Having Kids with Type 1 Diabetes

Both my son's have Type 1 Diabetes and it seems more and more kids lately are developing this mystery disease. But what Is Type 1 Diabetes? According to the Junior Diabetes Research Foundation, they simply explain it this way:

 

"Type 1 diabetes (juvenile diabetes) can occur at any age, but most commonly is diagnosed from infancy to the late 30s. In this type of diabetes, a person's pancreas produces little or no insulin. Although the causes are not entirely known, scientists believe the body's own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes must inject insulin several times every day."

 

When our oldest, Russell, got sick, we had no idea what the symptoms where. Honestly, we thought he was going through a growth spurt. But is just wasn't right. He was thirsty all the time, soaked his bed every night, lethargic and eating more then normal but losing weight. I took him to the doctor and they did a simple urine test and checked his blood. At the time his brother was only 4 months old and sleeping in my arms. As soon as the tests came back, the Dr. told me I need to get him to the ER right away! I called my husband and we raced to Children's Hospital. He spent 1 night in the ICU as his blood sugar numbers where so high and out of control.

 

We felt guilty waiting so long to take him in, but honestly had no idea what was going on in his body. He spent 4 days total at the hospital (they did move him to a reg. room after the first day) so my husband and I could be educated on how to take care of him at home.

 

A few short years later, his little brother Brian was also diagnosed weeks before his 3rd birthday. He was showing the same symptoms for about a week or so and so we used his big brothers meter to check his blood sugar. Finally, while on Russell's 7th birthday, we decided to take Brian to Children's Hospital as the blood sugar meter kept saying "hi" (meaning his numbers where over 600). He spent 5 days at Children's Hospital because he also developed a viral infection.

So now we have two kids with Diabetes, two kits, two sets of insulin, meters, syringes, test strips, etc. All the tools of the trade to manage this mystery disease from home. But we do manage it. The kids have taken it on as normal as brushing their teeth.

 

Both my kids are on Lantus (long acting insulin) and Humalog (short acting). Every morning they each get a shot of Lantus, units are different for each child due to age and weight. The Humalog is given every time they eat food with carbohydrates that fall within a ratio of their target blood sugar. For example, at lunch, my youngest may eat food that ads up to 25 grams of carbs, so if his blood sugar is within its normal range before he eats, his shot will be 1 unit of Humalog. Same applies with his big brother, just a different dosage ratio.

How do we figure out their dosages for Lantus and Humalog? Every three months since the date of their diagnosis, we visit the Endocrine Clinic at Children's Hospital here in Seattle. Their Dr. takes a blood sample, much like their finger pokes and that will tell her their A1C levels (A1C is a test that measures a patient's blood glucose level over the previous three months that might also help predict serious health complications like heart attack and stroke).

 

They also download their blood glucose meters to get a readout of their average blood sugars over the last few months. With this information, she can decide where the peaks and lows are, and where the Lantus and Humalog may need adjusting. Their Dr also has a computer program on the hospital database that helps with the calculations as well as "cheat sheets" we use for each child. You see. They many times have different dosages for the Humalog for EACH meal during the day, for EACH child. A chart for Breakfast, Lunch and Dinner (if they eat a snack, for example, mid morning, I use the dosage for breakfast to treat it if necessary).

 

We've been very lucky with Children's Hospital, they've got the best Endocrine team there and have helped us weather many storms through both boys dealing with illness or simply not able to get their numbers under control.

This leads me to another thing we have to watch out for, ketones. Or as we like to tell our kids, we need to fight the "ketone monsters".

 

What are Ketones?

Ketones are due to not enough insulin being available to meet the body's needs. The 2 main causes are illness/infections (the body needs extra energy to fight off a virus or bad cold) or forgetting to take an insulin shot. There are other causes, but the primary ones we've had to deal with are the two mentioned. Another bugger, which is worse, is acidosis.

 

Now acidosis is the result of letting ketones get out of hand. Perhaps insulin isn't available due to an emergency situation, or the person is simply not taking care of their diabetic needs properly. See, it is not high blood sugar that causes ketones or acidosis; eating sugar does not cause acidosis. Ketones come from the breakdown of body fat. The role of insulin is to shut off fat breakdown. Now if the stress hormones are high or there simply isn't enough insulin, fat will begin to break down. And the side product of fat breakdown is ketones production. In the early stages, it can be tested with urine. But if left undetected, ketones can also build up in the blood and eventually in the body tissues. When it gets this far, it will result in acidosis (DKA).

