So when your mom and dad want you to test, it’s really important to do it. I test 5-8 times a day. Its not all that much fun getting poked in the finger but…..there are places that don’t hurt quite as much. And you will start to get use to it……believe it or not. :)

Testing will help you know where your blood sugar is and how different activities make it change. How does playing an hour of soccer change things or how does ridding your bike around all afternoon with your pals affect if and how does sitting at the computer all day (yuck) affect it. Plus, you will start to figure out how to feel where your blood sugar is. This is very, very helpful.

If one of your favorite things is a peanut butter sandwich….you need to know how this affects things. If you’re at school for a basketball game and they have walking tacos…they’re great…you need to know how that affects you.

First of all, let’s back up and think about what makes up a food. For the sake of our discussions, we’re going to think about foods in terms of being made up of carbohydrates, proteins, and fats. You eat food to give your body energy (and because it tastes good :)) and your body gets energy from the foods by converting them into sugar/glucose. Now, which one of these are going to give you the most energy? Well, when you eat a carbohydrate, approximately 100% of that will get turned into sugar so your body can use it. And approximately 80% of a protein gets converted into sugar(and it takes a longer time to do it). And approximately 50% of a fat gets converted into sugar. The majority of foods we typically eat are made up of carbohydrates. So, out of these three things, we’re going to focus mainly on carbohydrates and how they affect your blood sugar and how much insulin you need.

Let’s take a ham sandwich for example. There’s lots of variations to one, but in this example, let’s say you’ve got some bread, cheese, ham, maybe a little mayo, and a tomato. This bad boy will have about 21 grams of carbohydrates. Let’s see how we figured that out. You can check the Nutrition Facts on each package or use an app like MyFitnessPal or Calorie King to help you determine this.

Ham sandwich

• Thin rye bread: 15 gr of carbohydrates
• Swiss cheese: 2 gr
• Deli ham: 2 gr
• Slice of tomato: 1 gr
• Light mayo (1 Tbs.): 1 gr

Then let’s throw a few grapes and a banana in there.

• Fresh grapes (about 4 oz.): 18 gr
• Small banana: 24 gr

Total carbs: 63 gr

So now we need to figure out how much insulin you need to cover that lunch you had, which was 63 grams of carbohydrates. Ha, and you thought it was just a ham sandwich and some fruit! Before long you’ll know how and you’ll be thinking about food in terms of carbohydrates. Fun stuff!

Now let’s say your doctor or your parents have already determined that you need 1 unit of insulin for every 12 grams of carbohydrates you eat. Then the amount of insulin you need to cover this lunch is approximately 5 units. Here’s how we came up with this mysterious number: Take 63, divide it by 12 and you get 5.25, so we’ll round it off to 5. I need to ask you a question: Would you rather eat a ham sandwich or a pile of carbohydrates? Ha! :) They’re really one and the same.

Parents, you can help with this one too; you and your child need to get familiar with the Glycemic Index (GI) and Glycemic Load (GL) of the foods you eat.

For GI: 0-55 is low; 56-69 is moderate; 70-100 is high.

For GL: 0-10 is low; 11-19 is moderate; 20 and up is high.

The Glycemic Index (GI) index is a classification system for carbs based on how high and how quickly they increase your BG – foods that are digested rapidly and cause large increases in BG have a high GI. Foods that are absorbed more slowly into the system, causing a more gradual rise in BG have a low GI^1,2,3. The University of Sydney maintains an updated, searchable database of GI for foods at http://www.glycemicindex.com/index.php.

Glycemic Load (GL) takes into account not only the food’s GI, but also the amount of carbs it contains. You need to know not only the way different types of foods’ carbs affect you, but also the quantity of those carbs you consumed if you’re going to be able to accurately predict how the food will affect your BG^1,2,3. Take a Twix candy bar, for example. This tasty little treat has a low GI of 44, very similar to that of the apple, whose GI comes in at approximately 40¹. Before you start gobbling down Twix bars thinking they won’t impact your BG, remember – the GI is a classification for the way in which this type of carb is absorbed by your body; we haven’t yet considered how many of these carbs you will be consuming when you eat this candy bar. A full package (2 bars) of Twix has 34 g of carbs, giving it a GL of approximately 15 (we’ll show you how to calculate this in a minute). An apple contains approximately 22 g of carbs, giving it a GL of about 8.8. Lo and behold, these foods’ GLs tell you that eating the Twix bar will have about 1.7 times the effect on your BG as the apple.

For this reason, a food’s GL gives you the most accurate prediction of how what you just ate will affect your BG. GL is calculated by multiplying the food’s GI by the amount of carbs contained in the serving you ate, divided by 100¹. For example, that piece of carrot cake has a relatively low GI of 36; however, it contains a whopping 41g of carbs. Its GL can be calculated like this: 36(GI) x 41(carbs) = 1476. Divide that by 100 and you get a GL of 14.76, a moderate ranking on the GL scale, much more indicative of how it will impact your BG than its low GI ranking.

Considering this, I know that both the carrot cake and lunch have been converted into BG. I also know the Humalog has already peaked after 2 hours. So I now need to get my BG down…now.

If you’re at 280 and want to get it down to a healthy range (let’s say 80-120), you will need to know how much insulin is needed. Each person is different but from some of the tools in the tool kit you will understand how much is needed. Depending on your age this may be something you need help from your parents with. But for the sake of understanding how this works….let’s say, from the work you did with the Toolkit, you know that each unit of insulin will reduce your BG by 40 pts.

