October 16, 2001
Meal Planning, Food and Diet
Question from Woodbridge, Virginia, USA:
I have a really hard time teaching my four and a half year old son (diagnosed with type�1 diabetes three years ago) the importance of eating all the food I serve him. We have to fight about it on a daily basis, and we are both getting very frustrated. He often gets low, but that still doesn’t change his eating habits!
Dealing with managing the meal plan in a very young child with diabetes is a true struggle. I usually suggest that my very young patients with diabetes be given long-acting insulin (Lantus [insulin glargine] once a day or Ultralente twice a day) along with reasonable amounts of Humalog given for carbohydrate intake only after after the child as eaten with an adjustment as needed for high blood sugars over 200 mg/dl [11.1 mmol/L]. If you try to give the Humalog before the meal (as is usually suggested for older children, teens and adults with diabetes) and the child then refuses to eat, you’re stuck with a child who will have a low blood sugar or even a severe low blood sugar that could lead to a low blood sugar seizure.
Adopting the above strategy should help to end the fights about eating all of the foods served to him. I would not encourage you to have a “clean your plate” strategy at mealtime, but rather use a calculated dose of Humalog for the carbohydrates your child does eat with a correction for the occasional high blood sugar. Until your child grows some and you can reasonably predict what he will eat at a meal, you may wish to discuss the above strategy with your child’s diabetes physician.
[Editor’s comment: I completely agree with Dr.�Brown’s philosophy. Forcing young children to eat can lead to severe psychological problems including possible eating disorders later on. An excellent discussion of these issues can be found in Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Brackenridge & Richard Rubin.