Diabetes: Food Management

Why is food management 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 of diabetes food management 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 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.
• Exchange meal plan: Foods are grouped into lists. Foods on each list have a similar number of calories and amount of carbohydrate. It is called the exchange diet because you can exchange one choice on a list for another and be sure that it will have the same food value. Your dietitian helps you plan a diet that includes a set number of exchanges to eat each day and which food lists the exchanges should come from. This plan is not used very often anymore.

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 diabetic is the same as it is for anyone. A healthy diet contains 10% to 20% of calories from protein (milk, cheese, yogurt, meat, poultry, fish, egg white, nuts and seeds), 50% to 60% from carbohydrate (fruits, vegetables, and whole grains), and 20% to 35% from fat (butter, egg yolk, animal fat, vegetable oil).
• Keep the day-to-day calories consistent: If your child eats about the same amount of calories each day, the insulin and food will be in 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. Your child should also try to eat similar amounts of carbohydrate, fat, and protein each day. Your child's body will need more or less insulin depending upon how much carbohydrate is eaten. It is important for your child to eat a consistent amount of food at the same times each day. For children getting a relatively constant insulin dose, the constant carbohydrate and the exchange food plans both help keep the daily amount of carbs consistent.
• 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, 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, he or she can take more responsibility for eating when the normal routine changes.
• 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. Proteins with fat, such as 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.
• 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. It is also important to make sure your child has enough insulin in his system when carbs are eaten. 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 combinations of foods affects your child's blood sugar.
• Reduce 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 become 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 diabetes. Starting insulin treatment allows the body to regain weight. Usually your child's appetite is ravenous for about a month as the body returns to its usual growth pattern. The appetite then returns to normal. An important part of clinic visits is to make sure your child's height and weight are increasing appropriately. 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 a set number of calories to eat each day. The exchange food program 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 roughage in our food 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 an apple (15g of carbohydrate) as it is 2 hours after drinking a 1/2 cup of apple juice (also, 15g of carbohydrate). 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 all people eat under 2,300 mg of sodium (1 tsp of table salt) each day. Discuss salt with your child's dietitian.
• Avoid eating too much protein: Americans eat a lot more protein than a healthy diet recommends. Eating too much protein is bad for people with diabetes who have kidney problems. Spaghetti, pasta, and casseroles that do not have a lot of meat are healthier than a hamburger, steak, or other red meat. You can take away protein from breakfast (except milk) and the morning and afternoon snacks. However, it is generally good to eat a bedtime snack that includes carbohydrate, protein, and fat. This helps keep the blood sugar at a good level through the night.