 

For example, my youngest spent a week at Children's Hospital when he got the stomach flu last February. He was so sick; we couldn't get him to keep any food or liquid down. Because he wasn't eating, his blood sugar dropped low, and we couldn't give him insulin to deal with the heavy ketones because he wasn't eating. So in turn, he was on an IV drip to help rehydrate his little system as well as supply glucose for his body to work with. Even the smallest amount of long acting insulin dropped him low to the point the Glucagon wouldn't work (that is an emergency glucose administered through as a shot to help the body draw stores of sugar from the liver). But because we where able to get him in and on an IV drip, he never got as far as DKA.

 

Our oldest son has also developed ketones because of the flu and or a head cold. His body will have really high blood sugars (only a couple of times has he had heavy ketones and low blood sugars, luckily never needing to be admitted, but did have an ER visit). So we follow a sick day management regimen and different calculations according to how heavy his ketones are so we know how much extra insulin he needs to get his blood sugar under control. As with any illness, lots of fluids, especially water are a necessity but even more so with diabetics.

 

So anytime my kids come down with even just a sniffel, we're on them to check for ketones and watching their blood sugars closely. We have test strips that can be dipped in urine that show a color code to how light or heavy their ketones are. Staying on top of their sick day management has prevented many trips to the ER.

 

What can my kids eat?

Anything! What is so nice about the insulin they're on; they're not restricted to how much food or type of food they can eat. We do, however watch how much fat (limited "fast food" and "junk food") and salt intake because it raises blood pressure as well as threatens the circulatory system. The reason fat restriction is very important because high cholesterol and diabetes are two of the four risk factors for developing heart disease. (The other two for developing heart disease is smoking and family history).

 

So I make a lot of my own foods for home. I've posted many of our favorite recipes at The Poor Chef website. I also input the nutrition information on a program I use at home that gives me the carb amount on home recipes per serving (FitDay.com). Another great resource for food items, especially if you're eating out (most restaurants now supply nutrition info) is a pocket book from Calorie King. I keep a copy in the car just in case, trust me, having extra resources to go to in a snap is so handy.

 

What about school?

Again, we are very lucky to have a great school district who supplies a full time nurse. Nurse Alice is the best. We have a system down for my oldest son Russell. I make his lunch and provide all the carb info for what is packed. She just has to add up what he's eaten and is able to use the "cheat sheets" I've provided so she knows how much insulin to give him at lunch time. We talk almost every day about his numbers so I have a complete log for when it's time to go to the doctor. It's a team effort and I can use all the help I can get. Brian isn't quite ready for school yet, but I know he'll be well taken care of when it's time.

 

I can't say it's been an easy road and wouldn't wish it on anyone. But if you're reading this and have a loved one with Type 1 Diabetes, I hope the information has been of some help. It's an ongoing education and we're so grateful to live in a time where medical breakthroughs are happening all the time. Who knows, maybe by the time my kids are in high school, there may be a cure for Diabetes. Until then, we'll keep managing their care, not let it get us down or hold us back from living a happy and normal life.

 

For more information regarding Type 1 Diabetes, please visit:

http://www.jdrf.org

 

"Understanding Diabetes, A Handbook for People Who Are Living with Diabetes", by H. Peter Chase, MD (aka: The Pink Panther Book)

 

This Article is Written by Kathleen Schmidt (c) 2009

Kathleen Schmidt:

Domestic Goddess and Work At Home Mom

877-762-1450

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Diabetic Meal Menus for Kids

Kids like to eat food that is pleasing to the eye irrespective of the fact that whether they are nutritious or not. What when kids suffer from diabetic problem? Diabetic kids need to restrict on some food even if they do not like it. Controlling the diet can be the solution that will help in reducing the threat of diabetes and symptoms if the kids are already attacked by it. Parents whose kids are diabetic need to show a greater amount of attention regarding the food habits of these kids and thus has to carefully plan diabetic meal menu for kids.

 

They have to be careful on the amount of carbohydrates they consume in order to keep a check on their blood sugar levels. There are two problems tied with diabetes which can be faced by kids which includes coronary disease and strokes but by sticking to diabetic diet plan kids can escape the threat of these problems. A healthy diabetic meal menu for kids is related with consuming a balanced diet of non-fat dairy foodstuffs, poultry, whole grains, lean meat, fish, fruits, and vegetables. There are many delicious recipes which are particularly approved for kids with diabetes helping parents to plan diabetic meal menu for kids with ease.

 

Diabetic meal menu for kids can include Breakfast on the Go, Club Wrap, Cranberry Spritzer, Grilled Cheese Sandwich, Nutty Chocolate Chip Cookies, Vegetable Skillet Frittata, Strawberry Cheese Tart, Taco Popcorn, Tomato Basil Pizza Snack, and Zesty Turkey Tenderloin With Vegetables. If the kids are restricted to a low diabetic diet then they can eat carrots, avocados, kidney beans together with fish, cheese, domestic fowl, meat and eggs. Kids suffering from diabetes need not have to undergo a poor selection of diet particularly when diabetic recipe formulations are made with variety and health in mind.

