How To Count Carbs: Tricky Foods
Background info on carbohydrates and type 1 diabetes:
An Introduction to Carb-Counting: General Tips
Why Do Some Foods Create More Chaos Than Others?
Although the carb content of a food is the main factor affecting blood glucose, there are other factors involved. Some foods are famous for causing other-than-expected post-meal glucose results. The problems they pose may be related to counting carbs accurately, or to a low Glycemic Index value (which relates to slower digestion of that food), or to high-fat content (which creates later insulin resistance). Whatever the reason, there is no reason for your child to give up formerly-favourite foods just because she has diabetes – your family just needs to learn some new ways of dealing with insulin dosing when these foods are on the menu.
Glycemic Index
If a food is digested quite slowly (such as whole grains, apples, spaghetti, fruit juice), then the affect on blood glucose will be different than that of quickly-digested foods, even if the two different foods contain the same amount of carbs. This relates to the concept of Glycemic Index (GI). The carb-counting is straightforward, but the effect on post-meal blood sugar is not, so you may need to deal with these "tricky foods" differently to tame post-meal spikes that are caused by GI.
Fat & Protein
Also, keep in mind (without worrying too much about it right after diagnosis - get carb-counting under your belt first) that protein and fat consumed in large amounts will affect blood glucose.
Huge Meals!
In addition, some people report that very large meals affect their blood glucose differently than smaller meals. This may be related to the concept of Glycemic Load.
Some Common "Tricky" Foods
Pasta is problematic for some kids, and not for others. Pasta with loads of rich cream sauce may have a particularly pronounced effect. If you find that after eating pasta, your child’s blood glucose first drops low and then spikes a few hours after the meal, this is likely due to the low Glycemic Index of pasta (and/or the high-fat content of the cream sauce). Essentially, the insulin is getting in before the food is fully digested; there is too much insulin present right after the meal, and not enough insulin present later, when the glucose from the digested pasta has reached the bloodstream.
Fast Food is generally high in saturated fat, which leads to insulin resistance later (that is, the body uses insulin less efficiently and so needs more insulin for the same effect), resulting in high blood glucose readings in the hours following a high fat meal (especially overnight). You may see higher blood glucose readings for several hours after your child eats fries, hamburgers, chicken nuggets and other deep-fried foods.
Pizza can be problematic, for a couple of reasons. First, it can be tricky to accurately determine the carb content of a slice of pizza. Initially, it may be helpful to go only to restaurants which make carb info available – this takes one variable out of the equation. Also, using nutritional scales and other measures can help you to count the carbs as precisely as possible. Also., pizza has a high fat content. This poses additional challenges, as saturated fat slows down digestion and increases insulin resistance, often resulting in high blood glucose readings several hours later, and sometime lows soon after eating, too.
How Can We Deal with Tricky Foods?
Soon after diagnosis, it is enough to simply be aware of this trend, so that you are not confused and frustrated by atypical blood glucose readings when your child eats these foods. Each family will decide for themselves, based on where they are in their journey with the diabetes dragon, how they want to handle this situation. Some families will avoid fast food restaurants and pizza parties initially, until they are ready to add another layer of learning. Some families will continue to eat out, but will steer their children toward healthier food choices with fewer complications (for example: chicken wraps and apple slices at McDonald’s; a Subway chicken sub instead of burgers and fries). Some families will choose to eat these foods and deal with the highs as they arise. (Michelle says: This is what we did for the first year or so after diagnosis, until we understood what was causing the highs.) Some families will choose to eat these foods and learn new ways of dosing/timing insulin so that the effect on blood sugar is reduced.
When your family is ready to learn more about how to tame post-meal spikes caused by GI and Fat, we've outlined some effective solutions here:
The above information was significantly modified with permission from The Alberta Children’s Hospital Diabetes Clinic information handouts.
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
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