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

 

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

Information for parents of kids aged 2-4 years

A child aged 2 - 4 years with or without diabetes

 •Wants to be in control, wants to "do", to be in charge
• Achieves tasks, repeats them, gradually becoming more competent
• Daydreams and uses magic and pretend-play in their day-to-day life
• May have an imaginary 'friend' who is very real to them and with whom they have long conversations!
• Develops language skills
• Constantly asks "why?.. why?"
• Develops a range of gestures to express themselves
• 'Reads' you like a book!
• Throws (and recovers from) tantrums more easily
• Thinks in 'black and white', right or wrong, good or bad
• Has you as parent or carer as their main attachment
• Is self-centred, happily playing with a toy alone, then gradually learning to share toys
• May have to gradually learn to share the love of their parents when a brother or sister joins the family

 

When a 2-4 year old is diagnosed with diabetes

• It is difficult for your child to understand what has happened and that a needle helps them to stay healthy. They may see the injections as a punishment. You may be able to simply explain to your child that diabetes just happened - "Johnny got asthma, it's nobody's fault, you didn't catch it"
• A will of their own is already developing so your toddler may resist finger pricks and injections. Again you may explain - "Injections are medicine, you don't have to go back to hospital"
• Painful procedures are frightening to toddlers and pre-schoolers so these should be performed quickly and treated as routine. Prolonging the agony only makes things worse for you and your child
• Your child may gradually be taught about hypo symptoms. From about 4 years old, during a hypo, you can draw their attention to the way they are feeling so that they begin to recognise their symptoms and ask for help
• You may gradually encourage your child to learn about the right foods to be eaten and give them some choices, but...
• Concept of time is not understood, so your child will not be able to connect times with insulin and food

Living with diabetes

Parent's responsibility and coping from day to day
• Play, such as allowing your child to give pretend needles to a doll or soft toy, gives the toddler a chance to act out their feelings and lays some groundwork for their future involvement in diabetes related tasks
• As your child approaches four or five and asks why?, try to make your answer concise and encourage small tasks, one at a time, to fit in with your answers. They may push the button on the meter, choose which finger to be pricked or a site for their injection. But do not give in to the same spot being used all the time!
• At times when you are tired and overwhelmed with it all, remember that your child will eventually become independent, however need you to help along the way
• Give lots of hugs and kisses after any diabetes related procedure

Pre-school
• You will probably be very reluctant to let your child out of your sight but for you and your child's sake it is a good time to give your child a chance to spread their wings (and you a chance to spread yours)
• To take this huge step you must feel comfortable that your child will be safe as well as happy
• Ask your educator to visit the pre-school to talk to the staff so they in turn will feel comfortable with the situation. They are usually most helpful and only too happy to assist
• It is helpful to the staff if you provide one or two hypo kits for them to store in a prominent place. Remember to restock hypo kits regularly
• A photograph of your child placed in the staff room and details of hypo symptoms is advisable. An emergency action poster next to the photo as a reminder is a good idea. 
• Your child should wear some type of diabetes identifi¬cation chain or bracelet. This habit is a good one to encourage at a young age as it may encourage them to maintain that habit as they get older
• The pre-school staff don’t usually mind you going at lunchtime to check your child's blood glucose level (BGL) especially when newly diagnosed

If you don’t have access to an educator, add some handy hints of your own for your child's teacher:
• If the teacher is unsure if it's a hypo, they will do more harm than good withholding treatment than treating unnecessarily
• The teacher should not be afraid to re-treat the hypo if your child is not feeling better. The teacher should not send the child alone to obtain treatment
• The teacher should stay with your child until fully recovered

For more information about managing diabetes at pre-school click here.

