We are having our first vacation since my daughter’s diagnosis and I’m wondering how others deal with uncertain carb counts while eating out? We also both have celiac, so for example, we find a restaurant that has a gluten free burger bun or pizza crust, but have no idea
what to count. I have been guesstimating based on calorieking, or similar products we’ve used, being conservative, then she spikes to 300+ and I give a correction 3 hours later, which is bedtime. Is there a better method anyone has used? Thanks, as always for the input and advice, this forum has been extremely helpful!
I hope others will have some tips for you. I struggle with this as well. When eating out, I tend to go with low carb options and ask questions about certain foods like rice. In some places, the rice may have added sugar. I also avoid sauces, since they often have added sugar too. I think that some chain restaurants have a nutrition list on their menus. You can get off the menu or online. I think Denny’s provides that.
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Does she have a CGM? Personally, a mild low blood sugar is preferable to a high blood sugar and far easier to correct. I’m only going to feel bad for a fraction of the time with a low blood sugar.
I say this in the context of a medium to small amount of carbohydrates. If a meal is 60 carbs and youre off by a factor of 50%, you’re only talking about 3 units off for most people. That’s not enough to be alarmed about, 3 units too much and some sugar will fix it easily. Hypoglycemia should be avoided if possible, as it sucks and it is more dangerous than hyperglycemia, but I dont think it’s so scary that it should make your estimates always conservative. For a big, high carbohydrate meal, perhaps you should be cautious, but at some point both you and your daughter are going to have to get good at guessing carbs and be unafraid to trust your judgement of those carbs.
You will get better, though you wont always get it right. You just carry some snacks and some insulin everywhere so you can make inevitable adjustments.
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I always make sure to ask the restaurants for a carb list, but unfortunately most places don’t have one. I know that chain restaurants usually have carb nutritional list online. I usually look up “sonic nutrition” for example and it brings up a PDF of all they food they have including the carbs. But other than that it is very difficult to guesstimate for food you have never ate. Sorry hope I could help.
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Cathleen @cminer, being your daughter’s [and your] first experience in correctly counting carbs in restaurant food is probably no different that her thousandth attempt - I’ve been eating in restaurants for over 60 years while I’ve had diabetes and I still get baffled.
Chain restaurants are often the easiest places to get carbohydrate counts for meals but in some cases the “chef” might add a little something to improve the taste - I have a pocket size CalorieKing manual that lists many restaurants plus carb values for individual foods. The CalorieKing on-line is also very good and convenient if you have access.
Dee @HighHopes wrote the items I was going to suggest your daughter avoid. You already have practice estimating carbs in the food she eats, so just expand from that. One very strong caution I will offer is do not bolus until the meal has been served and tasted - and you are sure she will finish all the food you’ve counted. Keep in mind too that while you are on vacation your whole family will probably be more active than usual and your daughter may need to eat more - but be very careful about over dosing with insulin; sometimes after exercise her BGL may drop several hours later.
I hope all of you have fun, a happy and memorable vacation - and don’t try to hold your daughter back from enjoyment just because she has diabetes. Be very observant but not overbearing.
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Hi, Cathleen,
I hope this reaches you in time (before you head off on vacation). I, too, wrestle with “counting carbs” on a gluten-free diet, and have had T1D now for well over 60 years. So, I will pass on these tips.
First, if you are traveling some distance, the “inactivity” caused by being “trapped” in a vehicle is your number one concern. And if you are traveling several days in a row the lack of activity “adds up” (although it’s not a linear relationship; it’s not “1 + 1 = 2”).
Here’s what I mean by the above. When my wife and I travel after 10:30 in the morning (even if it is just an hour-long trip) I set a temporary basal on my insulin pump that raises my “normal” basal from .65 Units per hour to 1.10 Units per hour (your daughter’s numbers will vary from the above). I let that basal run for the entire time I’m in the vehicle (i.e., 6-hour trip = 6-hour temporary basal). And, if we stop to eat a meal and then get back on the road, I often “raise” that temporary basal to 1.20 Units per hour for an hour-and-a-half after the meal (your daughter’s numbers will vary from the above). When using this strategy I check my blood glucose level an hour after we start the trip, and, then, every two hours as long as I am running either temporary basal.
