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

Diabetes Dictionary

A

 

 

Adrenal glands
Glands located at the top of each kidney that secrete important hormones for the function of many organ systems in the body.

Adrenaline
One of the secretions of the adrenal glands. It helps the liver release glucose (sugar) and limit the release of insulin. It also makes the heart beat faster and can raise blood pressure.

Alpha Cells
Alpha cells are found in the pancreas. They produce a hormone called glucagon, which raises blood glucose levels. 

Antibodies
Proteins that the body makes to protect itself from foreign substances.

Antibody
A special kind of protein made by the immune system that is released in response to something foreign in the body eg. virus. Antibodies help fight infection.

Autoimmunity
Pertaining to development of an immune response to one's own tissue. 

B

Basal Bolus Injections
Insulin injections four times a day.

Beta Cells
Cells in the pancreas that make the hormone insulin.

Biopsy
Removal of a small amount of tissue or fluid from the body, examined under a microscope to determine whether disease is present. 

Blood Glucose Level (BGL)
The amount of glucose (sugar) in the blood stream.

Blood Glucose Meter
A device used to measure blood glucose levels.

Bovine (beef) insulin
Insulin extracted from the pancreas of cattle. Has been replaced by human insulin.

C

Carbohydrate
A nutrient in food that provides a major source of energy. Usually found in grains, fruits, starchy vegetables and dairy foods. Is broken down to glucose in the blood stream and raises blood glucose levels.

Cannula
A small tube that is inserted into the body to assist in various methods of insulin delivery eg. pumps, insuflon.

Cholesterol
A fatty waxy substance made by the body and also found in some foods. High levels of cholesterol in the blood stream are a risk factor for heart disease.

Coeliac Disease
A condition where there is an intolerance to gluten, a protein found in foods that causes damage to the small intestine.

Complications
The long term effects of uncontrolled diabetes on the body.

Convulsion
A fit or seizure that can be a symptom of severe or untreated hypoglycaemia.

D

Dawn Phenomenon
This occurs when BGLs rise in the early hours of the morning due to the natural release of the hormones cortisol and adrenaline.

Diabetic ketoacidosis (DKA)
A sudden loss of control of type 1 diabetes with high blood glucose levels and breakdown of fat leading to a build up of acids in the blood with nausea, vomiting and dehydration. Without urgent medical attention, DKA can lead to coma and death.

Diabetes Educator
A health professional who specialises in providing education about the management of diabetes.

Diabetes Dietitian
A health professional who provides advice on the dietary management of diabetes.

Diabetes Control and Complications Trial (DCCT)
A 10-year study (1983 - 1993) in the United States to assess the effects of intensive therapy on the long–term complications of diabetes.

E

Endocrinologist
A doctor who specialises in the management of diseases of the glands, including the adrenal, thyroid, pituitary, parathyroid glands, ovaries, testicles and pancreas.

Enzymes
A special protein made in the body that assists with naturally occurring biological functions of the body.

Erectile Dysfunction (Impotence)
The loss of a man’s ability to have an erection. Some men may become impotent after having diabetes for a long time because the nerves or blood vessels have become damaged. Sometimes the problem has nothing to do with diabetes and may be treated with counselling.

F

Fats
One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are three types of fats: saturated, polyunsaturated and monounsaturated.

Fibre
A substance found in foods that come from plants. Fibre helps in the digestive process and is thought to lower cholesterol and help control blood glucose (sugar). The two types of fibre in food are soluble and insoluble.

Fit
A convulsion or seizure that can be a symptom of severe or untreated hypoglycaemia.

G

Gastroparesis
A complication of diabetes that causes delayed digestion resulting in unpredictable swings in blood glucose levels

Glucose
The body’s main source of energy.

Glucagon
A hormone made by the pancreas that causes the liver to release glucose from body stores. Manufactured glucagon is injected to raise blood glucose levels in a person with severe hypoglycaemia.

Glycaemic Index
A ranking of carbohydrate foods according to their effect on blood glucose levels.

Glycemic Response
The effect of different foods on blood glucose (sugar) levels over a period of time.

