Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.
Dr. Danielle Weiss is the founder of the Center for Hormonal Health and Well-Being, a personalized, proactive, patient-centered medical practice with a unique focus on integrative endocrinology. She enjoys giving lectures and writing articles for both the lay public and medical audiences.
Whether your child has been newly diagnosed with type 1 diabetes or has had it for some time, figuring out how foods affect their blood sugar is an ongoing process.
Although there is no one-size-fits-all to meal planning, certain food combinations may have more favorable blood sugar effects. This can be particularly important if your child is school-age and receiving insulin at school when you are not around.
Verywell / Theresa Chiechi
There are some key concepts you want to consider when planning lunch. First off, pack something you know they will actually eat, as this can prevent hypoglycemia (low blood sugar). You also want to make sure the meal is satisfying and visually appealing and that it includes foods that reduce the risk of large glucose spikes.
With careful planning, kids can and should be able to eat what they want. Food combinations that include foods with fat, protein, and fiber can help achieve good glycemic control. This article discusses how these nutrients affect blood sugar and suggest meals for your child's school lunch.
According to the American Diabetes Association, about 1.6 million people have type 1 diabetes. Of those, there are approximately 187,000 children and adolescents.
Type 1 diabetes is an autoimmune disease in which the body mistakenly attacks the pancreas, destroying the cells that produce insulin. People with type 1 diabetes need to take insulin daily to keep their blood sugars in range.
Insulin is a hormone that has many functions, including blood sugar control. There are many different types of insulin regimens and vehicles for delivery.
With advancements in technology, people with type 1 diabetes may use smartpens, insulin pumps, sensor-augmented pumps, hybrid closed looped systems, and continuous glucose monitors, to name a few. Regardless of what type of insulin regimen your child is on, the kinds of foods they eat will impact blood sugars.
Food is just one of the many variables affecting blood sugar in kids with type 1 diabetes. Food is also fun, social, and enjoyable. Certain nutrients are especially important for growth and development. Children with type 1 diabetes are not excluded from these specific needs.
In addition, kids with type 1 diabetes should not be put on strict, restrictive diets. Instead, balanced meals can optimize glucose control and make kids happy.
Carbohydrates are an important fuel source of energy. Foods that contain carbohydrates, such as whole grains, legumes, milk, yogurt, fruits, and vegetables, also contain essential nutrients like fiber, B vitamins, calcium, and iron, to name a few.
It's important to understand that carbohydrates are the macronutrient that impacts blood sugars the most. When carbohydrates are metabolized, they get broken down into sugar. In people who don't have diabetes, the pancreas produces the perfect amount of insulin to match the carbohydrate content, keeping blood sugars within range.
This does not mean that children with type 1 diabetes should be on a no-carb diet. They need carbohydrates, too. But the type and amount of carbohydrates eaten at one meal can have different effects on blood sugars. In addition, carbohydrates must be matched with insulin.
Insulin is responsible for bringing sugar from the blood to the cells to use for energy. The amount of carbohydrates your child should aim to consume per day will depend on their age, weight, activity level, and blood glucose levels.
Most kids will have what is called an insulin-to-carbohydrate ratio. This is just one calculation that is set to control blood sugars. Using an algorithm specific to their physiological needs, clinicians can formulate an insulin-to-carbohydrate ratio. This formula can be set to different ratios at specific times per day.
An insulin-to-carbohydrate ratio matches carbohydrates to units of insulin. For example, if your child's insulin to carbohydrate ratio is 1-to-8, that means for every 8 grams of carbohydrate, they will receive 1 unit of insulin.
Depending on which insulin regimen your child is on, you may have the option to program specific meals for your child so they are getting the right amount of insulin to match their meals. If you are not sure what this means, ask your certified diabetes care and education specialist.
You can also ask them to help you with carbohydrate counting. Apps and online tools can assist with carbohydrate counting.
Protein is an essential macronutrient that is present in all cells. It is made up of amino acids. Protein helps the muscles, tendons, blood vessels, skin, hair, and nails grow. It also is involved in synthesizing and maintaining hormones and enzymes and helps to fight infection and inflammation.
When paired with carbohydrates, protein helps to slow down blood sugar rise because it takes longer to digest. Many protein sources contain virtually no carbohydrates, such as meat, chicken, fish, pork, turkey, game, eggs, and most cheese.
Foods that contain protein may also contain essential vitamins and minerals such as B12, iron, and zinc. Protein is also found in whole grains, milk, yogurt, kefir, legumes (like peas and beans), nuts, and seeds, which may contain some carbohydrates.
The minimum amount of protein a child needs is set based on age. But this amount will also vary based on height, weight, and activity level. For reference, the Recommended Dietary Allowance for protein for kids (the minimum amount needed daily) is:
Again, this amount will vary based on other factors.
