carb counting for kids
Ask the dietician: Genevieve Jardine
From our community: “As the mom of a diabetic child, I’m constantly wondering what to make her that is delicious but won’t spike her blood sugar. Could you give me some basic guidelines please?” Bernadette Simons.
As a mother of three (constantly hungry) young boys I am kept on my toes when it comes to healthy eating. Although my children are not diabetic, I practice “diabetes-friendly” eating in my household. The bottom line is that you want your children to eat real, whole foods. This means no foods that are manufactured, processed and refined: time for a cupboard clear-out!
For children with diabetes, you need to make meals novel, colourful and exciting, while reducing refined carbohydrates and harmful fats. It’s important to break away from the rut of cereal for breakfast, sandwich for lunch and one-pot meal for dinner. Parents need to constantly focus on increasing fresh foods and not wait for dinner to try and make up the daily vegetable intake…
Here are some menu options:
- Bring back eggs for breakfast! Make eggs more interesting and nutritious by adding vegetables and baking in a muffin tray as mini crustless quiches. Serve with chopped strawberries or other brightly coloured fruit.
- Try making your own cereal out of nuts and seeds, coconut shavings and some rolled oats. This can be eaten with plain yoghurt or milk. Use vanilla, cinnamon and half a grated apple to sweeten it naturally.
- Move away from a daily sandwich for lunch. Try choosing other low GI starch like baby potatoes or corn on the cob.
- Add some protein – chicken drumsticks, hard-boiled eggs, meatballs, homemade fish cakes or cheese. Remember protein makes you feel fuller for longer and doesn’t spike blood sugar levels.
- Add a small amount of colourful fruit like a fruit kebab or fruit salad.
- All lunchboxes should have vegetables! If your child doesn’t like salad, give some cucumber and carrot sticks, baby tomato kebabs or cucumber sandwiches (two slices of cucumber with cheese or cream cheese in the middle).
- Most traditional South African dinners are one-pot meals like curry, stew, cottage pie or spaghetti bolognaise that are high in starch and low in vegetables. Try adding more vegetables to stew, curries and mince. Make the mashed potatoes with added cauliflower, add lentils to brown rice, and use baby marrow or aubergine instead of pasta.
- Always serve dinner with vegetables on the side. Raw carrot sticks, sliced cucumber or snap peas are kid-friendly. Children need to get used to eating vegetables that are not hidden in food but out in plain sight!
Remember: Children learn eating habits from their parents so you need to set the example. Tastebuds are influenced early on by processed foods with hidden sugars and fats, so it’s up to you to encourage your kids to eat – and love – real food.
When Vickie de Beer’s son Lucca was diagnosed with Type 1 diabetes, she started a journey that ended with her publishing an award-winning cookbook and lifestyle guide: The Low Carb Solution for Diabetics.
Looking back, what do you wish you’d known when Lucca was first diagnosed with Type 1 diabetes?
That insulin takes much longer to reach the blood stream than we were told. I had a lot of anxiety about Lucca going into a hypo after eating, and it was completely unnecessary. I also wish I knew what a huge impact carbohydrates had on his blood sugar! We did carb count and test and inject diligently, but there were always unexplained highs and lows that frustrated me and made Lucca feel awful.
What inspired you to write The Low Carb Solution for Diabetics?
We have always, from the first day, taken Lucca’s diabetes seriously. We did everything the doctors and dietician told us. We adapted our diet to eating only low GI foods and tested Lucca’s blood sugars diligently. Every time we went to the doctor they congratulated us on his great HbA1c result and said that we were doing everything possible for Lucca’s health.
The doctor always said that the next step would be to control the extreme fluctuations between high spikes and lows in Lucca’s blood sugar. I could never get clear information on how we were supposed do that though, apart from doing what we were already doing. About a year ago I met Prof Tim Noakes at the book launch of Real Meal Revolution. We significantly reduced our carbohydrate intake, but did not remove carbohydrate completely from our diet.
I didn’t understand how we could remove all the carbohydrates from Lucca’s diet as suggested by the LCHF (Low Carb High Fat) movement. We were taught that children needed carbohydrates for energy, growth and brain function and I also knew that Lucca needed to get insulin. If we took away the carbohydrates how would he get the insulin he needed? I still gave the children small amounts of Low GI carbs like brown rice and brown pasta with their evening meals. Lucca’s blood sugar did not improve significantly – I would say that we were on a moderate carb diet.
A few months ago I made contact with a group in the USA that follow a low carb high protein (not high fat) diet with great success in managing steady blood glucose levels in Type I diabetic children. This way of managing diabetes is based on a book: Dr Bernstein’s Diabetic Solution. Dr Bernstein has been a Type 1 diabetic for 69 years. After reading his book and studying various other low carb websites and books, we decided to change the way we eat.
Do you have any tips for people who feel overwhelmed at the thought of changing their way of eating?
Do it gradually. We started with breakfast (because the boys love bacon!) and then did dinners – lunchboxes were the last!
What advice would you offer to people living with diabetes who are struggling?