 

At the end of this article, I'd like to share cool website with related articles on topics like simple diabetic menu and diabetic menu planner. Visit for more information.

 

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Kids Diabetes Alert - Are Your Kids At Risk?

When most people think of diabetes, they usually either think of young kids with Type I diabetes who need daily insulin shots or older, overweight adults with Type II diabetes.

 

Now though, with the childhood obesity epidemic, there has also been a big increase in the number of children with Type II diabetes, which used to be thought of as adult onset diabetes.

Diabetes Risk Factors

Obesity or being overweight is one of the biggest risk factors for diabetes, both in kids and adults. You can use our BMI Calculator to see if your children are overweight. If they are, it would be a good idea to discuss it with their Peditrician, help them to eat a more healthy diet, and increase their physical activity.

 

Your child's ethnic background can also be a risk factor for diabetes, which is more common in American Indian, African-American, Hispanic American, and Asians/South Pacific Islander children.

 

A family history of diabetes, especially in first- and second-degree relatives, can also be a risk factor for children developing type 2 diabetes. Unlike kids with type I diabetes, who usually only have a 5% chance of having a family member with diabetes, type 2 diabetics have a 74-100% chance of having a family member with diabetes.

Symptoms of Diabetes

In children with Type I diabetes, the typical symptoms are well known, including increased urination (polyuria), increased drinking (polydipsia) and weight loss.

Type II diabetes is more subtle in children, who are usually overweight and either have mild or no polyuria or polydipsia. Another sign or symptom of Type II diabetes is acanthosis nigricans, a black, velvety discoloration to a child's neck and skin folds.

Testing Children for Diabetes

All children who are at risk for diabetes should be tested or screened, beginning when they start puberty or by age 10, since most kids are diagnosed during middle-to-late puberty.

 

The American Diabetic Association considers kids at risk and requiring testing if they are overweight and has any two other risk factors, including:

• a family history of type 2 diabetes in first- and second-degree relatives,
• belonging to a certain race/ethnic group (American Indians, African-Americans, Hispanic Americans, Asians/South Pacific Islanders),
• having signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS)

Some children who don't meet these criteria may also be tested based on a your Pediatrician's clinical judgement.

 

Testing for Type II diabetes should usually include a fasting plasma glucose level, which will be high (hyperglycemia) if your child has diabetes. Other tests might include a urine glucose test, which will likely show sugar in the child's urine (glycosuria), a random glucose, and/or a HbA1c (a more long term test of glucose levels).

 

Since your child is likely overweight if he is being tested for Type II diabetes, he should usually also have his cholesterol tested at this time.

 

If testing is normal, you should still help your child be more active and have a more healthy diet. While your child is at risk, testing is usually repeated every two years.

 

Source: By Vincent Iannelli, M.D., About.com Guide

 

Diabetes requires adjustments for all members of the family

When a child is diagnosed with diabetes it undoubtedly will affect the entire family. Much attention is usually given to the child with type 1 to ensure proper diabetes management. But less attention is often given to the siblings of the diagnosed child. It is not uncommon for there to be feelings of neglect, anger and favoritism that arise in siblings.



Siblings can adjust to diabetes in their home if parents create a supportive environment that addresses the needs of all the children, not just the one with diabetes.

 

Here are some tips for parents on how to manage the responses of siblings to the changing family dynamic of living with diabetes.

Explain diabetes in terms they can understand

It is important that you clearly explain what diabetes is and how it works to each of the children in age-appropriate language. This will help calm fears and enable them to normalize the diabetes management process much faster.

 

For example, one of the big misconceptions that siblings often have after a brother or sister is diagnosed with diabetes is that they will “catch it.” They need to clearly understand that diabetes is not contagious and that close contact with their sibling is not dangerous. In fact, you can even emphasize that when the diabetes tasks are completed, it might be easy to forget that their sibling even has diabetes.

Look for opportunities to probe the feelings of your children

Initially, siblings adjust to diabetes with some intrigue, wanting to understand what it is about. But within a few weeks most siblings would like life to go back to “normal” before the diabetes came to live in the home. This causes a wide range of feelings in kids. The goal is to listen for these emotions and coax them out when appropriate.