To care for your child you must care for yourself
diabetes takes a lot of time and energy so it's normal to feel frustrated and tired from the constant daily demands of management. Your emotions may change and recur (perhaps frequently) - guilt, frustration, helplessness, sadness, anger ... and elation when all goes according to plan!
• Try and talk to someone who may understand.
• Share your feelings with your partner, a friend or relative, support groups, your doctor, other health professionals such as a social worker or psychologist
• Share diabetes-related tasks with your partner or supportive family and friends
• Keep in touch with your educator as ongoing education can help you and your child at different stages
• Don't be afraid to ask your health professional team for support and guidance.
• Encourage relatives or friends to attend education sessions and/or support groups to learn more about diabetes so that they may in turn give you support
• Find some time for yourself. It's a worthwhile investment for the daily demands of parenting

What does any child do with food at this age?

Being a toddler means that they are learning to be independent and a person in their own right. It also means learning the boundaries of this independence. Eating food... how much, what, when and where is a way in which a child at this stage explores the boundaries of behaviour and rules. As a parent, try to help your child understand what is reasonable.

Refuses food
A toddler (like many adults) will choose foods because they like them, not because the foods are healthy. Toddlers also learn very quickly that refusing one food will mean they will get their favourite, so try not to fall into the trap of providing less nutritious alternatives.

Much of the stress of food refusal can be eased if you keep calm. Keep food preparation simple, so if it does end up on the floor or on the wall, you don't feel you have wasted time.

The love/hate relationship with food that often occurs with toddlers is quite normal. Likes and dislikes of food can change on a daily basis. There is no logic in their actions, so don't be tempted to bribe. Meeting demands for a favourite cup or plate is reasonable, but preparing special, separate meals is not. If the same food is eaten for three days in a row there is no reason to be concerned as you'll notice that over the next week or two, the range will broaden.

Has a fickle appetite
At this age it is very common for appetite to vary from day to day and meal to meal. Snacks are important, so try to offer healthy choices such as fresh fruit pieces, yoghurt, triangle or finger sandwiches and pikelets.

Drinking too much milk or juice can be contribute to poor appetite. To prevent this, it's very important to wean toddlers from a bottle to a cup from 18 months onwards. This helps decrease the amount of fluid taken and leaves more room for solids. As a guide, toddlers only need 600mL milk and up to 200mL of juice per day. It’s also a good idea to avoid giving drinks just before a meal or snack as this can reduce appetite. Anaemia and tooth decay can result if fluids are chosen in place of food, particularly from a bottle.

If you are worried that your child doesn't seem to be eating anything, try recording all the food and fluid taken over the day - you may well be surprised. Young children can nibble away at food over the day and take in quite a considerable amount. It’s therefore important that snacks are nutritious.

Sometimes the variety may be limited to two or three choices such as cheese sandwiches and bananas, but if the foods are nutritious there's no need to worry. Try introducing new foods a little at a time and often during the day. The problem may resolve itself over the next week or so. Toddlers are learning about their likes and dislikes and testing them out.

Begins to share family foods
At this stage, seating your child at the table is an important social event. Your child can enjoy many (if not all) of the meals that the rest of the family eats, such as stews, casseroles, mild curries, bolognaise sauce and pasta. Food may have to be cut into smaller pieces, but cooking two meals is not necessary. If there are siblings at the dinner table, offering praise for eating well can also encourage positive eating habits in your toddler.

Sometimes midday and evening meals may need to be served earlier than the rest of the family. Smaller children can't wait as long as older children or adults. Their attention span is shorter, they may lose interest in eating and they also may become very grumpy if a meal is delayed too long.

After the age of two, low fat dairy foods can slowly be introduced into your child's diet. Before this age, it is difficult for children to consume adequate amounts of energy for their requirements and regular or full cream dairy products are needed.

Some fats which can be limited at this stage are:
• Processed meats (such as devon and salami)
• Sausages
• Fried foods (such as battered fish and chips)
• High fat snack foods like crisps, corn chips
• Creamed and chocolate-coated biscuits
• Pastries
• Chicken skin and visible fat on meat

In addition, more fibre rich foods can also be encouraged, such as wholemeal breads and crackers and high fibre cereals.