Diabetes is in the details. The best tool is to test constantly and diligently. The bottom line is that cutting carbs makes diabetes easier to manage. All the hundreds of reasons I used to give to explain Lucca’s unstable sugar – the heat, stress, tiredness – it was always the carbs!
What makes your life sweet?
Hugs from my boys! Playing board games with them (and winning), swimming and braaing with them, reading with them… The fact that Lucca’s blood sugar is under control has changed our lives. We had a lot of anxiety in our life beforehand. Although we still test and inject diligently, the anxiety is gone. I think we have finally taken control of diabetes, and diabetes has lost its control over us.
Get in touch with Vickie: @Vickiefantastic on Twitter
When Roxanne and Derick de Villiers wanted to enroll their son Noah in pre-school, they didn’t think diabetes would be an issue. When it turned out it was, they turned the situation around.
Can you tell us about Noah’s diagnosis?
It was just before his 3rd birthday. When Noah got really sick and then diagnosed with Type 1 diabetes, we were really emotional. Here was our little boy who had this huge change in his young life: nurses and needles – that’s a picture we will never forget. But we can promise you this: in the midst of those overwhelming emotions, your parental instinct to protect your child immediately kicks in and your mind opens up so much to take in all that you need to. There is an urgency to get on top of the changes and adapt as quickly as possible.
Has it become any easier with time?
It has, it really has. You know that old saying that time is a healer? We believe time is a teacher. Diabetes is now second nature and so much a part of life. Having other family members also educated about Type 1 diabetes has made it easier as well because they can also test and inject when necessary.
When did Noah start pre-school?
Noah actually started pre-school the January before he was diagnosed with Type 1. When the pre-school was informed about him being diagnosed, the principal and his class teacher were at the hospital and were really supportive about this change in his life. What really impacted our lives positively was that they were prepared to learn and take part in this process too.
Could you tell us about the school application process?
At Noah’s first pre-school in 2012, he was already enrolled ahead of being diagnosed. We then made a home move and Noah needed to move pre-schools too. The school we enquired at for enrolment was amazing. Applying for Grade R was a little bit different and more involved. They had never had an application that included full disclosure of the child having Type 1 diabetes. We had a few meetings with the Executive Head and we pressed on for the understanding that we (the school and parents) could put a fair process in place that would protect both the child and the school without discarding school laws.
We needed to be a voice for Noah, for other diabetic children to follow and especially for the parents of diabetic children who go through this worry and want to enroll their precious children at the schools of their choice. The Executive Head and Regional Head of Noah’s grade school were true blessings because they agreed to put the suggested process in place and were on board to becoming the forward thinking, proactive and progressive school that they are. A beautiful school/parent relationship exists now.
What advice would you offer to other parents about diabetes education in schools?
The education is ongoing. It is never a once-off. Urge the school to have more teacher / parent sessions to talk openly about Type 1 diabetes. Whether your medical support is private or public, involve the nurse, the pediatrician, or the professor looking after your child. There is a big need, a big want and a big drive for education in this area. Minds need to be changed about diabetes and its management within the school system.
What makes your life sweet?
For Noah, having control of the DSTV remote and the Smart Tab and for us, his parents, seeing him so confident and secure even though he lives with diabetes.
Photos taken at Noah’s current school, Curro Century City.
From Facebook (Diabetic South Africans):
Belinda wants to know if there are any parents of Type 1 diabetic kids out there… Want to share advice?
Some advice: the treatment of diabetes is not a perfect science. What works for one person may not work for the next. You need to make notes of what works for your child. This will take much of the guess work out of controlling your child’s blood sugar.
Allow your kids to have a say and let them see the effects. Never wrap them in cottonwool! Let them live, learn and experiment!
Hi. I’m also new to this. My little girl was diagnosed in May. She’s 2 and a half. Very scary and completely heart breaking often.
Hi Belinda – join Kids Powered by Insulin if you haven’t yet. You’ll get good advice and support there. My son is 15 – diagnosed when he was 13. A good endo and educator, healthy diet and an understanding of how much insulin is needed and how each insulin works has helped us a lot so far. Take care x
Hi there my daughter is 3 years old and Type 1 diabetic, she was diagnosed last year two weeks before her 2nd birthday.
Belinda there are LOTS of us – join the Facebook group Kids Powered by Insulin.
Never tell them they can’t do something because of diabetes. As a child, I was told that I can’t do many things because of my diabetes – I missed out on a lot.
My daughter is 9 years old now and was diagnosed when she was 4. I would love to help anyone who has had to endure diagnosis – it was 3 months of pure hell and would have loved a shoulder to cry on or some tips to help.
Thank you everybody for the reply. I am feeling much better that there are so many parents that are prepared to give me advice!
If there’s one question we get all the time, it’s about the insulin pump: what is it, how it works and how to get it covered by medical aid. So we’ve gathered together all your Frequently Asked Questions, and found the answers.
Meet the expert
Name: Imke Kruger
How long have you been diabetic? 25 years
How long have you been on the pump? 5 years
What made you decide to get an insulin pump?
I battled to get my blood glucose under control on multiple daily injections, especially when doing sports. It was before my first 94.7 cycle challenge that my doctor suggested insulin pump therapy. It has changed my life! I can’t imagine life without my Accu-Chek Combo pump.
