My 8 year old granddaughter will be spending Thanksgiving with me. She has three insulin injections a day and still has high blood sugar count (200-over 300) What can I prepare for her that will not make her sugar go up, and what do I do when the sugar goes high between injections?

It’s hard to try to take on improving your grandchild’s diabetes control during her short holiday with you. If you will accept a bit of advice from another grandma (but one who eats, lives and breathes diabetes) relax as much as you can and enjoy her — and let her do the same. Safety is vital, of course, but a few days with you of stricter attention to control won’t change the “Big PIcture” and could make her visit particularly trying on both of you. It’s possible that her overall therapy needs to be reviewed. Perhaps some additional education would be helpful to her and her parents. You might all want to read my book Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace. It covers insulin, food, nutrition and testing in the context of how to keep the family from going crazy over controlling the diabetes.

But to speak to what you can do while she’s visiting, you don’t say what time of day your granddaughter’s blood sugars are high. If it is the fasting value first thing in the morning that is elevated, that may or may not be related to food choices. (That’s more a matter of finding the right overnight insulin dose.) It is the readings for about three hours after meals that are most affected by the match between insulin and food. Your granddaughter’s need for food (calories, vitamins, minerals, proteins, etc.) are no different because of her diabetes. Type 1 diabetes cannot be controlled by withholding food. The trick is keeping the insulin doses in balance with the food that’s eaten and with the child’s overall needs as she grows and changes.

You can tell how this is going on a day to day basis by checking blood sugars. When blood sugars are high (say over 180 1-2 hours after eating) extra snacking would probably best be limited to things that contain no carbohydrate (starch or sugar). Examples of carbohydrate-free snacks include celery and peanut butter, nuts, sugar-free Jello, veggies and Ranch dressing, cheese, cold chicken, and jerky.

Good Luck — and if she loves pumpkin pie, let her enjoy it — it’s the total amount of carbohydrate that’s important. It’s not necessary to avoid sweets, although portions may need to be small since it sounds like she’s on a set dose of insulin.

BB