 

For example, suppose your non-diabetic child says he also wants to have diabetes so he can spend more time with Mom and Dad. This type of comment is full of emotion. Rather than correcting your child and instructing them about the difficulties of having diabetes, focus in on helping them talk about their feelings. You might say, “Does it seem that your brother gets more attention from Mom and Dad because of his diabetes?” An inquisitive response that attends to the emotion your child is feeling sends the message that you want them to tell you more; you want them to express their feelings and you are willing to listen.

Make a point to talk about a wide variety of topics with children

Immediately after the diagnosis it is easy for diabetes-related conversation to dominate the household interaction. While this is understandable, make an effort to broaden out the topics to include areas of interest that pertain to all members of the family. This will not only help siblings to feel their lives are important but will also help the child with diabetes to see that there is more to life than diabetes.

Limit the amount of responsibility you give regarding diabetes tasks

While it is fine to ask for sibling help now and then with diabetes-related tasks, limit the responsibilities. For example, it is okay to ask an older sibling to periodically check the younger sibling’s blood sugar, but be cautious about making this type of responsibility a routine task. Diabetes is a difficult condition to manage and can be stressful, even for teens.

Be deliberate about nurturing each child’s needs

In reality, you may end up spending more time and energy addressing the needs of your child with diabetes than the others. But this doesn’t mean you can’t make adequate time for the other children as well. Show interest in their activities and challenges. Affirm their skills, abilities and efforts. Each child will have their own unique relationship with you. Nurture it by giving them one-on-one time where there is lots of conversation and fun. This is one sure way to avoid the problem of favoritism for the child with diabetes.

 

_{Source: American Diabetes Association. "Diabetes Affects Siblings Too.”}

Pregnancy and Type 1 Diabetes

It’s very important that pregnancy in females with type 1 diabetes is planned and closely monitored from preconception until delivery by a diabetes team (endocrinologist, diabetes educator and dietitian) and an experienced obstetrician. Contraception should be used by females with diabetes unless there is active planning for a pregnancy. In the case of planning a pregnancy it’s important to have very good diabetes control, as well as any diabetes complications being stable, and folate supplementation having been commenced.

 

To ensure the best pregnancy outcomes it’s important that blood glucose levels (BGLs) are well managed both before and during pregnancy. Pregnancy should not be planned until HbA1c (3 monthly average of BGLs) is within or close to the range for people without diabetes. It’s important to aim for tight blood glucose control throughout the pregnancy while still avoiding hypos.

 

The risks of unplanned pregnancy or poorly managed diabetes during pregnancy include the risk of miscarriage, having a baby that is too large or too small and the baby having congenital malformations (especially heart or kidney problems).

Pregnancy may also increase the risk of progression of diabetes complications, especially eye damage. There is also a higher risk of developing raised blood pressure during pregnancy and problems related to it. Studies have shown that a well-managed pregnancy with good blood glucose control and regular monitoring can reduce these risks significantly.

 

During labour the medical team will monitor both mother and baby carefully. Insulin is usually required during labour and may be given by regular injections, pump or via a drip (intravenous infusion). It is possible to have a natural birth, however sometimes a caesarean section will be required to deliver the baby. Both mother and baby will be closely monitored after the birth. After the baby has been born, the mother will experience a significant fall in insulin requirements especially in the first few weeks – and this may be more marked with breastfeeding. The insulin doses will be lower than before the pregnancy.

 

More information on diabetes and pregnancy can be obtained from the Australasian Diabetes in Pregnancy Society –www.adips.org

 

To hear more about women’s experiences and medical guidelines, refer to “Diabetes and Pregnancy” by Alison Nankervis & Josephine Costa, Miranova Publishers 2001. ISBN 0 9587142 31. Available for purchase from Diabetes Australia-NSW.

 

Expert advice from Dr Glynis Ross, Endocrinologist at The Royal Prince Alfred Hospital is gratefully acknowledged.

 

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_15.html

Physical Activity and the Benefits of Being Active

Physical activity is important for all children, including children with type 1 diabetes. There is no reason for a child with diabetes to be excluded from or not participate in sport or any form of physical activity.

Benefits of being active

There are many benefits to physical activity, active children are more likely to:
• Be a healthy weight
• Be happy, relaxed and sleep better
• Maintain healthy growth and development
• Feel good, inside and out
• Have good coordination and be flexible
• Develop good social skills

Physical activity and diabetes

Physical activity may assist with managing blood glucose levels (BGLs) in children with diabetes. Physical activity usually lowers BGLs by making the body more sensitive to insulin. Sometimes BGLs may be higher prior to and following physical activity because of other hormones released during the activity. Rises in BGLs during activity are usually temporary and may be followed by lower BGLs and the risk of delayed hypoglycaemia, 12-16 hours following the activity.

