Healthy Eating and Carbohydr
Healthy Eating and Carbohydr
Healthy Eating and Carbohydr
and carbohydrate
counting for
children and adults
with type 1 diabetes
Indian Foods – Edition 1, 2021
2
Authors
Sheryl Salis
Registered Dietitian, Certified Diabetes Educator, Nurture Health Solutions, Mumbai, India
Anna Pham-Short
Senior Diabetes Dietitian, PhD, Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
Carmel Smart
Senior Endocrine Dietitian, PhD, John Hunter Children’s Hospital, Newcastle, Australia
Cecile Eigenmann
Registered Nurse, Credentialled Diabetes Educator, MPH, Education Manager, Life for a Child, Diabetes NSW, Australia
Graham Ogle
Paediatric Endocrinologist, MBBS, DMedSci, General Manager, Life for a Child, Diabetes NSW, Australia
Acknowledgements
Food photos kindly provided by:
Sheryl Salis
Nurture Health Solutions, www.nurturehealthsolutions.com
Julia Zinga
Please see her book "How Much Carb in That?”, www.howmuchcarbinthat.com.au
Carmel Smart
Senior Endocrine Dietitian, PhD, John Hunter Children’s Hospital, Newcastle, Australia
Tobias Ogle
Toggle - Digital Creative Agency, Sydney, Australia, www.heytoggle.com.au
3
Table of Contents
This book is divided into three sections:
Foreword Page 5
2
Section 2 – List and pictures of carbohydrate foods commonly Pages 23 – 40
eaten in India - separated into breakfast and snack items, main
courses, breads, rice preparations and desserts
3
Section 3 – List and pictures of carbohydrate foods commonly Pages 41 – 53
eaten in most countries. It includes fruits, bread and cereals, dairy,
snack and bakery foods, some restaurant foods, take aways and
fast foods
Foreword
Management of type 1 diabetes is a balancing act with three big players – insulin, food and exercise.
This is not easy, particularly for children and adolescents, with all the excitement and changes that are
happening in their lives. But, when it is done well, young people with diabetes can lead normal and
active lives and avoid long-term diabetes complications. Knowing how much carbohydrate is in each
meal is a critical part of this. This book will help teach the young person with diabetes and their family
about healthy eating and provide tools to work out the carbohydrate amounts in the foods they eat,
so they can adjust insulin doses according to the carbohydrates they consume.
In Section 1, this book explains about why carbohydrate counting is important. Section 2 does a
magnificent job of covering the great variety of foods across India, and Section 3 covers common
international foods. This is the first version of the resource, and other versions for other countries will
follow. The layout of this book makes this easier to do, as, for each new version, Sections 1 and 3 will
remain largely unchanged.
Life for a Child (LFAC) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) are
delighted to endorse this new resource, and thank all the authors and contributors.
Copyright © 2017 Joslin Diabetes Center. Reprinted with permission. All rights reserved.
9
9 Make sure to have short or rapid acting insulin before Wholegrain breads
eating meals that contain carbohydrates! and cereals
9 If you eat a snack that contains less than 10 grams of
carbohydrate, no insulin is usually needed.
Lean meat, fish,
9 Avoid sugary drinks: keep hydrated with water. chicken, nuts
and eggs
9 Avoid eating in front of screens (e.g. TV, phone, computer).
Pay attention to the meals and snacks you eat.
Foods containing poly-
9 Maintain a healthy weight (limit take away foods, pay & mono-unsaturated
attention to portion sizes, be active every day). fats (e.g. avocado,
olive oil, groundnut oil,
mustard oil and rice bran oil)
10
Insulin works like a key that unlocks the doors to our body cells. Once the door is unlocked, glucose
from the blood can enter and be used as energy by the body.
Insulin regimens
The type of insulin and the number of injections per day will determine how you spread your
carbohydrate intake throughout the day. There are three common insulin regimens:
The ICR will vary depending on body weight, physical activity, how sensitive the body is
to insulin and may be different at different times of the day. Your health professional
will discuss and work out the ratio with you.
