carb counting for kids
Together with Pick n Pay, we’ve designed a cookbook specifically for people with diabetes who want ideas for every meal of the day. Breakfast, lunch, dinner, snacks and treats – there’s something for everyone!
Get nutritional advice on how to build balanced meals, and delicious recipes the whole family will enjoy – whether or not they have diabetes.
If you met Shiara Pillay, a happy, healthy and confident 21-year-old who loves Art and is studying International Relations and Diplomacy, you wouldn’t guess that she had a chronic condition. But Shiara is a Type 1 diabetic. She just doesn’t let it get her down.
When did you find out you were diabetic?
When I was in Grade 4 and just about to turn 10. It wasn’t too horrible a diagnosis in comparison to some – my parents noticed that I was losing an extreme amount of weight, I was very dehydrated and waking up in the night to pee – all the classic symptoms.
Then one morning I threw up and they took me to the doctor. I was in hospital for a week and since then I’ve figured out how to live as normal a life as possible with diabetes. The hardest thing to get used to was not being able to eat sweets!
How has diabetes changed your daily life?
I think I’m obviously way more healthy than I would have been because I have to watch what I eat. I have a great diabetes team, and they’ve helped me to adjust my medication and my meals whenever I need to. I like the idea of being able to eat everything in moderation.
How does it help to have a community of fellow diabetics?
It helps to know that there are others in the same situation, it reminds you that you’re not alone. Youth With Diabetes really helped me to meet other people who have to think about the same things every day. I also think diabetes education is so important – new diabetics especially need to know what helps and what doesn’t, what you can eat, how you should exercise, how you feel when you’re low or high. It’s nice for me to share my experiences too. I do have bad days, it’s annoying to have to inject every day, but it’s just something you have to make the best of.
What advice would you offer to other diabetics?
Just do it – you can’t get out of it. If you look after yourself, it’ll be better for you in the long run, it’s for your benefit. And it makes you healthier too!
What makes your life sweet?
Just being happy – when things are going well and the sun is shining!
Ask the dietician: Genevieve Jardine
From our community: “Being newly diagnosed, I am learning about foods that I can and can’t use. I cannot find an article explaining what to look for. It’s all a bit confusing. Help would be greatly appreciated.” David Staff.
“Eat the right type of food, in the right amount, at the right time of the day”
It’s important to make dietary changes that are simple and progressive. First you need to learn what foods should be in your trolley, fridge and kitchen cupboards: that will make good eating decisions easier to choose.
I have one simple rule: eat food that is as close to its natural form as possible! This helps to reduce the amount of processed, high sugar, high-fat foods that cause problems with weight and blood sugar control. Try not to focus on what you can’t have (it is very depressing) and rather be adventurous in experimenting with healthy nutritious meals.
Once you know which foods are suitable, you need to get specific and work out how much to eat. Portion control is very important. The good news is that almost all foods are allowed in correct portions.
Here are some general rules:
Starch: Use low GI, high fibre starches. Reduce foods made with lots of white flour and sugar (doughnuts, biscuits, cakes ). For your main meal, the portion size of starch should be the size of your fist (approximately 2 portions of starch).
Protein: Opt for low-fat protein. Remove visible fat from meat and skin from chicken. For your main meal, the portion of protein should be the size of the palm of your hand and the same thickness as your baby finger (less at other meals)
Dairy: Choose low-fat or fat-free dairy. Try for 2 portions of dairy a day.
Vegetables: Choose a variety of colours and serve raw, steamed and roasted. Eat lots – double portions where possible!
Fruit: Try to eat a variety of fruits. The size should be that of a tennis ball and you should aim for 2 servings of fruit a day.
Fat: Try to reduce the use of fats in your cooking. Rather grill, bake, boil, steam, microwave or stir-fry your food. The portion of fat should equal the size of the tip of your thumb.
