I am a school nurse at an elementary school. I have a type I diabetic student/patient. His parents say “let him eat what he wants and count the carbohydrates.” His diet consists of mostly sugar carbohydrates. I have tried to explain the difference between simple and complex carbohydrates. Can you please help me with this? I am concerned about long term damage, years from now, especially to his eyes, kidneys, etc. Can you give me some information about long term damage because of his sugar/simple carbohydrate diet?

Also, what complicates this scenario is that his dad is a paramedic who knows you treat a low with sugar. I cannot get him to understand that you CANNOT eat sugar all day and maintain a “normal” blood sugar. His son’s blood sugars on any given day can range from 50 mg/dl [2.8 mmol/L] to 300 mg/dl [16.7 mmol/L] (most days).

The first part of my answer to you on this question is going to be very general, in that eating healthy foods should be a priority for all children (and adults). We should not just look at carbohydrates, but at our total food intake. The old expression “you are what you eat” applies. When this topic came up in my practice, I would ask parents if they would prefer that any of their children (with or without diabetes) would eat a healthy diet or have a diet filled with junk food.

That said, for a child with diabetes, I would want to know that the family has had a chance to meet with a dietitian and diabetes team experienced in the care of children with diabetes to help them navigate the complex issues around food, healthy eating and glucose control. A dietitian can help the family look at the total food picture and striving for a healthy balance of nutrients, factoring in exercise/schedule changes, medication, illness, etc.

Diabetes care is very difficult and relentless, and even with careful attention to diet, the glucose levels can be very variable. It is important that children are allowed to eat regular sweets and to feel good about themselves and their diabetes care, so that they can stay motivated to keep up with great diabetes care.

In this child’s case, the diet may be what the family eats and would bring me back to how our society is doing from a food and fitness perspective and what we need to change in our communities and schools.

LM