Okay, so what in the world does this have to do with “counting carbs” on a gluten-free diet? Well, nothing - it has to do with managing your daughters blood glucose level, and that’s the reason that you count carbs in the first place.
Here’s the deal. When we are in a vehicle for any extended period of time our “normal” level of activity is dramatically reduced. When we reduce our level of activity, our blood glucose level goes up. So we need more insulin in our system. “Correction boluses” can help to reduce “spikes,” but, as the duration of the trip extends, .our blood glucose level is going to go up again. We could choose to take correction bolus after correction bolus after correction bolus, but that puts us on the “blood glucose roller-coaster” and riding that machine is very, very tiring, and very dangerous. There is nothing more frightening to me than taking a correction bolus just before going to bed; if I do that I set an alarm to wake me up in two hours and I get up and check my blood glucose level to ensure I’m not heading into a hypoglycemic (killer) episode. Ugh!
Rather than using multiple correction boluses, in my opinion, the more prudent thing to do when traveling is to use temporary basals that cover extended periods of inactivity (I have one running right now since I anticipate being on the computer the rest of this morning). It’s not the carbs that raise our blood glucose levels when we are traveling - it’s the inactivity (IMHO). Check with your daughter’s physician; see if he/she can help you arrive at a “temporary basals routine” to use when traveling.
Okay. To counting carbs. First, every time you and your family sit down to eat at a restaurant, consider the amount of “fuel” your daughter might need in the three hours after the meal. If it’s “back in the car” after the meal, consider reducing the carb load a scooch (compared to her normal carb load for that meal at that time of day). However, if she’ll be walking, running, swimming or whatever in the hours after the meal, adjust the carb load to match her anticipated level of activity. And, most importantly, adjust her basal to match that level of activity, just as you would if you were at home. As an example, there are times when I have to turn my pump completely off when I am involved in a day of heavy activity. I take reduced boluses to cover meals on those days, I snack when needed, and I either turn my pump off for short periods or run reduced basals as the hours of activity roll on. This strategy allows me to remain physically active, reduces the potential for severe hypoglycemic episodes, and prevents hypoglycemic episodes the next day (those are the ones that “sneak up on you” - rascals).
Have you noticed I still haven’t really talked about counting carbs? The key to managing diabetes when you travel is adjusting insulin to match activity (IMHO). And you consume the “fuel” you need to match the anticipated activity for the next three hours of the trip (and monitor blood glucose level regularly and frequently). The goal is to manage diabetes well and avoid the “blood glucose roller-coaster.”
You already seem to know that “dense carbohydrates” are tough to handle (fried rice, etc.). They are more difficult when you are traveling. Corn tortillas aren’t that bad (appx. 18 grams each) unless they have been fried (what a way to ruin a tortilla). Any time extra oil is used to prepare a carbohydrate the rapid effect of the carbohydrate goes up, and so does the duration of the blood glucose rise (IMHO). I avoid such foods when I am traveling; if I will be active after the meal I may choose to eat them. It’s that “balance” thing.
Pizza when traveling. No. Unless it is pizza with a cauliflower crust. And then it depends on how much cheese and tomato paste/sauce are on it. Tomato paste/sauce is almost like “instant glucose.” And cheese on pizza has the potential to affect blood glucose levels like a cheese enchilada can. It just depends on the level of activity expected after the meal as to whether it might cause a problem.
I am going to end here for now so you can “absorb” what I have posted. I hope you can appreciate that, to me, when traveling with T1D it’s all about balancing insulin need to activity. Vacations are swell. It’s the inactivity of travel that can make T1D really tough to manage.
