When it comes to managing holidays with type 1 diabetes, Halloween and Thanksgiving get all the press. Strategies abound for handling the spoils of trick-or-treating and feasting at grandmother’s house. But what about the springtime holidays? As many T1D parents find, a bunny serving candy for breakfast can be more frightening than any ghost or goblin. And a four-hour Seder makes turkey and stuffing look like child’s play.
Rest assured, there are ways to let your child enjoy Easter and Passover without wreaking havoc on his or her blood sugar. “Holidays that revolve around food require a little extra thought and preparation,” says Diane Kress, R.D., C.D.E., a diabetes author and dietitian in private practice in Morristown, N.J. “To make these times more relaxed and enjoyable, it’s best to think ahead and have a go-to special event plan.”
If you’re going to someone else’s house to celebrate, it’s fine to give them a heads up about your child’s diabetes — but there’s no need for special accommodations. “Let the host know that you will manage all aspects of your child’s care and will choose foods from what is available,” says Kress. “There really is no need to make a big fuss about your child at the holiday meal.”
At the meal, make sure you have all your diabetes supplies on hand. “A different meal schedule, varying activity levels, and unusual foods may result in either high or low blood sugar,” Kress cautions, “so make sure you’re prepared for anything.”
Kress recommends avoiding trying to calculate an insulin dose before the meal, since many factors — unfamiliar flavors and recipes, cousins deserting the kids’ table to go play — could keep your child from cleaning his or her plate. “Instead of guessing what food your child will eat and how much will be consumed, figure out an accurate amount of insulin to match what was actually eaten,” she advises.
Afterwards, test often. “Depending on your child’s age, make him or her aware that more frequent testing will be needed that day because of the special meals and treats,” she says. “Don’t refer to holiday foods as ‘bad’ — instead, convey the message that special foods require special attention.”
Top Tips for Passover
Many Seder foods are high in carbs, so make sure you’re well-acquainted with the carb content of these before the meal. On the other hand, foods like brisket, chicken, hard-boiled eggs, gefilte fish, and vegetables like celery, romaine lettuce, horseradish, and asparagus have negligible carb grams, so Kress recommends encouraging your child to load up on those. If you’re cooking or bringing a dish, you can also substitute high-carb foods with lower-carb versions when possible — for instance, swap out white matzah for whole wheat or spelt matzah.
“Because of the duration of the Seder, which can be three to four hours, children who take insulin by injection may do better splitting the insulin dose, so consult your healthcare provider about that beforehand,” Kress advises. For children on pumps, you can use the square or dual wave options to compensate for the length and higher fat content of the meal. Recheck blood sugar midway through the meal and after the afikomen, just to be safe.
As for beverages, “kosher grape juice diluted with water can be substituted in place of wine, as the carb grams in the grape juice can be covered by insulin,” Kress explains. As always, it’s a good idea to discuss your family’s menu and traditions with your diabetes care team.
Top Tips for Easter
A basket full of candy first thing in the morning? Children’s dream; parents’ nightmare. Some families get around the blood sugar spike of chocolate bunnies on an empty stomach by serving a protein-rich breakfast before any candy-eating is allowed. “You could also start a new tradition of setting a candy limit — a certain number of pieces for Easter morning and on the days following Easter,” Kress says. “Parents should also be aware of the carb counts of the candies given out (when possible) so that they can adjust insulin doses accordingly.”
Natalie K., who has two children with type 1 diabetes, suggests marking each individually wrapped candy with the amount of carbohydrates and counting out loose candy like jelly beans into a baggie marked with the total carbohydrates.
Another new tradition can be for the Easter Bunny to bring a small amount of candy and a small toy or gift. “Easter presents need not be extravagant, but can replace most of the high-carb, empty-calorie candy,” Kress adds. Plastic eggs at an Easter egg hunt can be filled with stickers or temporary tattoos instead of jelly beans.
If your little one does indulge his or her sweet tooth, just remember that all candy is not created equal. “Keep in mind that pure sugar candies like jelly beans, licorice, and gummy bears are often used to treat hypoglycemia because of their very fast and high impact on blood sugar,” Kress says. “They lift blood sugar within a few minutes of their consumption. Insulin needs to be present when these high-sugar, low-fat foods are eaten.”
Chocolate, nuts, and coconut, on the other hand, have a high fat content. “Fat slows the conversion of carbohydrate to blood sugar,” Kress says. “After eating chocolate, even if the correct units of insulin have been given, higher blood sugar may occur later in the day. This can be brought back in range with a correction injection or bolus correction before the next meal.”
With these tips and a little more frequent testing, kids with type 1 diabetes can continue to enjoy the holiday traditions they — and you — look forward to each spring. Sweet!
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.