Riding the food merry-go-round ... of diabetes

Erratic eating and avoiding hypos
Food fads, fussy eating, variable likes and dislikes and tantrums are common in toddlers – with or without diabetes! For the parent of a child with diabetes, these food behaviours are often an additional source of stress. In particular fears about hypoglycaemia are common.

Although many parents worry that their child is not eating enough, the rate of growth usually slows around this age, so a reduction in food intake is common. A grazing style eating pattern with regular carbohydrate choices is encouraged.

Children of this age are very aware of parental stress, so where possible try to remain calm about your child’s mealtime behaviours. It’s important to keep food choices simple and offer the choice between one or two foods. Resist the temptation to offer treats if your child refuses to eat. Try to offer a nutritious alternative instead. Avoid bribes, force-feeding or following your child around the house trying to coax them to eat. Sometimes a simple plate of finger food without fuss is enough to encourage your child to eat.

Keep encouraging healthy food choices. You may find that changing from a bottle to a cup also helps encourage appetite at meal times. Offering meals and snacks ahead of time or giving insulin after meals may also help reduce stress and avoid some of the problems that may arise with food

There's more to meals than food
Carbohydrate foods often become the focus for parents and children with diabetes – and for obvious reasons. Remember, for overall good nutrition and appropriate growth and development, other foods are equally as important. So don’t forget about vegetables, lean meats and other protein foods.

It may be tempting to resort to any carbohydrate food such as sweets or juice to prevent hypos but this is not a nutritious habit to encourage. Try to encourage a variety of food choices instead. Note: 200mL of juice a day is ample and remember that water is the best everyday drink.

The importance of a flexible insulin regimen
If you are having difficulties with amount and timing of your child’s food intake, discuss possible variations to the insulin regimen with your child's diabetes doctor or educator. If your child is refusing to eat and their BGLs are not low, it may be OK to wait a short time before offering the meal again. It may also be possible to give insulin after the meal or adjust the dose to prevent hypos. Talk to your diabetes team about possible changes to your child’s insulin plan - it is preferable adjust insulin dosage rather than to force-feed the toddler who refuses to eat.

Source: http://www.diabeteskidsandteens.com.au/parents_and_carers_2.html

Information for parents of kids aged 0-2 years

A child aged 0-2 years with or without diabetes

• Young children of this age are completely dependent on you for all care
• Up to six months of age they eat, sleep and like a regular routine
• The senses are very important - touching, smelling and feeling
• Physical self is all important at this stage, with self comfort at the fore. For example, a wet or dirty nappy produces tears, as does being left alone when company would be much nicer!
• From two to four months of age smiles and gurgles will reward you for your efforts, with sights, sounds and movement providing increasing pleasure
• From six to ten months of age your child responds to different facial gestures, speech and interactive behaviour
• From nine to twelve months of age your child develops more control of anger and dissatisfaction, beginning to copy behaviour and emotions. Actions become deliberate rather than reflex. For example, a cry from your child gets you to run!
• Socialising has begun!

When a 0-2 year old is diagnosed with diabetes

Your child has no understanding of diabetes but it is possible to gradually introduce simple tasks into the everyday routine. For example, at eighteen months to two years of age, your child may be encouraged to hold their finger out for fingerpricks, push the button on the meter or help to choose an injection site.

Living with diabetes

Parent's responsibility and coping from day to day
• At the age of eighteen months to two, play, such as allowing your child to give pretend needles to a doll or soft toy (break the needle off to avoid accidents), gives your toddler a chance to act out their will and lays some groundwork for their involvement in diabetes-related tasks.
• Your toddler can participate through playing games around the diabetes routine. For example, have a race to collect the meter (although this may lead to an endless chase to catch them to give their insulin) or give teddy a needle too.
• Give lots of hugs and kisses after any diabetes related procedure.
• You need time out when possible. If you have relatives or friends close by, they may be persuaded to attend education sessions to become comfortable with diabetes and to look after your child if only for a short time. For parents whose relatives are not close by, there are parent support groups which may build up a network of friends and perhaps even a baby sitting service.

