Diet plays an important part in the successful management of diabetes but choosing the right diet and regulating mealtimes can seem like a minefield to a youngster. It needn't be. By following a few simple guidelines and making healthy eating a part of your everyday life, you can start worrying less about 'breaking rules' and more about what fabulous favourites you're going to eat tonight. After all, food is supposed to be fun.
Food
In the past, dietary advice for people with diabetes was very restrictive when it came to carbohydrate intake. Foods containing sugar were excluded from the diet. This created feelings of guilt in people with diabetes when the "rules were broken". To do as most other people do, i.e. to vary one's food intake and indulge in the occasional sweet "treat" was discouraged and by some looked upon almost as "sinning". But this is an outmoded and inappropriate approach. The inclusion of foods containing moderate amounts of sugar has not been found to worsen blood glucose control.
Sticking to a rigid pattern of meal times and selected food is unlikely to be necessary because of diabetes alone, especially if you are taking premeal insulin in a multiple injection or pump regimen, although regular eating habits and a knowledge of carbohydrate quantities is important. Many people with diabetes live full and varied lives, enjoy their food, and still manage to control their blood glucose levels effectively. The more knowledge you have about carbohydrate foods and their effects on your blood glucose, the more control you will have over your diabetes. This chapter will give you many details about blood glucose and different foods, but you will learn the general aspects of healthy eating from your dietician.
It is important to be careful about what you eat, even if you don't have diabetes. But remember that food should not be looked upon as medicine. Food should look and taste good. Meals are meant to be pleasurable, we should enjoy food and feel satisfied afterwards. If you concentrate upon food being "good for you" to the exclusion of everything else, you will find no pleasure in it. It will be much more rewarding if you are able to discuss what you can eat with a dietician who will help you draw up a meal plan based on the mealtimes, routines and preferences that are important to your family.
"What can I eat?", "What should I avoid?" People newly diagnosed with diabetes commonly ask such questions. Usually, the comment after the first consultation with a dietician will be: "I am glad to discover I can eat most of the things as I used to before getting diabetes". Dietary advice should be directed towards the whole family from the very beginning. In a Finnish study of young children with Type 1 diabetes, all family members increased their consumption of skimmed milk, low-fat cheese and low-fat cold meats. They also ate more fruit and vegetables.
Nutrition
People with diabetes should exclude sugar from their diet, right?
Wrong. These days, research shows that diabetics can enjoy their food and also live a healthy, active life. Eating well may sound like a minefield but foods containing a moderate amount of sugar are often acceptable. Understanding carbohydrate foods and how they affect blood glucose will help your child manage their diabetes - but always remember that food should be fun for all the family, not just boring old medicine. A nutritionist can help fine-tune your child's eating plan, but this guide covers some of the basics.
From a historical perspective, dietary advice for people with diabetes has been very restrictive when it comes to carbohydrate intake. Foods containing sugar were excluded from the diet. This created feelings of guilt in people with diabetes when the "rules were broken". To do as most other people do, i.e. to vary one's food intake and indulge in the occasional sweet "treat" was discouraged and by some looked upon almost as "sinning". But this is an outmoded and inappropriate approach. The inclusion of foods containing moderate amounts of sugar has not been found to worsen blood glucose control.
Sticking to a rigid pattern of mealtimes and selected food is unlikely to be necessary because of diabetes alone, especially if you are taking premeal insulin in a multiple injection or pump regimen, although regular eating habits and a knowledge of carbohydrate quantities is important. Many people with diabetes live full and varied lives, enjoy their food, and still manage to control their blood glucose levels effectively. The more knowledge you have about carbohydrate foods and their effects on your blood glucose, the more control you will have over your diabetes.
It is important to be careful about what you eat, even if you don't have diabetes. But remember that food should not be looked upon as medicine. Food should look and taste good. Meals are meant to be pleasurable; we should enjoy food and feel satisfied afterwards. If you concentrate upon food being "good for you" to the exclusion of everything else, you will find no pleasure in it. It will be much more rewarding if you are able to discuss what you can eat with a dietitian who will help you draw up a meal plan based on the mealtimes, routines and preferences that are important to your family. "You should never eat what you don't like", says UK dietitian Sherry Waldron. "What can I eat?", "What should I avoid?" Such questions are commonly asked by people newly diagnosed with diabetes. Usually, the comment after the first consultation with a dietitian will be: "I am glad to discover I can eat most of the things as I used to before getting diabetes". Dietary advice should be directed towards the whole family from the very beginning. In a Finnish study of young children with Type 1 diabetes, all family members increased their consumption of skimmed milk, low-fat cheese and low-fat cold meats. They also ate more fruit and vegetables.
Nutritional recommendations will be based on requirements for all healthy children and adolescents. Children need to double their energy intake between the ages of 6 and 12 years if they are to grow as much as they should. At this time, they need to eat more food rich in energy and protein. However, if they do not reduce their energy intake once the growth spurt stops, they are at risk of becoming overweight. At the present time, there is no good scientific evidence for recommending vitamin or mineral supplements.
Absorption of carbohydrates
Glucose from food can only be absorbed into the bloodstream after it has passed into the intestines. It cannot be absorbed through the lining of the mouth, as used to be believed. To reach the intestines, the food must first pass through the lower opening of the stomach where a special muscle, the pyloric sphincter, acts as a "gateway" to the intestine below. The sphincter will only allow very small pieces to pass through. Complex carbohydrates must first be broken down to simple sugars before they can be absorbed into the bloodstream. The length of the carbohydrate chain does not seem to affect absorption as much as was once believed since "cleavage" (breaking) is a fairly rapid process. Simple carbohydrates are cleaved by enzymes in the intestinal lining while more complex carbohydrates and starch are first prepared by amylase, an enzyme found in the saliva and pancreas. Starch fibre cannot be cleaved into carbohydrates in the intestine. At one time, carbohydrates were divided into quick-acting and slow-acting, mainly depending on the size of the molecule. It is more accurate to speak of quick-acting and long-acting foods and to evaluate the composition, fibre content and preparation in order to determine the effect on the blood glucose level, rather than simply its content of pure sugar. The term "glycaemic index" (GI) is used to describe how the blood glucose level is affected by different food.
Dietary fibre content and particle size seem to be particularly important according to recent studies. The starch in vegetables is broken down more slowly than the starch in bread. The starch in potatoes is quick to break down to glucose. The starch from pasta products is broken down much more slowly, even though it is made from white flour, which is low in fibre. How much you chew the food and the size of the food particles swallowed also influences the blood glucose response. Industrially manufactured mashed potatoes contain a fine powder that is mixed with fluid. The glucose in mashed potatoes is absorbed just as quickly as a glucose solution. Pasta and rice are swallowed in larger bites and must be digested before they can be absorbed. Likewise, a whole apple will give a slower rise in blood glucose than apple juice, which contains smaller particles and is in a liquid form. Heating decomposes starch, making sugar more accessible and faster to digest. Industrial food processing usually involves higher temperatures, which gives food a quicker blood glucose raising effect compared with home-cooked meals. Industrial baby food and semi-manufactured food (sometimes used in schools) can raise the blood glucose more than comparable home-cooked meals.
Indigestible carbohydrates (dietary fibre) cannot be broken down in the intestines and will therefore not give a blood glucose response. The amount of carbohydrate listed on a food label can be misleading as no distinction is made between digestible and indigestible carbohydrates. Your dietitian can discuss this with you further.