My two and a half year old has been put on a diabetic diet because she weighs 60 pounds. They say they can’t determine whether she hase type 1 or type 2 diabetes. She doesn’t eat much, and she is very active but she still gains an average of five pounds every two weeks. How can I help get the weight off?

In any child where the diagnosis of type 1 vs. type 2 diabetes is in question, a consultation with a pediatric diabetologist or pediatric endocrinologist is a good idea. There are some lab tests that can be helpful in distinguishing between the two diagnoses, and a pediatric endocrinologist or pediatric diabetologist will have the expertise to determine if these are necessary or if any further testing may be necessary.

In addition, I have yet to meet a two year old that can tolerate a “diabetic diet”. Most of the time, I encourage parents of children with type 1 diabetes to adjust the dosing of rapid acting insulin (Humalog or Regular) to cover the amount of carbohydrates a child is eating. Consulting with a dietitian who is familiar with type 1 diabetes in children may be helpful. If your child is quite overweight, working to change a diet to better use nutritious foods is likely in order.

MSB
Additional comments from Betty Brackenridge, diabetes dietitian:

As you know, at 60 pounds, your daughter is literally “off the charts” for her age. You don’t mention her height, but I will assume that she’s overweight for her height since the doctors have not ruled out Type 2 diabetes (and this suggests that she’s probably overweight). Whatever her weight status (from lean to obese), five pounds is lot of weight for a little one to gain in two weeks. It’s not clear from your letter whether this excessive rate of gain has been going on for some time or only since your daughter was diagnosed with diabetes. If this rapid gain has only been apparent since she was diagnosed, it is possible that it is, at least partly, a temporary situation. If her blood sugars were running well above normal before she was diagnosed, her body would be replacing lost fluids, muscle and other tissues as soon as it had adequate insulin to restore normal body function. This would add to whatever rate of gain she was experiencing before.

Whether that is a factor or not, I think evaluation of her growth by a pediatric endocrinologist is in order. At nearly twice the average weight for her age, it’s important to rule out any growth disorder. A pediatric endocrinologist would also be able to clear up the “type 1 or type 2” question.

Once you and your team really know what you’re dealing with, you still need practical advice about how to manage your child’s food intake from this point forward. Weight loss diets are not advised in growing kids – stopping weight gain is a safer and more realistic goal. This usually requires attention not only to what the child in question is eating, but attention to the family’s overall eating and exercise habits. I strongly suggest you get two books: Child of Mine and How to Get Your Kid to Eat but Not Too Much Both are by Ellyn Satter, and will give you wonderful, sound ideas about how to help your child.

BB