Specific portion sizes:
- ½ cup wholewheat cereal / muesli
- ½ cup cooked, cooled and reheated mealie meal / oats porridge
- 1 slice seed loaf
- ½ wholegrain seed roll / low GI bread roll
- 3 Provita / 2 Ryvita
- ½ cup (2 Tbs) beans or whole corn
- 1 small mealie on the cob
- ½ cup cooked, cooled & then reheated samp
- ½ cup pasta / long grain rice / wild rice
- ⅓ cup white rice
- ½ cup brown rice with added lentils
- ½ medium sweet potato
- 2 – 3 baby potatoes
- ½ cup cooked lentils
- 1 egg
- 30g grilled chicken / ostrich / extra lean mince / grilled beef or pork
- ¼ cup tuna
- 30g steamed / poached / grilled / baked fish
- 2 tbs peanut butter
- 50g raw soya
- 90g tofu
- ½ cup cooked lentils / beans
- 1 cup low-fat / fat-free milk
- 100ml low-fat / fat-free sweetened yoghurt
- 30g low-fat cheese (Lichten Blanc, Dairybelle InShape, Elite Edam, Woolworths, Mozzarella)
- 50g low-fat feta cheese (Pick n Pay Choice Danish Style / Traditional, Simonsberg)
- 50g low-fat cottage cheese (Dairybelle, Lancewood, Parmalat, In Shape, Clover)
- Green pepper
- Baby marrow
- Bean sprouts
- Mixed vegetables
- Green beans
- 1 medium apple / peach / pear / grapefruit / orange
- 1 large naartjie
- 3 small apricots
- 10 – 12 grapes (only!)
- 1 small to medium nectarine
- 1 tablespoon dried fruit
- ½ cup fruit salad
- 2 teaspoons low-fat margarine / mayonnaise / dressing
- 4 olives
- ¼ avocado
- 80ml low-fat gravy / sauce
- 1 teaspoon olive / canola oil
We were just sent this advice about raising children with diabetes… It takes a family to raise a diabetic child, as we all know! Do you have anything to add?
Hearing the diagnosis for the first time can be overwhelming and will leave any parent and child with mixed emotions – it’s unfair, it’s exhausting, it’s stressful, it’s scary and it’s tough to manage. Yet there is nothing on earth that any parent could have done better to prevent their child from living with Type 1 diabetes. It is estimated that there are now more than half a million children aged 14 and younger living with Type 1 diabetes according to the 7th IDF Diabetes Atlas.
According to Dr Ntsiki Molefe-Osman, Diabetes Medical Advisor at Lilly South Africa, Type 1 diabetes is a disorder of metabolism caused by the body’s immune system which attacks the cells in the pancreas that produce insulin. “Children are not born with it, rather it develops over time and there is usually a genetic predisposition. In children, Type 1 diabetes presents commonly at around 14 years of age and younger. This means that Type 1 diabetes is a lifelong condition, it is serious, and managing it needs to be done diligently as poor control of the condition today will have lifelong repercussions. When a child is diagnosed with Type 1 diabetes, so is the entire family who all need to adapt to a new lifestyle.”
“The importance of good glycaemic control can’t be emphasized enough,” says Dr Ntsiki Molefe-Osman. The basic 101 of managing and preventing the complications of Type 1 diabetes is careful daily management of blood glucose and sustaining tight glucose control as close to normal levels as possible.”
“Diabetes is a progressive disease, which left unchecked will cause organ damage. This has significant health repercussions for later on in life – from kidney failure, heart failure, blindness, nerve damage (diabetic neuropathy) and as a result loss of limbs. What you do for your diabetic child today and the responsibilities you teach your teen in managing Type 1 diabetes, will influence the quality of life they can expect to live later in life,” explains Dr Molefe-Osman.
Why do Type 1 diabetics need insulin?
People living with Type 1 diabetes do not produce any insulin at all, so it needs to be replaced with insulin injections. Insulin moves blood sugar into body tissues where it is used for energy. When there is no insulin, sugar builds up in the bloodstream. This is commonly referred to as high blood sugar, or hyperglycaemia – it is dangerous and has many side effects. Fortunately when the blood sugar is stabilised with insulin treatment, these symptoms go away.
It can be managed
While a diabetes diagnosis for your child may come as a shock and will mean that lifestyle adjustments will have to be made, it is important to remember that with consistent control and the support of a healthcare provider, people living with Type 1 diabetes can live full, active lives.