Managing physical activity

There are some important things you need to consider when a child with type 1 diabetes participates in physical activity. These include:

Blood Glucose Testing
Blood glucose testing provides you with useful information about your child's response to exercise and will help you to determine how to manage your child's diabetes during physical activity. It's important to test before, during and after the activity.

Insulin 
Adjustments may be required to your child's insulin dose prior to and following exercise. This adjustment will depend on factors such as type of activity, duration and your child's individual response to the activity. Discuss insulin adjustments for physical activity with your diabetes team.

It's advisable not to give insulin into an exercising muscle as it is absorbed more quickly and may increase the risk of hypos. The tummy is the best place to give your child's insulin.

Carbohydrate Foods
Extra carbohydrate foods may be required before, during and after physical activity. This is very individual and depends on factors such as type of activity, duration, your child's individual response to the activity and BGL. As a guide, one additional serve or exchange of carbohydrate may be required for every 30-40minutes of exercise. Lower GI foods such as fruit, yoghurt, milk or raisin toast prior to exercise may assist in maintaining BGLs during physical activity.(GI)

Hypos
Hypoglycaemia (hypo) or low BGLs may occur as a result of physical activity. It’s important to make sure that your child has a hypo kit readily available when they are exercising (hypos). Teachers and sports coaches need to be aware of the risks of hypos during and following sport and allow your child to treat the hypo immediately and re-treat if necessary. Click here to view The Schools Pack.

Exercise may also cause delayed hypoglycaemia for 12-16 hours afterwards. To prevent delayed hypos, it's important to ensure that your child eats additional carbohydrate following the activity and that bedtime BGLs are above 7mmol/L. Testing your child's BGLs overnight is also advised after strenuous physical activity.

Lowering the insulin dose, giving extra carbohydrate foods and carrying out regular blood glucose testing can reduce the risk of hypos.

Physical Activity & High BGLs
Physical activity should be avoided when your child is unwell or their BGL is over 15mmol/L with the presence of ketones. Exercise at this time may increase your child's BGL even further causing them to feel more unwell.

High risk activities

There are some activities that need a cautious approach when undertaken by children and teenagers with type 1 diabetes. These include: 
• Sports which are solo in nature
• Activities which take place in a potentially dangerous environment such as mid air or in water
• Those which limit the ability to recognise and self treat hypos

High risk activities include rock climbing, flying, abseiling, car and motorbike racing, skiing, swimming, surfing and snorkeling. The older child or teenager with type 1 diabetes may be able to participate in these activities with careful planning.

Sports that should not be undertaken include scuba diving, solo hang-gliding or solo flying.

Encouraging physical activity

Help your child or teenager with type 1 diabetes to be active by:
• Being an active parent
• Turning off the TV more often
• Limiting the time your child spends on the computer and playing video games to 30 minutes each day
• Encouraging active play such as skipping, ball games, bike riding, roller blading or walking the dog
• Finding fun activities that your child enjoys
• Waking your child to and from school if possible
• Being an active family, explore new places - parks, trails, walks and sporting facilities
• Encouraging your child to try new sports and activities like dancing, netball, swimming, athletics, cricket and soccer
• Keeping them active around the house

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_8.html

What Should I Eat?

Healthy eating is important for all kids, including kids with diabetes. Your body needs the right balance of healthy foods to grow and develop, and to help you look after your diabetes. Understanding all about the food you eat can help you to make healthy choices.

Healthy Eating is easy! 
Healthy eating is as easy as choosing foods from the “eat most” section of the healthy food pyramid everyday, with smaller amounts of “eat moderately” foods each day. The “eat only a little” foods should only be included in small amounts or enjoyed for treats.

 
To be healthy you need to eat a variety of food every day
This food pyramid is a good guide to making good choices

Kids with diabetes don’t need special foods, so your friends, brothers and sisters should all be eating the same healthy foods as you, everyday!

All About…Carbohydrates, Proteins & Fats 
Carbohydrates, proteins and fats are found in the food you eat. They give your body energy and help you to grow. Everyone needs the right amounts of carbohydrates, proteins and fats each day for good health.

Carbohydrates 
Carbohydrate foods give your body the energy to do all the things you like doing. When you eat carbohydrate foods, they break down into sugar or glucose in your body. With the help of insulin, your body uses this glucose for energy.