Fat is filling and pleasing to the palate. Dietary fat is also essential in providing structure to cells and cushion to membranes to prevent damage. Dietary fat plays a role in maintaining healthy cholesterol and absorbing fat-soluble vitamins A, D, E, and K.
Fat is found in oils, coconut, avocado, dairy products, nuts, seeds, meat, and fish. Fat contains no carbohydrates.
When it comes to blood sugar, the amount of fat in a meal may impact blood sugars by delaying how quickly blood sugars rise. Depending on how much fat is eaten in a meal, the effect of blood sugars can vary. It's always a good idea to have some fat in each meal.
Fiber is the indigestible part of carbohydrate that helps regulate blood sugars, pulls cholesterol away from the heart, and promotes bowel regularity. Fiber is also important for a healthy gut microbiome (the mix of microbes that normally inhabit the gut).
Research suggests that a high-fiber diet can have a favorable effect on healthy gut bacteria and improve glycemic control. The amount of fiber your child needs per day will depend on their age.
According to the Dietary Guidelines for Americans, daily fiber nutritional goals should be as follows:
If this seems like an overwhelming amount of fiber, start slowly and ensure your child is drinking enough fluids. A good starting fiber goal to aid in blood sugar control is to consume at least 5 grams of fiber per meal.
Some kid-favorite, high-fiber foods include berries, apples and pears with the skin, whole-grain bread and wraps, whole-grain cereal, hummus, avocado, oats, carrots, and peas.
Following are some ideas for lunch choices that contain high-fiber carbohydrates, protein, and fat.
Using whole-grain bread adds fiber and micronutrients. Cut your French toast into sticks and sprinkle it with cinnamon for a beautiful-looking, fun lunch.
French toast is usually made with egg, which contains fat and protein. Instead of using syrup as a dipper, pack a serving of low-fat Greek yogurt as a dipping sauce, or, if your child is more selective, consider a sugar-free syrup.
Keep in mind that sugar-free does not mean carbohydrate-free and carbohydrates in the syrup will need to be accounted for.
Pancakes are always a fan favorite when it comes to kids. And it's easy to batch cook pancakes and freeze for later use.
Make your pancakes with whole-grain batter, and add egg and ground flaxseed for additional healthy fats and fiber. Add a serving of blueberries, banana, chopped apples, or another kind of fruit for added fiber, flavor, vitamins, and minerals.
Get creative and make pumpkin, beet, or chocolate chip pancakes. If your child is allergic to eggs, substitute flax eggs (1 tablespoon of flax for every 3 tablespoons of water). Or, for every 1 egg, use 1/4 cup of applesauce.
This yummy, cheesy lunch choice is a great source of calcium, fat, and protein. It can be a good allergen-friendly lunch choice for schools that don't allow peanuts and tree nuts.
If your child cannot have dairy, consider a non-dairy cheese alternative. You can also get creative. Depending on how adventurous your child is, add beans or sour cream inside or on the outside for extra flavor.
Eggs are rich in choline (an essential nutrient for optimal brain functioning) as well as protein and fat. Egg salad can be made with mayonnaise or avocado for a delicious lunch.
Place the salad on crackers to make a cracker "sandwich" or on a slice or two of whole-grain bread. Look for bread or a wrap that contains at least 3 grams of fiber per serving.
Add a side of grapes and a low-fat cheese stick for a complete meal. If your child is leery of the egg smell or is allergic to eggs, substitute chicken or turkey breast.
Some kids don't have a big appetite at lunch, but if they are taking insulin, you want to make sure they eat all of their food to prevent low blood sugar. If you are permitted to send nut butter, whole-grain English muffins with nut butter is a yummy and satisfying option.
If nut butter is not permitted, try cream cheese, butter, or English muffin pizzas with cheese and tomato sauce.
One serving of egg noodles contains about 3 grams of fat, 39 grams of carbohydrate, and 8 grams of protein. This can be a great option for more selective eaters.
Mix your egg noodles, some butter, and Parmesan cheese. If your child cannot have cheese, you can substitute the butter for olive oil and use nutritional yeast for extra vitamins and cheesy flavor.
Pair this meal with a serving of fruit and a slice or two of fresh turkey breast or yogurt for a complete meal. Mixing some protein like chicken, fish, or cheese with traditional or bean pasta is also an option.
Avocados contain heart-healthy monounsaturated fat as well as filling fiber. Top your whole-grain wrap (which can be corn, whole wheat, or another variety) with mustard.
If your child eats vegetables, you can throw in some crunchy peppers, fresh tomato, or cucumber. If they aren't into veggies, pair this with a serving of fruit and their favorite snack for a filling and nutritious meal.
Traditionally, store-bought muffins can be high in carbohydrates, sugar, and saturated fat. But when you make your muffins at home, you control the ingredients.
Homemade muffins are also a great way to add extra nutrition (like vegetables) to your child's meal. In addition, depending on the recipe, they can also serve as a good source of fiber and healthy fat.