Family support is vital
Managing Type 1 diabetes in your child takes a lot of courage and determination. Imagine the mountain that a child faces knowing that injections will be part of their daily routine. They may also worry that their condition will preclude them from enjoying all the things that other children get to experience, or lead to them being treated as ‘different’ in their school and peer environment.
It all comes down to how you work together as family to support and guide your child in helping them see their daily treatment regime as a positive step towards a healthy and normal life, rather than as a punishment or burden. It is important to help your child believe wholeheartedly that with the right control and responsible approach, they can do whatever they want to do.
Managing chronic illness
“Coping with and learning to manage a chronic illness like diabetes is a big job for a child or teen. It may also cause emotional and behavioral challenges and talking to a diabetes educator or psychologist can help immensely. It’s also important that family, friends, teachers and other people in your child’s network know of and understand the condition so they are alert to any symptoms or signs that their blood sugar is out of control and what to do to help them in an emergency situation,” adds Dr. Molefe-Osman.
It takes a huge amount of discipline on the part of the parent and child in managing the demanding diet, lifestyle and treatment regimen, so it’s essential to establish a routine that works for everyone concerned. Establishing good habits early, providing a support structure and ensuring that your child understands why good control is important are vital. It’s the difference between your child managing their diabetes, or diabetes managing them,” she concludes.
- The 7th Edition of the International Diabetes Federation Atlas, World Health Organisation (WHO)
- http://www.who.int/mediacentre/factsheets/fs310/en/), Statistics SA
Remember when low carb wasn’t as well known as it is today? We do! Here’s an article from Sweet Life magazine published a few years ago that explains all the ins and outs…
Professor Tim Noakes says that a low carb, high fat diet is the way to go. We gathered your questions and asked him how the low carb diet affects diabetics. Here’s what he had to say.
What exactly is this diet?
A low carbohydrate, moderate protein, high fat diet. This diet is most effective for people with diabetes – either Type 1 or Type 2, or pre-diabetes, like myself. It also helps treat obesity, but it’s obviously not the diet for everyone. The question is whether it’s for 10% of the population, or 90% of the population – I think it’s about 60% or more.
Low carb means no bread, pasta, cereals, grains, potatoes, rice, sweets and confectionery, baked goods. You have to be resolute – and the more severely affected you are, the more resolute you have to be. If you’re already diabetic, you have every reason not to eat these foods.
Can you explain what carbohydrate resistance is?
My opinion is different from the traditional teaching. Carbohydrate resistance is traditionally described as someone who is unable to take glucose out of the blood stream and store it in their muscle and liver. I disagree with this explanation: I think we’re all born with varying degrees of carbohydrate resistance, and the children who get really fat very young are the ones who are most carbohydrate resistant. The carbs they take in they simply store as fat. That’s the first group.
The second group are people who become pre-diabetic at 30 or 40, and then they become diabetic at 50. They are overweight, and that’s a marker of the high carbohydrate diet. They eat a high carb diet, they are carb resistant and it gets more and more severe until they become diabetic. I think it’s genetic, and the reason I think that is because in my case, although I’ve lost weight, I’m still carbohydrate resistant – I can’t go back to eating carbs.
What if you have high cholesterol? Isn’t it dangerous to eat so much fat?
Firstly, the theory that high cholesterol is a good predictor of heart disease is not true – it’s a relatively poor predictor. A far better predictor is your carbohydrate status. Everyone knows this – if you’re diabetic or pre-diabetic, your risk of heart disease is increased. Diabetes, hypertension and heart disease are linked, but most heart attacks occur in people with cholesterol below 5. It’s very frustrating, because the public has got the wrong idea.
A high fat diet corrects everything, in my opinion – your HDL goes shooting up, your triglycerides come shooting down and that HDL to triglyceride ratio improves dramatically: that’s one of the better predictors of heart attack risk. The LDL small particles are the killers, and on a high fat diet, those go down. Your total cholesterol can go up, but that’s because your HDL has gone up, and the large, safe LDL particles have gone up. So unless you measure all those variables: HDL and LDL and triglycerides and glucose tolerance, you can’t judge the effects of the diet.
What carbs do you eat?
