My granddaughter is 15 months old and has just been diagnosed with Type 1 diabetes. My daughter-in-law is having problems in finding foods to feed her that are nutritious and will alleviate the spiking. Do you have any suggestions?

My daughter-in-law is at her wits end and we really need some help with diet for her.

Managing diabetes in children is always challenging, but as your family has discovered, management in infancy is a special undertaking. Because of her small body size, tiny differences in food portions and insulin doses can produce dramatic changes in blood sugar. She will need all the same foods and nutrients that an infant without diabetes needs. But, as you may have already figured out, it is all but impossible to force an infant to eat — spitting up is the ultimate “I didn’t want that” message. That is why trying to give short-acting insulin before a feeding can be a real trial — once the insulin is in, it can’t be taken away, but there is no effective way to “make” the baby eat. Consequently, insulin management in the infant can be a tricky business.

You want someone with significant experience to be handling it — and that means either a pediatric endocrinologist or pediatric diabetes educator with a lot of experience. Infants with diabetes do not come along every day, so unless a health care provider specializes in this area, they are unlikely to have seen enough infants to have developed much skill. Some pediatric programs avoid short-acting insulins until infants are eating real meals, relying mostly on background insulins like NPH. Some use tiny doses of Humalog insulin given after the infant eats to better match the dose to the need. (These babies need a background insulin too.) At the very least, the family should be using a one-half unit insulin pen to help to accurately give the small insulin doses.

The book Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace has a chapter on food, insulin and parenting in infants with diabetes that you may find helpful. There are also subsequent chapters on what lies ahead — toddler, pre-school and school-age issues in diabetes care and parenting.

BB