Meal Planning for Children with Diabetes, Basal-Bolus Insulin Plan

Important information:

• A basal/bolus insulin plan allows flexibility with eating. For it to work well, carbohydrate (carb) counting and insulin dosing must be accurate to keep blood sugars in the target range. Learn more about diabetes and food.

• There are three main nutrients in food: protein, fat and carbohydrates.

Protein

• Protein helps build muscle.

• Protein-rich foods include meat, poultry, fish, eggs, and cheese.

• Nuts, beans and vegetable proteins, such as tofu, veggie burgers, and other soy products have protein and carbs. The carbs in these foods will turn into sugar in your body.

• Healthy protein choices include low-fat cheese, grilled or baked chicken, turkey, fish (not fried), lean ground meats, nuts, and beans.

• Protein does not raise blood sugar quickly. Meat (not breaded), cheese, and eggs do not contain carbs, but should not be eaten and a "free food" to avoid taking insulin.

Fat

• Fat helps your brain and nervous system work. Fat does not raise blood sugar quickly.

• Foods that are 100% fat are butter, oils, and mayonnaise. Fat-rich foods such as nuts, nut butter, avocado, and salad dressing contains a small amount of carb and will require insulin.

• Healthy fat choices include olive oil, avocado oil, avocados, nuts, and nut butter.

Carbohydrates

• Carbohydrates (carbs) give you energy. The body breaks down carbs into sugar. The sugar goes into the blood and raises blood sugar levels. Insulin carries the sugar from the blood to the rest of the body to be used as energy.

• The amount of carbs needed daily is different for each child and will change over time. Contact your Diabetes Center team if you have questions about the amount of carb that is right for your child.

• Do not cut out carbs from your diet. Carbs are important to help your child grow and for energy. Eat healthy foods that have carbs. Healthy carb choices include whole grain breads and cereals, fruit, milk, brown rice, whole-wheat pasta, and starchy vegetables.

Carbohydrate sources:

• Fruit: Fresh fruit, fruit cups (packed in water), dried fruit, applesauce and other fruit pouches, and 100% fruit juice

• Milk: White milk, chocolate milk, soy milk, plant-based milks (almond, rice, oat), and yogurt

• Grains: Bread, hot and cold cereals, waffles, pancakes, tortillas, rice, pasta, and pizza

• Vegetables: All vegetables including green beans, broccoli, salad, cooked greens, and carrots

• Starchy vegetables: Potatoes, sweet potatoes, corn, winter squash, and green peas

• Nuts, seeds and beans: Peanuts, tree nuts, seeds, nut butter, dried beans, chickpeas, and edamame.

• Breaded meats and cheese: Chicken nuggets, chicken patties, fish sticks, and mozzarella sticks

• Condiments: Ketchup, tomato sauce, prepared salad dressing, sweet and sour sauces, honey mustard sauce, and barbeque sauce

• Snack foods and treats: Pretzels, crackers, cookies, fruit snacks, granola bars, chips, pudding, ice cream, and other desserts

• Beverages: Lemonade, sweetened ice tea, regular soda, fruit punch, sweetened coffee specialty drinks, energy sports drinks, and nutrition shakes

Patient instructions: Dosing insulin for food

• Every time you eat food with carbs, give a bolus insulin dose as directed by your diabetes team. Common brand names include Humalog®, NovoLog®, Apidra®, Admelog®.

• Count the grams of carbs to be eaten to give the correct amount of bolus insulin.

  • If you are in a situation where you cannot measure portion size, always underestimate rather than overestimate the portion size.

  • Overestimating carbs and giving too much insulin can cause low blood sugar.

• Use your prescribed insulin-to-carb ratio to calculate the dose of insulin required for the meal.

• You must eat and drink all the carbs counted or the insulin dose will be too much. This may cause low blood sugar. If your child cannot finish the food you dosed for, give additional carbs from other foods or beverages to make up for the carbs missed before the end of the meal.

• Try to finish the meal or snack within 30 minutes.

Reading food labels to count carbs:

1. Check the serving size. The nutrition facts listed are based on 1 serving size. Weigh and measure foods to portion out the serving size.

2. Check the total grams of carbs per serving. Use carb counting books, websites or apps on your phone or tablet if a food label is not available. Ask your dietitian for recommendations.

Scheduling meals with diabetes:

• Your child does not need to eat every 3 hours, but spacing meals and snacks 3 or more hours apart can help determine if the bolus insulin is working. It can also help keep blood sugar in range.

• Grazing, or eating often throughout the day, makes it difficult to dose insulin. It is not a healthy way to eat.

• Sometimes children eat foods back-to-back, like a dessert or a second plate. At these times, dose insulin only for the additional carbs being eaten. Do not dose insulin based on the blood sugar value.

Sugar-free, diabetic, low-carb, or low-glycemic index foods:

• Most of these foods are made for adults. They may not be appropriate for children.

• Many of these foods have sugar substitutes called sugar alcohols. Sugar alcohols turn into sugar differently than other carbs, but they still break down to sugar. It is difficult to match them with insulin. Sugar alcohols may cause gas and bloating. Try to limit the amount of sugar alcohols in the diet.

• Sugar-free drinks like diet sodas, unsweetened tea, or artificially sweetened beverages may okay to drink in small amounts. They have different sugar substitutes that do raise blood sugars. Always check the nutrition label to make sure they do not contain carbs. Remember, water is always best.

Learn more about tips for healthy eating with diabetes.

Reviewed May 2025 by Megan Robinson, MS, RD, CDCES, CSSD, LDN, Ally Zepp, DTR