What do you love about the pump?
Everything! It helps me to live life the way I want to. I love the discreetness of it – I can give a bolus in a meeting or when going out with my friends, without anyone noticing.
What are some of the challenges?
The first two months were difficult to get used to sleeping with the pump, but now I don’t even realize that I’m wearing it. The challenge is more with diabetes – not the pump. It’s important to realise that insulin pump therapy is not taking the condition away. There are so many variables in diabetes, and that will always be a challenge.
When should someone consider getting an insulin pump?
- If they are experiencing severe hypoglycaemic (low blood sugar) episodes despite careful management.
- If they are on multiple daily injections, following a meal plan, testing their blood glucose levels 4 times a day, and still not getting target HbA1c results.
- If they have irregular eating, working and resting times.
Insulin pump therapy won’t work for those who aren’t committed to it, and there isn’t enough evidence to recommend it for Type 2 diabetics.
A more comprehensive description of the Indications and Contra-Indications to Pump therapy can be found in the SA Guidelines for Insulin Pump Therapy. A Amod, M Carrihill, JA Dave, LA Distiller, W May, I Paruk, FJ Pirie, D Segal, Association of Clinical Endocrinologists of South Africa (ACE-SA) JEMDSA 2013;18(1):15-19.
FAQ about the insulin pump from our community:
What is an insulin pump?
- Insulin pumps are portable devices attached to the body that deliver constant amounts of rapid or short acting insulin via an infusion set.
- The pump tries to mimic the release of insulin from a normal pancreas, but you have to tell it how much insulin to inject.
- It delivers insulin in two ways: a basal rate which is a continuous, small trickle of insulin that keeps blood glucose stable between meals and overnight; and a bolus rate, which is a much higher rate of insulin taken before eating to “cover” the food you plan to eat or to correct a high blood glucose level.
- Because the insulin pump stays connected to the body, it allows the wearer to change the amount of insulin they take with the press of a few buttons at any time of day. You can also program in a higher or lower rate of insulin delivery at a chosen time – when sleeping or doing sports, for instance.
Where do you buy an insulin pump and how much does it cost?
You need to be a patient at one of the accredited pump centres in South Africa. Your doctor will decide if you are a pump candidate according to the Association of Clinical Endocrinologists of South Africa (ACE-SA) guidelines. If you are, you will need a script to claim the pump through your medical aid, or buy it cash from one of the supplying pharmacies.
What are the advantages and disadvantages of using an insulin pump?
Insulin pump therapy improves metabolic control while giving you greater freedom and a better quality of life.
- Your metabolism stays more stable, with better HbA1c values and fewer low blood sugar episodes.
- You can be more flexible in your eating, if you understand the concept of carbohydrate counting.
- You can participate in sports whenever you feel like it — without having to plan in advance
Disadvantages are that you have too much freedom in making food choices, and that there is a risk of diabetic ketoacidosis (DKA) from pump malfunction or absorption problems.
Remember: Deciding on insulin pump therapy is not a simple decision and should be carefully discussed with your healthcare team.
Will my blood sugar control be better if I use an insulin pump?
It all depends on you. You can wear a pump and it can have no impact on your blood sugar. Or you can use a pump, and with the right settings, motivation and help from your healthcare team, you can have better blood sugar control.
Will I still have to test my blood sugar as much?
A pump patient needs to be a motivated patient who tests regularly, around 4 times a day.
Are there insulin pumps that have a Continuous Glucose Meter attached?
Yes there are – it’s a good idea to discuss with your healthcare team which pump would best suit your needs
How would the insulin pump be used for sports? Are there special casings made or will I have to play without it?
You can engage in any kind of physical activity while wearing an insulin pump. But for sports with intensive body contact and water sports we recommend temporarily disconnecting the insulin pump (not for longer than 1 hour). Special cases and pouches can protect the pump, but it’s always a good idea to insure it as well.
At what age can you put a child on the insulin pump and how easy is it for them to adapt?
I would say at any age, but it’s best to get advice from your pediatric endocrinologist. Children often adapt the easiest of all age groups to insulin pump therapy.
What is the risk of infection?
If you follow the right hygiene steps, the risks are low. You should always disinfect the pump site before inserting the infusion set. It is also critical to replace the infusion set every three days.
How much is an insulin pump with and without medical aid?
That depends on the type of medical aid plan and whether the medical aid covers the costs fully or partly. It would be best to discuss this with your healthcare team or your medical aid. If your doctor agrees that pump therapy is the best option for you, they will send an application to the medical aid.
Ask the expert: Dr Claudine Lee, GP
“Pump therapy is a beautiful and practical way of delivering insulin that tries to fit in with you, the patient, in terms of meals, exercise and illness, as well as just living a normal life.”
Of all the sports a diabetic could choose, ice skating – with its precision, edge of danger and need to be feeling 100% every time you take to the ice – isn’t the most obvious. But that didn’t stop KZN champ Rachel Lombard from competing.
Who did you skate for?
I was part of the Toti Seals Synchro Team, and we represented KwaZulu/Natal twice a year in the inter-provincial competitions, as well as the KZN championships.
