Paediatric Diabetes: Carbohydrate counting

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1 Department of Nutrition and Dietetics Paediatric Diabetes: Carbohydrate counting Everyone with diabetes need to be careful about the foods they eat to ensure that their blood glucose levels stay as close to normal as possible. Glucose in the blood comes from carbohydrates eaten in the diet. There are five groups of carbohydrate foods that affect blood glucose:- Starchy foods Potato, yam, sweet potato, plantain Bread, chapattis, Pasta, rice, noodles, cous cous, oats, corn, breakfast cereals, Flour and foods prepared with flour e.g. pizzas, pastries, pies, crackers, biscuits and thickened sauces and soups. Starchy foods should be eaten regularly to provide the body with energy. They also provide vitamins, minerals and often fibre. Starches need to be broken down into glucose before they can be digested. They usually raise blood sugar levels more slowly than sugary foods but this does depend on how much is eaten, how the food is cooked and how much starch is in the food Sugary foods Glucose (dextrose), sugar (sucrose), honey, jam, syrups Sweet drinks, sweet cakes, sweet biscuits, sweets and chocolate. Sugars are digested very quickly so will have a quicker effect on your blood sugar levels. Often these foods are low in other nutrients. You should not eat these too frequently and they are best taken for an occasional treat as part of a meal or if You are not overweight before exercising.

2 Milk & Dairy foods Milk, yoghurt, fromage frais, custards, ice cream Milk contains a sugar called lactose which will raise blood sugar. However milk also contains protein and fat which slows down the breakdown of lactose to glucose. Milk and dairy foods are fine to have with diabetes and are an excellent source of calcium. Cheese does not contain carbohydrate. Fruits & fruit juices Fresh, tinned in juice, dried or fruit juices Fruit contains a sugar called fructose which will affect your blood sugar levels. Fruit also contains fibre which slows down the absorption of this sugar into the blood stream. Fruit is rich in important vitamins and minerals so you should aim to eat some fruit everyday. Other carbohydrate foods Beans, pulses, lentils and vegetables The carbohydrate content of these foods is variable. There are only small amounts of carbohydrate in most vegetables so unless you are eating a very large portion you will not need to count them. Certain vegetables-parsnip, beetroot, sweetcorn, peas, mushy and processed peas and, have higher carbohydrate contents. If portions are large, or the vegetables are highly cooked/ processed e.g. creamed sweetcorn, you may then need to include some carbohydrate value for them. Beans, pulses and lentils (including baked beans) are absorbed into the blood stream very slowly due to their high fibre content. If eaten as the main protein source of a meal (i.e. in place of meat and in a large quantity) they should be counted. If added to a meal, so the portion is small i.e. kidney beans in chilli con carne you can usually avoid counting them. Everyone reacts differently to these. Watch your blood sugars after having beans or pulses to help you calculate how much carbohydrate you will need to count for them. These foods are very nutritious and should be eaten regularly. Vegetables should ideally be eaten everyday. If you are on twice daily injections, the amount of carbohydrate eaten during meals and snacks should stay reasonably steady. This will prevent large swings in blood glucose levels. If you are on basal bolus injections (4 injections daily) you will be able to eat different amounts of carbohydrate at meals. However, you will need to work out how much carbohydrate you will eat, to enable you to calculate the amount of insulin you need to inject. The Carbohydrate content of most foods can be divided into portions of 10g to help you learn and remember them easily. The following pages show the Carbohydrate content of some commonly eaten foods Paediatric diabetes: Carbohydrate counting October

3 Carbohydrate Counting The following food portions contain 10g of carbohydrate 1 Weetabix/ Oatibix or Shredded Wheat 15g (4tbsp) cereal 4tbsp cooked porridge/ instant porridge 1 rounded serving spoon cooked pasta 1level serving spoon cooked rice 1 boiled baked or roast potato (egg-sized) 1small scoop of mashed potato 5-6 medium or 3 large chipped potatoes 1potato waffle =20g Carbohydrate 2 smiley face potatoes 1 level serving spoon tinned spaghetti 3 small chipolata or 2 thick sausages 2 Fish fingers 5 chicken nuggets 1 fish cake 1 / 3 rd small, thin base individual pizza (5 ) 2 beef/ hamburgers (not 100% meat) 1 small sausage roll 1½ small Yorkshire puddings 1 / 4 individual meat/vegetable pie Paediatric diabetes: Carbohydrate counting October