12
The rise and fall in BGLs depends on how accurately the bolus insulin dose is matched to the amount
of carbohydrate you eat. In the graph above the bolus insulin dose is matched perfectly.
Tip!
If you write down your BGLs, carbohydrate foods and insulin
doses for a few days, it will help you and your health care team
adjust your insulin to carbohydrate ratio (ICR).
13
Grains: Includes bread, bread rolls, flat bread, handbreads/chapattis/roti, millets, porridge, breakfast
cereal, pasta, rice, noodles, flour, quinoa and barley. Wholegrains are the best choices.
Fruit: Includes all fresh fruit such as apple, orange, pear, banana, watermelon, grapes, dried fruits (such
as apricots, dates, raisins, figs) and canned fruit.
Starchy vegetables, legumes and pulses: Includes potato, sweet potato, corn, taro, yam, legumes – baked
beans, chickpeas, kidney beans and lentils.
Low Carbohydrate Vegetables: Most non-starchy vegetables are low in carbohydrate and are important for
good health. Eat plenty of vegetables including tomato, cucumber, celery, carrots, capsicum, cauliflower,
mushrooms, peas, green beans, zucchini, broccoli, lettuce etc. These can be eaten in salad, soup, stir fry or
as steamed vegetable. Frozen vegetables are also a healthy choice.
14
Milk and dairy: Includes milk, yoghurt, lassi, custard, ice cream and dairy desserts.
Packaged, processed snack foods and take away foods: Includes chips, crackers, bars, biscuits, muffins and
chocolate. Take away foods include hamburgers, hot chips, and pizza. These foods are not recommended
to be eaten on a regular basis as they can cause high blood glucose levels and lead to unhealthy weight
gain.
High sugar foods and drinks: Includes regular soft drinks, cordials, juice, lollies, sports drink, jelly
and sugar. These foods are not a good choice. They can cause high blood glucose levels and lead to
unhealthy weight gain. However, some of these foods are appropriate to treat low blood glucose levels
(hypoglycaemia).
Proteins
Protein foods help your body to grow, develop and repair body tissue. You need to eat some protein
foods each day. NOTE: Some protein foods such as legumes (dals and pulses) and dairy (milk and
yoghurt) also contain carbohydrate and must be considered when counting carbs. Non vegetarian
protein foods such as chicken, seafood/fish, eggs and red meat do not contain carbohydrates.
Lean meat, chicken, fish, dairy (cottage cheese/paneer), eggs, nuts (for example almonds, walnuts,
pistachios, peanuts) and seeds, tofu, and legumes such as lentils, broad beans, chickpeas. Choose protein
foods that are low in saturated fat i.e. lean meat, skinless chicken, eggs and fish.
15
Fats are a normal part of a healthy diet and are essential for growth and development. However, use
them in small amounts (approximately 4 teaspoons of added oil or fat per day). Too much of any fat
or oil can lead to weight gain. Ask your dietitian for advice.
Polyunsaturated and monounsaturated fats include healthy fats such as sunflower oil, safflower oil,
olive oil, groundnut oil, rice bran oil, peanut butter, nuts, avocado, sesame seeds, soybean, canola and
mustard oil.
Include omega-3 fatty acid rich foods such as fatty fish like mackerel, sardines, tuna and salmon, chia
seeds, flaxseeds, walnuts and soybean. These are the best types of fats.
Unhealthy fats: Limit foods high in saturated or trans fats including cream, butter, ghee, cooking
margarine and processed foods. Too much saturated fat can raise blood cholesterol levels and increase
the risk of heart disease.
GO SLOW!
Cake, chocolates, sweets and take away food are treats which you
can eat for special occasions like everyone else. But make sure you
count the carbs and give extra short or rapid acting insulin!