 

To care for your child you must care for yourself
Diabetes takes a lot of time and energy so it's normal to feel frustrated and tired from the constant daily demands of management. Your emotions may change and recur (perhaps frequently) - guilt, frustration, helplessness, sadness, anger ... and elation when all goes according to plan!

• Try and talk to someone who may understand
• Share your feelings with your partner, a friend or relative, support groups, your doctor, other health professionals such as a social worker or psychologist
• Share diabetes-related tasks with your partner, supportive family members or friends
• Keep in touch with your educator, as ongoing education can help you and your child at different stages
• Don't be afraid to ask your health professional team for support and guidance
• Encourage relatives or friends to attend education sessions and/or support groups to learn more about diabetes so that they may in turn give you support
• Find some time for yourself. It's a worthwhile investment for the daily demands of parenting

 

What does any child do with food at this age?

Birth to Six Months
Until the age of six months, babies require only breast milk or formula to grow and develop. Breastfeeding is encouraged where possible for all children – with or without diabetes. Breastfeeding offers many benefits including increased immunity and bonding between mother and baby. Breast milk or formula are nutritionally complete for the first six months and provide all of the nutrients that your baby needs.

After this age, solids are important, however they should not be introduced too early because:
• Babies don't have good tongue control to deal with solids. They tend to push their tongues forward and so push the food out
• The body is still maturing and not able to cope with solids. There is an increased risk of developing allergies to food
• Babies are unable to sit up or hold their head upright for feeding. This increases the risk of choking
• Feeding solids means less milk may be taken by the baby. This can upset the fine balance of nutrients required during this rapid stage of growth and development

 

Six Months
The exact stage at which babies become interested in solids varies. For most babies this is around 6 months of age, when:
• They are able to sit up and hold their head upright
• They show interest in food and reach for it
• Milk alone no longer satisfies them
Solids are important to encourage new experiences of taste and texture, help with speech, jaw and teeth development and provide additional nutrients such as iron and vitamin C.

 

Recommended first foods
Rice cereal is the first food usually recommended for most babies as it is generally well tolerated, high in carbohydrate and is a good source of iron. Rice cereal can be mixed with expressed breast milk, formula or cooled boiled water to a thick paste consistency. The amount of cereal should be increased according to your baby's demands. Start with a teaspoon and work up to two to three tablespoons.

Solids need to be introduced gradually. During the first week of beginning solids, try offering cereal once a day after the breast or formula feed. In the second week pureed fruit or vegetable can be offered for variation. Solids can then be offered twice a day after the breast or formula feed. At first some babies spit food out straight away or are simply not interested. It's best not to force the food, wait and try again in a few days.

New foods should be offered one at a time and continued for a few days before the next is introduced. This allows you to observe any reaction to the food. Begin with a couple of teaspoons and increase slowly to two to three tablespoons. You will notice that your baby slowly starts to take more solids at each meal.

Commercial baby foods are extremely convenient for occasional use, however, these products are not designed to replace all meals as they lack texture for stimulating chewing skills. They are also expensive. As a time saver, it is worthwhile preparing food for your baby and freezing small amounts. Freezing baby foods in ice cube trays gives convenient meal sized portions. Most foods will keep for at least a couple of weeks.

 

Seven to Nine Months
Your baby will gradually learn to chew and progress to eating lumps and small chunks. How quickly babies progress with solids is quite varied. At this age, solids can be offered before the milk feed.
Babies at this stage can cope with three 'solid' meals and three to four breast or formula feeds a day. Even without teeth, babies can chew food at this stage, so more textured food featuring lumps and small chunks should be encouraged. This helps with development of feeding and speaking.

 

New foods to introduce:
• Meat, chicken, fish - cooked and chopped finely, minced or in the case of fish, flaked without bones. Visible fat and skin removed
• Egg yolk - mashed. Whole egg can be introduced later
• Legumes - such as mashed baked beans, kidney beans, lentils
• Cereals and grains - such as baby cereals, oats, baby rusks
• Yoghurt
• Custard
• Fruits and vegetables - increase variety

 

Nine to Twelve Months
At this age your baby will show more independence when being fed and can progress onto finger foods.