The good carbs are veg – that’s it. Sweet potatoes (not regular potatoes), butternut, squash and then I also eat dairy: milk, cheese, yoghurt. I don’t eat any fruit except apples, but that’s because I severely restrict my carbs. You’re not cutting out nutrients if you eat nutrient-dense foods like liver, sardines, broccoli and eggs – those are the most nutrient-rich foods you can eat. You can get vitamin C from meat if it’s not over-cooked. The key is that you eat lots of fat, and you don’t avoid the fat. I eat lots of fish, like salmon and sardines. And you want to eat lots of organ meats – that means liver, pancreas, kidneys, and brains if you can get them, but particularly the liver. Liver is very nutritious.
Is this diet possible for people who don’t have a lot of money?
You don’t have to eat meat every day – you can eat sardines and kidneys, for example, which are both very cheap.
Could the positive effect of a low carb diet on insulin resistance be because of the weight loss and not because of the new diet?
No, absolutely not. Because it happens within one meal – your insulin requirements go down within one meal, because you’ve shut off the production of glucose by not eating carbohydrates.
What is wrong with the old fashioned idea of a balanced diet? Why does it have to be so extreme?
If you’re diabetic, you have a problem with metabolising carbohydrates. You have to understand that if you want to live a long life and have minimal complications, you want to minimise your carb intake. Start at 50g a day. What that looks like is two eggs for breakfast, with some fish – salmon or sardines, and some veg. And dairy: cheese or yoghurt. That will sustain you until early afternoon. For lunch, I think you should have salad and some more protein and fat – and exactly the same for dinner. Chicken, cheese, nuts, salad, tomatoes, broccoli. It’s an incredibly simple way to eat, but you don’t get bored.
Once you’re on this diet, you feel so good, and you get rid of all these aches and pains and minor illnesses: you won’t want to go back. If you do go back to eating carbs you’ll put on the weight again. It’s not a diet, it’s a lifelong eating plan. It’s not a quick fix.
I think the diabetics who live to 80, 90, 100 are the ones who eat this kind of diet.
Ask the dietician: Genevieve Jardine
When someone is newly diagnosed with diabetes, it’s helpful to start with very simple dietary advice as they come to terms with the necessary lifestyle changes. The spectrum of food choices for diabetics involves “good choices” on one end and “bad choices” on the other. In the middle lies ‘moderation’, which can be adapted to the individual depending on personal factors and other conditions like blood pressure or cholesterol.
Here, we’ll break down what good and bad choices look like in each of the food groups – proteins, starches and sugars, vegetables, fruit, fats and oils, and drinks.
Proteins: meat, chicken, fish, eggs and dairy
- Fish more frequently (especially fatty fish like salmon, trout and mackerel)
- Eggs, especially boiled eggs
- Plain yoghurts, milk and cottage cheese
- Plant-based protein options like beans, lentils and chickpeas, instead of meat
- Using chicken that has skin removed (preferably grass-fed)
- Game meat that is very low in fat
- Deep fried meat, chicken and fish
- Very fatty red meats and processed meats
- Diary that has been sweetened, like ice cream
- Imitation cheese and coffee creamers
Starches and sugars
- Unprocessed, high fibre starches like sweet potatoes, rolled oats, brown rice, wild rice, quinoa, buckwheat and barley.
- Items made with wholegrain flour with little or no added sugar such as wholegrain bread, crackers and cereals.
- Any food item that has a lot of sugar added, like sweets, chocolates and biscuits.
- Refined flours that have been processed and bleached white such as white flour, white breads, white crackers, white rice and refined cereals (especially if the cereals have sugar added).
- Deep fried starches such as doughnuts, koeksisters, vetkoek, fried potato chips and crisps.
- Homegrown, fresh or even frozen vegetables with emphasis on lots of different colours. Try to eat a rainbow of vegetables. Eat them raw, juice them, steam them or bake the root vegetables for maximum nutrient retention.
- Fresh herbs and spices like garlic, ginger, turmeric, cinnamon, mint, rosemary and coriander.
