One of the most important elements in successful blood sugar managements is strict portion size. Obviously, knowledge of precise carbs-per-gram for a given food is meaningless if the number of grams is unknown or subject to error. One of the best things a family can do to support a person with diabetes is to embrace precisely measured, unitized food.

As you likely know, nutrition facts are required on a variety of foods, and we would guess there are penalties for “lying” – misreporting these figures. This gives food companies a legal motivation to properly calculate the nutritional values for their foods – including carbs. Once calculated, then it becomes a motivation for them to keep “serving” sizes consistent…to package the foods to precise quantities. Our results here have generally been very good. For food on the go, it’s best to be careful about sauces and such – like ketchup – which may be ladeled-on by a local employee who’s eager to please by “putting on a little extra.” As for the meal components themselves – buns, burgers, even nuggets with breading – these seem to be very reliable. It’s usually agreeable to the party to order a few extra chicken fingers, for instance, and let the person with diabetes choose the ones on which the breading seems the most “average!”

Supermarket meals – TV Dinners, if you will – are likewise quite reliable in our experience, which is a source of real comfort. Delicious and easy to prepare meals are available to suit most any taste, so long as you don’t demand the experience of “home cookin.” Pre-cut cookie dough has been close-enough, so long as you don’t eat too many, and cake mixes are reliable as well. Just make sure you weigh the baking pan first, and let the dish cool (losing weight as steam) before getting the cooked weight. Here’s the process:

1)Weigh pan

2)Determine number of servings in cooked quantity

3)Multiply servings times carbs per serving

4)Cook and allow to cool.

5)Weigh prepared dish. Subtract empty weight of pan, divide total carbs by grams of food.

6)Weigh each portion as you serve and multiply grams times ratio above.

This is obvious, but remembering to weigh the pan first saves a lot of worry later. We’ve found that things like paper cupcake wrappers – and the amount of cupcake that sticks to them – are negligible in these calculations, so enjoy!

A PLACE TO BE CAREFUL is pasta, and especially cheap ramen noodles. We’ve found that the actual dry weight is regularly 10% off of that posted (for a 20% variability!) simply weigh the ramen before preparing. Give the person with diabetes the one closest to the posted weight, or simply increment the carbs by the extra grams of material. We’ve had good results either way, but near-disaster without such care.

As in all things, empathy is critically important. Aunt Martha needs to understand that the person with diabetes may NEVER sample her cherry cobbler, and it is not a slight. Likewise, the rest of the family should be understanding that Aunt Martha doesn’t necessarily mean to take offence, she just has NO IDEA of how difficult blood sugar management can be, and let’s wish for her she never finds out.

Just as our newly-diagnosed type 1 diabetes sufferer was getting the hang of managing carbs and insulin, we had an episode that shook our faith and courage. After carefully counting carbs and adjusting precise insulin ratios for weeks, we decided to try to feel normal and enjoy pizza.

We knew that pizza was high in carbs, but we’d just been given clearance to ramp-up carb intake and insulin dosages. We did…and the results surprised us! Minutes after injecting, then eating, everything looked good. Blood glucose levels staying in healthy range…success!

Only some time after eating did my son’s blood sugar start to rise…and rise…uncomfortably close to the numbers that drove him to the hospital in the first place!

Only after a bit of Googling did we find out about the Pizza Effect. The for-profit(?) education site Type1University has an excellent free video here.

It’s a shame that none of our physicians were familiar-enough with this effect to warn us. Our local Dietitian and Nutritionist insisted they’d never heard of it. Well, now YOU have.

Our experience is as the video and other online resources suggest. Carbs cloaked in grease simply take longer to be digested. Then, all at once, those carbs seem to hit a point in the digestive tract that they are digested in short order, maybe 9o-120 minutes after the meal itself and long after the insulin dose has peaked in effectiveness.

Now that my son is on an insulin pump he can take steps to address this effect. We’ll talk more about that in pumps, but the short version is that the pump can be programmed to release the insulin over time, rather than all at the beginning of the meal. I’ll update this page as we develop any helpful rules of thumb!