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Diabetes: Healthy eating & physical activity


Disclaimer: This fact sheet is for educational use only. Please consult your doctor or other health professional to make sure this information is right for your child.

Meal planning

Healthy meal planning is an important component in the management of diabetes. Healthy eating for people with diabetes is the same as healthy eating for everyone. There is no need for the child or young person to eat special foods.
 
A dietitian specialising in diabetes will be able to help you and your child to work out an individual meal plan considering factors such as:
  • nutritional requirements for growth and development
  • daily routine
  • food preferences
  • (most important) matching the amount of carbohydrate with your child's insulin regimen or medications and physical activity
This will help to keep blood glucose levels steady and within the target range most of the time.
 

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Carbohydrate

Carbohydrate is the best source of energy for the body. It is broken down into glucose in the bloodstream. Glucose is used as a fuel by the body including the brain and the muscles.
 
Carbohydrates are found in the following foods:
  • cereals and grains
    - breakfast cereals, breads, crackers, rice, pasta, noodles
  • legumes and lentils
    - baked beans, chickpeas, split peas, kidney beans, soya beans
  • starchy vegetables
    - potato, kumara, corn, yam, parsnips, taro, green banana
  • natural sugars
    - fruit, fruit juice, milk, yoghurt
  • foods with added sugar
    - jam, cakes, biscuits, ice-cream, cordials, soft drinks
Carbohydrate has the most direct influence on blood glucose levels. It is important to include carbohydrate foods at each meal (and snacks) to balance blood glucose levels. Your child / young person’s dietitian can advise you on the appropriate amount of carbohydrate your child / young person needs.
 

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GI (glycaemic index)

The GI (glycaemic index) is a ranking of carbohydrate foods based on their immediate effect (compared to pure glucose) on blood glucose levels.
 
Some carbohydrate foods are digested slowly producing a gradual rise in blood glucose levels. These slow release carbohydrate (low GI or low glycaemic index) foods help to keep blood glucose levels steady. They help to provide sustained energy for your child / young person, especially during sporting activities.
 
Some examples of low GI foods are:
  • heavy and dense wholegrain breads, such as Burgen®, Holsom’s® 9 grain
  • wholegrain or unrefined cereals, such as rolled oats, muesli (choose unsweetened and untoasted), All Bran® , Special K®
  • pasta – white, wholemeal
  • rice, such as Basmati, Doongara, Uncle Ben’s® parboiled
  • legumes and lentils, such as baked beans, chickpeas, split peas, kidney beans, haricot beans
  • milk, yoghurt, low fat ice-cream
  • fruits such as citrus (oranges), stone (apricots, peaches, plums), cherries, apples, pears, dried apricots, prunes and apples
  • vegetables, such as corn, yams, taro, green banana
Some carbohydrate foods are digested quickly and produce a rapid rise in blood glucose levels. They are called quick release or high GI foods. 
 
A dietitian will be able to recommend the use of different types of carbohydrates to fit in your child / young person’s meal plan and activities.
 

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General guidelines on dietary management

The principles of the dietary management of type 1 and type 2 diabetes are similar. Following is general information only. Please see the dietitian for more details and individualised advice.
  • have regular meal times everyday
  • do not skip meals
  • try to stick to meal plan and times as much as possible
  • carbohydrate should be included at each meal
  • spread carbohydrate food evenly over the day
  • a carbohydrate snack in-between meals is important for children and young people who are on insulin injections, to avoid hypoglycaemia
  • try to include low GI foods in meals and snacks
  • choose a variety of food from the different food groups for growth and development
  • limit intake of high fat (especially saturated fat) food by:
    - choosing low or reduced-fat dairy products and cheeses
    - choosing lean cuts of meat (removing visible fat from meat and skin from chicken and poultry)
    - limiting high fat snacks and takeaways, and processed meat

A low fat diet is not recommended for children under the age of two years

  • limit intake of high sugar food such as sweets, cordial, powdered drinks, soft drinks and fruit juice
  • remember ‘treats’ are not the same as ‘snacks’. Foods that are high in fat, sugar and salt are for occasional treats only and should not be given as regular snacks. 'Treat' foods are potato chips, corn snacks, muesli bars, chocolate, sweets, cakes, sweet biscuits, pies and pastries

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Type 1

Learning how to work out the amount of carbohydrate from foods is important for the management of type 1 diabetes. Amongst the three main nutrients (carbohydrate, protein and fat) in food, carbohydrate has the most direct effect on blood glucose levels.
 
