In recent years, there seems to be a growing rift in the type 1 diabetes community, and it’s all about carbohydrates. On one side are families who have found diabetes-management benefits to adopting a low-carb diet. And on the other side are those who advocate that children with diabetes can eat the same foods as anyone else. If you’re the parent of a newly diagnosed child, what are you to make of the debate?
We asked experts and parents to weigh in on considerations that might go into the decision of what to feed your family — as well as navigating the parental judgment zone around what has become a heated topic in the diabetes online community.
When a child is diagnosed with type 1 diabetes, parents are given a crash course in how to give their child insulin to cover carbohydrates contained in the child’s foods. This can be a tricky process to master. “The biggest challenge facing people with any form of diabetes, and especially type 1, is controlling blood sugar around meals,” David Ludwig, M.D., an endocrinologist and researcher at Harvard’s School of Public Health, explains.
Foods that directly impact blood sugar levels include fruits, grains, starchy vegetables, dairy and sugary foods like candy, desserts, and other sweets. Parents learn how to measure carb counts in these foods to calculate how much insulin is needed to keep their child’s blood sugar levels within a target range.
Some foods seem to be easier to manage than others. Pizza, for example, is notorious among families with T1D for bringing about fluctuating blood sugar levels and delayed blood sugar spikes that can be difficult to anticipate.
But that doesn’t mean that pizza or any other food is on a “forbidden” list. Both the American Diabetes Association and JDRF are clear in their guidelines that children with diabetes — like all children — should be encouraged to eat a wide variety of nutritious foods containing vitamins, minerals and a balance of carbohydrates, proteins, and fat. The universal advice for children that sweets and sugary treats should take a backseat to healthier choices goes for kids with T1D too. But no food is truly off-limits as long as the carbohydrates in the food are covered with insulin.
Hearing this kind of inclusive dietary advice from their diabetes care providers may be one of the first pieces of information about type 1 diabetes that can help parents think, “We’ve got this.”
This was definitely the case for Cassie, a mom from Florida, whose son Evan was diagnosed with type 1 diabetes two years ago just after his 11th birthday.
“When my son was diagnosed, I was prepared for a super strict diet.… I had flashes of my son eating all his meals separate from us and his lunches of ‘diabetic foods’ looking so different from his classmates… but then I found out that was absolutely not the case. When the nutritionist told me no food was off-limits, I remember being flooded with a sense of relief. I suddenly felt like, yes, we can do this,” she recalls.
Since Evan’s diagnosis, Cassie’s family continues to eat a “mainly very healthy diet with the occasional slice of birthday cake or ice cream cone after sports practice.” A highlight is making her grandmother’s beloved recipe for arroz con pollo (chicken and rice) for her family every Sunday. She has memorized the carb count per serving for her son’s insulin bolus.
“Every time we eat this dish, I feel such gratitude for family food traditions and that we can all be a part of it.”
Some parents have taken a different view than the standard advice and believe that certain foods, namely carbohydrate-rich foods, should be restricted in kids with type 1 diabetes. These parents embrace the idea that following a very low-carb diet can help them achieve greater blood sugar control. As reasons for embracing this approach, they often cite research on the benefits of low-carb eating for overall health.
Dr. Ludwig, along with colleagues from Boston Children’s Hospital, tracked members of a social media group centered around very low-carb diets for type 1 management, and observed that many members — both adults and kids — who used the diet as part of T1D management had stable blood sugar levels without any real drawbacks. The researchers noted that prior to the discovery of insulin, severe carbohydrate restriction was one of the only known methods for helping children with diabetes stay alive.
Ann, a mom from Indiana, put her child on a very low-carb eating plan and has found it to be helpful. “We’ve focused meals and snacks around foods like lean proteins, healthy fats, and non-starchy vegetables, and I can see a difference in steadier numbers. It’s working for us.”
However, there is concern from some in the diabetes community that any kind of severely restrictive diet is setting children up for possible risks.
Alison Pelz, R.D., C.D.C.E.S., L.C.S.W., a certified diabetes care and education specialist from Austin, Texas, is straightforward about her concerns. “I would not recommend a low-carbohydrate diet to a child or teen with type 1, as carbohydrates are needed for normal development and growth,” she states.
She also has concerns about the effects of a severely restricted diet on mental health and risk for eating disorders, especially for teens with T1D. “It’s been shown that dietary restriction may lead to problematic eating behaviors. The stress of managing type 1 diabetes plus the normal stressors of navigating the teen years could be a recipe for the development of an eating disorder.”
Weighing the pros and cons of any changes to your child’s diet is something that should involve a conversation with your child’s diabetes care provider.
Still, as a hot topic of debate in T1D groups across social media, parents may feel pressure to publicly come down on one side of this issue or the other.
Therapist Klarece Grudzinski from San Diego, California, is also a parent of a child with T1D. She’s concerned that this “food fight” may wind up adding to parents’ feelings of guilt over their child’s type 1 diabetes.
“There are so many emotional, frustrating, and frankly lonely aspects to being a parent of a child with type 1 diabetes. Parents often feel so guilty about their child having T1… that somehow it is their fault.… With this diet debate, now there’s a new issue to feel guilty about.”
Grudzinski recommends parents lean in to their support circles and their care team for needed emotional support whenever possible, including speaking to a therapist to work through guilt, wherever it stems from.
Caring for diabetes is a multilayered and complex task for parents. The bottom line is that decisions you make about your child’s type 1 care are an individual issue between you, your child, and your child’s care team.
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.