My 13 year old step-daughter was just diagnosed with type 1 diabetes in another state, and even though she has spent several weeks in a hospital the doctors were never able to get her down below 300 mg/dl [16.7 mmol/L]. Although I have had friends and family through the years with diabetes, I thought it was all about sugar. She is coming to live with us because her mother does not have time and is making her fearful of injections. I don’t have a clue as to what kinds of foods she will need. Fat free or sugar free? Can I get a few sample meals and a recommendation for the best reading material?

I applaud your efforts at trying to find out accurate nutritional information for your stepdaughter. You are right — sugar is not the “enemy” nowadays. It is more important to focus on total amount of carbohydrate at each meal and snack as opposed to sugar amounts. I would recommend that you ask your stepdaughter what nutrition education she received while hospitalized. Hopefully, a registered dietitian who specializes in teens with diabetes spent time with your stepdaughter setting out an individualized meal plan that fits her usual eating times and food preferences. Individualizing meal plans based on increased growth needs during puberty will optimize blood sugar control. There is no such thing as “forbidden foods” in a diabetes plan; portion sizes are more of a concern.

A few very informative resources are:

The Diabetes Food and Nutrition Bible by Hope S. Warshaw, Robyn Webb, Graham Kerr (Foreword)
Diabetes Meal Planning Made Easy by Hope S. Warshaw
Complete Guide to Carb Counting by Hope S. Warshaw, Karmen Kulkami

JMS

[Editor’s comment: If your step-daughter is coming to live with you, you (and your husband) will need a lot of education about type 1 diabetes and its management, including the meal plan. This is especially crucial since it appears that your step-daughter’s blood glucose control is far from adequate.

As soon as your daughter arrives [or perhaps before she arrives!], please set up an appointment with a diabetes team well versed in dealing with teens that includes not only a physician, but a nurse, dietitian, and mental health specialist. You should expect to spend several sessions with them at first to develop a treatment plan, based on your step-daughter’s lifestyle, that focuses on optimal blood glucose control and quality of life. You can ask your doctor for names of appropriate centers, or contact your local American Diabetes Association or Juvenile Diabetes Research Foundation affiliate for information about nearby diabetes programs who specialize in the care of teens. If you don’t take the time now, you’re headed for many problems.

SS]