I am a school nurse in an elementary school and have a first grade student who has type 1 diabetes. The dietary method for the control of high blood sugar is using a carbohydrate to insulin ratio. In my experience, it appears as though too many carbohydrates are being countered with insulin. Although the carbohydrate to insulin ratio is the preferred method, can insulin be abused in counteracting too many carbohydrates? Shouldn’t parents be a little more conscientious with food choices i.e., reduced sugar jellies for peanut butter and jelly sandwiches, protein snacks versus carbohydrate snacks?

You are correct that the carbohydrate counting systems can be “abused,” but the concept that you outlined has problems as well. There is not much science to support it, just consensus from those who sat around the tables in the 1940s and 1950s and set up reasonable approaches to foods. The strictness of limiting carbohydrates has not stood the test of time and the scientific foundations are extremely weak. Having said that, it is common sense that certain fast acting sugars will require more insulin than slower acting sugars (i.e., unsweetened cheerios versus Frosted Flakes), so, why not use a combination of common sense avoidance of most faster acting carbohydrates and insulin to carbohydrate coverage? If you have some specific concerns about an individual child, it would be prudent to have you contact this child’s diabetes team and lean if this is a more systematic problem, how the child’s overall control is (A1c values, for instance) and then decide how best to support this child and this family in the school environment. My compliments for your interest and enthusiasm.

SB