11. Food and diabetes

Introduction and basic food groups

Children and young people with diabetes need to eat the same healthy foods as any other child or young person. Having diabetes doesn't mean you have to be on a 'diet' for the rest of your life, or that you can't enjoy some of your favourite foods from time to time as part of your normal meal plan.

You can read a transcript of this video here.

It is important that we have an understanding of how foods affect blood glucose levels.

Carbohydrates

Carbohydrate or starchy foods are really important because they provide energy for our body. We need to pay special attention to carbohydrates when you have diabetes, as they break down into glucose and will have the biggest effect on your blood glucose levels.

Carbohydrate foods include:

• all breads, crackers, and cereals such as weetbix, cornflakes, and rice bubbles

• all pastas, rice, and noodles

• starchy vegetables like potato, kumara, corn and taro

• foods such as beans, legumes, lentils, and baked beans

• foods that have natural sugar like fruits and milk

• foods that have added sugar like biscuits and cakes, jams, ice cream, chocolate, and muffins.

• drinks such as milk, fruit juice, cordial, fizzy drinks, and energy drinks

Simple carbohydrates break down into glucose fast and cause blood glucose levels to rise quickly. These foods are often highly processed such as juice, fizzy drinks, sugar, honey, lollies etc. We call these "quick acting carbohydrates" and only use these to treat low glucose levels. Complex carbohydrates take longer to digest, so blood glucose levels rise slower. These are foods such as bread, pasta, rice, fruit, milk, yoghurt etc. The less processed and higher fibre, the slower these foods are digested, which is better for our health. We often refer to these as long acting carbohydrates.

Read the attached information sheet on Carbohydrates to give you more detailed information about which foods are Carbohydrate foods.

Proteins

Protein foods do not get broken down into glucose so will not have a significant effect on your blood glucose levels.  Protein foods include:

• meat,  fish,  poultry,  eggs, and vegetarian equivalents

• dairy products and cheese or dairy alternatives

• legumes, lentils, beans and nuts (note these both have protein and carbs)

Fats

Fat based foods such as avocado, nuts, seeds, butter, margarine and oils also do not get broken down into glucose and therefore do not have a big effect on your blood glucose levels.

Non-Starchy Vegetables

Non-starchy vegetables include salad veges, carrots, broccoli, leeks, peas, cucumber, tomatoes and other colourful vegetables. These vegetables do not get brokend own into glucose and we encourage tamariki to include these at most meals.

Starchy vegetables include potatoes, kumara, taro, cassava and sweetcorn and they are considered carbohydrates.

Foods that do not have carbohydrates and do not affect blood glucose levels are often called 'free foods'. Some of these free foods can still be high in energy, particularly fat and protein rich foods, and need to be included as part of a balanced and healthy diet.

Balancing your food intake

Appetite

When you are first diagnosed, you might be very hungry. This is normal as your body did not have any insulin working so you could not use the glucose in your blood for energy for the weeks before you were diagnosed. Now your body wants to catch up, so it is making you hungry. This will calm down after a few weeks and it is important to eat to your appetite and activity level.

Main meals

An important part of managing your diabetes is to match your insulin doses to the amount of food you are eating so that your body can use it properly.  To work out how much insulin to give at each meal, your dietitian will teach you how to count carbohydrates and match your insulin dose to this using an insulin to carbohydrate ratio.

Snacks

As insulin is only given for main meals, we need to limit the carbohydrates at snack times to 15g or under, so we do not make our blood glucose levels rise too high before the next meal. People with diabetes do not need a snack before bed as this can cause high blood glucose levels overnight.

Below are some examples of healthy 15g carb snacks:

• a piece of fruit

• a pot of yoghurt

• 3-4 crackers and cheese

• veggie sticks with 1/2 cup hummus

• 2-3 plain biscuits

• a small bag of popcorn.

Your dietitian can discuss in more detail how this would look in your family's day to day life. See also our Carbohydrate and Snacks factsheet.

Foods and drinks that need to be limited

While we can eat all foods, some foods should be saved for special occasions. These foods (treat foods) like cakes, ice creams, chocolates and lollies have a bigger impact on your blood glucose levels due to the added sugar in them.

Remember that some "sugar free" foods may still have carbohydrates e.g. cake made with sweetener instead of sugar will still have carbohydrates from the flour, or reduced sugar fruit juice still has all the natural sugars from the fruit. Being able to read a nutrition information label will help you in being able to decide whether a food is an 'everyday choice', or an 'occasional treat food'. Your dietitian will help explain to you the best way of reading a food label and what values of carbohydrate and sugars are okay for different foods.

For all children and young people the best drink is water and plain milk. If you have diabetes, milk has some natural sugar in it, so we would need to count it as part of your overall carbohydrate intake alongside a meal.

It is important to avoid all other sugary drinks. This includes all fruit juices, cordials, powdered juice drinks, fizzy drinks, sports drinks, energy drinks, iced teas, flavoured waters and flavoured milks.  The only time a sugary drink should be used is in the treatment of low blood sugar levels, or hypo (see the hypoglycaemia module for more information).

Drinks such as a diet or 'zero' drink that are sugar-free can be consumed occasionally in place of a standard soft drink. These drinks can be very acidic and still cause your teeth to decay. Water is the best choice of drink to keep your body working well and it has no effect on your blood glucose levels.

Let's go over the main points. Read our one page summary about nutrition and diabetes. Ready?

Think you've got it sorted now?

If you and your parent/carer have read through the information above and watched the video, and you feel confident that you understand this topic, print off and fill in the evaluation form below (you might need to ask someone to print this off for you) and return to the nurse on your ward. If you have any questions, note them down on this form and your diabetes nurse specialist will discuss them with you.

Food and Diabetes: Evaluation

After reading this module and watching the video I:

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