From nine to 12 months, your baby will be able to mash food very well with their gums and teeth. Food should be chopped, grated, diced or served in small pieces.

At this age your child will often refuse to be fed by you and insist on feeding themselves. If you can put up with the mess, it is important for your baby to practise feeding themselves to encourage hand-to-mouth co-ordination!

Finger foods may now be introduced as co-ordination improves, and your baby can sit up without support and begin to chew.

Some finger foods include:
• Finger sandwiches
• Soft crusts
• Rusks
• Cooked (steamed, microwaved) potato pieces
• Toast fingers
• Peeled banana

Be aware that babies should always be watched when eating finger foods in case of choking.

Food should now have replaced milk as the staple although it is still important for babies to receive an adequate amount (600 ml/day) of breast milk or formula. Weaning from the bottle to a baby's cup can begin at around nine months.

 

New foods to introduce:
• Cows milk - can be gradually introduced to mix with cereals and use in cooking. Cows milk should not be used as a drink until after 12 months
• Eggs - if egg yolk is well tolerated, then cooked egg white may also be offered such as boiled egg, egg custard or scrambled egg
• Cheese - full cream varieties, grated or finger food size
• Cereals and grains - rice, pasta, wholemeal cereals and breads
• Spreads - margarine or smooth peanut butter can be spread thinly on bread and toast
• Fruit and vegetables - increase variety
• Aim to offer three meals and snacks in addition to the formula or breast milk each day

 

One to Two Years
At this age your baby is becoming a toddler and you may notice new food behaviours such as food refusal or playing with food. These behaviours are normal toddler behaviours to test you, observe your reaction and assert independence. You may also notice a decrease in your child’s appetite at this age, this is normal and corresponds with slowing growth in the second year. Children of this age tend to have a grazing style of eating, so regular snacking is important.

 

Suggested Snack Ideas:
• Finger sandwiches
• Crumpets or Pikelets
• Crackers & cheese sticks
• Fresh fruit pieces
• Breakfast cereal and milk
• Mini tub of yoghurt
• Snack pack of fruit
• Baked beans on toast

 

Riding the food merry-go-round... of diabetes

The types of food you feed your baby should be no different from other babies at this age and stage. Until 6 months of age, breast milk or infant formula is the only food that they need and breast feeding is encouraged when possible. There is absolutely no reason not to breast feed just because your baby has diabetes. Breast feeding offers benefits of immunity and bonding between mother and baby.

Breast milk or formula is a complete food during the first six months and supplies adequate amounts of carbohydrate to prevent hypos if the baby is fed at regular intervals (every two to three hours during the day). A breast/formula feed before the baby goes to sleep at night will also help to prevent a hypo during the night.

At six months, when solids are being introduced, excellent sources of carbohydrate include breast milk/formula, rice cereal, fruit (apple, pear) and starchy vegetables (potato, sweet potato).

Preventing Hypos
Most parents worry about detecting hypos in their children at such a young age when communication is limited. If parents can aim to provide regular feeds and solids for their baby, it is usually possible to maintain acceptable blood glucose levels. The first solids introduced are usually cereals and fruit, which are excellent sources of carbohydrate. As the variety of food eaten by your child increases, it is important to provide some carbohydrate, either from milk (breast or formula) or solids at each meal time. This helps prevent hypos occurring. A handy tip is to keep the time between meals and snacks to less than three hours. 'Grazing' on foods between meals is important for young children. This also reduces the risk of hypos occurring. Keeping carbohydrate-based finger foods ready is a good idea such as crackers, rusks, fruit fingers, and fruit. If meal times become a battle and hypos occur as a result of poor carbohydrate intake, adjusting the insulin routine may help. A dietitian and diabetes educator can be very helpful with any queries regarding food and insulin issues.

 

Source: http://www.diabeteskidsandteens.com.au/parents_and_carers_1.html