How long have you been diabetic?
I was diagnosed about 10 years ago, when I was 7 years old. It was pretty traumatic, I was scared that I was dying because I was misdiagnosed – they thought it was cancer. It was a huge shock for my mom, but I just remember feeling relieved it was only diabetes and it wasn’t anything worse.
Is it difficult to compete when you have to worry about blood sugar levels on top of everything else?
I have an insulin pump, so that helps, but I still have to be very careful. I make sure my blood sugar is fine an hour or two before we’re due to go on the ice, because my pump is under my tights and my costume and it’s difficult to get to if I need to adjust my levels. I also test just before I go on the ice, because the adrenalin can do funny things to my blood sugar. And I make sure I always have fast-acting sugar on hand in case I go low.
What do you love about ice skating?
I love it mainly because it’s different, and because there’s a real community – especially with my team and the coach. I skate four times a week, so it’s also really good exercise.
What do you think the biggest challenge of living with diabetes is?
The testing – having to test all the time. And how you can never predict what your blood sugar is going to do: you’ll eat something and know how much insulin to take, and it works… And then the next time you eat exactly the same thing and take the same amount of insulin and it doesn’t work, for some reason.
What advice would you offer to diabetics who are struggling?
Get support: that’s the one thing you need, you can’t do it alone. Also be aware that parents go through the highs and lows of diabetes just as much – my mom does so much for me, I don’t know what I’d do without her.
What makes your life sweet?
Just my friends and family around me, helping me through any situation and offering support if I need it. That’s what makes my life sweet.
Get in touch with Rachel: firstname.lastname@example.org
Children with diabetes often experience stigma. Carine Visagie explains how to make life easier for your child.
When Njabulo Dlamini was diagnosed with diabetes at the age of 16, he didn’t reveal his diagnosis to his friends. Fear of being called a drug addict, and standing out from the crowd, made him keep it a secret until the age of 19.
After he met Jenny Russell from Diabetes South Africa’s Durban branch, this young man (also an Idols star) started using his experience to break down some of the myths about the condition. But many other children with diabetes still have to deal with rejection and ridicule – so much so that their mental and physical health suffers.
Is there something that can be done to eliminate this social side effect of diabetes? We asked the experts.
Don’t make a fuss
When parents, teachers and other role models make a diabetes diagnosis and the day-to-day management a simple part of life, other children are more likely to accept this model as the norm. “Children don’t usually have preconceived prejudices, and they tend to follow models of behaviour set out for them,” says paediatric endocrinologist Dr Michelle Carrihill. “There’s no reason for children with diabetes to feel stigmatised if everyone is shown the right way to behave.”
Parents have a special role to play in this process, which starts with giving school staff and classmates the correct info. The more informed others are, the less likely it is that they’ll treat the child with diabetes differently.
Not sure where to start? Here are some guidelines*.
How you can help:
- Learn as much as possible about your child’s condition and do a simple presentation to teachers and classmates explaining what diabetes is, and what blood glucose testing and insulin injections involve. This moves the kids’ response away from fear and suspicion towards acceptance.
- Provide teachers with written information about your child’s needs. Include:
- A care plan for your child’s routine school day.
- A plan for days when the routine isn’t followed (for example, during outings).
- Signs and symptoms that could indicate a problem.
- What to do in an emergency, including all necessary contact information.
Make these plans with the teachers’ input, so that their roles are clear and accepted. A diabetes educator, dietician or diabetes specialist nurse can assist.
- Explain to teachers that blood glucose testing, additional trips to the bathroom and eating extra carbohydrates may sometimes be necessary. No big deal should be made of this.
- Explain that your child can exercise and also take part in outings, just like the other kids: there’s no need to treat them differently.
- Some kids are okay to inject in front of friends, while others are not. Ask the school to provide an area where your child will feel comfortable to test and inject. This could be the corner of a classroom or the nurse’s office, as long as the space is clean and quiet. They shouldn’t have to resort to the school bathroom.
- Ask teachers to provide positive support and encouragement, especially if your child seems anxious. Also ensure that a staff member is always available to them, so that they know who to ask for help.
* From Dr Carrihill, Jenny Russell and diabetes educator Kate Bristow.
Remember: Your child should always have their medical info and emergency contact details on hand: an ICE band or MedicAlert bracelet will do the trick. Find out more at www.medicalert.co.za
Make sure your child’s backpack always has:
– Testing equipment (a glucose monitor, lancets and strips).
– Insulin in a small cooler bag.
– A quick-acting sugary food or drink (like Super Cs).
– A glucagon emergency kit for severely low blood sugar emergencies: be sure to show teachers and older friends how to use it!
Join the community: Does your child have diabetes? Come and talk to us about it at www.facebook.com/DiabeticSouthAfricans
Together with Pick n Pay, we’ve designed a cookbook specifically for people with diabetes who want ideas for every meal of the day. Breakfast, lunch, dinner, snacks and treats – there’s something for everyone!
Get nutritional advice on how to build balanced meals, and delicious recipes the whole family will enjoy – whether or not they have diabetes.
