I have determined that if my seven year old daughter sticks with the same amount of carb each day, I can generally expect a normal reading the next morning. I always count the total carbs for the day after supper which determines the amount of carb she has at bedtime. It ranges 140-160 grams of carb per day — is that adequate?

When my daughter has 50 grams of carb at supper (which may include macaroni and cheese), I check her two hours later (before bedtime), and her blood sugar will be 100 mg/dl [5.7 mmol/L]. She will have a bedtime snack of 25 grams, and sometimes she wakes up with normal reading, but other times will be over 200 mg/dl [11.1 mmol/L]? Has the macaroni and cheese affected her blood sugar later?

First of all, unless you are really measuring out/weighing portions, it is easy to over or underestimate portions. I do not typically require patients to measure out. However, with a dish like macaroni and cheese, or spaghetti, other casseroles, or pizza, it does not take too much of an extra helping to overshoot the carbs slightly. Generally, this is not a real big issue, and the higher glucoses can be accounted for and/or easily addressed with extra insulin, if warranted. I gather that you do not really dose a short-acting insulin (Regular, Humalog, or NovoLog) based on the carbs consumed. You might ask about this.

In addition, despite the frowns I get from some of my dietitian colleagues, not all carbs are created equal. Fifteen grams of carb in rice affects the glucose levels differently (albeit slightly) than 15 grams of carb in a piece of fruit. This could be attributed to the varying glycemic index of foods. Finally, the amount of fat in a food affects the absorption of that food. Macaroni and cheese is a great example, especially if extra cheese is added.

Your daughter’s diabetes team (especially the dietitian) should be a helpful resource for you.

DS