Overall, our 10 year old daughter, diagnosed with type 1 diabetes four years ago, is quite responsible in the daily management of her diabetes. Our family’s philosophy on eating is to eat healthy foods and that sweets are okay in moderate amounts. Of course, the only difference for our daughter is that we expect her to be responsible and bolus which isn’t an issue with other foods, but when it comes to sweets she is prone to sneak them. We’re truly puzzled since we haven’t made sweets a forbidden thing. Any thoughts on what might be happening here? How can we better support her to be responsible with sweets in the same way she is with other foods?

I applaud your efforts at remaining supportive with respect to your daughter’s meal planning and allowing occasional sweets to be worked into her eating. Meal planning has become a bit more liberalized without compromising optimal blood sugar control. Two scenarios come to mind when reviewing your question:

Young women at this age might be worried (or needlessly guilt-ridden) about bolusing to cover these occasional sweets and the weight gain that might accompany this bolusing if it happens on a regular basis. Unfortunately, one of the “down” sides of insulin pump therapy is the possibility weight gain caused by obtaining better blood sugar control and the flexibility that pump therapy can allow. This possible weight gain can be minimized with another component of diabetes self management — exercise and a schedule of consistent physical activity.
Another possibility here is even though your family has adopted a healthy meal planning lifestyle with occasional sweets, maybe she is running into others who haven’t been educated on the more liberalized nutrition recommendations for diabetes. These individuals might be creating some unnecessary guilt or shame for your daughter when she does have a sweet and she will not bolus accordingly. I would suggest that you and/or your daughter address this issue with your diabetes health care team and/or dietitian so that blood sugars don’t suffer unnecessarily.

JMS