Diabetes: Food Choices

Why are food choices important?

A child with type 1 diabetes does not make enough of a hormone called insulin. Insulin helps sugar enter the body's cells and controls the level of sugar in the blood. When there is not enough insulin in the body, the amount of sugar in the blood reaches very high levels and can be very dangerous. The goal is to try to keep your child's blood sugar at a consistent level through the day. This is done by matching the amounts of insulin to the types and amounts of food eaten. Meal plans can be designed to fit your child's lifestyle.

A child with type 2 diabetes is unable to use the body's insulin efficiently. This causes the blood sugar to rise. Sometimes the blood sugar level can be controlled with just diet and exercise. Sometimes, your child will also need to take oral medicine, have insulin injections, or both.

In all cases, understanding how the food your child eats affects blood sugar is an important part of managing diabetes.

What are the types of meal plans?

There are several common ways to manage meals. Your diabetes care provider will help you make a meal plan that works for you. Most plans are based on measuring carbohydrates (carbs) in food because carbs have the biggest affect on the blood sugar level.

Three common types of meal plans are:

• Constant carbohydrate meal plan. Your child eats a consistent amount of carbs each day to match a relatively consistent dose of insulin.
• Carbohydrate counting meal plan. You figure out how many carbs your child is going to eat at a meal and adjust the insulin dose accordingly. The amount of carbohydrate may vary from day to day.
• The Plate Method: This is an easy way to make healthy food choices and control portions, carbs, and calories. Fill half the plate with non-starchy vegetables, one quarter with lean meats or beans, and one quarter with starchy foods (carbs). Your child can have portion of low-fat milk or yogurt and fruit on the side. Small amounts of healthy fat can also be added. The plate method helps your child eat more vegetables and less starchy foods. This helps to control blood sugars.

It is important to meet with a dietitian to develop a meal plan that meets your family's lifestyle.

What are the principles of food management?

All meal plans are based on the following principles:

• Eat a well-balanced diet. A healthy diet for a child with diabetes can be the same as it is for anyone. One that focuses on a balance of fresh vegetables and fruit, low fat dairy, lean meats, beans, whole grains and heart healthy fats.
• Manage carbohydrates carefully. Carbs make up half of the food your child eats each day. Because insulin is needed for the body to use the carbohydrate, it is very important to keep track of how much carbohydrate is eaten and when it is eaten. If your child takes insulin and eats about the same amount of carbohydrate each day, the insulin and food will be in better balance. If your child eats less one day, he may have too much insulin and have a low blood sugar reaction (hypoglycemia). If your child eats more one day, he will have too little insulin and have high blood sugar. For children getting a relatively constant insulin dose, the constant carbohydrate food plan can help keep the daily amount of carbs consistent. The carbohydrate counting plan allows carbohydrate intake to vary. Sometimes the effect a carbohydrate has on blood sugar will be different depending on what other foods are eaten with it. Testing blood sugars 2 hours after a meal will help you find out how eating different foods can affect your child's blood sugar.
• Eat meals at the same time each day. The insulin you inject will be working to lower the blood sugar whether your child eats or not. Therefore, when using a set insulin dose, it is important for your child never to miss meals and to eat at about the same time each day to prevent a low blood sugar. Have your child carry snacks for emergencies, such as a late bus or family schedule change. If a family member is late arriving home for a meal, your child should go ahead and eat. As your child gets older, short-acting insulin dosing times may be adjusted to allow for a more flexible eating schedule.
• Use snacks to prevent insulin reactions. Snacks help to balance the insulin activity. Peaks in insulin activity vary from person to person. You will learn from experience when your child needs snacks. It may be before lunch, in the late afternoon, or at bedtime. Almost everyone with diabetes needs a bedtime snack. Do not let your child skip snacks. The type of snack is also important. Sugar from fruits will last only 1 or 2 hours. Fruits are good for a morning or afternoon snack. Carbs eaten with proteins such as low fat cheese or meat, convert to sugar more slowly. A solid snack containing protein, fat, and starch is best for bedtime. It will last through the night better.
• Reduce saturated and trans fat in the diet. People with diabetes have a higher risk of getting heart disease later in life. It is important to watch the fat in your child's diet. Cholesterol and triglyceride are 2 of the major fats in our blood. Cholesterol is found in many foods, but is very high in egg yolks, organ meats, and large portions of high-fat red meat (for example, prime rib). Blood cholesterol and triglyceride levels can get too high if blood sugar levels are too high. The blood cholesterol level and triglyceride level should be checked once a year. If a high level is found, your child's dietitian can make suggestions to help lower it.
• Maintain appropriate growth and weight for height. Many children have lost a lot of weight before they are diagnosed with type 1 diabetes. Starting insulin treatment allows the body to regain weight. An important part of clinic visits is to make sure your child's height and weight are in the normal range. A teenager will have a shorter final adult height if sugar control is poor during the teenage years. If too much weight gain becomes a problem, the dietitian can suggest the number of calories to eat each day. A calorie controlled program that includes carb counting and portion control can help if your child must eat a set number calories per day. If being overweight is a problem, talk to your dietitian about making a plan for gradual weight loss.
• Eat more fiber. Fiber is the part of plants that is not absorbed into the body. Adding fiber may reduce the rise in blood sugar levels. For example, your child's blood sugar may not be as high 2 hours after eating 2/3 cup of beans (30 g of carbs) as it is 2 hours after eating 2 slices of white bread (30 grams of carbs) Raw fruits, vegetables, legumes, high-fiber cereals, and whole wheat breads are the most effective high-fiber foods.
• Avoid foods high in salt (sodium). Eating a lot of salt can raise the blood pressure in some people. Increased blood pressure is a risk factor for both eye and the kidney complications of diabetes. Therefore, it is important not to eat large amounts of salt. It is recommended that people with diabetes eat no more than 1,500 mg of sodium each day. Discuss salt with your child's dietitian.
• Take insulin. Take the insulin dose 15 to 20 minutes before eating if the blood sugar is above 80 mg/dl (4.4 mmol/L). This is especially helpful at breakfast, when insulin resistance is the greatest.