Carbohydrate foods are things like:
• Bread and bread rolls
• Breakfast cereals
• Dairy and soy milk, yoghurt, ice cream and custard 
• Fruit and fruit juice
• Starchy vegetables like potato, sweet potato and corn
• Rice, pasta and noodles
• Baked beans and lentils
• Snack foods like biscuits, chips, muesli bars
• Sugars and sugary foods 
• Takeaway foods like pizza, chips and burgers

• To look after blood glucose levels (BGLs) it’s important to eat carbohydrate foods at each meal and snack and try to balance these from day to day.
• Carbohydrate exchanges can help – exchanges (or serves) tell you how much carbohydrate is in different foods. Counting carbohydrate exchanges can help you balance the carbohydrate foods that you eat with your activity level and insulin dose. 
• The type of carbohydrate foods that you eat is also important. The best carbohydrates to choose every day are things like fruit, bread, cereals, low fat milk & yoghurt, starchy vegetables, rice and pasta. 
• Sugars and sugary foods are not the best carbohydrates to choose because they put a lot of glucose in to the blood stream and may cause high BGLs. 
• Some carbohydrate foods give you longer lasting energy. These foods are things like grainy breads, raisin bread, fruit, baked beans, pasta, noodles, yoghurt and milk. These carbohydrates are good when you need longer lasting energy, like before sport. They are also a great choice before bed.

Proteins
Protein foods are important to help you grow and develop. Protein foods are things like:
• Meat
• Fish
• Chicken 
• Eggs
• Cheese

Kids need about 1-2 serves of protein foods each day for good health. One serve is how much fits into the palm of your hand. Most protein foods don’t breakdown into glucose in your body, so they don’t raise BGLs. Unlike carbohydrate foods, you don’t need to count protein foods or eat these at each meal and snack. The best protein foods to choose are the ones that are the lowest in fat – like fish, lean meat, chicken without skin, eggs and low fat cheese.

Fats
Fats are important for good health, but you only need a small amount everyday. Fats are found in lots of different foods, especially:
• Butter
• Margarine 
• Oil
• Cream

Some fats are better for you than others. The best types to choose are the vegetable fats like margarine and vegetable oils. Fats don’t raise BGLs, but too much fat can lead to health problems like being overweight or having high cholesterol (a type of fat in the blood). Remember that fat can also be added to foods, especially things like snack foods and takeaways. Try not to eat too much fat or foods high in fat.

Food & Diabetes 
It is important for everyone to make healthy food choices. When you have diabetes there are some extra things that you also need to think about to help look after diabetes and keep you healthy. It is important to:

Eat your meals and snacks at the right time 
Depending on the insulin you are on, you might need to eat every 3 hours or so. If you forget to eat, skip meals or leave it too long until you eat, you might have a hypo (low BGL).

Eat carbohydrate foods at each meal and snack
You need to make sure that you eat some carbohydrate foods at breakfast, lunch and dinner and at snacks like recess, afternoon tea and supper. If you have been told to follow carbohydrate exchanges, try and eat around the same number of exchanges at meals and snacks each day.

Choose foods low in fat
Too much fat can be bad for your health. Try to choose low fat milk, yoghurt, and cheese. Watch out for foods that are high in added fats, like snack foods - crisps, biscuits, chocolates, cakes, donuts, as well as takeaways, fatty meats and fried foods.

Watch out for foods that are high in sugar
Foods high in sugar like regular soft drinks, cordials and lollies can cause BGLs to go too high. Make sure that you use diet / low joule soft drinks and cordials and try to save lollies for special occasions. Foods high in sugar can be used to treat a hypo.

Always carry hypo foods
Sometimes BGLs can drop too low and you can have a hypo. To treat a hypo, you need to quickly eat or drink something sweet and then eat something else straight away to stop the hypo from coming back. Make sure that you always have hypo foods like juice or jellybeans with you, plus follow up carbohydrate foods like plain biscuits or a muesli bar to stop you from dropping low again.

Healthy Eating Day 2 Day
To be healthy, it’s important to make healthy food choices from day to day. This means having a healthy lunchbox, having healthy snacks and being a detective in the supermarket and looking for healthy food choices.

Food at School

A healthy lunchbox…
It is important that you eat the right amounts of food at recess and lunch to help keep your BGLs mostly within the normal range. If you are not sure, mum, dad or someone at home can help by writing you a list for your lunchbox and labelling what to eat when. Stickers are a fun way to label your food! It is important not to skip recess or lunch or you might have a hypo.

Try some of these healthy lunchbox ideas:
• Sandwiches 
– try different types of breads like rolls, grain bread, Turkish bread, bagels, lavash or pita bread
– fill with your fave fillings like salad, low fat cheese, vegemite, ham, chicken, tuna, salmon, egg, baked beans, spaghetti or banana
• Pasta, potato or rice salad
• Fresh pieces of fruit eg. apples, pears, mandarins, oranges
• Chopped fruit eg. rockmelon, pineapple
• Fruit in zip lock bags eg. grapes, cherries
• Fruit snack packs (plus a spoon)
• Crispbreads, rice cakes or corn thins
• Pikelets, scones or low fat muffins
• Low fat yoghurt or dairy desserts
• Dried fruit boxes eg. sultanas, apricots
• Small tins of baked beans or spaghetti
• Low fat milk tetra pack
• Rice crackers or rice crisps

To keep lunch cool, add a frozen water bottle to your lunchbox or use a cool pack!

