I have a question about my son’s diet. My five-year-old son has had type 1 diabetes since age three. Many things that my wife and I have read about, even on this site, or heard from other parents with type 1 diabetes tell us that we need to limit his candy, sweets or carbohydrate intake because of his diabetes. Our endocrinologist, through the Joslin Center, states that he should not have to be limited and should be able to eat what ever he wants (within a normal diet). What is the truth?

When we tell people that our son can eat anything he wants, that we just have to accommodate his food with the proper insulin, they look at us as if we are crazy. They state that we are not taking proper care of our diabetic child. This is very frustrating and I want to know why his endocrinologist states one thing but it seems everything else we come across states another.

Please help us to understand this more.

As a registered dietitian, diabetes educator and a person who has type 1 diabetes, I can relate to your predicament. I think that, as a parent, you have to decide for your son what will work best for him with regards to achieving optimal diabetes management. I think children do best with meal planning and diabetes management somewhere in the middle between the two ends of the spectrum you described.

According to the American Diabetes Association in their latest position statement on nutritional recommendations and interventions in the 2008 issue of Diabetes Care (Diabetes Care 31:S61-S78, 2008),

A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health.

Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control.

Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake.

Sugar alcohols and non nutritive sweeteners are safe when consumed within the daily intake levels established by the Food and Drug Administration

With these tenants in mind, a healthy meal plan for a child with diabetes includes foods and beverages that are considered healthy for everyone. Regular monitoring of blood glucose and regular visits with a registered dietitian who will monitor and assess growth requirements will assure that your son is receiving a proper and adequate meal plan.

JMS