If you met Shiara Pillay, a happy, healthy and confident 21-year-old who loves Art and is studying International Relations and Diplomacy, you wouldn’t guess that she had a chronic condition. But Shiara is a Type 1 diabetic. She just doesn’t let it get her down.
When did you find out you were diabetic?
When I was in Grade 4 and just about to turn 10. It wasn’t too horrible a diagnosis in comparison to some – my parents noticed that I was losing an extreme amount of weight, I was very dehydrated and waking up in the night to pee – all the classic symptoms.
Then one morning I threw up and they took me to the doctor. I was in hospital for a week and since then I’ve figured out how to live as normal a life as possible with diabetes. The hardest thing to get used to was not being able to eat sweets!
How has diabetes changed your daily life?
I think I’m obviously way more healthy than I would have been because I have to watch what I eat. I have a great diabetes team, and they’ve helped me to adjust my medication and my meals whenever I need to. I like the idea of being able to eat everything in moderation.
How does it help to have a community of fellow diabetics?
It helps to know that there are others in the same situation, it reminds you that you’re not alone. Youth With Diabetes really helped me to meet other people who have to think about the same things every day. I also think diabetes education is so important – new diabetics especially need to know what helps and what doesn’t, what you can eat, how you should exercise, how you feel when you’re low or high. It’s nice for me to share my experiences too. I do have bad days, it’s annoying to have to inject every day, but it’s just something you have to make the best of.
What advice would you offer to other diabetics?
Just do it – you can’t get out of it. If you look after yourself, it’ll be better for you in the long run, it’s for your benefit. And it makes you healthier too!
What makes your life sweet?
Just being happy – when things are going well and the sun is shining!
Ask the dietician: Genevieve Jardine
From our community: “Being newly diagnosed, I am learning about foods that I can and can’t use. I cannot find an article explaining what to look for. It’s all a bit confusing. Help would be greatly appreciated.” David Staff.
“Eat the right type of food, in the right amount, at the right time of the day”
It’s important to make dietary changes that are simple and progressive. First you need to learn what foods should be in your trolley, fridge and kitchen cupboards: that will make good eating decisions easier to choose.
I have one simple rule: eat food that is as close to its natural form as possible! This helps to reduce the amount of processed, high sugar, high-fat foods that cause problems with weight and blood sugar control. Try not to focus on what you can’t have (it is very depressing) and rather be adventurous in experimenting with healthy nutritious meals.
Once you know which foods are suitable, you need to get specific and work out how much to eat. Portion control is very important. The good news is that almost all foods are allowed in correct portions.
Here are some general rules:
Starch: Use low GI, high fibre starches. Reduce foods made with lots of white flour and sugar (doughnuts, biscuits, cakes ). For your main meal, the portion size of starch should be the size of your fist (approximately 2 portions of starch).
Protein: Opt for low-fat protein. Remove visible fat from meat and skin from chicken. For your main meal, the portion of protein should be the size of the palm of your hand and the same thickness as your baby finger (less at other meals)
Dairy: Choose low-fat or fat-free dairy. Try for 2 portions of dairy a day.
Vegetables: Choose a variety of colours and serve raw, steamed and roasted. Eat lots – double portions where possible!
Fruit: Try to eat a variety of fruits. The size should be that of a tennis ball and you should aim for 2 servings of fruit a day.
Fat: Try to reduce the use of fats in your cooking. Rather grill, bake, boil, steam, microwave or stir-fry your food. The portion of fat should equal the size of the tip of your thumb.
Specific portion sizes:
- ½ cup wholewheat cereal / muesli
- ½ cup cooked, cooled and reheated mealie meal / oats porridge
- 1 slice seed loaf
- ½ wholegrain seed roll / low GI bread roll
- 3 Provita / 2 Ryvita
- ½ cup (2 Tbs) beans or whole corn
- 1 small mealie on the cob
- ½ cup cooked, cooled & then reheated samp
- ½ cup pasta / long grain rice / wild rice
- ⅓ cup white rice
- ½ cup brown rice with added lentils
- ½ medium sweet potato
- 2 – 3 baby potatoes
- ½ cup cooked lentils
- 1 egg
- 30g grilled chicken / ostrich / extra lean mince / grilled beef or pork
- ¼ cup tuna
- 30g steamed / poached / grilled / baked fish
- 2 tbs peanut butter
- 50g raw soya
- 90g tofu
- ½ cup cooked lentils / beans
- 1 cup low-fat / fat-free milk
- 100ml low-fat / fat-free sweetened yoghurt
- 30g low-fat cheese (Lichten Blanc, Dairybelle InShape, Elite Edam, Woolworths, Mozzarella)
- 50g low-fat feta cheese (Pick n Pay Choice Danish Style / Traditional, Simonsberg)
- 50g low-fat cottage cheese (Dairybelle, Lancewood, Parmalat, In Shape, Clover)
- Green pepper
- Baby marrow
- Bean sprouts
- Mixed vegetables
- Green beans
- 1 medium apple / peach / pear / grapefruit / orange
- 1 large naartjie
- 3 small apricots
- 10 – 12 grapes (only!)
