If it were me with the diabetes, I'd go straight to Dr. Bernstein's super-low-carb diet, since I've been on a low-carb diet since 2008 anyway. The fewer carbs you eat, the less your blood sugar spikes the less insulin you need, and the fewer health issues and complications you have.
Karl isn't me, though, and he has strong food preferences that don't align very well with a super-low-carb diet, so what do we do?
Karl loves peanut-butter sandwiches. Here's how we game the system to get his carbs down without shorting him on calories.
Step 1: More Peanut Butter!
Peanut butter is a low-carb food that's also rich in fats and proteins, meaning that, while it's low-carb, it's high-calorie. Since the game is to reduce Karl's carbs while keeping his calorie intake high (he was painfully thin after his trip to the hospital), peanut butter is exactly the kind of food we want!
In theory, a "serving" of peanut butter is two tablespoons, but you can get three onto a sandwich without having it drip around the edges. We use tablespoon measures to get this right.
Calories: 270
Carbs: 12 g
Fiber carbs: 3 g
Net carbs: 9 g
Step 2: Dinky Little Diet Bread Slices
Using less bread is the obvious way to cut the carbs way down. Our method is to use bread aimed at dieters, which uses small loaves and thin slices to cut the calories and carbs in half. We've used Orowheat's 40 calorie per slice bread and Sara Lee's 45 calorie per slice bread. Here's the breakdown for two slices of Sara Lee "45 Calories & Delightful 100% Whole Wheat and Honey" bread:
Calories: 90
Carbs: 14 g
Fiber carbs: 5 g
Net carbs: 9 g
We prefer the Orowheat bread. The Sara Lee is okay, except that it often has big holes in it, which I find annoying at bread that costs over $4.00 what (let's face it) amounts to half a loaf!
Step 3. A Dash of Honey
Karl prefers honey on his sandwiches. We started out with a teaspoon (6 grams of carbs), but when we reduced it to half a teaspoon (3 g), he didn't mind.
Calories: 20
Carbs: 3 g
Step 4: Add It All Up
Calories: 380
Carbs: 29 g
Fiber Carbs: 8 g
Net Carbs: 21 g
We base insulin dosage on net carbs (total carbs minus fiber), which is considered to be "advanced carb counting" for some reason. See http://clinical.diabetesjournals.org/content/23/3/120.full for a discussion on the basic flavors of carb counting.
Variations
Karl prefers to have a peanut-butter sandwich as part of every single meal (sigh), unless we're eating out. He takes one to school with him each day to round out the food he buys in the cafeteria. The school has little in the way of low-carb options, and the sandwich is a key to keeping him well-fed at 75 carbs or less per meal.
Because Karl loves peanut-butter sandwiches so much, it pays for us to spend some energy on getting this optimized for him, and, under the circumstances, we think that a 380-calorie entree with only 21 g of net carbs is pretty good!
A peanut-butter sandwich is the gold standard of kids' meals anyway, so there are worse things.
I've tried substituting calorie-free pancake syrup for the honey, which Karl doesn't mind, but since the honey has only 3 g of carbs and he specifically asks for honey, I don't do this as a regular thing. Using jam instead of honey would be fine for anyone but Karl, who doesn't want jam. Just use an amount that matches your goals.
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