Building Independence: Carbs + Exercise

Building Independence in Diabetes Skills… What Does My Child Need to Know about:

We all know that eventually our T1D child needs to be able to complete diabetes self-care tasks for themselves. But how do we hand over that baton? The first step is identifying the concrete skills that we need to teach them.

Ask yourself if your child can – and will – independently do all of the following tasks related to managing carbs and dealing with exercise. 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 nutritional 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 your insulin pump’s database (Insulin Pump users only), OR
  6. By using nutritional info on a restaurant’s company website, OR
  7. By using any other reliable method of determining carb content.

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).

More information on carb counting:

Intro to Counting Carbs
Advanced Counting Carbs

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.

More information on managing exercise:

How Exercise Affects Blood Glucose

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

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.