- 1 small to medium nectarine
- 1 tablespoon dried fruit
- ½ cup fruit salad
- 2 teaspoons low-fat margarine / mayonnaise / dressing
- 4 olives
- ¼ avocado
- 80ml low-fat gravy / sauce
- 1 teaspoon olive / canola oil
We were just sent this advice about raising children with diabetes… It takes a family to raise a diabetic child, as we all know! Do you have anything to add?
Hearing the diagnosis for the first time can be overwhelming and will leave any parent and child with mixed emotions – it’s unfair, it’s exhausting, it’s stressful, it’s scary and it’s tough to manage. Yet there is nothing on earth that any parent could have done better to prevent their child from living with Type 1 diabetes. It is estimated that there are now more than half a million children aged 14 and younger living with Type 1 diabetes according to the 7th IDF Diabetes Atlas.
According to Dr Ntsiki Molefe-Osman, Diabetes Medical Advisor at Lilly South Africa, Type 1 diabetes is a disorder of metabolism caused by the body’s immune system which attacks the cells in the pancreas that produce insulin. “Children are not born with it, rather it develops over time and there is usually a genetic predisposition. In children, Type 1 diabetes presents commonly at around 14 years of age and younger. This means that Type 1 diabetes is a lifelong condition, it is serious, and managing it needs to be done diligently as poor control of the condition today will have lifelong repercussions. When a child is diagnosed with Type 1 diabetes, so is the entire family who all need to adapt to a new lifestyle.”
“The importance of good glycaemic control can’t be emphasized enough,” says Dr Ntsiki Molefe-Osman. The basic 101 of managing and preventing the complications of Type 1 diabetes is careful daily management of blood glucose and sustaining tight glucose control as close to normal levels as possible.”
“Diabetes is a progressive disease, which left unchecked will cause organ damage. This has significant health repercussions for later on in life – from kidney failure, heart failure, blindness, nerve damage (diabetic neuropathy) and as a result loss of limbs. What you do for your diabetic child today and the responsibilities you teach your teen in managing Type 1 diabetes, will influence the quality of life they can expect to live later in life,” explains Dr Molefe-Osman.
Why do Type 1 diabetics need insulin?
People living with Type 1 diabetes do not produce any insulin at all, so it needs to be replaced with insulin injections. Insulin moves blood sugar into body tissues where it is used for energy. When there is no insulin, sugar builds up in the bloodstream. This is commonly referred to as high blood sugar, or hyperglycaemia – it is dangerous and has many side effects. Fortunately when the blood sugar is stabilised with insulin treatment, these symptoms go away.
It can be managed
While a diabetes diagnosis for your child may come as a shock and will mean that lifestyle adjustments will have to be made, it is important to remember that with consistent control and the support of a healthcare provider, people living with Type 1 diabetes can live full, active lives.
Family support is vital
Managing Type 1 diabetes in your child takes a lot of courage and determination. Imagine the mountain that a child faces knowing that injections will be part of their daily routine. They may also worry that their condition will preclude them from enjoying all the things that other children get to experience, or lead to them being treated as ‘different’ in their school and peer environment.
It all comes down to how you work together as family to support and guide your child in helping them see their daily treatment regime as a positive step towards a healthy and normal life, rather than as a punishment or burden. It is important to help your child believe wholeheartedly that with the right control and responsible approach, they can do whatever they want to do.
Managing chronic illness
“Coping with and learning to manage a chronic illness like diabetes is a big job for a child or teen. It may also cause emotional and behavioral challenges and talking to a diabetes educator or psychologist can help immensely. It’s also important that family, friends, teachers and other people in your child’s network know of and understand the condition so they are alert to any symptoms or signs that their blood sugar is out of control and what to do to help them in an emergency situation,” adds Dr. Molefe-Osman.
It takes a huge amount of discipline on the part of the parent and child in managing the demanding diet, lifestyle and treatment regimen, so it’s essential to establish a routine that works for everyone concerned. Establishing good habits early, providing a support structure and ensuring that your child understands why good control is important are vital. It’s the difference between your child managing their diabetes, or diabetes managing them,” she concludes.
- The 7th Edition of the International Diabetes Federation Atlas, World Health Organisation (WHO)
- http://www.who.int/mediacentre/factsheets/fs310/en/), Statistics SA
Remember when low carb wasn’t as well known as it is today? We do! Here’s an article from Sweet Life magazine published a few years ago that explains all the ins and outs…
Professor Tim Noakes says that a low carb, high fat diet is the way to go. We gathered your questions and asked him how the low carb diet affects diabetics. Here’s what he had to say.
What exactly is this diet?
A low carbohydrate, moderate protein, high fat diet. This diet is most effective for people with diabetes – either Type 1 or Type 2, or pre-diabetes, like myself. It also helps treat obesity, but it’s obviously not the diet for everyone. The question is whether it’s for 10% of the population, or 90% of the population – I think it’s about 60% or more.
Low carb means no bread, pasta, cereals, grains, potatoes, rice, sweets and confectionery, baked goods. You have to be resolute – and the more severely affected you are, the more resolute you have to be. If you’re already diabetic, you have every reason not to eat these foods.
