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Food psychology:why dietitians should take a holistic approach to treating children with T1 diabetes

Taking a holistic approach to treating children wi
Photo: Taking a holistic approach to treating children with T1 diabetes
When Beck Davis was told her four-year-old daughter, Mackenzie, had Type 1 Diabetes, she was overwhelmed by the enormity of knowing this was an incurable condition, and would require daily management for her lifetime.

“Doctors pull no punches when diagnosing Type 1 diabetes and will tell you directly to your face that there is currently no cure,” says Ms Davis.

“The fact that your child will most likely live with this for the rest of their life is enormously overwhelming.”

When most people think of diabetes, the minefield of potential dietary restrictions often  comes to mind, and from the beginning, Ms Davis felt this focus on food was problematic.

“She was only four years old, which in itself can present some challenges with foods, but there was a lot of reference to the word ‘diet’, and foods with big red crosses through them.
“Children with Type 1 Diabetes do not have different nutritional requirements compared with other children,” says Accredited Practicing Dietitian, Exercise Physiologist, and Diabetes Educator, Kate Save.

Rather, a consistent diet is required to match doses of insulin given, and achieve good control of blood glucose levels.

"It is important to have regular meals and snacks from all five food groups as described in the healthy eating guidelines," she says.

"Low blood sugar also known as hypoglycemia can be very dangerous and requires immediate attention. Low blood sugars levels are treated by consuming easily digestible carbohydrates such as honey or jellybeans. If left untreated it can be life-threatening."

When it comes to Type 1 Diabetes and diet, there are plenty of misconceptions, and this can lead to confusion among parents, and fear among children.

“There are a lot of misconceptions amongst the general population about diabetes,” says Ms Davis.

“There is also an unfair stigma aligned with people who live with both Type 1 and Type 2 Diabetes. I think a lot of people are confused about food, and we all should do the best we can.”

Ms Save says one of the biggest misconceptions is that people with Type 1 Diabetes can’t have sugar.

Another is that Type 1 Diabetes can be reversed with diet and exercise.

“(Some people think that) when people with diabetes experience episodes of high or low blood sugar, it means they aren’t taking care of themselves.”

This combination of confusion, misconception and stigma, can unfortunately lead people with diabetes to form a negative relationship with food.

“Studies show that a person with Type 1 Diabetes is more than twice as likely as the average person to develop an eating disorder,” says Ms Save.

“The dual diagnosis is likely due to people with Type 1 Diabetes being taught to be so focused on food, and managing what they eat.

“Perceptions of food may become distorted which may increase the risk of developing an eating disorder.”

With Mackenzie now a teenager, Ms Davis says encouraging a positive relationship with food is crucial, to ensure both the physical and mental wellbeing of her daughter.

“There is an enormous amount of pressure on young girls and women to look a certain way, and we identified early on that anything less than a healthy, positive relationship with food would be unacceptable.

“How we speak about food, how we choose to enjoy food, and how we allow food into our lives, forms the basis of that relationship for her.”

Instead, Ms Save recommends parents empower themselves with knowledge, understanding the food they eat, and the foods they provide for their child.

“When preparing food for children with Type 1 Diabetes the main nutrient that needs to be considered is carbohydrates," says Ms Save. 

“Carbohydrates have a direct impact on blood glucose levels and need to be consumed at all meals.

“Carbohydrates can either have a high glycemic or low glycemic index. A high glycemic index means that the sugar is digested into the bloodstream quickly leading to a spike in blood glucose levels.

Whereas, a food that has a low glycemic index has a slower release keeping blood glucose levels more stable.

“Learning how to count the carbohydrates in a meal is important to ensure the amount ingested matches the insulin dose.”

While dietitians play a crucial role in assisting parents of children with Type 1 Diabetes, how that information is delivered to patients may impact their ability to maintain self-care, due to overwhelm or unsustainable expectations.

To promote positive mental health, and proactive diabetes management, Ms Davis believes educators and dietitians should take a holistic approach to educating.

“Dietary advice for Children with Type 1 Diabetes should be holistic, encompassing  physical, mental and emotional health,” she says.

“I think dieticians are amazing for the work that they do to educate people on what food does once it enters the body.

“But not all educators/dieticians have hands-on experience with Type 1, and parenting a diabetic child is vastly different to providing clinical support. More compassion is needed, and less judgement when things aren’t going to plan.”

Ms Save says when parents aren’t properly educated in lifelong implications and management of Type 1 Diabetes, they’re likely to become confused by the misinformation that is out there.

“The burden of Type 1 Diabetes management is high due to the potential outcomes if not managed correctly.

“This is likely to contribute to a high level of parental stress.”

For Ms Davis, maintaining a long list of restricted foods simply wasn’t sustainable, nor did she believe it would it give their daughter the best chance of developing a healthy relationship with food. 

“So, we took a lot of the advice that was given to us and used it to create what was best for our child.

“On paper, lists of good and bad foods might seem like the answer, but in reality, all kids require a balanced diet and regular exercise, alongside fun, laughter, love and encouragement.”

Although dietitians understand the dietary requirements or implications of Type 1 Diabetes, and additional training is not required , Ms Save says it can be beneficial to upskill in this area if you wish to specialise in this field.

Health professional training in Type 1 Diabetes and carbohydrate counting is offered by Baker Heart and Diabetes Institute, OZ Dose Adjustment for Normal Eating (OZdafne) and Diabetes Australia.

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Nicole Madigan

Nicole Madigan is a widely published journalist with more than 15 years experience in the media and communications industries.

Specialising in health, business, property and finance, Nicole writes regularly for numerous high-profile newspapers, magazines and online publications.

Before moving into freelance writing almost a decade ago, Nicole was an on-air reporter with Channel Nine and a newspaper journalist with News Limited.

Nicole is also the Director of content and communications agency Stella Communications (www.stellacomms.com) and a children's author.