MANAGEMENT OF DIABETES MELLITUS

Children with diabetes do not need to be on a special diet, but particular attention should be paid to good nutrition and regular and frequent eating. They have the same nutritional needs as other children for growth and development except they can't miss meals and shouldn't delay them. Main meals should be similar in size and content with about the same amount of carbohydrates and the same amount of protein. Because the insulin is constantly being absorbed, they need to eat more often, with between-meal snacks and a bedtime snack. They also need to eat more if they are more physically active than usual, since this activity increases the effect of insulin.

Diabetes and Diet

A good diet for children with diabetes at all ages is the same as that recommended for everyone. This includes plenty of complex carbohydrates, such as whole grain breads, pastas, potatoes, beans and peas; unprocessed foods, such as bran cereals, oatmeal, and fresh fruits and vegetables; and no more than 30 percent of calories from fat. The fat should be mostly unsaturated, such as liquid oils. Special diabetic and dietetic foods are a waste of money, and some, such as those that replace sugar with extra fat, can actually be harmful.

Snacks are important to maintain a supply of food for the insulin to work on and thus prevent hypoglycemia (low blood sugar). Good snack choices include fresh fruit, dried fruit, cheese crackers, peanut butter crackers, yogurt, trail mix, vanilla wafers, grain crackers or granola bars, if strenuous exercise is planned. These snacks also are used for treating mild symptoms of hypoglycemia. Desserts that are good for all members of the family include fresh fruit, low-fat yogurt or pudding, and fruit pies.

Day-care and school personnel need to know about the youngster's diabetes and snack needs and how to recognize signs of hypoglycemia.

Involving Children in Diabetes Treatment

Having children participate as much as possible in their care gives them some measure of control. Children under age 3 can choose which finger to stick for blood sugar tests or which place to use for the insulin injection. Parents should handle treatment with a matter-of-fact yet affectionate attitude, and we suggest that all adults in the family share responsibility for shots and blood tests. Children 4 to 7 years old can help with monitoring blood sugar and with injections. Children in this age group are likely to think that diabetes is a punishment for something they have done. They need regular reassurance from you that the diabetes is not their fault and they are not being punished.

Diabetes Support and Information

Emotional support for the entire family is very important. You can get this and learn more about the disease from the Juvenile Diabetes Foundation (432 Park Avenue South, New York, NY 10016) and the American Diabetes Association (1660 Duke Street, P.O. Box 257, Alexandria, VA 22314).

The more you understand about diabetes and deal with it matter-of-factly, the better the chance that your child will do well. The tools available for managing diabetes today make it possible to control diabetes to a degree that will reduce the risk of later complications and permit children to grow up and lead productive, fulfilling lives.