Getting to grips with diabetes and its relationship with food can be hard enough without having to add in further problems. We give some answers to common problems to help you along the way.
My toddler simply refuses to eat his dinner – what can I do?
Food refusal by a child of any age is a powerful weapon and causes parents much anxiety. If your child is growing well, it’s unlikely that this refusal is causing any significant long-term problem, but it is understandable that you will be concerned about the immediate effect on diabetes, eg hypoglycaemia. Wherever possible, keep calm about their refusal to eat. Even though it is frustrating, try not to let it show. Children are good at picking up signals from parents and it is all part of their game. Speak to your paediatric diabetes team for advice on managing food refusal.
You could also try the following:
- Offer regular carbohydrate containing meals and snacks. If they are not managing big meals, then small snacks will be needed. But try not to provide a constant supply of snacks, which will then reduce the appetite for meals.
- Limit mealtimes to 30 minutes then clear away the meal without offering alternatives.
- If you have given insulin and your child has refused to finish their meal, make up some of the missing carbohydrate with a drink of milk or a yogurt/custard for pudding, to reduce the risk of a hypo.
- If your child is on multiple dose injections (MDI) or pump therapy, inject soon after eating rather than before and adjust the insulin based on what they have actually eaten.
- Offer small portions, so as not to overfeed them, and praise good eating behaviour.
- Try to avoid your child drinking 30–45 minutes before their meal is due, so they don’t fill up on fluid.
- Be consistent. Everyone who feeds your child should manage their food refusal in the same way – both parents, grandparents, nursery staff etc. Hopefully your child will then receive the same positive message about eating.
- Encourage eating with other children who are good eaters. Children love to copy.
I don’t know what my teenage son eats when he’s out and about…
Food choices may not always be ideal when teenagers are choosing their own food. They know that and you know that, but you cannot always police this when they are eating away from home. Encouraging them to always take their insulin with food, in a safe dose, may be the best you can achieve. If they are eating fast food with their friends, encourage smaller portions rather than ‘going large’. No fast foods are ideal, but teenagers with diabetes will usually make the same choices as their friends, despite your requests to make ‘healthy’ choices. Many fast food outlets list the nutritional information online (for further information see Food questions and answers).
Make sure that the food you provide at home is the healthiest you can present, so be reassured that breakfast choices and another meal are appropriate. School meals have now improved and many less healthy options have been removed from school canteens.
If insulin is missed on a regular basis, this leads to weight loss. Food eaten without insulin is not absorbed properly and fat is used as an alternative energy source causing weight loss. Blood sugars rise and long-term control slips, and can lead to Diabetic ketoacidosis (DKA) and long-term complications. Other young people may miss meals or over-restrict their food to control their weight. If you suspect your child is regularly intentionally missing insulin to control their weight, or seems to be developing an unhealthy obsession about their weight or food intake, speak to your diabetes team immediately.
My daughter is looking a bit chubby – should I be worried?
If your child is gaining weight too rapidly and becoming overweight, diabetes may become more difficult to control. An overweight growing child should aim to maintain their weight for six–12 months while they grow, rather than actually lose weight. Successful weight management will always involve an element of activity or exercise, as well as age appropriate portion sizes at meal
times. Being active does not mean having to do team sports – active play, bike riding, dancing, drama, dog walking, trampolining, skateboarding, walking (to school, around town), swimming, and active console games all count as activity.
Discourage your child from missing meals to lose weight – children are more likely to snack on inappropriate foods if they are hungry. Teenagers may become more conscious of their weight as their bodies change. They should be weighed and measured regularly when attending clinic. On a flexible insulin regime, it is possible to reduce insulin at mealtimes before exercise, rather than have to give a snack before exercise, which will help weight maintenance.
Unexpected weight gain can be as a result of poor thyroid function, and this can be more common in people with Type 1 diabetes. Your child should have their thyroid function checked every year as part of annual diabetes blood tests.
If insulin is missed on a regular basis, this leads to weight loss. Food eaten without insulin is not absorbed properly and fat is used as an alternative energy source causing weight loss. Blood sugars rise and long-term control slips, and can lead to DKA and long-term complications. Other young people may miss meals or over-restrict their food to control their weight. If you suspect your child is regularly intentionally missing insulin to control their weight, or seems to be developing an unhealthy obsession about their weight or food intake, speak to your diabetes team immediately.
I’m torn about ‘treats’. Can they really still have sweets?
Treats should be exactly that – a treat and not an everyday occurrence.
Chocolate and sweets are part of normal childhood, and you should treat all your children in the same way. Too many sweets and chocolate aren’t good for anyone – choose a couple of days a week when all the family can enjoy these things together. For your child with diabetes it may be better that sweeter foods (sweets, chocolate, sticky puddings) are eaten as part of a meal, as your child will be taking insulin at that time anyway, (but you may need to increase the dose). Sweets or chocolate eaten outside of mealtimes should definitely be taken with extra insulin.
If grandparents or other relatives regularly buy sweets and chocolates for the children, suggest that they buy other non-food gifts instead, eg sticker books, magazines or small toys. Christmas selection boxes and Easter eggs should be spread out over several days (or weeks) rather than eaten all in one go. Don’t buy ‘diabetic’ or ‘sugar free’ sweets – they don’t taste the same, are expensive, and contain a type of sweetener that can cause diarrhoea if too many are eaten. They are ‘sugar free’ from a teeth point of view, but contain a type of sweetener that can still have an effect on blood glucose. Sugar-free chewing gum is acceptable in small quantities due to the small amount of sweetener in each piece.