Meal Planning for Children with Diabetes

Setting up the meal plan

Your child’s meal plan provides the basis for healthy eating and safe blood sugar control. Regular mealtimes and snack times and consistent amounts of food are key parts of the plan. Almost all children with diabetes need 3 regular meals and a bedtime snack every day, to avoid low blood sugar emergencies. For most children the meal plan also includes a mid-afternoon snack. Some children, especially younger ones, have a regular mid-morning snack as well. How is the meal plan developed? How do you know the timing of meals and snacks, and how much food should you provide? These are important questions.

A registered dietitian (RD) will help create a meal plan to meet the needs of your child and family. The dietitian is experienced in nutrition planning for children and adolescents. She is a key member of your diabetes team. The meal plan is based on what and how much food is normally eaten. Food intake records are important in helping the dietitian figure out how much food your child needs at first, as well as changes down the line. 

Your family will record the amount and types of food eaten at each meal and snack over a period of about 3 days. The dietitian reviews these records and calculates the average amount of carbohydrate, protein, and fat eaten at each meal and snack. This forms the basis of the meal plan. The timing of meals and snacks depends on the family’s routines. As the child grows and daily routines change, the meal plan must be changed to reflect these changes.

An alternative to this plan is to focus only on the carbohydrate content of each meal. This “carbohydrate counting” is a more flexible approach to meal planning. It may be most appropriate for older children and teens who can apply the ideas they have learned.

For each of these meal planning strategies, you need to pay careful attention to the amount of carbohydrate eaten at each meal and snack.

The food choice system or diabetes meal plan

The Canadian Diabetes Association has a food choice system, called the Good Health Eating Guide. It organizes food into 7 groups, based on protein, fat, and carbohydrate content. Carbohydrates are further divided into starches (grains and cereals), fruits, vegetables, dairy products, and sugars.

The American Diabetes Association has an exchange (choice) system that is similar to the Canadian system. However, it organizes foods into 6 rather than 7 groups including bread/starch, meat/protein, milk, fruit, vegetables, and fat. The carbohydrate content in some of the food groups is different in the Canadian and American exchange lists. The following table compares the grams of carbohydrate content in each system based on average servings.

Exchange group	Canadian system	American system
Bread/starch	15 grams	15 grams
Fruit	10 grams	15 grams
Vegetables	10 grams	5 grams
Sugars	10 grams	—
Meat/protein	0 grams	0 grams
Fat	0 grams	0 grams
Milk	4 oz = 6 grams	8 oz = 12 grams
(1 exchange)

Sample exchanges or choices

(Each food item reflects one choice from that group)

Starch: 15 g carb.	Fruit and veg: 10 g carb.	Milk: 6 g carb.	Fat choices	Protein choice
1 slice bread ½ cup (125 mL) unsweetened cereal ½ hamburger bun or hotdog bun 3 cups (700 mL) popped popcorn ½ cup (125 mL) cooked rice ½ cup (125 mL) kernel corn (frozen or canned with no sugar added) or half a cob 2 cookies 1 small plain roll ½ cup cooked spaghetti 8 soda crackers 1 cup (250 mL ) canned soup	½ medium apple ½ banana ½ cup (125 mL) blueberries 1 cup (250 mL) watermelon ½ cup (125 mL) carrots ½ cup (125 mL) beets 1 orange 1 cup (250 mL) strawberries	½ cup (125 mL) milk ½ cup (125 mL) yogurt	1 tsp (5 mL) butter; margarine or oil 1 slice bacon 1 tbsp (15 mL) cheese spread 1 tbsp (15 mL) cream cheese 1 tbsp (15 mL) salad dressing	1 oz (30 g) cheese 1 oz (30 g) ground meat 4 tbsp (60 mL) canned fish
Sugars—10 g carb, 2 tsp (10 mL) sugar, 4 jelly beans, 2 marshmallows
Extras—diet pop, broccoli, cucumber, celery, green pepper

Based on the food records, the dietitian plans a certain number of choices from each group for the child’s meals and snacks. She then converts the choices to grams of carbohydrates. This system will become easy to apply, with some help from your dietitian and some practice using available lists.

The dietitian will likely teach you both portion sizes and carbohydrate counting at the same time. This will make the nutrition information on food labels easier to understand.

It may seem difficult at first, but weighing and measuring food will help you learn to figure out what a portion size is. After a while, you won’t need to double-check every measurement. However, it’s a good idea to go back to weighing and measuring foods from time to time. This helps you be sure that your estimates are still more or less correct.

At first, many parents are overwhelmed by the amount of planning and measuring they must do to follow a meal plan. They start to plan their meals by the number of carbohydrates suggested. Instead, it’s easier to plan meals as you usually would. Then look at the carbohydrate count and give correct portions. Remember to include food from all food groups. Then you can be sure you’ll be serving a balanced diet that meets the needs of your child’s diabetes.

Food choice: Pino’s story

Pino is 12 years old. Now that his normal appetite has returned, the dietitian has given him and his family a meal plan. Here’s a look at how many portions of each food group Pino eats during the day:

	Breakfast 8:00 a.m.	Snack 10:00 a.m.	Lunch noon	Snack 3:00 p.m.	Supper 6:00 p.m.	Snack 9:00 p.m.
Starch	2	1	3	1	4	2
Fruit & veg	2		2	2	1	2
Milk (skim)	2		2		2
Protein	1		2		2	1
Fat	2	1	2	1	2	2
Extras			yes		yes

 

Pino’s meal plan calls for a supper that has 4 starch choices, 1 fruit and vegetable choice, 2 milk choices, 2 protein choices, and 2 fat choices. Tonight the family is having spaghetti and meat sauce, salad, rolls, and strawberries for dessert. So Pino can have:

4 starches	2 cups (454 g) spaghetti or 1½ cups (340 g) spaghetti plus a small dinner roll
1 fruit & veg	1 cup (250 mL) strawberries
2 milks	1 cup (250 mL) milk
2 proteins	2 oz (60 g) ground meat (in meat sauce)
2 fats	2 tbsp (30 mL) salad dressing
Extras	salad with lettuce, celery, peppers

Remember that a meal plan is not a diet because it does not limit the amount of food. It’s important for Pino to feel satisfied, so his meal plan will change as he grows. He and his parents need to be aware when he starts to feel hungrier. Then the dietitian will help adjust the meal plan to allow more food. The doctor or diabetes nurse will then adjust his insulin dosage to balance the effect of the extra food on his blood sugar.