Hope this makes sense. And I hope you and your family have a great vacation!
Bill
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I thank you all for taking the time for your kind responses and for sharing your learning. You have given us a lot to think upon and I will be reading these posts a few times to absorb the info! Inactivity in the car/plane, adjusting basal, rice & sauces, what to avoid…all very helpful points. I have noticed a big difference in bg on travel days. Also, we are in New Mexico and have discovered the nice option of the corn tortilla, which doesn’t spike her!
Hi,
My trick for eating out (not necessarily while on vacation, just in general) is taking my insulin after I’ve eaten instead of beforehand (or maybe immediately after the meals have been served if I know I’m not getting dessert), especially if I’ve never been to that restaurant before and don’t know what portion sizes or all of the sides are. It’s not ideal because I get a higher post-dinner spike that way, but at least I know how many carbs to cover and can come down quickly instead of several hours later.
Depending on how old your daughter is and how hypo-aware she may or may not be, I’d be careful about SpecialEDy’s advice to go a little low instead of high. It’s one thing when you’re doing that for yourself and you can feel when you’re going low. It’s another when you’re trying to guess for someone else. Yes, lows can be corrected more quickly than highs, but they’re far more dangerous. I was not good about telling my mother when I wasn’t feeling well and every time that I needed emergency help to treat a low was when I was in elementary school. And, as someone with celiac disease, I can say that making sure you have enough food available to treat lows while traveling is really nerve-racking. I pack so much food when I travel that I always get stopped by security at the airport because they can’t see what else is in my bag. Personally, I much prefer to err on the high side while traveling. Then I don’t have to worry about running out of food.
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Hi, Cathleen,
I hope you had a terrific vacation. All the advice so far has been super, as always.
My daughter’s got T1D and celiac, too, so I hear you. Thank goodness GF options are more available than they used to be, and people generally are more aware of simple precautions like washing hands and using separate serving utensils to prevent cross-contamination!
For eating at family’s or friends’ places, there are web sites that can tell you the carb count per serving if you enter a recipe’s ingredients. Those work really well, but obviously aren’t a realistic option for most restaurant meals.
For guesstimating purposes, then, I’ll just add that most restaurant carbs are higher than you probably think they are. For example, desserts at our home are usually 15-20g — a scoop of ice cream, some packaged cookies, that sort of thing. Restaurant desserts run 40-60g (I think), mostly because they’re way bigger, but also because of the extra sugar, syrup, frosting, candy, etc., that make those treats so much prettier and more delicious than what we keep in the house. For good reason. 
But my point is that for eating out, over time, you’ll see what works and what doesn’t, you’ll notice patterns, you’ll make adjustments, and you’ll get better at it. Not terribly satisfying advice, I know, but I’m afraid that’s really all we can do.
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On vacation we try to manage by having eat in options, so stay at place with at least a fridge and microwave and bring our own food. We eat in more vs going out. My son has brought his own food to restaurants where he knows exactly what he is eating and orders a “free” appetizer he can control ie salad, or shrimp cocktail. We research every place we go for nutritional facts, but unfortunately most local restaurants don’t have, so chains like a bone fish grill or longhorn steakhouse are examples of places we know have nutrition guides. If we go local with no nutrition guide, my son will stick with meat, fish veggies and not guess at carbs. Finally, the keto diet is starting to catch on and we are beginning to see places pop up offering. We recently had a local bakery start offering keto desserts (1-2 carb cheese cake, brownies, cookies, pudding per decent size serving) and Blaze Pizza now has a keto pizza (5 carbs in 6 slices). So now my son can add back in a couple things that he hasn’t been eating pizza and some dessert. Google on keto menus when you are away and see if you can find those local options. Bottom line, when we go on vacation we tailor eating to make it easier and less stressful on my son, but always have a safety valve of either he brings his own measured meal or orders items that are “free.”
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