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Children's Hospital at Dartmouth Hitchcock (CHad)
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Nutrition and Meal Planning

Pediatric Type 1 diabetes

To correct for the lack of insulin in Type 1 diabetes, families learn how to match insulin doses to the amount of food (carbohydrates) eaten at meals.

Foods contain a mixture of protein, carbohydrate and fat. One hundred percent of carbohydrates (carbs) are broken down to glucose.

Meals and snacks should include a variety of foods, for good nutrition. Include colorful fruits and vegetables each day. Choose whole grains to add fiber to the diet.

Protein and fat

A minimum amount of protein and fat end up as sugar in the blood, so additional insulin is usually not needed to cover these foods. Protein and a moderate amount of fats are important for good nutrition and a balanced diet. They can help maintain a steady level of blood glucose and play a role preventing hypoglycemia.

  • Include protein foods with two or more meals or snacks every day.
  • Include low fat dairy to meet calcium needs.
  • Most dairy foods count as carbohydrates; cheese is a low-carb protein substitute. Look for reduced-fat choices to help control saturated fat.

Carb counting

  • Carbohydrate is a broad category including sugars, fiber and starches (bread, cereal and starchy vegetables like potato).
  • Carbs are found in many food groups, such as grains, fruit, milk and sweets.

Food labels

Reading food labels will help you control your diabetes, and is essential to learning carb counting. Prepared foods are required to have food labels, and reference books will help you find carb contents for ones that do not, like produce, meats and restaurant foods.

It is important to compare your serving size to the serving listed on the nutrition facts label for accurate carb counting. If the food contains less than 5 grams of fiber, subtract half of the fiber grams from the total carbohydrate, as only part of the fiber is absorbed. Sugar alcohols are only about half-absorbed, so also subtract half of the grams of sugar alcohol from the total carbs.

Measuring foods is recommended to most accurately determine the carb count of high starch or sugar foods, especially just after diagnosis. Over time you will be able to carb-count with confidence and adjust your insulin based on your serving size.

Age-based carbohydrate counting guide

Use this table of suggested carb levels to help meet your needs for growth and good nutrition.






Daily Total


45 g 45-60 g 45-60 g 15 g x 3 210 g


60 g 60 g 75 g 15 g x 3 240 g


60 g 75 g 90 g 15 g x 3 270 g


Girls 60 g 75 g 90 g 15 g x 2
(no AM snack)
255 g
Boys 90 g 90 g 90 g 15 g x 2
(no AM snack)
300 g

Free foods

These foods contain few carbohydrates or calories and have minimal effect on blood sugar. They include low-calorie vegetables (i.e. celery, cucumbers and peppers etc.) and sugar-free foods (i.e. sugar-free popsicles, Jell-O and drinks).

Low-carb snacks

Controlled-carb snacks can help control your appetite between meals and insulin doses. Snacks that include high-fiber vegetables and protein or hot liquids like soup and tea can boost fullness to help control hunger between meals (and insulin doses). We recommend the following:

  • Small serving of nuts with sugar-free drink
  • Reduced-fat string cheese or hard boiled egg
  • Lettuce leaves rolled with meat or cheese
  • Marinated cucumber slices
  • Vegetable, miso, chicken or beef broth. Add cooked carrot, celery or other vegetables.
  • Scrambled egg with chooped cooked vegetables
  • Small tossed salad with flavored tofu cubes
  • Peeled cucumber logs filled with hummus or flavored cream cheese

Concentrated sweets

Concentrated sweets have a large amount of carbs in a small amount of food. They will raise your blood sugar quickly if they are not given with insulin. Use moderation with sweets, and give at a meal with insulin. Examples are cake frosting, candy, cookies, regular soda and other sweets. Substitute artificially-sweetened foods to help limit carb intake.

Type 2 diabetes

Pediatric Type 2 diabetes is associated with obesity and insulin resistance. A cornerstone of treatment is work on lifestyle changes with diet and exercise to promote weight loss. For the best success rates, the whole family needs to make changes rather than single out only the child or teen with diabetes. Individual and group nutrition counseling with motivational interviewing and behavioral therapy is recommended.

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