I recently spent some time attempting to determine carbohydrate counts for a child with T1D at a sleepaway summer camp not designed for children with diabetes. The parents had done some advance research with the camp and gave me carb counts that the camp had given them. The camp provided me with their menus and gave me access to the kitchen and storage facilities so that I could look at the nutrition fact labels. I set to work photographing the labels and comparing them with the menu items, and when in doubt, comparing my estimates with Calorie King’s estimates. By the time the kids arrived in the afternoon I thought I had a reasonably good handle on the numbers for the first few meals.
Then reality set in. The first dinner on the menu, Roast Turkey/Gravy or Honey Glazed Ham with Sweet Potato Fries /Rolls Stuffing, Broccoli, Cranberry Sauce, Punch, and Pound Cake had somehow morphed into Meatballs and Baked Ziti, Hero Bread, Peppers and Onions, Green Beans, Punch, and Vanilla Cake. I quickly tried to redo the numbers with an impatient camper who didn’t like any of it. Breakfast was a toast and protein-fest, so that was easy. Although had the promised first-morning mega-cinnamon roles actually showed up, it might have been a different story. Luckily we found out before he bolused!
Next up: Macaroni and Cheese. OK, so it was supposed to be ziti with tomato sauce. We could count the macaroni carbs easily enough, or so I thought, even though I am an RN, not an RD or nuclear physicist. I flipped through my photos and checked out the macaroni label. I kid you not: serving size: 2 pieces (50g). 1/180 pkg. Huh? Ok, well, the serving size must be 50g, not two pieces, I hoped, since no one I know eats 2 pieces of macaroni, especially not for 38 grams of carbs, and dividing by 180 has never been my forte (as it turned out, the ‘2 pieces’ was referring to the contents of the carton – 2 bags with 180 servings each). Presumably the carb count was for dry macaroni, since it was in a bulk package. I checked the list from the parents: Macaroni and cheese: one cup, 74 grams of carbs. Well great. How much sauce (at ¼ cup with 6 grams of carbs does that include)? We weighed the unsauced macaroni the camper had brought to me – 10 oz. “Do you really think you’ll eat all that?” I asked. The answer was a definite yes – it’s what he eats at home all the time. Rounding down, that’s 5 ½ servings, or a mere 215 grams of carbs. Cooked, of course, so it wasn’t really. It’s 45 carbs, said the camper. I always put in 45 at home. And my friends are almost finished with lunch so I’m just going to put in 45. We had some negotiations as to quantity and numbers, and he eventually put the agreed upon number in his pump. When your head stops spinning from the calculations, you can decide if you think he waited 15 or even 5 minutes before eating.
Every meal had its issues. A different brand of sauce was delivered for the following week than the one I had the label for. It looked the same in the metal cafeteria dish … but had much more sugar. Eyeballing the chicken tenders (14grams with ¼ cup of breading,) there was nowhere near ¼ cup of breading. The chocolate pudding with whipped cream described by the camp as ½ cup with 26g carbs, was anywhere from a hand-dropped large teaspoon of pudding to 3oz of pudding, covered by the whipped cream. Somewhere I am sure are cartons of pudding in single-serve containers that are in fact ½ cupful, but they were not to be found at that dinner.
To be fair, the camp wasn’t doing anything wrong. Like most away-from-home places in which people with diabetes eat, it was not designed for people with diabetes. I have to say they did a terrific job of serving the relatively large number of gluten-free campers, and they went out of their way to accommodate just two with diabetes. But the experience made me question just how accurate carb counts are when people try to do them in a restaurant, even in one with posted counts. Does anyone know how close people usually come to getting it right…and when unsure, how to determine a margin of error that will provide reasonably good carb coverage (whatever that may be) without going low? I would appreciate any thoughts or insight!