Building Independence: Carbs + Exercise

passing the T1D baton: Exercise + Counting Carbs

We all know that eventually our T1D child needs to be able to care for their diabetes for themselves. But how do we hand over that baton? The first step is identifying the concrete skills that we need to teach them. Here we will zoom in on the sub-skills needed for your child/teen to count carbs and manage the effects of exercise safely, effectively and independently. Why not pick one now and work toward its mastery?

Here are two lists, one outlining the sub-skills involved with assessing the carbohydrate-content of a snack or meal, and another outlining the sub-skills for dealing with the effects of physical activity on blood glucose. Ask yourself if your child/teen can – and will – independently do all of the following tasks. If you answered “no” to a certain step, that could become a teaching target to move your child towards independence.

Carb Counting Skills:

a. Measures the amount of the food to be eaten according to:

  1. Volume (ex. ½ cup of mashed potatoes), OR
  2. Weight (ex. 25 grams of breakfast cereal), OR
  3. Item count (ex. 2 slices of bread).

b. Locates a carb value for a particular food:

  1. By reading the nutrition info label on a package, OR
  2. By using a nutritional scale, OR
  3. By looking up carb value in written tables (ex. Healthy Eating manual, personal list), OR
  4. By using a smartphone app, OR
  5. By using their insulin pump’s database, OR
  6. By using nutritional info on a restaurant’s company website.

c. Determines the grams of carbs contained in the current portion size (using steps 1 & 2 above).

d. Determines carb content of whole meal (by adding values of the individual foods).

e. Determines correct insulin dose for the meal (according to his or her individual I:C ratio).

Exercise Management Skills:

  1. Recognizes that exercise typically LOWERS blood glucose.
  2. Recognizes the conditions under which exercise can RAISE blood glucose.
  3. Checks blood glucose before, during, and after exercise.
  4. Checks blood glucose for several hours after exercise including the middle of the night, looking for delayed lows.
  5. Uses an effective strategy to avoid exercise-related LOW blood glucose:
    1. consumes extra carbs, AND/OR
    2. decreases insulin doses (under circumstances which typically lead to lower blood glucose).
  6. Uses an effective strategy to avoid exercise-related HIGH blood glucose:
  7. increases insulin doses under those special circumstances which typically lead to a rise in blood glucose.
  8. Based on past personal experience, adjusts pump basal rates as applicable to adjust for the increased insulin sensitivity which may follow exercise.
  9. Avoids exercise if blood glucose is high AND ketones are present.

The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.