Glycemic Load
The predicted effect of a food on blood glucose levels that takes into account glycemic index and total available carbohydrate.

Glycogen
The body’s stores of glucose in the liver and muscle which release glucose (sugar) into the blood when needed by cells. Glycogen is the chief source of stored fuel in the body.

H

HbA1c
A test to identify the average blood glucose level over the last 2-3 months. Also known as glycosylated haemoglobin, this test measures the amount of glucose that attaches to red blood cells which depends on how much glucose is in the bloodstream. If BGLs have been high over the 2-3 month period, more glucose will attach to the red blood cells and HbA1c will be high. If BGLs are mostly within the recommended range, then HbA1c will be closer to the desired level.

Honeymoon Period
A remission phase after the diagnosis of type 1 diabetes when there is partial, temporary recovery of insulin production by the pancreas. The amount of injected insulin required to manage diabetes is significantly reduced. The honeymoon period may last a few months to a year.

Hormone
Hormones are chemicals released by special cells that tell other cells what to do. For instance, insulin is a hormone made by the beta cells in the pancreas. When released, insulin tells other cells to use glucose (sugar) for energy.

Human Insulin
Insulin that has been manufactured to be identical to that produced naturally in the human pancreas.

Hyperglycaemia
Blood glucose levels higher than the desirable range.

Hypoglycaemia
Blood glucose levels lower than the desirable range.

Hyperlipidemia
Too high a level of fats (lipids) in the blood.

I

IDDM 
Insulin dependant diabetes mellitus, now known as type 1 diabetes.

Immune system
A system of the body that provides protection from infection.

Infusion Set
Consists of a length of thin plastic tubing with a lock connector at one end, attached to a very small cannula placed under the skin. It is connected to the insulin pump and used to deliver insulin to the body.

Infusion Site
The place on the body where the infusion set needle is inserted under the skin.

Injection
The introduction of medication into the body with a delivery device eg. needle and syringe, pen, pump. A person with diabetes injects insulin by putting the needle into the tissue under the skin (called subcutaneous). Other ways of giving medicine or nourishment by injection are putting the needle into a vein (intravenous/IV) or putting the needle into a muscle (intramuscular/IM).

Injection Site
The place on the body where the insulin is injected.

Insulin
A hormone made by the pancreas that is responsible for controlling blood glucose levels.

Insulin Resistance
The inability of the body to recognise and use insulin as it should.

Intramuscular
Into the muscle.

J

Juvenile Onset Diabetes
Another name for type 1 diabetes.

K

Ketones
Acids in the blood formed when body fat is used instead of glucose to provide energy.

L

Lancets
A sharp needle like device used to prick the skin to test the blood glucose level.

Lipohypertrophy
Fatty lumps that form when insulin is constantly injected into the same area.

Long acting insulin
Insulin that is absorbed slowly into the body after injection. Commonly used in conjunction with short acting insulin in the management of type 1 diabetes in children.

M

Macrovascular 
Referring to the large blood vessels of the body.

Metformin
A tablet that lowers blood glucose levels by blocking the release of glucose from the liver. Usually used in the treatment of type 2 diabetes, sometimes used for weight management in children with type 1 diabetes in conjunction with insulin.

Microvascular 
Referring to the small blood vessels of the body.

Millimole (mmol)
A unit for measuring the concentration of glucose and other substances in the blood.

Microalbuminuria
Leakage of small amounts of protein into the urine.

Monounsaturated fat
A healthy fat that may help reduce the risk of heart disease. Found in olive and canola oil, nuts and avocadoes.

N

NDSS
The National Diabetes Services Scheme (NDSS) is a Federal Government funded initiative, administered on behalf of the Government by Diabetes Australia. For further information see Advocacy and Support.

Nephropathy
Damage to the kidneys.

Neuropathy
Damage to parts of the nervous system.

NIDDM
Non Insulin Dependant Diabetes Mellitus, now known as type 2 diabetes.

P

Paediatric
About children.

Paediatric Endocrinologist 
A doctor who specialises in the management of diseases of the glands, including the adrenal, thyroid, pituitary, parathyroid glands, ovaries, testicles and pancreas in children.