- Vegetables that have been boiled
- Vegetables with thick sauces
- Canned vegetables which are higher in salt (for those people who need to watch their salt intake)
- Fresh fruit in season
- Fruits with a naturally lower sugar content, such as berries, apples and citrus
- Fruit juices
- Dried fruit with sugar coating
- Fruit canned in a thick syrup
Fats and oils
- Foods that are naturally high in fats like olives, avocado, nuts and seeds
- Good quality oils such as extra virgin cold pressed olive oil
- Foods that are high in trans fatty acids and hydrogenated vegetable oils (read the food labels to spot these words).
- High quantities of plant seed oils like sunflower and canola oil (usually deep fried products).
- Filtered water flavoured naturally with lemon or mint
- Herbal teas
- Sugary drinks such as sports drinks, fizzy drinks, iced tea, flavoured water.
- Alcoholic beverages that are high in sugar, such as cocktails, dessert wines and fruity mixed drinks.
My granddaughter who has Type 1 diabetes is going with us for 2 weeks to Mauritius by boat.
I am very unsure how to keep her blood sugar between 4 and 10.
My question is: how long after meals should I check that her blood sugar is not above 10?
Any other tips?
If you’re trying to find a way to put together healthy lunchboxes and snacks that still taste great, check out these great tips from Novo Nordisk:
Keeping tabs on children of any age can be a challenge, but keeping tabs on a child living with diabetes adds on to that challenge. One of the top priorities for parents of children with diabetes is to manage the condition from an early age, so that their children can lead normal, healthy lives. The treatment regime includes making sure they have a healthy diet based on foods with a low GI (Glycaemic Index); foods that digest slowly and therefore don’t play havoc with the body’s blood glucose levels. This can be enough of a challenge at home, but what about the times when children are out of the home – at school, parties or sports events?
The trick is to make carb counting for lunchboxes and snacks easy, so that it becomes a simple routine rather than a complicated chore. But counting carbs, as anyone who’s been on a carbohydrate-restricted diet will know, can be difficult – and frustrating. And who has time in the mornings to figure out whether the lunchbox they’re preparing is ‘carb-safe’ for their child?
Luckily, there are some easy techniques to use for counting carbs, and these can be really useful for busy Moms and Dads.
“The first thing is to make a list of the foods that are high in carbohydrates and to paste this onto the door of the fridge as an easy go-to reminder,” says Shelley Harris, Public Relations Manager of Novo Nordisk (SA), local division of the world’s leading diabetes healthcare company. These include fruits and starchy vegetables like potatoes and corn; foods made from refined grains like bread, crackers and pasta; and sugar or foods sweetened with sugar.
“Do this with a column next to each item to record the carbohydrate count, so that you don’t have to do it from scratch every day,” says Harris.
“If you’re packing in something like low-fat sweetened yoghurt, for instance, it’s easy to check the total carbohydrate content on the label, which includes the measure of both sugars and starches. Do that and then write it down on your checklist for easy reference.”
Another technique is to allocate average carbohydrate counts to common foods like bread and apples.
“An apple, a slice of bread or a cup of skim milk all contain around 15g of carbohydrates, so it’s easy to do quick calculations based on what the American Dietetic Association refers to as ‘food exchange groups’. The term means that foods with a standardised carb count are interchangeable, and that the total carb content of a lunchbox can be quickly calculated in this way.
For children on insulin, this methodology makes it easy for parents to calculate the insulin-to-carbohydrate ratio that determines the amount of insulin they need to take before each meal, making allowances for variables like levels of activity and individual responses to certain foods.
With over 6.5 million South Africans living with diabetes, and with approximately 45% of all new cases of Type 2 diabetes being diagnosed in children, as stated by the IDF the Diabetes Atlas and the American Diabetes Association, easy-to-use, time-saving methods like these can be invaluable to parents.
The other side of the coin, of course, is to make lunches and snacks interesting by varying the contents from day to day, and by focusing on foods that kids enjoy. A nutritious and satisfying lunch could, for instance, include a sandwich made from whole grain bread, a homemade treat like a low-fat choc chip cookie, a portion of fresh fruit, a few veggie sticks and some low-fat milk or bottled water.”
“Carb counting for children with diabetes needn’t be difficult,” concludes Harris, “and lunches don’t have to be boring. All it takes to put together a healthy, appetising lunchbox every day is a bit of forward planning and a good dose of imagination. And voila! A healthy, happy child – every day.”