Lunchbox swaps…
If you want to do a lunchbox swap, make sure you are swapping something the same, like a sandwich for a sandwich. Otherwise you might not get enough carbohydrate and might have a hypo later. Try not to swap your lunch too often.

At the canteen…
Canteen foods are OK, but not a good choice everyday – once a week is plenty. Talk to mum, dad or someone at home about the best types of foods to choose from the canteen.

Special events at school…
Parties, birthdays and special events at school can be lots of fun. You can join in the fun like all of your friends and enjoy some special treat foods. Remember to tell mum, dad or someone at home when there's a party at school, this can help them work out if they need to make any changes to your insulin. They can also help you decide how to swap some party foods for your usual recess or lunch.

Snack Attack 
Snacks like recess, afternoon tea and supper are important to help keep BGLs mostly in the normal range. Kids love snacks and there are heaps of healthy snacks that you can try, like:

• Piece of fresh fruit e.g. apple, pear, banana, orange
• Chopped fruit – rockmelon, pineapple, honeydew
• Fresh fruit salad
• Frozen pieces of fruit
• Grapes or cherries
• Canned fruit snack pack e.g. two fruits, peaches, pears, fruit salad
• Dried fruit boxes e.g. sultanas, fruit salad, sultanas and apricots
• Low fat yoghurt
• Low fat dairy desserts
• Low fat custard
• Corn cob
• Pikelets with fruit jam
• Fruit loaf or fruit bun 
• Plain or fruit scones
• Crispbread or rice cakes with low fat toppings e.g. tomato, low fat cheese
• Popcorn
• Crumpets or English muffins
• Rice crackers with low fat dip
• Rice crisps
• Low fat fruit bars

Being a Supermarket Detective
Looking at food labels when you are in the supermarket can help you find the best everyday food choices. To work out the best choices, look at the nutrition panel on the food label. This tells you things like how much carbohydrate and fat is in different products. A nutrition panel looks like this:

Servings per pack: 1 Serve Size 200 g
	Per 200g serve	Per 100g
Energy Protein Fat Saturated fat Carbohydrate -total -sugar Sodium	864kJ 8.2g 5.0g 2.0g 31.8g 27.8g 298mg	432kJ 4.1g 2.5g 1.0g 15.9g 13.9g 149mg
Ingredients: Full cream milk, concentrated skim milk, skim milk, sugar, thickener, vegetable gums, mineral salts, flavour

To make healthy food choices, compare different products and look for foods that are lowest in fat, especially saturated fat. To work out carbohydrate exchanges, look at how much total carbohydrate is in the food in the amount that you are going to eat.

One exchange is the amount of food that contains 15 grams of total carbohydrate. Look at the amount of total carbohydrate in the per serve column, then divide by 15. For example, the food shown above is equal to about two exchanges because it has around 30 grams of total carbohydrate divided by 15 = 2 exchanges.

You can also look at the ingredient list to work out whether or not the food is a healthy choice. If fat (e.g. butter, cream, oil) or sugar (e.g. sugar, sucrose, glucose) are listed first or second then the product may not be a good everyday choice.

It’s party time!
Everyone loves parties, and kids with diabetes can join in and have as much fun as everyone else and enjoy some special treat foods. Mum, dad or someone at home will help you work out how to balance your food, activity and insulin dose when you go to a party.

Kids with diabetes can enjoy party fun as much as everyone else, but don’t forget to:
• Eat regular carbohydrate foods while you’re at the party 
• Take some hypo foods with you and make sure that an adult at the party knows what to do if you have a hypo
• Take some diet soft drink with you or maybe everyone at the party can have diet soft drink?
• Have a good supper that night – you might need extra carbohydrates at supper, especially if you have been running around a lot
• Have fun!!

Try some of these tasty party treats:
• Mini pizzas – with chicken, ham or vegies on top
• Pikelets – plain, banana or sultana
• Chunky chips or potato wedges
• Crumbed chicken strips
• Fish fingers 
• Chicken skewers
• Muffins – try berry, banana or choc chip
• Frozen fruit blocks
• Yummy yoghurt cups
• Fruit kebabs
• Ice cream in a cone
• A Paddlepop or Billabong
• Popcorn 
• Party pretzels
• Crackers and dip
• Chocolate mousse cups 
• Diet jelly cups
• Sushi

Food 4 Sport
When you are active you need extra carbohydrate foods for energy and to stop your BGL from dropping too low. You might need extra carbohydrate foods before the activity, then every 30-40 minutes, especially if you are really active. Sometimes you might also need extra carbohydrates at dinner or before bed, to stop you from having a hypo later on.