Pancreas
A gland or organ behind the stomach that produces hormones such as insulin.

Polydipsia
Excessive thirst and drinking large amounts of water.

Polyunsaturated fat
A healthy fat that may help reduce the risk of heart disease. Found in fish, vegetable oils such as sunflower oil, nuts and seeds.

Polyuria
Passing large amounts of urine due to excess glucose in the blood stream.

Porcine (pork) insulin
Insulin extracted from the pancreas of pigs. Has been replaced by human insulin.

Post-prandial
After a meal.

Protein
A nutrient in food that is important for growth, development and repair of tissues. Food high in protein include meat, poultry, fish, eggs, legumes and dairy foods.

R

Retinopathy
Damage to the small blood vessels at the back of the eye.

S

Saturated fat
A type of fat that has been shown to increase the risk of heart disease. Found in animal foods such as butter, full fat dairy foods, and fatty meats, as well as many processed and takeaway foods.

Sharps
A word commonly used to describe syringes, pen needles and lancets used by people with diabetes which require safe disposal after use.

Short acting insulin
Insulin that is absorbed quickly into the body after injection. Commonly used in conjunction with long acting insulin in the management of type 1 diabetes in children.

Sliding Scale
A method of insulin adjustment based on blood glucose levels.

Social Worker
A health professional who helps families cope with the diagnosis of diabetes and the impact on family life.

Subcutaneous
Underneath the skin.

T

Thyroid
A large gland located at the base of the neck that releases an important hormone for the control of normal growth and development in children, and maintenance of normal metabolism in adults.

Type 1 diabetes 
Also known as insulin dependent diabetes, occurs when the pancreas stops making insulin. Requires daily insulin injections for survival.

Type 2 diabetes 
Also known as non- insulin dependent diabetes, occurs when there is either insufficient insulin or the insulin produced does not work effectively.

U

Ultra short acting insulin 
These insulins are absorbed after injection and have a shorter duration than short acting insulins eg. Humalog and Novorapid.

Unit
A method of measurement eg. insulin dose.

 

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

Australian Diabetes Council

Meal Planning for Children with Type 1 Diabetes

When you have a child with type 1 diabetes, it's easy to get carried away with the notion of a diabetic diet. But in reality, your child's dietary needs are no different from a child who doesn't have diabetes. Of course, there are certain considerations you need to be aware of, and understanding the carbohydrate content in food is arguably the most important. In this article, you will learn about the importance of carb counting, with a special emphasis on how fiber and sugar alcohols may also affect your child's blood glucose (blood sugar) levels.
 
Nutrition Basics
There's really no such thing as a diabetic diet. That's why you should focus instead on providing your child with balanced nutrition. A good nutritional resource to consult is the Food Pyramid. In recent years, the United States Department of Agriculture has made some updates to the standard Food Pyramid that most of us grew up knowing. Instead of being a set-in-stone guideline, now you can create personalized eating plans that are flexible and balanced. To refresh your memory on healthy eating, visit MyPyramid.gov.
 
There are 3 main nutrients in foods—fats, proteins, and carbohydrates. These essential nutrients affect blood glucose in different ways.

• Fats: Fat typically doesn't break down into sugar in your blood, and in small amounts, it doesn't affect your blood glucose levels. But fat does slow down digestion, and this can cause your blood glucose to rise slower than it normally would. After a high-fat meal, your child's blood glucose may be elevated up to 12 hours after the meal.
• Proteins: Protein doesn't affect blood glucose unless you eat more than your body needs. In most cases, you need only about 6 ounces or less (which is about the size of 2 decks of cards) at each meal.
• Carbohydrates: Carbohydrates affect your blood glucose more than any other nutrient. All of the carbohydrates in food turn into sugar in the blood, and they get into the blood at a much quicker rate than fats and proteins. Carbs usually enter the blood stream an hour after consumption and are usually out of the blood stream in 2 hours. That's why you should check your child's blood glucose levels before he or she eats, and then again 2 hours later. Ideally, the measurement after the meal should be within 30-50 points of the pre-meal levels. If it's not, you will need to adjust the carb content of the meal or adjust your child's insulin dosage.

