One warm Sunday afternoon in May 2013, I stood in the kitchen, hugging my sobbing 8-year-old daughter. The ice cream truck had just gone by and I had to say no.
Just a few days earlier our daughter had been diagnosed with Type 1 diabetes. She’d been put on a rigid insulin regimen and a meal plan that required her to eat a certain number of carbohydrates for each meal and snack, and we did not yet know how to dose insulin for “special occasions.” That day, as I held my daughter, stifling my own tears, I felt like her childhood innocence had been ripped away in an instant with her diagnosis. And to some extent that innocence had been ripped away from me, too.
The topic of healthful eating for children with Type 1 is a sensitive one. Feeding any child can be difficult; feeding a child with diabetes can be doubly so. Parents of kids with Type 1 do their best to encourage and model healthy eating while operating in a sleep-deprived and overwhelmed state, under the scrutiny of medical professionals who often provide conflicting information, and swimming upstream in a larger culture of unhealthy eating and judgment.
That’s why I cringed when I saw the title of Insulin Nation’s article, “Why Kids with Type 1 Are Fed an Unhealthy Diet.” Not another person telling us about the “diabetic diet” and how we are failing at properly feeding our children! On behalf of myself and all other parents with diabetes, I felt judged before I even read the article.
Interestingly, while I won’t claim we are the poster family for a healthy lifestyle, we are not half bad either. We rarely drink sweetened beverages, don’t keep junk food at home, encourage fruits and vegetables, minimize processed foods, and are physically active. We were relieved that we only needed to make fairly minor changes to our diet after our daughter’s diagnosis. The “diabetic diet,” it turns out, is not so different from regular healthy eating.
Yet we constantly question and judge ourselves and worry about not feeding our daughter an optimal diet. Are we kidding ourselves when we say that her diet is reasonably healthy? That ice cream, or pizza, or cookie – is it really only for special occasions or is it becoming more common? How bad is it that she eats cereal for breakfast almost every morning? How can we feed her more vegetables? How do we balance the need to restrict foods that wreak havoc with our daughter’s glucose control with her need to be a normal kid, unburdened by what her pancreas can no longer handle?
Eventually, curiosity won over my initial apprehension and I set out to read the full text of the study cited in the article. Not surprisingly, I first noticed what I consider to be the study’s flaws. The researchers defined healthy eating as meeting the USDA dietary guidelines. None of the children in the study met the “optimal score of 100,” mainly because of insufficient consumption of fruits and vegetables and higher than recommended consumption of empty calories. However, other studies demonstrated that children in the general population do not meet those same dietary guidelines, either.
The study does not differentiate between the ideal score of 100 and what can be considered “good enough.” Remember how I said earlier that we think our daughter’s diet is okay? So did most parents in the study. I would venture to guess that in our daily lives we do not define healthy eating as meeting the USDA ideal standards. Also, despite not meeting the dietary guidelines, the average A1C score for the study’s children was 7.8, only slightly above the recommended target of 7.5, indicating less than ideal but still decent glucose control. And, of course, let us not forget that diabetes management is so much more than a balance of carbs and insulin, especially with younger children.
All the shortcomings notwithstanding, the study won me over because its objective was not to shame and blame parents for feeding their kids with Type 1 a poor diet. On the contrary, at the heart of the study was a discovery of the disconnect between recommendations of medical professionals and the reality of feeding a young child with diabetes. The many barriers to healthy eating that the parents discussed – difficulty in getting the kids to eat new foods, time and financial constraints, insufficient nutritional education on meal planning as opposed to carb counting, and insulin regimens that lead to force-feeding the carbs to make up for insulin given – are all too familiar to all parents of kids with Type 1. Yet these issues are rarely addressed at doctors’ appointments. Parents are often told to make changes without any regard to how feasible they may be to implement in real life.
And then there is the big emotional factor about that “diabetic diet” – how do we protect our children from feeling different? All parents in the study voiced how difficult it is to keep their children eating healthfully when everyone else around them is eating and offering treats and junk food. It’s not the denial of diabetes diagnosis that makes parents give in to their children’s junk food requests; it’s the heartbreak of having to say no to a young child who does not understand why he or she can’t eat like everyone else. Healthcare providers need to understand and address this reality, and show genuine compassion for young children with Type 1 and their parents who are grieving the lost innocence of childhood.
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