Birthday Cake:
To Have or Have Not?

That is the question frequently asked of Berrie Center Clinicians—often by parents of recently diagnosed children with type 1 diabetes (T1D). Many parents associate birthday parties, not as a symbol of celebration (as their children undoubtedly do), but as a carbohydrate extravaganza, and a scary sign of impending high blood sugars to come due to the food served—from pizza to cake with frosting. 

So is there a correct answer to the birthday cake question? The conventional wisdom at the Berrie Center, according to Dr. Mary Pat Gallagher, a pediatric endocrinologist, is to “Let them eat cake. We want our kids to be healthy, but we also want them to have normal psychosocial development too. No one should have cake three times a day, but it’s OK for your child to have a piece of cake at a special occasion like a birthday party. You want your child to have normal experiences. Children with diabetes feel so different already.”


test defualt
That is not to say that your child’s blood sugar won’t rise after having a piece of birthday cake. In fact, it probably will, said the Berrie Center’s Kira Almeida, who is the pediatric nutritionist and a diabetes educator:  “One high blood sugar isn’t going to do any lasting damage,” she added, especially if the child’s blood sugars are normally well controlled.

What you really need to know, Kira said, is how many carbohydrates are in that piece of cake—and then give the appropriate amount of insulin in advance. (See below to read the Center’s informative flyer titled, Let’s Eat Cake). “There isn’t anything, within reason, that can’t be covered with more insulin,” said Kira. “And hopefully you can avoid highs altogether, if you hit the correct insulin dosing.”

Berrie Center clinicians draw the line at the willy-nilly drinking of sodas and fruit juice, which they consider empty calories with no nutritional value, even on special occasions. Even so, you don’t want to say no to a child all of the time, especially about food, said Kira. “It’s tricky because if kids really want to try something and they can’t, they might really overdo it when their parents aren’t around. You don’t want to make anything forbidden.”

It's fair to say that not all parents feel comfortable heeding their clinician's advice on this subject.  "We'll say it's OK to have cake and treats in moderation for special occasions, but not all parents heed this advice, " said Kira.  "The association between sweets and high blood sugars is so strong that they feel funny giving their kids cake, no matter what we say. But ultimately, it is the parent's choice." 

Here are a few suggestions that may help parents allow their kids to have their cake and eat it too:

  • Always carry extra insulin
  • Have your child test his blood sugar after the cake as often as you need to feel comfortable—and adjust with insulin if needed
  • Your child can have fewer carbohydrates during the rest of the day, like a low carb breakfast before heading to the party, to keep carbs and calories in better balance
  • Cakes that are not loaded with frosting are better choices
  • Pick those that have some fat and protein (ie. chocolate & nuts)

"Sometimes running a little high is worth the experience of being with friends at a birthday party, said Kira, "and being like the other kids.   Chances are that when they are older they may choose to forgo the cake altogether...at least some of the time."




Serving Size

Carbs (g)

Pound cake

1/10 of cake (1.1 oz)


Cheesecake (plain)

1/6 of cake (2.8 oz)


Duncan Hines Creamy Classic Chocolate frosting

2 tbsp


Duncan Hines Creamy Classic Vanilla frosting

2 tbsp


Carvel Cookies n' Cream

1/8 cake (4.1 oz)


Baskin Robbins Vanilla Heart Cake

1 svg (4.4 oz)


Angel food cake

1/12 of 10in dia, (1.8 oz)


Carrot Cake with cream cheese frosting (from grocery store bakery)

1/12 of cake


Dark Double Chocolate Layer Cake (from grocery store bakery)

1/12 of cake


Betty Crocker Devil's Food Cake (no frosting)

1/12 of cake


Duncan Hines Vanilla Cake (no frosting)

1/12 of cake


Carvel Gameball Cake

1/8 of cake (4.1 oz)


Chocolate with chocolate frosting

1/9 (3 oz)


Duncan Hines Golden Cake (no frosting)

1/10 of cake


Chuck E Cheese Chocolate White

1/10 of 8in cake


Cold Stone Creamery Cakes

1/8 6in dia cake


Dairy Queen Cake

1/8 of 8in dia cake


Large frosted vanilla cupcakes (from grocery store bakery)

1 cupcake