Carb Counting, Meal Plans, and Insulin Adjustment
For people with type 1 diabetes, knowing the amount of carbohydrates in the food you eat is essential. The reason carb counting is so important is that the amount of carbohydrates in your child's meals determines his or her insulin dosage. Unfortunately, a one-size-fits-all insulin regimen doesn't exist. Your doctor will determine the appropriate dose for your child. To learn more, read our Patients' Guide to Insulin.

It's fairly easy to determine the total amount of carbohydrates in the food your child eats. All packaged foods contain a Nutrition Facts label, and that contains the total carbohydrates in each serving size. If the food doesn't have a label, your dietitian can give you resources that contain the carbohydrate count of common foods.

Everyone responds differently to carbohydrates. That's why working with a registered dietitian or certified diabetes educator (CDE) is so important. He or she will develop a balanced meal plan especially for your child that is based on your child's food preferences, nutritional needs, and medication (some insulin medications require that you eat a set number of carbohydrates in each meal, while others allow for more flexibility). The meal plan will contain the right amount of carbohydrates for your child.

Meal plans aren't strict in the sense that they outline specific foods to eat at any given meal; rather, they help you pick from specific food groups. This will help you manage the amount of carbohydrates in each meal, while still offering your child a balanced selection of food. Meal plans are also flexible in that they can accommodate to special events, such as birthday parties.

For healthy growth, it is important that your child follows his or her meal plan. Not only should your child eat from the food groups outlined in the plan, but he or she should also eat them at a specific time. Eating meals and scheduling insulin injections at the same time every day helps prevent blood glucose levels from getting out of control. Parents with younger children may find this aspect of type 1 diabetes management somewhat easier than parents who have teenagers. Not only are teens busier with activities and social schedules, but they are also transitioning to managing their diabetes without the help of their parents.

Fiber and the Type 1 Diabetes Diet
Fiber is important to any diet. Found primarily in fruits, vegetables, beans, and whole grains, fiber may reduce blood cholesterol, aid in weight management, and improve blood sugar levels by slowing the absorption of sugar. When it comes to fitting fiber into your child's type 1 diabetes meal plan, you need to understand how fiber affects a food's true carbohydrate count. Fortunately, it's a very simple formula.

If the food contains at least 5 grams of dietary fiber, simply subtract half the grams of dietary fiber from the total carbohydrate grams (you can easily find this information on the Nutrition Facts label on packaged foods). The total equals the net carbohydrate count in the food. For example, if a food contains 10 grams of total carbohydrates and 5 grams of dietary fiber, the amount of carbs that will affect your child's blood glucose is 7.5 grams.

Dietary fiber may have less impact on blood glucose since it is not absorbed 100% and releases glucose into the cells more slowly. The American Diabetes Association recommends that if a food has more than 5 grams of fiber per serving, you can subtract the amount of dietary fiber from the total carbohydrate. However, synthetic forms of fiber are being added to many processed foods, which may not provide the same benefit as natural foods. You may want to initially subtract only half of the fiber and check your glucose level after meals containing high-fiber foods.
 
A Special Note about Sugar Alcohols
Foods with sugar alcohols (sorbitol, isomalt, xylitol, etc.) on the ingredient list are popular with people with diabetes. Many sugar-free products, such as candies, chewing gums, and dessert items, contain sugar alcohols.
Sugar alcohols are artificial sweeteners. Unlike regular sugar, sugar alcohols don't need insulin to be metabolized and won't cause your blood glucose to spike. They also contain fewer calories than pure sugar.

Products made with sugar alcohols are often geared toward people with diabetes, but understand that these foods should be eaten in moderation. When consumed in controlled amounts, sugar alcohols won't cause blood glucose to rise. But if eaten in excess, these products will raise blood glucose in people with type 1 diabetes. It's also important to remember that foods made with sugar alcohols still contain carbohydrates. Always make sure to check the total carbohydrates listed on the Nutrition Facts. This will help you better understand how to fit them into your child's meal plan.

Source: http://www.endocrineweb.com/guides/type-1-children/meal-planning-children-type-1-diabetes