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6 Implementing tailored resources for carbohydrate counting in clinical settings
  1. Salma Mehar
  1. Imperial college London UK


It is recommended that children and young people (CYP) with type 1 diabetes (T1DM) should access ongoing education for self-management of their diabetes, including carbohydrate (CHO) counting.1 Despite all the technology, there is a need to understand the basics of how the various food groups interact with the body and the ways of CHO counting, protein and fat, to match the amount of insulin required.2

Families must be supported to implement CHO counting advice tailored and specific to cultural needs.3 Diabetes self-care requires knowledge of CHO counting of cultural foods including carbohydrates, protein and fat in commonly eaten cultural foods is limited and the effects that diet, insulin and exercise. Evidence suggests that CHO counting may have positive effects on metabolic control and on reducing glycosylated haemoglobin concentration (HbA1c).4 Moreover, CHO counting might reduce the frequency of hypoglycaemia.4 In addition, with CHO counting the flexibility of meals and snacks allows children and teenagers to manage their T1D more effectively within their own cultural lifestyles.4

Despite several methods and reference booklets that have been developed by diabetes care teams, CHO counting is often inaccurate, and can even be skipped by patients.2 Several medical applications in diabetes care to help patients with T1DM have been developed over the last decade.2 Studies suggest that CHO counting is difficult for both health professionals and children and adolescents with diabetes.4

There are a number of culturally specific resources such as CHO counting books, apps and websites to support CHO counting in clinical settings. However further studies will be needed to determine whether these culturally specific resources could be used in the long term to improve metabolic control in targeted populations. Provision of culturally appropriate education material and resources should be locally implement to educate CYP with T1DM and their families.3


  1. Phelan H, Lange K, Cengiz E, et al. ISPAD clinical practice consensus guidelines 2018: diabetes education in children and adolescents. Pediatr Diabetes 2018;19(Suppl 27):75–83.

  2. Deeb A, Al H ajeri A, Alhmoudi I, Nagelkerke N. Accurate carbohydrate counting is an important determinant of postprandial glycemia in children and adolescents with type 1 diabetes on insulin pump therapy. J Diabetes Sci Technol. 2017;11(4):753–758. doi: 10.1177/1932296816679850

  3. Lovely Gupta, Deepak Khandelwal, Sanjay Kalra. Carbohydrate counting-1: South Asian framework. J Pak Med Assoc Aug 2017;67(8):1296–1298.

  4. Bishop F, Maahs DM, Spiegel G, et al. The carbohydrate counting in adolescents with type 1 diabetes (CCAT) study. Diabetes Spec. 2009;22(1):56–62.

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