A guide to carbohydrate counting at school

This information leaflet is for parents of children or young people with diabetes, to help make it easier to carbohydrate count with confidence whilst at school. This is important because a large proportion of the food your child eats is at school (especially if they also attend breakfast clubs, after school clubs and eat at break-times). Accurate carbohydrate counting will greatly affect your child’s overall diabetes control.

The information in this leaflet can also be shared with school staff.

Who is responsible for carbohydrate counting at school?

At primary school, the parents are responsible for carbohydrate counting, the school staff will provide support to the child in school when carb counting and catering team should be able to provide information on carb content of foods. As your child reaches secondary school, they will need to become more independent and be able to carbohydrate count themselves. In preparation for this, it is a good idea to start building your child’s confidence with carbohydrate counting by practicing it at home, and involving your child in carbohydrate counting. You can also arrange a session with your dietitian.

Ensure that your child’s school health care plan is up to date and that your child’s school has received appropriate training in looking after your child’s diabetes. Please liaise with your diabetes educator if you need help with this.

It may be useful to be aware of the people at school who may assist your child with their diabetes.

They may be:

• School nurse
• Cafeteria manager
• Teacher / teaching assistant
• Sports / physical exercise teacher

Healthy eating is important for all children, not just those with Type 1 Diabetes. This is to help them grow well, be physically and mentally active and stay healthy. Offer a variety of foods from all food groups (you can find more information from the NHS Eatwell guide).

School staff may need to help keep an eye on your child’s blood glucose levels if a meal is not fully eaten.

How are meals provided at your child’s school?

• If it is supplied by a large catering company, nutrition information is likely to be available. The school kitchen staff may help provide this.
• Ask if they can provide the carbohydrate content of all dishes available on their menu. The menu may rotate on a weekly or fortnightly basis.
• Remember that the accuracy of this information relies on meals being portioned accurately by those serving the meals. Your dietitian can speak to the school catering staff about this if needed.
• If your child’s school does not have the nutritional information, find out if you can obtain a menu or recipes with approximate portion sizes, and one of our dietitians can work with you to calculate the carbohydrate content of dishes.

Some parents, particularly with younger children, choose to go into school and carbohydrate count initially and then provide school with a carbohydrate counted menu. You may like to take photos of typical school meals in order to estimate the carb content.

If a school is following national guidelines, an average school lunch will contain 40 - 70g carbohydrate.

Packed lunches

The benefit of bringing packed lunches is that you can make it healthy and calculate the amount of carbohydrate in advance. You can then place this onto a label in your child’s lunch box. It can be useful to itemise the lunchbox, in case your child decides they only want to eat certain items.

You may like to develop a list of healthy lunches and / or snacks over time, with pre-calculated carbohydrate content that you can then easily prepare without the need to calculate the carbohydrate content each time. Try to do this for snacks before sports and school trips.

If your child takes a packed lunch, they may find that they don’t finish all of their lunch at school. If this is the case, ask your child to bring home anything they don’t eat to help you get an idea of what they do eat at school.

Estimating carbohydrate content of meals

• If the food has a nutrition label, e.g. pre packed sandwich, crisps, cereal bar - use this.
• Schools often use standard portion sizes of foods such as rice, pasta, mashed potato e.g. spoonful, cupful with known carbohydrate values which can make carbohydrate counting easier.
• Visually estimate using your ‘Carbs and Cals’ book or app. It is important that you are using a resource that is UK based because those from other countries may have different carbohydrate contents. For the app, check that your child has permission to use their phone at school.
• If you have had to guess the carbohydrate content of a meal, testing blood glucose levels two to three hours after eating can help you know if the insulin dose given was appropriate and whether you need to adjust it next time when eating the same food.
• If you would like more information on carbohydrate counting or to have a refresher, ask your dietitian about attending our carbohydrate counting workshops or an individual session.

Giving insulin

• If your child is using a blood glucose meter / bolus advisor app or insulin pump that has a bolus calculator, use this to calculate the insulin required.
• It is ideal to give your child insulin 10 - 15 minutes before eating, so you may like to ask your child’s school to help make necessary arrangements for this (e.g. they may need to leave the class for lunch earlier).

References

• University College London Hospital NHS Foundation Trust Carbohydrate Counting at School (Children and Young People’s Diabetes Service). Available from: University College London Hospitals - Carbohydrate Counting at School (opens in a new tab) [Accessed Oct 2022]
• Diabetes UK. Carb counting tips: Avoiding guesswork. Available from: Diabetes UK - Carb counting tips (opens in a new tab) [Accessed Oct 2022]

This document is provided for informational purposes only and is not intended as and should not be used as a substitute for professional dietetic advice or treatment.

Copyright © Department of Nutrition and Dietetics, Addenbrooke’s Hospital. All rights reserved. Except that you can use this document for your own personal information, private study and non-commercial research, with this notice intact. Addenbrooke’s is open to share the document for supporting or reference purposes but appropriate authorisation is needed from the department in writing, in advance. Contact details below. Addenbrooke’s does not accept any responsibility against any unauthorised reproduction.

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