To count carbohydrates:
measuring cups,
3 Calculate the amount
of carbohydrates
Food labels
Reading and understanding food labels on The nutrition information panel provides details
packaged foods can help you make healthy of how much carbohydrate, fat, protein and other
food choices. It can also help to calculate nutrients is in that food. Not all food labels are
carbohydrate amounts and compare products. the same. We have described one type below.
Be Careful!
The serving size on the label is NOT always the same as the
serving size you will eat. If your serving size is larger, the
carbohydrate amount (g) will be more.
Glycemic Index
Different carbohydrates will cause your/your child's blood glucose to rise faster or slower. The
glycemic index (GI) is a ranking of how quickly your/your child's blood glucose levels rises after eating
a carbohydrate food.
If you are using an insulin pump, meals high in fat and protein may require a combination/dual-wave
bolus (as shown in the picture No. 3 below).
It is best to get advice from your diabetes health care team regarding how to manage these foods.
NORMAL EXTENDED
Important!
COMBINATION
BOLUS BOLUS BOLUS Carbohydrates raise blood glucose
INSULIN
1 2 3
levels more than protein or fat.
It is important to get the carb
counting right before you move
on to consider fat and protein.
TIME
20
Eating out
Children and adults with diabetes can enjoy eating out with friends and family. Try to ‘estimate’ the
amount of carbohydrate containing foods based on what you would usually eat at home. You may find
carbohydrate amounts of foods from books, websites, phone apps, or the restaurant or cafe's website.
You could also seek help from your health professional by deciding the menu in advance.
You will not always get it right and that is ok! You can make a note for next time.
Alcohol
9 Do not give insulin for alcohol. Alcohol can cause delayed
hypoglycaemia (low blood glucose) and this can be dangerous, Warning!
particularly overnight. Alcohol can cause
9 Limit intake to 1-2 standard drinks. If you drink more, your risk delayed hypoglycaemia.
of hypoglycaemia increases. If you have been drinking
9 You may need to adjust insulin doses or eat more carbs to alcohol it is important
prevent hypos. to have carbohydrates
9 Make sure you tell a responsible adult/friend if you are drinking before going to bed.
alcohol and always wear a diabetes identification (ID). Particularly if you have
been exercising or been
9 Too much alcohol can cause weight gain as it contains a lot of
calories. active, like dancing.
Check your BGL more
9 Don't drink alcohol until you are of legal age.
often, especially before
9 Don't drink and drive! going to bed and
overnight!
Sweet alcoholic drinks
Some alcoholic drinks like sodas have lots of added sugar and will cause a temporary rise in BGLs.
However, you are at risk of delayed hypoglycaemia even if you have this temporary spike. Be mindful if
you are active while drinking alcohol (e.g. dancing). You may need to eat extra carbohydrate containing
food. Talk to your diabetes health care team for advice on how to stay safe when drinking alcohol.
about 5% alcohol about 7% alcohol about 12% alcohol about 40% alcohol
21
Physical Activity
It is important to be physically active every day to maintain good health.
Exercise can increase your/your child's risk of hypoglycaemia (low blood
glucose) during and even many hours after exercising. Although, high intensity
exercise such as strength training, skipping or heavy gardening work can temporarily raise blood
glucose levels. So, it is important to check your blood glucose levels before, during and after exercise.
9 Check blood glucose 9 Always wear or carry diabetes 9 Eat a snack containing
levels, aiming for 5-10 identification (e.g. a bracelet, carbohydrate and
mmol/L (90-180 mg/dL). necklace, card). protein (e.g. yoghurt, a
9 Have 10-20 grams of 9 Check blood glucose levels sandwich with nut butter
carbohydrate if blood often. or a meal with protein
glucose is below 5 9 Drink lots of fluid – water is source & rice).
mmol/L (90 mg/dL) or best. 9 Check blood glucose
if you are exercising for 9 Consider having a drink levels directly after the
more than 45 minutes. or snack that contains exercise, before going to
9 Pack your hypo carbohydrate if exercising for bed and overnight.
treatment (e.g. glucose more than one hour or if doing 9 Do not drink alcohol!
powder or tablets, juice, more strenuous exercise (e.g. It increases the risk of
soft lollies, sugar, fruit, running, farm work etc). delayed hypoglycaemia
plain biscuit). (even overnight).
