The whole calorie counting, carb counting and related dieting sort of passed me by. I’ve never been one to watch my carb intake, and living a particularly active lifestyle has really meant I have never had to. Like most people, I knew the basics; I could name high carb foods, knew not to eat a whole cake to myself (although I’d be lying if I said I didn’t do this on occasion) and understood that on high activity days I burnt more carbs than during a duvet day. That basic knowledge was enough until my young son was diagnosed with type 1 diabetes.

Diagnosis and carb counting

Immediately upon diagnosis, the importance of carb counting is drummed into you. If you get this wrong, you’re in for a bumpy diabetes ride with long highs and stubborn and dangerous lows. So I decided to lay out the basics and the slightly less basics of carb counting and feeding an opinionated toddler.

What is carb counting?

Carb counting is simply the way we work out the number of carbs you are eating during a meal or snack. For a diabetic, this is essential, for a type 1 diabetic, the number of carbs you eat determines how much insulin you must inject.

How do we calculate carbs in food?

To work out how many carbs are in a food you need to know how each gram of food is designated. For example for every 1 gram of banana, 0.2 of that gram is carb. Next you need to know the mass of the food you are about to eat. If I weigh the banana and find it weighs 50g then I have to multiply 50 by 0.2. So my 50g banana contains 10 carbs. To work out the carbs in a meal, you need to repeat this process for every food that makes up the meal. Its long winded and tiresome!

top tip: Some small scales are a useful addition to your kit, especially when eating out.

How do you know the carb content in food?

Well I could pretend to have an in depth knowledge of a wide range of food, but the truth is, like most diabetikid parents, I use an app. There are a few different apps but they all do the same thing. You find the food, add the weight of the food and the carbs are calculated for you. We use Carb and Cals app, it also comes in book form, which I have to hand in the kitchen.

You become an expert at reading nutritional tables on food packets. Most packets give you carbs per 100g of food, so some simple maths is required (divide by 100) to get the content in 1 gram, then multiply by the mass of food you are going to eat.

Carb counting and insulin

Once you know how many carbs you are going to eat, you have to work out how much insulin you need to inject. This is done through a ratio calculation. Again, this is usually done via an app (technology is amazing).

The toddler factor

To avoid large spikes in blood sugar level, you will need insulin to be injected 10-20 mins before eating, although there is massive variation in when to inject depending on the type of food (I could write a whole book on this). But you quickly discover the immense horror of injecting your toddler in this way, only for said toddler to refuse to even lick the food you have presented. You desperately try to make a game of it, plead with them, hide the carb inside another food and pretend to eat it yourself, only for them to grab the plate and unceremoniously spray your kitchen with it like a game of Frisbee.

The backup plan

If you own a type 1 toddler, this is 100% going to happen to you at some point. The secret is to have an easy to carb back up plan. An Oreo biscuit is 9 carbs, a digestive biscuit is 10 carbs (you’re welcome).

It feels uncomfortable giving your toddler a biscuit or similar when they have just thrown a plateful of well balanced, carefully planned, home made food at your kitchen cabinets but 20 minutes ago you injected insulin and you know time is ticking! The food throwing and refusal is a fight for another day, today, they just need to eat some bloody carbs.

Post meal bolus

To reduce the anxiety of food refusal, you could consider post bolus injections. This means, giving the injection after food is eaten. Whilst it is likely to give a higher blood gluocose spike (depending on the food), you can avoid the situation of having to resort to high sugar foods as a back up plan. We calculate the carbs then estimate the left over food before calculating the insulin needed. We have found this really helpful in reducing the stress of food refusal and also having to resort to unhealthy alternatives to “feed the insulin” already given.

Common misconceptions

Like most parents of type 1’s, I get frustrated when I hear misconceptions about what my son can or can’t eat so here are some of the most common comments and questions I’ve heard and my bluntest responses. Fellow parents, what misconceptions really make your blood boil?

1. Oh it’s so sad he can’t eat cake.
   • He can. A cake is approximately 50% carb (depending on the cake), so he will be getting quite a large insulin dose.
2. He’s having a low, he needs insulin
   • Only if you want to kill him. Otherwise, hand me the apple juice and step away.
3. He has diabetes because you fed him a poor diet
   • I…can’t…even. Type 1 is an autoimmune disease, his diet has nothing to do with it.
4. (Whilst looking at my son’s bowl of chocolate buttons) Oh if you eat all that you’ll get diabetes.
   • Too late, and he’s having a low so he can eat as many of those buttons as he likes.
5. If you don’t eat carbs you don’t need to inject insulin
   • If you don’t eat carbs you’re going to be very unhealthy and your body needs insulin for more processes than just getting glucose into your body cells.