So let’s play a little game and think of BG in terms of blocks. In this situation, each block is worth 40 pts (replace the number 40 with what you determined a unit of insulin will lower your BG using the Toolkit). Your goal is to always have 2-3 blocks of BG (or 80-120 mg/dl). So lets say your BG is 280, how many blocks of 40 is this? 280/40 = 7 so you have a total of 7 blocks of BG. We know we want to be at 2-3 blocks so how many blocks of BG do we need to get rid of? 7 – 2 =5 blocks and 7-3=4 blocks. So you need to get rid of 4 to 5 blocks of BG! Since you already figured out from the Toolkit that one unit of insulin will get rid of 1 block of BG (or 40 mg/dl), you know you need 4-5 units of fast acting insulin.

So let’s play a little game and think of BG in terms of blocks. In this situation, each block is worth 40 pts (replace the number 40 with what you determined a unit of insulin will lower your BG using the Toolkit). Your goal is to always have 2-3 blocks of BG (or 80-120 mg/dl). So lets say your BG is 280, how many blocks of 40 is this? 280/40 = 7 so you have a total of 7 blocks of BG. We know we want to be at 2-3 blocks so how many blocks of BG do we need to get rid of? 7 – 2 =5 blocks and 7-3=4 blocks. So you need to get rid of 4 to 5 blocks of BG! Since you already figured out from the Toolkit that one unit of insulin will get rid of 1 block of BG (or 40 mg/dl), you know you need 4-5 units of fast acting insulin.

Remember to check out the Toolkit section with your parents to learn how to determine the impact of a unit of insulin on blood glucose (this is also called insulin sensitivity).

Since we spend so much time snoozing, nighttime is one of the biggest chances to help get better results on our A1C tests that we talked about earlier. It’s really important to have your blood sugar normal during the night. You don’t want it to get too low either, though, so I like to test about an hour before I go to bed and then right before so I know if it’s going up or going down and compensate accordingly. If I’m going to bed at about 9 or 9:30 I need to have a couple of tests leading up to bedtime. Let’s say I ate dinner at 6 or 6:30. I then try to test around 8:00 and then get my second test in before I go to bed. If my first test at 8:00 was 120 and then I test at 9:00 and it’s 175, I’ll think about what I ate. Considering the situation, what I ate, and how long it usually takes for it to completely convert (i.e. is it a high glycemic load food or not and what has been my typical experience with this type of meal?). If, based on all of this, I think most of my food has been changed to blood sugar, let’s look at this in terms of blocks again, you need to cover 1 block (each block being 40 pts.) to bring my blood sugar back down to 135, so I will take 1 unit. I might think about 2 units to get it down to 100, but I’ll play it safe since it’s nighttime. If I’m not sure that all of my food has been converted to blood sugar, I’m still going to stick with this plan since I don’t know for sure. Again, this is based on my calculated insulin to carbohydrate ratio. Be really careful, though, to make sure your blood sugar is not low and getting lower before you go to bed.

Now let’s say my first test was at 120 and my second test came in at 75…….holy cow! What do I do now? Well…again, I’ll think about what I ate. If I ate something like lasagna, with a high glycemic load (see above for more on glycemic load) I know this will take longer to complete its mission (be converted all the way into BG). So…..being concerned with “what if I’m wrong”…yikes, I might be a little reluctant about hitting the sack right away. I’ll probably stay up a little longer and test again in a half hour and make my decision on if to eat some thing based upon that test reading.

You wake up in the middle of the night from a weird, confusing dream. Things don’t seem to make sense. Then you notice the phone just quit ringing…or was it your imagination? You're tired, so, confused, you lay down to go back to sleep. Wait!!! Not a good thing to do. You just remembered when things don’t make sense you’re going to act – wake up your parents or the adult in the home and go to your go-to spot for your glucose source. You do and then check your blood sugar and find out it’s around 48.

You’re in gym class and the teacher is working you pretty hard today, but you’re having fun too. About halfway through the hour-long class you start to feel kind of funny. You know you should tell the teacher you think your blood sugar is getting low, but you know you have a candy bar in your go-to spot and you only have to hold on for another half hour. You might think it would be embarrassing to tell the teacher in front of all of your classmates…you can make it until the end of class. Wait!!!! Not a good thing to do. You just realized your plan is to ask for help. You tell the teacher you’re getting low and you need something to eat and he might give you permission to go get your stuff or he might have some glucose he can give you. As you can see by this example, it is good practice to let key people (like teachers, coaches, parents of your friends, etc.) know that you’re a Type 1 diabetic.

You're going to your friend Sam’s house after school and you’re at school, waiting for Sam’s dad to pick the two of you up. Sam’s dad calls him and says he is stuck in traffic and is going to be nearly an hour late. You had planned on eating a snack at Sam’s house when you got there, but now that snack isn’t going to happen and you can feel your blood sugar is starting to drop. You think you’ll just stick it out and hope you’ll be okay by the time you get to his house. Wait!!!! Not a good thing to do. You realized your plan is to act. You tell Sam you’re getting low and grab the candy bar from your backpack. You eat that tasty thing right in front of him; don’t worry about not sharing and don’t feel guilty. :)

Parent note: A candy bar might not be high on the list of preferred foods to eat, but when you’re low, you want to eat any high sugar food you can find, so always make sure you and your child have something on hand, just in case. Always.

Getting low is a dangerous condition and it WILL happen. Be prepared and know how you are going to act, so when the time comes, you don’t have to think about it.

Check out the Nutrition page for detailed information and tips about how to effectively use carbs to raise low blood sugar.