Try these great carbohydrates before sport:
• A piece of fruit
• A small flavoured milk 
• A muesli bar
• A fruit snack pack
• A crumpet or slice of raisin toast
• A ‘fun size’ chocolate bar

To top up during sport, try:
• A 100% fruit juice popper 
• A cup of sports drink
• A piece of fruit eg. banana, orange

Don’t forget to pack a hypo kit with hypo foods for sport.

Takeaways
Lots of takeaway foods can be high in fat and sugar. To be healthy, it is a good idea not to eat takeaways any more than once a week. When you choose takeaways, it is important to try and make the healthiest choices, look for lower fat takeaways like:
• Lean meat or chicken salad roll / wrap
• Doner kebab with lots of salad
• Plain hamburger with lots of salad
• A grilled chicken burger with lots of salad
• Baked potato (skip the butter)
• Toasted sandwich
• Corn cob 
• Sushi roll
• Vegie pizza or gourmet pizza 
• Toasted sandwich or focaccia
• Small bowl of pasta with tomato based sauce 
• Stir fried vegetables & noodles or plain rice

Take care with choosing drinks - avoid regular soft drinks as these are very high in sugar, choose diet or low joule drinks instead. If you are having juice, look for 100% fruit juice and choose a popper or small bottle.

Lots of takeaways are also very high in carbohydrate (eg. pizza, fries, smoothies). If you can, check out to see if the takeaway outlet has any nutrition information available. Many of the popular fast food chains eg. McDonalds, Subway, Krispy Kreme have nutrition information brochures that tell you the amount of fat and carbohydrate in their different products. Look for foods that are lower in fat and have about the same amount of carbohydrate to what you would normally eat at your meals. If you and your family adjust your insulin depending on what you eat, use this information to make sure that you take the right amount of insulin when you eat takeaways.

Healthy eating on an Insulin Pump…
Insulin pumps can be a great way to help manage your diabetes. If you decide to start on a pump you might notice that a few things about food are a little bit different…like closer counting of your carbohydrate exchanges / amounts, and more flexible meal times and amounts of food.

Why do you need to count carbohydrates?
We know that carbohydrate foods put glucose (sugar) into your blood stream for energy. The insulin you inject needs to match your carbohydrate foods (and activity) to keep BGLs mostly in the normal range. This is important whether you are on a pump or not.

When you are on a pump you can match your food and insulin more closely because every time you eat, you program the pump to give you quick acting insulin. Your diabetes team will tell you how much insulin you need to give for every carbohydrate exchange you eat. Some pumps even let you program in how many grams of carbohydrate you have eaten and it then works out how much insulin to give.

How do you work out how much carbohydrate is in different foods?
Your dietitian can help you work out how much carbohydrate is in different foods. You might need to weigh or measure some foods to help you count carbohydrates. You and your parents also need to be able read food labels to work out how much carbohydrate is in different foods.

Do you need to follow set carbohydrate exchanges?
When you are on an insulin pump you don’t need to eat the same number of exchanges at your meals each day. If you are not very hungry you can eat less and if you are really hungry, you can eat more. You can then give your insulin depending on how much carbohydrate you have eaten.

Do you need to eat snacks between meals?
On an insulin pump you don’t need to have snacks if you don’t want to, but it is important to eat three main meals a day to be healthy. Some kids still might need to have snacks to get the energy they need for all fun things they like to do.

Does being on a pump mean you eat anything you want?
When you are on a pump, you still need to make healthy food choices. Lollies, soft drinks, crisps and chocolates are not an everyday food for anyone. On a pump, you should still use diet or low joule soft drinks and keep snack foods as special occasion treats.

What do you do at school when you are on a pump?
At school, you need to remember to give your insulin bolus when you eat. To do this, you need to know how much carbohydrate is in the foods that you have at recess and lunch – asking mum, dad or someone at home to label the food in your lunchbox can help. Knowing the amount of carbohydrate in different canteen choices is also important.

What about food for sport when you are on a pump?
When you are on an insulin pump you can still play sport. You might find that you still need some extra carbohydrate foods for energy. On a pump you can reduce your insulin before and after sport and you might not need to eat as much extra food to prevent hypos. When you start on a pump your Dietitian can give you some extra healthy eating info.

Source: http://www.diabeteskidsandteens.com.au/foodnews.html