Important
9 Different exercises will affect your blood glucose levels in their own
way. For example, high intensity exercise may cause BGL to rise
initially and drop later, while swimming usually causes a decrease.
9 Don't do high intensity exercise if your/your child's BGL is above
15mmol/L (270mg/dl). This can raise BGLs even more and be
dangerous.
Be Aware!
9 Insulin doses can be reduced for planned activity to minimise the
amount of additional carbs you/your child need to consume.
Physical activity,
stress, illness, and
9 Everyone is unique – the more you exercise and the more frequently
alcohol can also
you check your blood glucose levels, the better you’ll know your
body and how it responds. affect your blood
glucose levels.
9 Always talk to your diabetes team for individualised advice!
Carboh
yd rate foo
d, stres
s, illnes
s
BGL Physica
l activity, a BGL
lcohol
2
23
Carbohydrate
foods commonly
eaten in India
This section gives pictures and the amount of The following images are separated into
carbohydrates of some of the traditional and breakfast and snack items, main courses,
most common carbohydrate foods eaten in breads, rice preparations and desserts.
India. The carbohydrate values mentioned in
this book are estimates only as many factors All bowl measurements used in this section
can affect the amounts, for example the refer to a 200ml bowl.
method of preparation etc.
24
8 inches / 20cm
8 inches / 20cm
Neer Dosa Appam Homemade Dosa
8 inches / 20cm
8 inches / 20cm
Masala Dosa with ½ bowl Uttapam with ½ bowl Rava Dosa with ½ bowl
chutney & ½ bowl sambhar chutney & ½ bowl sambhar chutney & ½ bowl sambhar
1 270g + 80g 1 240g + 90g 1 150g + 65g
100g + total 100g + total 100g + total
serving carbs serving serving carbs
100g 100g carbs 100g
25
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Home made Idli Restaurant Idli Idli with Sambhar
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Bowl = Bowl =
200ml 200ml
8 inches / 20cm
Sabudana/
Poha Upma
Sago Khichdi
1 80g 30g 1 100g 30g 1 120g 60g
bowl weight carbs bowl weight carbs bowl weight carbs
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Chole (1 bowl)
Chillas/Dal (pulse) dosas Moong dal vadas with 2 Bhatura
1 270g
2 90g 15g 5 40g 15g bowl weight 160g
number weight carbs number weight carbs
2 120g carbs
total
bhaturas weight
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
12.5 inches / 32 cm
12.5 inches / 32 cm
8 inches / 20cm
Bowl =
200ml
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Litti Chokha Kolkata Egg Roll Momos
1 200g
bowl weight 95g 1 100g 15g 6 180g 45g
total
4 160g carbs
number weight carbs pieces weight carbs
litti weight
Bowl =
200ml
8 inches / 20cm
8 inches / 20cm
Bowl = Bowl =
200ml 200ml
8 inches / 20cm
Bowl = Bowl =
200ml 200ml
8 inches / 20cm
Chicken/Mutton/ Chicken/Mutton/
Chicken Handi Meat Mince Kheema
Meat Curry
1 200g 5g ¾ 200g 5g ¾ 200g 5g
bowl weight carbs bowl weight carbs bowl weight carbs
34
Bowl =
200ml
8 inches / 20cm
8 inches / 20cm
Chutney
Baingan Baja Chicken Kebab
(applies for all chutneys)
½ 100g <5g 6 100g 4g 4 100g 5g
bowl weight carbs pieces weight carbs pieces weight carbs
8 inches / 20cm
If you add any sugar, honey or jaggery to the food you cook,
you will need to add it to your carb count.
