October 12, 2000
Behavior, Meal Planning, Food and Diet
Question from Elyria, Ohio, USA:
My six old daughter was just diagnosed with type�1 three months ago. She was never a good eater until she lost the weight and became ill. Now that she has all her weight back on (she lost 11 pounds), she is back to her, “I’m not hungry, I don’t want to eat” habits. She has always been picky, and, now, she is again. It’s very hard to make sure she gets her carbs in after her insulin shot in morning (8N-2R) then get her off to school. She gets up at 8 am, but this is a chore already. School starts at 9:10 am. I can’t force food down her throat. I’ve made three different breakfasts some days to try to coax her to eat. She snacks at 10:30 am, lunch at 11:50 am. I’m so worried she’ll go low quick at school. What to do?
I have a couple of thoughts for you. First, talk with your diabetes team about switching to Humalog instead of Regular. Then, you can avoid the food wars by giving her the Humalog after she’s eaten and only give her the dose that is based on the carbs she’s actually consumed. Second, the book Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Brackenridge and Rubin may be very helpful in giving you ideas on how to avoid the food wars.
Finally, keep in mind that your job as a parent is to provide healthy, well-balanced meals. Then your job is over. It is your child’s job to eat what is offered (or not). Once you engage in battles over food, you’ve guaranteed yourself aggravation, frustration, and you will lose that battle. Grown-ups will always lose food battles with their children. However, you can certainly have rules around meal-time behavior, such as sitting at the table until everyone in the family is done eating (so she can choose not to eat, but she can not choose to leave the table to go play or watch TV).
Once you choose not to battle your daughter over food, you can try one of two options. First, you can provide her the food and allow her to suffer the natural consequences of refusal (she’ll probably go low). Because you know she’ll probably go low, you will need to test her blood sugars more often (not a punishment, but the thing you must to do protect her health and safety). Once she is low, you will need to treat that low, just like you would treat any other low. Children don’t like having multiple blood sugar tests, and once they learn that this is the natural consequence of her choice not to eat, she will likely eat a bit more. The other option (usually this works best for younger children in the toddler/preschool years) is to develop a “beat the clock” game at meal and snack-time. Set the timer in your kitchen for 20 minutes. If she “beats” the clock and eats her food before the bell-rings, then she can earn a point (or sticker). (Keep in mind that “eating” is not cleaning her plate, but eating a reasonable amount). If she eats three meals and three snacks per day, she can earn a total of 6 points per day. After earning about 75% of the possible points for the week, she can cash in her points for a privilege. Once she is consistently earning 75%, increase it to 80, and then 90% in order to earn the privilege. Privileges are not things you buy. They are things like earning an extra bed-time story or being able to pick out a movie rental over the weekend, or playing a game with mom that no one can interrupt, etc.
[Editor’s comment: I would also suggest a return visit with your daughter’s dietitian to work out a new meal plan that your daughter can abide by. It is not unusual for newly-diagnosed children to need more food in the beginning in order to gain back lost weight. Once the body is back to where it was, these added calories are often no longer needed. I also agree that an insulin regimen based on what your daughter has eaten, rather than what she is supposed to eat, might be quite useful. The key is that, unfortunately, your daughter will have diabetes for a long time. You and your diabetes team need to find way to make the diabetes live with her, instead of allowing the diabetes to completely control her life.