My grandson, age 12, has had type 1 diabetes for about 6 months. He loves sugar and counts carbs but has sugar cereal for breakfast, Twinkies, etc., for snacks and feels as long as he doesn’t go over his carb allowance this is okay. Is this a problem?

In general, it’s fine that your grandson enjoys some sweets occasionally and has learned how to count them into his diabetes nutrition plan. But (there’s always a “but,” isn’t there!), I would want to be sure of two things: (1) that he’s reaching his glucose goals most of the time (all the time isn’t possible with our current tools); and (2) that his overall diet is complete and healthful.

The first concern is the diabetes concern, of course. Just because he’s counting the foods into a meal plan, doesn’t necessarily mean that his blood sugars are in control. Every meal plan has to be “road tested,” checking blood sugars before and after eating to make sure that insulin and food are actually in balance in both timing and amount. Following a meal plan has no value per se unless it is helping produce good blood glucose control. If that’s not happening, then a visit to the dietitian for a revised nutrition approach and/or the doctor for a better match of insulin to the food being eaten is needed.

The second concern is no different for your grandson than for any growing child. Good nutrition needs aren’t changed by diabetes. He can manage sweets by “playing pancreas” (matching insulin to the actual foods eaten just as his pancreas would do if he did not have diabetes), but that doesn’t change his need for adequate calories, protein, vitamins and minerals. If he’s eating a variety of healthful foods, his hunger is controlled, and he’s growing normally, chances are that everything is just fine. You might want to read my book Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace (available from the American Diabetes Association) for more information about overall nutrition needs in the child with diabetes.

BB