4 1 Hobnob/Garibaldi Digestive/oatcake/ fig roll 2 semi-sweet biscuits 2 crackers 2 tablespoons fruit fresh or tinned in juice 1 small piece of fruit 1 diet yoghurt (125g pot) 1 / 3 rd pint (200mls) milk 1 small scoop plain ice-cream 4 tablespoons low sugar milk pudding 1 small 25g bag of crisps Please note 1 medium slice bread= 15g CHO 1 thick slice bread =20g CHO 1 wrap/ tortilla =20-30g CHO 1 small bread roll = 20g CHO 1 pitta bread Large =30-50g CHO Small =15-20g 1 teacake /hot cross bun =30-35g CHO 1 scone= 20-30g CHO 1 oat based cereal bar =15-20g CHO 1 croissant =20g CHO Count 2 serving spoons of baked beans as 10g CHO (actual content is 30g CHO but low GI) } if counting } these as 10g } CHO make } your blood } sugars high } then count as } 20g or 30g as } necessary Paediatric diabetes: Carbohydrate counting October

5 To get the best idea of carbohydrate content of commonly eaten foods 1. Weigh food portions initially (on scales that weigh in grams). This is especially useful for breakfast cereals, rice and pasta. Once you know your normal portion size you can then work out the carbohydrate content of the meal more easily. Alternatively use a handy measure for example a plastic cup or pot. Weigh out the portion of food contained in this once. Then you will always know the carbohydrate content of your portion based on the number of measures you eat. 2. Look at nutritional labels these will tell you all you need to know about the carbohydrate content of purchased foods Nutrition Information Per serving Per 100g Energy (Kj) (Kcals) Protein (g) Carbohydrate (g) Of which sugars (g) Of which starch (g) Fat (g) Of which saturates Of which mono-unsaturates Of which poly-unsaturates Fibre (g) Salt When carbohydrate counting, you are looking for the total carbohydrate figure which includes all the starch and sugars in that food. The of which sugars figure is also important as it shows the amount of added sugars and naturally occurring sugars e.g. fruit sugar (fructose) and milk sugar (lactose) in a food. When choosing between similar foods, always go for the one with the lowest of which sugars content as this will have the lowest amount of added sugar. Points to remember when looking at labels How has the carbohydrate content been recorded? per 100g/ per item/ per serving This will make a large difference when calculating your intake if you read the figure as per 100g and the actual product weighs 420g Is the portion cooked or uncooked weight? Rice and pasta double their weight when cooked If it is per serving, is this your serving size? Or is it a great deal smaller? - weigh it out and see if you are unsure! Paediatric diabetes: Carbohydrate counting October

6 Calculating the carbohydrate content of foods from labels If using information from nutrition labels you can work out the carbohydrate content of a food by:- 1. Weighing your portion of food 2. Finding out the carbohydrate content per 100g from a food label on the packet 3. Divide the weight of your portion by 100 then multiply this number by amount of carbohydrate per 100g (as on packet) 4. The answer will tell you how much carbohydrate your food contains Follow the steps above for this example: 1. Your portion of Wake up cereal weighs 60g 2. The carbohydrate content per 100g is 64g x 64 = 38.4g of carbohydrate = 40g (rounded up to the nearest 10g) Wake up Flakes Per 100g kcal 294 Protein (g) 8 Carbohydrates (g) 64 (of which sugars) 23 (of which starch) 41 Fat (g) 2.5 Using Visual Carbohydrate Counting Guides When using visual guides for Carbohydrate Counting in the form of a book or a phone app, remember they include all foods containing carbohydrate, irrespective of whether they are a healthy option or not. Please contact your diabetes nurse on or your dietitian on if you feel that you need help. The Trust has access to interpreting and translation services. If you need this information in another language or format, we will do our best to meet your needs. Please contact the Department on The Trust operates a smoke free policy Author: Department: Published June 2011 Reviewed July 2013, October 2015 Review October 2017 Version 4 Reference No HIC/LFT/566/07 Susan Cooper, Sarah Jarvis Paediatric Diabetes/Nutrition & Dietetics Paediatric diabetes: Carbohydrate counting October

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