Can you explain what carbohydrate resistance is?
My opinion is different from the traditional teaching. Carbohydrate resistance is traditionally described as someone who is unable to take glucose out of the blood stream and store it in their muscle and liver. I disagree with this explanation: I think we’re all born with varying degrees of carbohydrate resistance, and the children who get really fat very young are the ones who are most carbohydrate resistant. The carbs they take in they simply store as fat. That’s the first group.
The second group are people who become pre-diabetic at 30 or 40, and then they become diabetic at 50. They are overweight, and that’s a marker of the high carbohydrate diet. They eat a high carb diet, they are carb resistant and it gets more and more severe until they become diabetic. I think it’s genetic, and the reason I think that is because in my case, although I’ve lost weight, I’m still carbohydrate resistant – I can’t go back to eating carbs.
What if you have high cholesterol? Isn’t it dangerous to eat so much fat?
Firstly, the theory that high cholesterol is a good predictor of heart disease is not true – it’s a relatively poor predictor. A far better predictor is your carbohydrate status. Everyone knows this – if you’re diabetic or pre-diabetic, your risk of heart disease is increased. Diabetes, hypertension and heart disease are linked, but most heart attacks occur in people with cholesterol below 5. It’s very frustrating, because the public has got the wrong idea.
A high fat diet corrects everything, in my opinion – your HDL goes shooting up, your triglycerides come shooting down and that HDL to triglyceride ratio improves dramatically: that’s one of the better predictors of heart attack risk. The LDL small particles are the killers, and on a high fat diet, those go down. Your total cholesterol can go up, but that’s because your HDL has gone up, and the large, safe LDL particles have gone up. So unless you measure all those variables: HDL and LDL and triglycerides and glucose tolerance, you can’t judge the effects of the diet.
What carbs do you eat?
The good carbs are veg – that’s it. Sweet potatoes (not regular potatoes), butternut, squash and then I also eat dairy: milk, cheese, yoghurt. I don’t eat any fruit except apples, but that’s because I severely restrict my carbs. You’re not cutting out nutrients if you eat nutrient-dense foods like liver, sardines, broccoli and eggs – those are the most nutrient-rich foods you can eat. You can get vitamin C from meat if it’s not over-cooked. The key is that you eat lots of fat, and you don’t avoid the fat. I eat lots of fish, like salmon and sardines. And you want to eat lots of organ meats – that means liver, pancreas, kidneys, and brains if you can get them, but particularly the liver. Liver is very nutritious.
Is this diet possible for people who don’t have a lot of money?
You don’t have to eat meat every day – you can eat sardines and kidneys, for example, which are both very cheap.
Could the positive effect of a low carb diet on insulin resistance be because of the weight loss and not because of the new diet?
No, absolutely not. Because it happens within one meal – your insulin requirements go down within one meal, because you’ve shut off the production of glucose by not eating carbohydrates.
What is wrong with the old fashioned idea of a balanced diet? Why does it have to be so extreme?
If you’re diabetic, you have a problem with metabolising carbohydrates. You have to understand that if you want to live a long life and have minimal complications, you want to minimise your carb intake. Start at 50g a day. What that looks like is two eggs for breakfast, with some fish – salmon or sardines, and some veg. And dairy: cheese or yoghurt. That will sustain you until early afternoon. For lunch, I think you should have salad and some more protein and fat – and exactly the same for dinner. Chicken, cheese, nuts, salad, tomatoes, broccoli. It’s an incredibly simple way to eat, but you don’t get bored.
Once you’re on this diet, you feel so good, and you get rid of all these aches and pains and minor illnesses: you won’t want to go back. If you do go back to eating carbs you’ll put on the weight again. It’s not a diet, it’s a lifelong eating plan. It’s not a quick fix.
I think the diabetics who live to 80, 90, 100 are the ones who eat this kind of diet.
Ask the dietician: Genevieve Jardine
When someone is newly diagnosed with diabetes, it’s helpful to start with very simple dietary advice as they come to terms with the necessary lifestyle changes. The spectrum of food choices for diabetics involves “good choices” on one end and “bad choices” on the other. In the middle lies ‘moderation’, which can be adapted to the individual depending on personal factors and other conditions like blood pressure or cholesterol.
Here, we’ll break down what good and bad choices look like in each of the food groups – proteins, starches and sugars, vegetables, fruit, fats and oils, and drinks.
Proteins: meat, chicken, fish, eggs and dairy
- Fish more frequently (especially fatty fish like salmon, trout and mackerel)
- Eggs, especially boiled eggs
- Plain yoghurts, milk and cottage cheese
- Plant-based protein options like beans, lentils and chickpeas, instead of meat
- Using chicken that has skin removed (preferably grass-fed)
- Game meat that is very low in fat
- Deep fried meat, chicken and fish
- Very fatty red meats and processed meats
- Diary that has been sweetened, like ice cream
- Imitation cheese and coffee creamers
Starches and sugars
- Unprocessed, high fibre starches like sweet potatoes, rolled oats, brown rice, wild rice, quinoa, buckwheat and barley.
