We have friends who just found out their three year old has type 1 diabetes. At first, they were doing well with adjusting her diet and doing the shots. Then, they were told that they should let her eat whatever she wants and adjust her insulin injections according to that. I am very concerned that they are taking this advice without consulting their physician and causing her more health problems. What exactly is it that they are doing to this child by letting her choose what she wants to eat? She is experiencing headaches and stomachaches aches frequently and are going for a second opinion to a doctor in Iowa on February 2. I am a concerned friend and don’t want to see them lose their child over not being able to handle the disease and fitting it into their lives.

It’s nice that you are such a caring friend. You, too, can learn about diabetes, how to check glucose levels, administer insulin, help plan meals, and then be a reliable safety valve or periodic baby sitter or other helper for your friends!

As to your question, I think the answer really depends on who gave the advise to allow the child to eat whatever she wants and what the insulin plan and meal plans are.

If the child has is getting fixed, set amounts of insulins at more-or-less specific times of the day (e.g. mealtimes) then, perhaps, she is also supposed to get rather fixed amounts of calories, typically in terms of carbohydrate grams, at specific times of the day. In this scenario, it may not matter too much if, for example, the 30 grams of carbohydrates at breakfast came from oatmeal, pancakes, cereal, juice or combinations, as long as it was the prescribed regimen of 30 grams.

But, perhaps the girl has been placed on an insulin plan whereby she is indeed allowed to eat variable amounts of calories (again, typically with tracking and counting the carbohydrates, primarily) at variable times of the day. With this meal plan, then, short-acting insulin can be dosed relative to the amount of food consumed. The parents are typically given a formula to follow such that, for example, one unit of insulin for every 15 grams of carbohydrates consumed. If the child ate 30 grams of carbohydrates (in whatever combination as used in the example above) she would then be given two units.

The first plan has the advantage of being tried and true, easy to remember and easy to do. But, it is rather restrictive in terms of daily flexibility as meals and insulin should be given at set points daily. The second plan is harder to track but allows more variability in food and activity planning. In any meal plan, a balanced diet is certainly important.

Talk to your friends and see what direction they have been asked to go at this time. Maybe there has been miscommunication.

DS