Diabetes and Carb Counting For Dummies (For Dummies (Health & Fitness)) by Shafer Sherri

Author:Shafer, Sherri [Shafer, Sherri]
Language: eng
Format: epub, azw3
ISBN: 9781119315728
Publisher: Wiley
Published: 2017-03-08T16:00:00+00:00

THE CASE OF THE COOKIE IN THE LUNCHBOX

Many years ago a child who was being followed in our pediatric diabetes clinic was politely confronted by an adult who worked for the school district. The offense was having a cookie in her lunchbox. The adult assumed that the parents were not properly taking care of their child who had type 1 diabetes, so she called child protective services to report the parents. The cookie had 10 grams of carbohydrate. However, also in the lunchbox were a turkey sandwich on whole-grain bread, which had 30 grams of carb; milk with 15 grams of carb; and carrots with 5 grams of carb. What the school employee didn’t seem to realize was that the parents had counted the carbs in the lunch, and the insulin dose was going to be appropriately matched to that amount of carb. The lunch contained a total of 60 grams of carb, which was completely appropriate. For reference, many school lunch programs serve lunches with 60–75 grams of carb per meal because that amount is standard for a child in middle school.

We de-escalated the situation by explaining that all of the carb foods in the child’s lunch would be digested and turned into glucose, and that the insulin dose would transport that glucose into the child’s cells to be used for fuel. Imagine the distress the child felt and the frustration the parents endured to defend their right to include a small cookie in the context of a balanced diet.

To be singled out as the only child who is denied a cookie can lead to undue psychological distress. A cookie is not pure sugar. Cookies have starch (flour), protein (eggs), and fat (butter, nuts) along with the sugar, so the cookie actually takes a while to digest and can easily be managed with insulin.

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