Halloween is just around the corner, and every year at this time I think of the unfortunate situation the parents of young children find themselves in as they face a giant candy celebration. It’s pretty much a nutritional nightmare.
If you’re like me, you work hard to keep your children’s candy consumption to a minimum. You avoid having candy at home so the temptation isn’t there, but then comes Halloween and suddenly a plastic pumpkin filled with enough candy for the entire year gets dumped onto the kitchen table. What’s a parent to do?
The candy situation is even more complicated for parents of children with diabetes. Not only are they faced with all of the candy, they have to figure out how to bolus for it. Factor in the candy they saw their child eat. Factor in the candy they think their child ate when no one was looking. Factor in how much their child walked (or ran) while trick-or-treating. Factor in the candy their child is about to eat. What parents face is a bolus nightmare hand-in-hand with the nutritional one.
I had the opportunity to talk to about this with an expert, Dr. William Tamborlane, Professor and Chief of Pediatric Endocrinology at Yale School of Medicine. When I asked Dr. Tamborlane how he thinks parents of children with diabetes should handle Halloween, his answer was definitely not “no candy.”
“Things have changed a lot since I started caring for children with type 1 diabetes more than 35 years ago,” Dr. Tamborlane said. “Then our kids weren’t allowed to eat sweets. The idea was that simple sugars pushed the blood sugar levels up too quickly for the old fashioned insulins to cover it. Kids were only supposed to eat starches because it took longer for these carbohydrates to be digested and absorbed. Much later we found out that, in the context of a regular meal, there wasn’t much difference between the rise in blood sugar levels after high sucrose versus high starch meals.”
But it’s not just our knowledge about carbohydrates that has made it easier for children with diabetes to eat candy. “We now have much more flexible and effective insulin dosing with smart insulin pumps, rapid-acting insulin analogs and continuous glucose monitoring devices,” said Dr. Tamborlane.
So does the fact that now it’s easier to cover the carbs than it was a few decades ago mean children with diabetes should feel free to eat candy? “Like kids without diabetes, kids with diabetes should still limit candy and sweets to a healthy amount,” said Dr. Tamborlane. “I also tell our parents that Halloween candy will cause less of an increase in glucose levels if it is given as a treat at the end of a regular meal.”
Dr. Tamborlane also said we should keep in mind the “diabetics don’t eat sweets” dictum was developed long before we could monitor blood sugar levels with blood glucose meters and that not eating sweets became a kind of ritual that made you a “good diabetic” even though your blood sugar levels were still probably sky high.
Today good diabetes management doesn’t only mean monitoring and bolusing. Dr. Tamborlane makes sure his patients and their families understand how insulin works, how to recognize blood glucose patterns that indicate a need to adjust insulin doses, how to count carbohydrates, and how to use that information in selecting bolus doses. “Most importantly,” he says, “We tell people to use common sense and treat your child with diabetes just like you should treat your children without diabetes.”
So if you’re treating your child with diabetes just like you treat your children without diabetes, does that mean there is no ideal diet for a child with diabetes?
“Children with type 1 diabetes should eat a healthful diet, just like other children,” said Dr. Tamborlane. “Regular meals that are nutrient balanced and in appropriate portions is the recommendation. Our current approach is that kids with type 1 diabetes should limit sugar intake to the same extent as is recommended for kids without diabetes.”
Still, despite the fact that a child with diabetes can eat a “normal” diet, proper insulin administration is crucial. When I asked Dr. Tamborlane about this and how he treats his patients he said both Novo Nordisk’s Levemir and Sanofi’s Lantus are better than the old fashioned NPH and Ultra-Lente insulins because they have flat-time action profiles that make them better basal insulins. “In my personal opinion,” he said, “I like Levemir better than Lantus because I have personally found that my patients get more consistent responses when the same dose is given to the same patient day after day with Levemir.”
The last question I asked Dr. Tamborlane was if he would share the single best piece of advice he has for keeping a child with type 1 diabetes safe and healthy. He said, “We know that we can beat diabetes with the tools that we now have. The trouble is that it is hard work and you have to keep beating it every day, which can be especially challenging for a small child or newly-diagnosed patient to understand. Frankly, the secret to success is remaining motivated to keep doing all the things that you need to do to win this battle. If all of the other people and companies who are working on artificial pancreas projects are successful, help will be on the way.”
*Dr. William Tamorlane is a consultant for Novo Nordisk related to their diabetes products and a member of their Speakers Bureau.