Diabetes: Constant Carbohydrate Meal Plan

What is the constant carbohydrate meal plan?

The constant carbohydrate meal plan is a food program that will help balance the amount of carbohydrates your child eats each day. Carbohydrates affect your child's blood sugar more than any other kind of nutrient. Insulin works with carbohydrates to supply energy for the body. It is important to keep insulin and carbohydrates in balance. Consistency is the key to this meal plan. The constant carbohydrate meal plan is the food program that many people start with when they are diagnosed with diabetes. Families can then progress to the carbohydrate counting meal plan when they are ready.

How is this plan different from the exchange meal plan?

In the exchange meal plan, foods are divided by food group. Foods from one list can be “exchanged” for other foods on the same list because they all have similar nutrient value. The exchange meal plan can be confusing and inflexible. It is no longer commonly used.

The constant carbohydrate plan is different from the exchange meal plan because the focus is keeping track of carbohydrates rather than keeping track of all food types. The Diabetes Exchange Lists (now often called diabetes food lists) are still a useful tool. These lists show calories, portions, carb, protein, and fat content from all the food groups. The constant carbohydrate plan is more flexible, but may not be as healthy as the exchange diet if you are not careful about your food choices.

How does the constant carbohydrate plan work?

Your child needs to eat a consistent amount of carbohydrates at each meal during the day. Your dietitian will tell you how many carbohydrates your child can eat based on the number of calories your child needs each day. Carbohydrates are found in many of the different types of food. You count carbohydrates in portion sizes of 15 grams. A serving of 15 grams of carbohydrate is called a "carb choice." You can tell how much carbohydrate is in a food by checking the diabetic food lists and reading the nutrition label on the food package.

What foods contain carbohydrates?

Food groups that contain carbohydrates are:

Starch (breads, cereals, rice, pasta, beans, and starchy vegetables)

Some examples of 1 carb choice (15 grams):

• 1 slice bread
• 1/2 cup pasta
• 1/2 cup peas
• 1/3 cup cooked rice or 1/2 cup cooked brown rice
• 1/3 cup cooked beans.

Fruits

Some examples of 1 carb choice (15 grams):

• 1 small size piece of fruit
• 1/2 cup of canned fruit (in its own juice)
• 1/2 cup fruit juice
• 1/4 cup dried fruit.

Milk and yogurt

Some examples of 1 carb choice (15 grams):

• 1 cup milk
• 3/4 cup plain or no sugar added low-fat yogurt.

Sugary foods

Sweets should be eaten in smaller amounts for a healthy diet. Sugar is a carbohydrate. Portion sizes vary depending on the item. One tablespoon of sugar equals one carb choice. One serving of sweets may equal 2 or more carb choices. You can read the nutrition facts on the package to check how many grams of carbohydrate are in the item.

You can also use the booklet Choose Your Foods: Exchange Lists for Diabetes to check how many carb choices are in different items. The Complete Guide to Carb Counting 3rd edition gives more detailed information and more carbs to choose from. You can order these publications from http://www.shopdiabetes.org/Categories/8-Diabetes-Books.aspx or by calling the American Diabetic Association at 1-800-232-6455.

What about non-starchy vegetables?

Vegetables such as spinach, tomatoes, cauliflower, green beans, and salad greens contain much less carbohydrate than the other carb choices (5 grams versus 15 grams per portion). These vegetables typically do not count toward your child's daily carb count. A healthy diet should include more of these types of vegetables and less refined grains, meats, and fat.

What about meat and fats?

Although these foods are important in the diet, they do not affect your child's blood sugar in the same way that carbohydrates do. However, these foods do count toward daily calories, so your child needs to be careful not to eat too much.

• Meats are protein. Although they do not count as carbohydrates, they do contain fat and calories. Your child should eat only the lowest fat meat group foods in moderation.
• Your child should eat little or no butter, milk based salad dressing, bacon, cream, sour cream, stick margarines and shortening. These contain saturated fats.
• Your child should limit soft margarines, light mayonnaise, oil based salad dressing, nuts, seeds, olive, canola, peanut, flaxseed oil and oily fish. These are healthier fats, but should be eaten in moderation.

How many calories should my child eat a day?

A dietitian will help you plan how many carb choices your child should eat during the day based on the number of calories your child needs per day. Estimated needs for young children range from 1,000 to 2,000 calories per day. The range for older children and teens ranges from 1,400 to 2,500 calories per day. Ask your dietitian how many calories per day your child needs.

How many carb choices should my child eat at each meal?

Your dietitian will help you come up with a plan that is right for your child. This table lists the approximate number of carb choices that should be eaten at each meal during the day based on how many calories your child needs per day.

            1200    1500    1800    2000    2200   2500
            cal.    cal.    cal.    cal.    cal.   cal.
----------------------------------------------------------
Breakfast    3       3       3       4       4       5

10:00 am     1       1       1       1       1       1
Snack

Lunch       2        3       4       4       5       5

3:00 pm      1       1       2       2       2       2
Snack

Dinner       2       3       4       4       4       5

9:00 pm      1       1       1       1       2       2
Snack
----------------------------------------------------------

The amount of food eaten at a meal or snack may need to vary with factors such as expected exercise, insulin dose, and blood sugar level. More food may be needed when your child plans to exercise. However, the normal eating pattern of the child and the family should stay the same as much as possible.