Understanding how to count carbohydrate will help your child to increase food choices and flexibility while maintaining blood glucose levels within the target range. There are two common ways to count carbohydrate.
 

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Carbohydrate portions

A carbohydrate portion is a given serving of food which contains approximately the same amount of carbohydrate.
 
One portion of carbohydrate contains 15 grams of carbohydrate.
 
The dietitian will advise you on the appropriate amount of carbohydrate portion your child needs for each meal and snack. The choices of carbohydrate foods can be changed on different days as long as the total carbohydrate portions for each meal and snack is relatively consistent everyday.
 

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Carbohydrate counting

This is a method to count the total grams of carbohydrate in meals and snacks. A gram (g) is a unit used in measuring foods.
 
You will count the grams of carbohydrate in each of the foods your child eats, and then add them all up to work out the total carbohydrate (g) for the meal or snack. Your child’s meal plan will specify the amount of carbohydrate needed for each meal or snack.
 
This method provides a more precise method of calculating carbohydrate in foods. Children or young people who are on insulin pumps or would like more flexibility may benefit from this method.
 

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Type 2

The treatment goal for type 2 diabetes is to normalise blood glucose as much as possible. Lowering blood pressure and reducing high blood lipids must also be targeted, once optimal blood glucose control has been achieved.
 
First line therapy is weight reduction by making the following changes:
  • healthy eating
  • becoming more active and engaging in regular physical activities
  • continuing to live a healthy lifestyle throughout adulthood
It is very important to involve the whole family/whanau in supporting the young person making healthy lifestyle changes to manage type 2 diabetes. It will improve the overall health and well-being for everyone in the family.
 

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Physical activity

Regular physical activity is important and beneficial for people of all ages. It includes anything that gets your child / young person moving, including walking to and from school, running around the house or in the playground at school, chasing the dog, organised sports, or even helping with housework! It is not necessary to join a gym or buy expensive equipment at home.
 
Physical activity helps to:
  • lower blood glucose levels
  • lower blood pressure
  • improve insulin sensitivity (the ability of insulin to work in the body)
  • manage weight within healthy range
  • strengthen muscles, heart and bones
  • increase flexibility and body co-ordination
  • increase energy levels
  • improve self-esteem and confidence
  • improve overall well-being
It is important to encourage children / young people with diabetes to be active as part of their daily routine – at home, at school and at play, and also throughout adulthood. Physical activity should involve the whole family for both support and overall health benefits.
 
If your child is using insulin therapy, your local diabetes team will discuss with you all aspects of balancing blood glucose control, insulin dosage, carbohydrate intake and physical activity, in relation to hypoglycaemia. The care plan for certain types of physical activities may be different and your child will be given individualised guidelines regarding exercise.
 
Tips to increase level of physical activity of your child / young person:
  • every activity counts!
  • involve the whole family
  • see activity as an ‘opportunity’ not inconvenience
  • think of fun activities that you child/young person likes doing
  • look out for activities for children/young people on community newspapers, local community centre, social clubs and teams
  • limit time for inactivity such as watching TV, playing video or computer games
  • avoid driving when walking is possible - walk to the dairy, for instance
  • find ways to be active - park the car further from your destination, take the stairs instead of the lifts
  • take children/young people to the park and beach on a nice day and encourage activities there
  • encourage your child/young person’s friends to visit and play
  • be a role model – be active! Support and encourage children/young people to participate in activities and try out new ones.
  • a pedometer may help to motivate your children/young person and yourself to make every step count (you can have a competition in the family!)
It is important that your child / young person sees a dietitian for individualised advice at least once a year to ensure the current meal plan is appropriate for optimal growth and development. A dietitian can also provide you with up-to-date information on the dietary management of diabetes and advice on changes to your child / young person’s meal plan.
 

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Acknowledgements

Fact sheet produced in collaboration with the Starship Diabetes Service.
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Endorsement

This fact sheet was endorsed by PSNZ - 14/08/2009

Copyright

Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2012


The Paediatric Society of New Zealand
http://www.paediatrics.org.nz 		Starship Foundation
http://www.starship.org.nz