- Items made with wholegrain flour with little or no added sugar such as wholegrain bread, crackers and cereals.
- Any food item that has a lot of sugar added, like sweets, chocolates and biscuits.
- Refined flours that have been processed and bleached white such as white flour, white breads, white crackers, white rice and refined cereals (especially if the cereals have sugar added).
- Deep fried starches such as doughnuts, koeksisters, vetkoek, fried potato chips and crisps.
- Homegrown, fresh or even frozen vegetables with emphasis on lots of different colours. Try to eat a rainbow of vegetables. Eat them raw, juice them, steam them or bake the root vegetables for maximum nutrient retention.
- Fresh herbs and spices like garlic, ginger, turmeric, cinnamon, mint, rosemary and coriander.
- Vegetables that have been boiled
- Vegetables with thick sauces
- Canned vegetables which are higher in salt (for those people who need to watch their salt intake)
- Fresh fruit in season
- Fruits with a naturally lower sugar content, such as berries, apples and citrus
- Fruit juices
- Dried fruit with sugar coating
- Fruit canned in a thick syrup
Fats and oils
- Foods that are naturally high in fats like olives, avocado, nuts and seeds
- Good quality oils such as extra virgin cold pressed olive oil
- Foods that are high in trans fatty acids and hydrogenated vegetable oils (read the food labels to spot these words).
- High quantities of plant seed oils like sunflower and canola oil (usually deep fried products).
- Filtered water flavoured naturally with lemon or mint
- Herbal teas
- Sugary drinks such as sports drinks, fizzy drinks, iced tea, flavoured water.
- Alcoholic beverages that are high in sugar, such as cocktails, dessert wines and fruity mixed drinks.
My granddaughter who has Type 1 diabetes is going with us for 2 weeks to Mauritius by boat.
I am very unsure how to keep her blood sugar between 4 and 10.
My question is: how long after meals should I check that her blood sugar is not above 10?
Any other tips?
If you’re trying to find a way to put together healthy lunchboxes and snacks that still taste great, check out these great tips from Novo Nordisk:
Keeping tabs on children of any age can be a challenge, but keeping tabs on a child living with diabetes adds on to that challenge. One of the top priorities for parents of children with diabetes is to manage the condition from an early age, so that their children can lead normal, healthy lives. The treatment regime includes making sure they have a healthy diet based on foods with a low GI (Glycaemic Index); foods that digest slowly and therefore don’t play havoc with the body’s blood glucose levels. This can be enough of a challenge at home, but what about the times when children are out of the home – at school, parties or sports events?
The trick is to make carb counting for lunchboxes and snacks easy, so that it becomes a simple routine rather than a complicated chore. But counting carbs, as anyone who’s been on a carbohydrate-restricted diet will know, can be difficult – and frustrating. And who has time in the mornings to figure out whether the lunchbox they’re preparing is ‘carb-safe’ for their child?
Luckily, there are some easy techniques to use for counting carbs, and these can be really useful for busy Moms and Dads.
“The first thing is to make a list of the foods that are high in carbohydrates and to paste this onto the door of the fridge as an easy go-to reminder,” says Shelley Harris, Public Relations Manager of Novo Nordisk (SA), local division of the world’s leading diabetes healthcare company. These include fruits and starchy vegetables like potatoes and corn; foods made from refined grains like bread, crackers and pasta; and sugar or foods sweetened with sugar.
“Do this with a column next to each item to record the carbohydrate count, so that you don’t have to do it from scratch every day,” says Harris.
“If you’re packing in something like low-fat sweetened yoghurt, for instance, it’s easy to check the total carbohydrate content on the label, which includes the measure of both sugars and starches. Do that and then write it down on your checklist for easy reference.”
Another technique is to allocate average carbohydrate counts to common foods like bread and apples.
“An apple, a slice of bread or a cup of skim milk all contain around 15g of carbohydrates, so it’s easy to do quick calculations based on what the American Dietetic Association refers to as ‘food exchange groups’. The term means that foods with a standardised carb count are interchangeable, and that the total carb content of a lunchbox can be quickly calculated in this way.
For children on insulin, this methodology makes it easy for parents to calculate the insulin-to-carbohydrate ratio that determines the amount of insulin they need to take before each meal, making allowances for variables like levels of activity and individual responses to certain foods.
With over 6.5 million South Africans living with diabetes, and with approximately 45% of all new cases of Type 2 diabetes being diagnosed in children, as stated by the IDF the Diabetes Atlas and the American Diabetes Association, easy-to-use, time-saving methods like these can be invaluable to parents.
The other side of the coin, of course, is to make lunches and snacks interesting by varying the contents from day to day, and by focusing on foods that kids enjoy. A nutritious and satisfying lunch could, for instance, include a sandwich made from whole grain bread, a homemade treat like a low-fat choc chip cookie, a portion of fresh fruit, a few veggie sticks and some low-fat milk or bottled water.”
“Carb counting for children with diabetes needn’t be difficult,” concludes Harris, “and lunches don’t have to be boring. All it takes to put together a healthy, appetising lunchbox every day is a bit of forward planning and a good dose of imagination. And voila! A healthy, happy child – every day.”