‘Desserts’ is STRESSED spelled backwards.
Due to the staggering global prevalence of Diabetes (all types), it is one of the most intensively funded and researched autoimmune diseases in the world. This NIH report  alone is very interesting when you consider that diabetes comes 7th on the US mortality list (after cancer, heart disease, lung disease etc.) and the 2015 Edition of the IDF Diabetes Atlas report confirms some further worrying results such as it is still unclear why Type 1 diabetes is on the increase globally and why Europe and the Middle East suffer the highest rate of type 1 in children. But it isn’t just clinical research or the pharma industry that invests heavily in this area. As with any other disease which is affected by diet, the food industry will be sure not to be left behind. Companies the world over invest eye-watering amounts of cash to develop and market specialised products for those living with diabetes or other diet-dependent conditions such as coeliac.
Thankfully, the treatment and understanding of T1D has advanced immensely since the end of the last century, where it was widely believed that a low sugar diet was the only way to manage it. Since the 1970’s, supermarkets and pharmacies have been stocking low or sugar-free products to cater for patients with T1D by offering goodies like ‘diabetic chocolate’ and ‘diabetic jam’. The term ‘goodies’ is used loosely here as it’s doubtful they were very tasty and are reportedly prone to causing diarrhoea. Pleasant. Prices were imposed at a premium which forced millions of families out of the market for these products. Instead those less fortunate must choose between withdrawing sugar altogether or facing the longer term prospect of serious health complications as a result of consuming regular sugary products. Neither of those choices sound very appealing to anyone.
From cow to calve
Times have changed though, and in The Netherlands (where I live) those ‘diabetic specific’ food products in the supermarkets are almost non-existent. Why? Well, contrary to popular ignorance (mine included before Noah was diagnosed) sucrose, glucose, fructose and dextrose are not actually ‘bad’ for a diabetic. In fact, just like the rest of us, they play a vital role in a balanced diet. This may be bad news for the food industry as their cash cow dwindles (although we shouldn’t feel too concerned, they have the gluten-free Coeliac “cash calve” to nurture to maturity now…) but it is good news for diabetics. Our improved understanding of the treatment of diabetes means diabetics can basically eat any food group they wish. Of course there are certain foods that work better for a diabetic than others; a low carb diet appears to be getting good long term results on reducing the patients HbA1C. The freedom one gives in the treatment of their child’s diabetes must address reducing the risk of that child developing food association issues later in life, whilst also trying to apply the principle that a diabetic should lead a normal and balanced life like anyone else.
With that in mind, why are desserts so stressful for me as a parent of a T1D child? All kids love a dessert after dinner right? And let’s not forget: desserts are the currency that every parent can bargain with to bribe their child into eating a savoury course properly. It’s a classic and usually effective battle strategy deployed to overcome the food war on most evenings. The underlying principle being the important lesson in discipline and general respect for food. But even though I have told you we are encouraged to treat our children like any other child, there are two significant issues with desserts. Firstly, there are little to no prefab desserts that are both healthy and appealing to small children, and which do not cause a rapid spike in sugar levels immediately after consumption. These spikes are impossible to effectively counteract with chemical insulin. Natural insulin (in the body of someone who does not have diabetes) instantly works and the pancreas provides the correct dosage – always. Secondly, and for myself at least, the most stressful issue is that diabetics must calculate and inject insulin BEFORE they eat a meal.
Allow me to elaborate on the complications this entails. An adult usually lives a fairly well planned daily routine; they know when they will eat, sleep, exercise etc. They also know how hungry they are and can commit themselves upfront to how much food they will eat. As a result, they know more or less how much insulin they need to inject before their first bite. Now let’s consider the same scenario for a diabetic child: because the insulin is injected before the child starts eating you need to be certain of exactly how much the child will eat. Parents the world over understand how unpredictable this decision is under normal circumstances. Parents of young diabetic children are constantly battling between over and under dosing their children at every meal time.
Imagine I have calculated the main meal and dessert to equal 43 carbohydrates and I have injected the required amount of insulin into Noah to counteract these carbs. Unfortunately, after 6 bites of the main meal, he declares he doesn’t like what’s on his plate and flatly refuses to eat any more. In a normal situation, like with my daughter, I would persist and try to ride out the inevitable tantrum. Failing that, I may use the dessert as a bargaining tool or I may opt for the stern discipline route and insist she either eats what is on offer or goes hungry. With a diabetic child however, everything is turned on its head. To begin with, tantrums often lead to hypos and considering Noah is now loaded with insulin and refusing his food, I must face the fact that he is guaranteed to go into a hypo; meaning I will have ‘overdosed’ him if I don’t resolve the problem quickly. Sticking to ones guns and taking the discipline route is never an option in this case. I have no choice but to counteract the insulin by offering Noah an alternative food option. This is always, and understandably, met with a loathing scowl from my daughter who knows she would never get away with that. I can’t blame her if I am honest. Our personal situation is further complicated by our son’s blanket refusal to eat all things ‘fruity’. Noah refuses to eat any fresh fruit, jam, ice-cream, cake, sweets, biscuits, yoghurt…you name it, he refuses it. He is however, a chocoholic, but you show me a chocolate-based dessert that isn’t laced in glucose-spike-inducing-sugars! This is VERY frustrating and totally unrelated to his T1D. I know he will back down one day but I really hope it is sooner rather than later.
So, dessert time is stressful in our house. Once we have weighed the ingredients of the main meal, calculated the carbs, added the dessert carbs, tested Noah’s blood glucose levels, decided on the amount of insulin to give him, popped our wizard hat on and predicted how much he will actually eat, put the plate in front of him and kept our fingers crossed all will go smoothly; we may still be faced with the dilemma of throwing our parental discipline out the window, suffer the wrath of our eldest child whilst trying to explain that in this case one rule does’t fit all and instead give our T1D kid an extra dessert just to counteract the effect of the already injected insulin so we can be sure we are keeping him safe through the night…ARGH!