Adding ground flax, chia, or hemp seed is a great way to boost healthy fats and fiber content in a muffin recipe. They can be made ahead of time and frozen for later use or placed in the refrigerator the night before, which adds convenience.
Pair muffins with a serving of protein such as cottage cheese, or serve them with a serving of low-fat milk. For a full lunch, add your child's favorite snack. Following are a couple of recipes:
This might sound like a difficult task, but bagels made with Greek yogurt offer a ton of protein and calcium. They are also soft and delicious. Keep in mind you’ll have to calculate the carbohydrates in the entire recipe and divide it among the number of bagels you make to calculate the carbohydrates in each bagel.
In addition, most recipes call for all-purpose flour. You can substitute half of that for whole white wheat or another whole-grain variety to increase the fiber content. And if your child is eating gluten-free, you should be able to use gluten-free flour as a direct substitution.
Will your kids eat leftover dinner for lunch? This is an easy way to save time and ensure a meal they loved last night will be a meal they will probably eat for lunch. Try things like chicken, beef, or vegetable tacos, whole-grain pasta salad with mozzarella and cheese, or roast turkey sandwiches on whole-grain bread.
Perhaps your child doesn't like it when all their food touches or has a sensitivity to texture. If this is the case, plan to choose one fruit or vegetable, one serving of protein, and one serving of fat for lunch.
For example, this could be cheese, whole-grain crackers, and apple slices; or whole-grain cereal with Greek yogurt and berries, sun butter on crackers with banana, avocado toast with Everything but the Bagel seasoning, and a peach. The options are endless.
A child with type 1 diabetes will need to have lunches that are balanced with their insulin regimen. The best meal combinations will be ones that contain some healthy carbohydrates, fiber, fat, and protein. In addition, packing foods you know your children like and will eat is important.
Lunchtime in school can be a stressful time for you if you have a child with type 1 diabetes, especially when you are not familiar with how food will affect their blood sugars.
Get your child involved in meal planning for the week. Have them help you prepare their lunch, figure out the carbohydrates, and pack items they like. Working together can help ease the burden of diabetes and allow your child to have some independence.
If you have any questions about carbohydrates, insulin, blood sugars, or any other part of their medical regimen, be sure to discuss it with their medical team.
If you and your child agree about school lunch, there should be no reason why (unless your child has allergies) they cannot buy lunch. Purchasing foods like other children do may help your child feel more included and not as different.
It's a good idea to look at the menu the night before and help your child calculate the meal's carbohydrate content so they receive an accurate dose of insulin. It might take some time to figure out how these foods affect their blood sugar, but after some trial and error, you should be able to figure it out.
Eventually, if you need to, you can adjust their insulin setting at lunch if you notice a pattern of hyperglycemia after lunch meals.
When foods don't have labels, parents and children with diabetes need to figure out how to count carbohydrates accurately. Many resources are available to use.
Smartphone apps, such as MyFitnessPal and CalorieKing, contain an extensive food database inventory and can help identify the carbohydrate counts of food items. For example, chicken doesn't contain carbohydrates, but chicken nuggets do.
You can also work with your registered dietitian or certified diabetes care and education specialist to create a cheat sheet for the carbohydrate counts your child is used to eating. Most kids prefer a rotating menu for lunch. Once you establish how many carbohydrates are in a given meal, you can use those amounts moving forward.
Because of insulin action time, most people with diabetes should receive their insulin dose before a meal. The amount of time will depend on various things such as what they are eating, how active they will be, and if they usually eat all of their food. If your child is not eating their lunch, you may need to change how you give insulin at this meal.
Discuss your child's regimen and blood sugars with their medical team to see what types of adjustments need to be made. In addition, have your child be part of the meal shopping, preparing, and packing. Sending foods to school that they like and know they will eat is an important part of the process.
Because protein and fat delay carbohydrate metabolism, meals with a large amount of fat can affect blood sugars several hours after a meal. To figure out your child's patterns, you can analyze their continuous glucose monitor or check their blood sugar more frequently.
Depending on your child's insulin regimen and delivery system, you can modify their insulin to correct elevated blood sugars. This is something parents and children can work out with their medical team until they feel comfortable making changes on their own.
American Diabetes Association. Statistics about diabetes.
American Diabetes Association. Carb counting and diabetes.
U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.
Delahanty LM. Patient education: Type 1 diabetes and diet (Beyond the Basics).
Calabrese CM, Valentini Am Calabrese G. Gut microbiota and type 1 diabetes mellitus: The effect of Mediterranean Diet. Front. Nutr. 2021;7:612773. doi:10.3389/fnut.2020.612773
Linus Pauling Institute. Choline.
Barbie Cervoni MS, RD, CDCES, CDN, is a registered dietitian and certified diabetes care and education specialist.
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