Meal & Snack Planning

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The meal plan is the second element in diabetes care. Ideally, the types of food your child eats and the timing of her meals and snacks work together with her insulin injection schedule and exercise to keep her blood glucose in her target range for much of the day.

The good news is that the ideal meal plan for your child with diabetes is no different from the healthy meal plan that nutrition experts recommend to everyone. There is no need for her to eat special foods or give up her favorite treats. With the help of a dietitian, you and your child can create a healthy and appetizing meal plan.

Dietitians are food and nutrition experts and can help with the following food-related tasks:

Further Reading . . . Healthy Calendar Diabetic Cooking This cookbook features month-by-month, week-by-week, and day-by-day meal plans and recipes complete with tips for healthy eating. For more cookbooks, click here.

• Make and use a healthy meal plan
• Find out how different foods affect blood glucose
• Find and recommend good cookbooks and food guides
• Fit favorite foods into the meal plan
• Change the meal plan when your child's life changes
• Learn how to fit special occasions (parties, holidays) into the meal plan
• Choose healthy foods in the grocery store and in restaurants
• Learn how to treat low blood glucose

It's best to see a dietitian twice a year, in the spring and fall. Often, calorie needs differ throughout the year, depending on how your child's sports and school activities change with the season. Also, see a dietitian whenever you think the meal plan should be changed. Some reasons for changing the meal plan include:

• Poor blood glucose management
• Too many incidents of low blood glucose
• More (or less) exercise
• Trouble following the meal plan
• Normal growth, which necessitates eating more
• Attempting to lose (or gain) weight
• New insulin schedule or dose

Look for dietitians with the letters RD (Registered Dietitian) or LD (Licensed Dietitian) after their name. To find dietitians who are experts in working with people who have diabetes, look for a CDE (Certified Diabetes Educator) after their name. To find a dietitian where you live, ask your child's doctor or call the American Dietetic Association Consumer Nutrition Hot Line at 1-800-366-1655.

The Food Pyramid

The food pyramid is an easy way to remember the healthiest way to eat. The food your child needs the most is at the bottom. Your child needs less of the foods located towards the top of the pyramid. At the very top is food that's not all that good for her, so she should only eat it once in a while. Let's take a closer look at what the food pyramid tells us about healthy eating.

The Foundation

At the bottom of the pyramid are bread, cereal, rice, and pasta. These foods contain mostly carbohydrates. The foods in this group are made mostly out of grains, such as wheat (flour), rye, and oats. Some starchy vegetables go in this group, too, like potatoes, peas, and corn. Really, they're vegetables, but your child's blood glucose levels react to them as if they were carbohydrates. So she should count them as carbohydrates for her meal planning. She needs six to eight servings of these foods per day.

The Second Floor

The next layer is fruits and vegetables, which are also made up of carbohydrates. They have plenty of vitamins and minerals. Your child needs about three to five servings of vegetables and two to four servings of fruit per day.

The Third Floor

Near the top of the pyramid are milk and meat. These foods usually contain a lot of protein. Milk is also the best source of calcium, which helps your child's bones and teeth to stay strong as you grow. Milk products include all types of milk, cheese, yogurt, and other dairy products. Your child needs two or three servings of milk per day. The meat group includes - you guessed it - all types of meat: beef, chicken, turkey, and fish. Even eggs, tofu, and some kinds of beans and nuts are included. She needs two or three servings of meat a day.

The Attic

At the very top of the pyramid is a little triangle. That's for fats, oils, and sweets. Things like potato chips, candy, and fried food contain a lot of fat or sugar. They aren't as nutritious as vegetables or grains. So your child shouldn't eat these foods every day. It's better to save them for a special treat.

The Basement

Some people like to imagine the food pyramid with another layer on the bottom, underneath the grains & starchy vegetables. This layer shows people walking, running, and riding their bikes everywhere we go. So, it's not really a part of the real food pyramid, but if it were, the exercise layer would remind us that it's very important for us all to be active every day. Staying active is important for everyone, but even more so for people with diabetes.

Scheduling

For people with diabetes, when they eat is nearly as important as what they eat. Insulin has peaks-times when it works the hardest. Meals and snacks should be planned around those peaks. There are two reasons for this. First, your child will get the most energy from her food when insulin levels are at their highest. It's the best way to ensure that the carbohydrates are used efficiently. Second, once insulin is injected, it works no matter how much (or how little) glucose is in the blood. If there is too little glucose in her blood when the insulin reaches its peak, your child could experience hypoglycemia (low blood glucose).

Your child's meal plan will include a schedule of meals and snacks that coincides with her insulin injections. It's important for her to stick to the meal times as much as possible to avoid hypoglycemia and get the nutrition she needs. If she consistently has trouble eating on schedule, it may be time to make a change in the treatment plan. Consult the doctor or dietitian about how to better fit your child's insulin and eating plans into her daily lifestyle.