrients, both for diabetes management and to make meals satisfying.

Here are some estimates to shoot for over the course of a day:

• About 10% to 20% of the calories your child eats should come from protein. Try to select lean meats like chicken or beef.
• Roughly 25% to 30% of calories should come from fat. Avoid foods with lots of trans and saturated fats (or serve them only in moderation).
• About 50% to 60% of the calories your child eats should come from carbs. Encourage your child to eat lots of green and orange vegetables every day — like carrots and broccoli. And choose vitamin-rich brown rice or sweet potatoes instead of white rice or regular potatoes.

The diabetes health care team will provide meal planning guidelines based on the foods that your child usually eats. The team might ask you and your child to keep a detailed food diary for 3 days to get an idea of what your child likes and what amounts he or she is used to having.

The team may recommend other meal planning guidelines depending on your child's individual nutritional needs. For example, if your child has a weight loss goal, then the doctor or dietician might focus more closely on controlling calories.

Three Common Approaches to Meal Planning

Although each child with diabetes will have a distinct set of needs and an individualized meal plan to fit those needs, three kinds of meal plans are commonly used:

1. the exchange meal plan
2. the constant carbohydrate meal plan
3. the carbohydrate counting meal plan

Some people with diabetes, especially those who have just developed the condition, use a food-balancing program called the exchange meal plan. For this meal plan, foods are typically divided into six groups: starch, fruit, milk, fat, vegetable, and meat.

The plan sets a serving size (amount) for foods in each group, with each serving having a similar amount of calories, protein, carbs, and fat. This allows flexibility in planning meals by exchanging, or substituting, choices from lists of foods with similar nutritional content. The number of exchanges (servings) from each food group recommended for each meal and snack is based on the total number of calories the person needs per day.

The diabetes health care team can provide you with exchange lists, which also are available through the American Diabetes Association (ADA). This meal plan is particularly useful for people with diabetes who are overweight or others who need to pay closer attention to the amount of calories and nutrients they eat each day.

The other two meal planning approaches also are based on eating a balanced diet but specifically focus on matching the amount of insulin or diabetes medications a person takes with the amount of carbs they eat. With the constant carbohydrate meal plan, the person eats set amounts of carbs in each meal and snack, then takes insulin or other diabetes medicines at consistent times and amounts each day to handle the rises in blood sugar from meals. Although it lacks flexibility, this plan has the advantage of being simple to follow for people whose food intake and physical activity levels are fairly consistent from day to day.

Many people with diabetes now use the carbohydrate counting meal plan to estimate the amount of carbs in the foods they eat at each meal or snack. They then match their insulin dosage to that carb amount. This plan is most useful for those who manage their diabetes by taking a dose of insulin (as a shot or given through an insulin pump) with each meal. This technique can help people achieve better control of blood sugar levels as they manage their diabetes. It also allows more flexibility because the person takes insulin when meals are eaten, not at the same set times each day.

Helpful Tools

Keeping a written record of what your child eats can help you and the diabetes team create and change your child's dietary plan as needed. You might continue to track carbohydrate intake alongside blood sugar readings in a blood glucose record to see how well food and insulin are being balanced.

Kids can keep track while they're at school or away from home. If you need to make insulin adjustments, this written record can help you understand why and help you decide how much and at what time your child should have the new dosage.

It can also help you plan if you keep a few quick references handy, such as charts that show portion sizes and how many carbs various foods contain. The diabetes health care team or a nutritionist can supply this information, and the ADA offers it, too.

If you ever feel stuck while you're planning nutritious, well-balanced meals, inspiration is easy to find. Cookbooks and recipe websites offer lots of healthy meal suggestions — many of which you can prepare quickly and easily. With diabetes knowledge and the right tools, you'll be prepared to help your child eat right for good health.

Reviewed by: Steven Dowshen, MD
Date reviewed: August 2010