The Protein-Carb Balancing Act

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HI Hope

Children with protein-sensitive hyperinsulinism (HI), including most children who have hyperinsulinism-hyperammonemia (HI/HA), will have low blood sugars (hypoglycemia) when they eat protein-rich foods, either alone or as part of a meal.

Because protein is an important nutrient in all children’s healthy diets — fueling growth and development — it shouldn’t be eliminated from their diet.

But protein does need to be managed to prevent lows. That is why it’s important children with or HI/HA or other forms of protein-sensitive HI eat at least 15 to 30 grams of carbohydrates along with foods containing protein.

For younger children, ensuring they’re getting enough carbs to offset the protein falls to parents and caregivers. Planning meals and snacks that offer the correct balance may seem complicated at first, but soon it will become second nature, just like checking for sugars and giving medication.

A Refresher on Carbohydrates

Everyone needs carbs to give their bodies energy. Simple carbohydrates, like sugar and white flour, break down in your body quickly and raise blood sugar levels quickly. Complex carbohydrates, like starchy vegetables and whole grains, take longer to turn to sugar and have a slower, steadier, but still upward effect on sugars.

Some typical carb-filled foods are: breads, cereals, pastas and grains; fruits; starchy vegetables like potatoes, carrots, peas and corn; and milk and dairy products.

You can get information on carbs on the nutrition label of foods or search for them on websites like Here is a quick list of examples of foods that have 15 grams of carbs so you can make sure your child is eating enough carbohydrates.

  • 1/4 bagel
  • 1 slice of bread
  • 1/2 English muffin
  • 1/2 cup cooked oatmeal
  • a 4-inch pancake
  • 1/3 cup cooked pasta or rice
  • 1/2 cup of corn
  • 1/4 large potato or 1/2 cup mashed potato or sweet potato
  • 4 to 6 crackers
  • a 6-inch tortilla
  • a small piece of fruit
  • 1/2 cup beans or starchy vegetable
  • 2 small cookies
  • 1/4 serving of medium French fries

Protein Isn’t Just in Meat

While it’s easy to remember that beef, pork, lamb, poultry and seafood are sources of protein, it can also be found in beans, legumes (green beans, sugar snap peas), nuts, seeds and eggs; and soy and soy products (such as tofu and veggie burgers). There are plenty of options to suit your family’s tastes and vegetarian leanings.

In general, a serving of protein is about the size of a deck of playing cards.

Planning Balanced Meals

While typical people can eat a balanced diet throughout the day to maintain a healthy lifestyle, children with HI/HA need to have each meal or snack balanced.

Here are some pairings that provide the protein-carb balance: peanut butter on crackers, chicken and pasta, rice and beans, eggs and toast, and cheese and applesauce.

The foods can be given together. However, if a child resists eating carbohydrates, it’s a good idea to offer the carbs first, and once those have been eaten, then serve the protein.

Your team at the Congenital Hyperinsulinism Center is available to answer any questions you have about keeping your child’s low blood sugars in check.

Contributed by: Liesje N. Carney, RD, CSP, LDN


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