35
8 inches / 20cm
8 inches / 20cm
Chapati Millet Bhakri/Roti Rice Bhakri
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Koki Luchi Ragi Mudde
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Baati Litti
Bowl = Bowl =
200ml 200ml
Bowl = Bowl =
200ml 200ml
8 inches / 20cm
Pulao
1 170g 30g
bowl weight carbs
39
Desserts
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Modak Puran Poli Peda
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
8 inches / 20cm
Mishti Doi Jalebi Shrikand
8 inches / 20cm
Bowl =
200ml
Curd
1 250g 10g
bowl weight carbs
3
41
Carbohydrates
in common
international foods
The first part of this section (pages 42 - 47) The second part (pages 48 - 53) provides
shows images of common fruit, bread, cereals, examples of common Italian, Asian, Mexican
grain products, starchy vegetables, legumes and other common restaurant or take away
and pulses, milk, dairy or dairy alternatives that dishes as well as cakes, snack and bakery
contain approximately 15g of carbohydrates. foods. The images indicate a serving size with
the weight of the food, and the approximate
All cup measurements used in this section refer amount of carbohydrates they contain.
to a 250ml cup.
42
Fruits
1 cup = 250ml
Bowl =
18cm/
7inch
Bowl = Bowl =
18cm/ 18cm/
7inch 7inch
Cornflakes
¾ 20g 15g
cup weight carbs
Bowl =
18cm/
7inch
Bowl =
18cm/
7inch
Baked Beans
½ 135g 15g
cup weight carbs
47
Bowl =
18cm/
7inch
1⅓ 300g 15g
cups weight carbs
48
Massaman Curry
Sweet and Sour Pork (including 2 potato pieces) Green Curry
8 inches / 20cm
Pork Gyoza
3 48g 15g
pieces weight carbs
8 inches / 20cm
8 inches / 20cm
I have a regular daily routine: I get up early in the morning to do exercise/yoga with my mother and have a healthy
breakfast with dry fruits and a lot of water to keep hydrated. I also have a well-balanced dinner at night. I always
try to maintain my blood sugar. Whenever I get hypo or hyper blood sugar levels, I start shaking, sweating, get dizzy,
anxious, hungry, have fast heartbeat, weakness, headache and irritation which affects my health.
I was diagnosed with Type 1 diabetes aged 18, following poorly treated tonsillitis that lead to a diabetic coma. After
I recovered, my family and I had to make some lifestyle changes that in a certain way helped us all, especially in
terms of healthy eating.
At first it was hard to face this new reality, mainly due to the lack of knowledge about diabetes until through a
friend I became part of the ‘Living with Diabetes’ Center Youth program where they gave us a lot of emotional and
educational support and supplies to control the disease. They become a second family to which we will always be
very grateful.
SECTION THREE ARTWORK (page 41)
Marking the steps for my health
My drawing shows what I have learned at the AMD Guerrero Association to maintain my glucose control and
continue to take care of myself by applying those steps every day in my life.
Thanks to my family and the Mexican Diabetes Association in the State of Guerrero I have acquired the knowledge
for my life condition.
At present I study high school and I continue to take care of myself doing a lot of exercise.
When I was diagnosed with chronic diabetes in 2009, aged 11, it was a turning point in my life. As a child I had a
very difficult time, but I slowly adjusted to life with diabetes and started to see it as a challenge. Now I’m moving
on towards achieving my goals and objectives in life. I consider having to adjust to a healthy diet as ‘a good side
effect’ of having diabetes.
Having become an artist, I will not stop there but I am moving forward with the goal of becoming a meaningful
artistic young architect to the world.
Disclaimer
The information in this booklet is intended and can be used for educational and informational purposes only.
It does not replace individual medical advice. If you have any concerns about your health, or further questions, you
should contact your health professional.
Life for a Child (LFAC) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) takes no
responsibility for any adverse consequences that arise as a result of using the content of this resource for clinical
purposes. Health professionals need to consider the individual circumstances and needs of children and young
adults with diabetes when they are applying the information outlined in this resource in their clinical practice.
Copyright
This book can be reproduced in whole or part but individual images cannot be used without permission from
Life for a Child and contributors.