1.     The diabetic diet is planned to provide a well balanced, nutritionally balanced diet. As with any diet, it is important that there are plenty of all essential nutrients to ensure good health, satisfactory growth and development.

2.     Maintain ideal body weight for height and age. Particular emphasis is placed on the energy or calorie content of the diet to be sure that weight gain is satisfactory and obesity does not develop. There will be regular dietary reviews as your child becomes older. Sometimes, particularly in teenage girls, the energy content of the diet may need to be reduced to avoid obesity.

3.     Help maintain blood glucose levels within satisfactory limits. This requires restriction of sugar and sweetened foods, a constant intake of carbohydrate spread over the day, and regular times for meals and snacks.

The diabetic diet uses normal foods and can be enjoyed by all members of the family. There is no need for a person who has diabetes to have meals prepared separately for them. The main principles and guidelines for a diabetic diet are consistent with the Australian Dietary Guidelines for better nutrition and health for all the community. They are as follows:

1. Eat a variety of foods each day.

2. Prevent and control obesity.

3. Decrease fat intake in the diet.

4. Decrease consumption of sucrose in the diet.

5. Limit alcohol consumption.

6. Increase intake of bread, cereals, fruit and vegetables.

7. Reduce salt intake.

8. Encourage intake of water.

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Here are some guide-lines that seem appropriate for most families.

1.     Be about when you are needed. Even when a teenager is being most disagreeable he still needs to feel his parents love him and are there to care for him. He may want to fly solo and fly high, but it is nice to know the ground is down there to land on later.

2.     Listen as well as advice. Teenagers have points of view which give you insights into their feelings and behaviour. This will help you understand them and will make them less frustrated that their parents don’t understand. Never mind that their ideas seem immature or misguided: sometimes the way to work things out is to talk and to work it out for yourself that way.

3.     Provide firm and sensible guidelines for behaviour. Don’t relax your own standards just to accommodate a rebellious youngster. Be prepared to discuss rules and the reasons for them and then make decisions together.

Despite teenagers rebelling against adult authority, and their many complaints to the management, they do respect firm guidelines. If you don’t set high standards, how can you achieve even minimal behaviour?

4.     Discuss with your teenager how much help with diabetes care they would like you to give and how much reminding they need from you. You will still be accused of nagging but at least you will have an agreement to work to. You may feel that it is helpful to have your child’s doctor discuss this with you both and act as an independent arbiter if there is disagreement.

5.     Trust your teenager. He will probably let you down many times, but that’s part of development. The less you trust him the more he will give you reason not to do so. Giving responsibility is a good way of developing a responsible attitude.

6.     Remind yourself of your teenager’s good points and strengths. Don’t dwell on all the bad things which may be so much in evidence.

7.     If communication isn’t going well between yourself and your teenager, involve someone you both can trust. Teenagers can still relate to some adults even if they are temporarily rejecting their parents. Perhaps your teenager’s physician can talk to him or a school counselor or youth leader or another relation.

If your teenager is giving you concern and doesn’t seem to be looking after himself, discuss it with your doctor. But take heart; this is usually a temporary phase and often the most rebellious teenager becomes a model of zealous good care within a few years.

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There is no shame in diabetes

There is nothing shameful about diabetes, but still some people do feel some sense of shame. All medical conditions suggest to some people perhaps that the person is less than perfect, or has some weakness. This is largely due to ignorance, and the thing that gives the lie to this attitude is the sight of the child with diabetes in perfect health and vigour, succeeding at school and at sport and socially with friends. Naturally you, as a parent, and your child with diabetes, do not parade the fact that he has diabetes – but neither should you conceal it like a shameful thing. Anyone who ought to know for the child’s sake (such as teachers, scout master, close friends) should be told in a matter-of-fact way, without any emotional overlay, and be given information about the condition that might be useful and relevant to their day-to-day contact with your child.

As with you as a parent, so it is true with members of the community; the most important thing to avoid is pity. No child wants to be pitied, and it does not help him to regain his self-confidence in himself, and self-esteem as a healthy individual.

Be prepared to talk about diabetes

You will want to be aware of his problems, be prepared to talk about diabetes when he wants to do so, and give help with adjustment to the treatment when needed. Try to avoid giving the impression you are worried about him or sorry for him. You will feel sorry for him at times of course, and perhaps worry about him often. But to show this will be upsetting for him, and will stop him feeling like a normal child.

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Examples of what to give for a hypo reaction

On first sign of a hypo, give at once one of the following:

150ml Orange Juice

3 level teaspoons Sugar or 3 Sugar cubes

15g Barley sugar – i.e. 3 pieces

150ml Lemonade or other ordinary soft drink (not low calorie soft drink)

5 level teaspoons Glucose Powder e.g. Glucodin

3 level teaspoons Honey – may be especially useful for young children as it can be placed in the mouth and is difficult to refuse.

If the hypo did not occur just before a meal or snack it is sometimes a good idea to give an extra exchange of more complex carbohydrate, e.g. bread, biscuits, as well as the sugar. Otherwise the usual meal or snack should be taken promptly to prevent a recurrence of the hypo. The sugar you gave was an extra – don’t deduct an exchange from the usual diet allowance.

If the hypo is not improving in 10 minutes or so, or if it appears to be becoming worse, give further sugar as above.

An early or mild hypo reaction

The early signs (including the warning signs) of insulin hypoglycemic reaction may include one or more of the following:

Paleness, sweating, tremulousness

Dizziness and vagueness

Headache

Odd behaviour, bad temper, misery, crying

Trembling, twitching

Drowsiness

The things to do are:

1. Give sugar quickly: 3 teaspoonful or equivalent.

2. Make a note on the test record of the hypo.

A late or severe hypo reaction

The late signs of an insulin reaction may include:

Intense sleepiness, uncooperative behaviour.

Loss of consciousness or ‘coma’.

Convulsion.

The things to do are:

1. Give sugar if you can: 6-8 teaspoonful or equivalent.

IF NOT:

2. Give a glucagon injection.

3. When he responds, give the sugar at once.

4. If no response, call your doctor at once.

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Older children should do their own tests

As soon as your child is old enough to do the test (perhaps at the age of 5 or 6) he should be encouraged to do it himself. This will give him a greater sense of responsibility and will help him to accept blood testing as part of his daily routine. Some supervision will be needed.

Some children object to tests

It is common for children, as they become adolescent, to object to doing their tests. This is part of the general resentment of ‘being different’ that is common and natural at this age. Also if they do not appreciate the reason for doing the tests, they will be less inclined to do them.

Also the teenager is starting to have a busier social life, school work is getting more demanding or sport more important, and it is harder to get up in time in the mornings. For these and other reasons many tests may be left undone, and the parent may wonder how much to push the child, and how much to do the tests herself.

Your child may want privacy when doing the test, and this should be respected. A child needs some discipline at this age, but also a lot of understanding. Each child presents a different problem for himself and for those who are trying to help him. Usually it is best to allow your child’s doctor to help with the solution of this problem, if it should arise, rather than allow it to be a continuing battle between parent and child.

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