It is important to eat a high carbohydrate and low-fat diet The following practical tips which we have set out in an easy A to Z format will help you reduce the fat content of some of your favourite recipes at the same time as you are lowering their G.I. factor.

Milk. Many people dislike skim milk, particularly when they taste it on its own or in their coffee! However, you can use skim milk in a recipe and no one will notice—and the fat saving is great. For convenience you might want to keep powdered skim milk in the pantry so that can be made up to the desired quantity when you need it. It will taste more like fresh milk if you mix the powder and water according to directions and refrigerate the milk overnight before using it UHT (long life) milk is handy in the cupboard, too.

Nuts. They are valuable for their content of vitamin ?, but they are also high in fat To keep the fat content of a recipe low, the quantity of nuts has to be small.

Oil. Most of our recipes call for no more than 2 teaspoons of oil. Any polyunsaturated or monounsaturated oil is suitable. Cooking spray or brushing oil lightly over the base of the pan is ideal. If you find the amount of oil insufficient, cover your pan, or add a few drops of water and use steam to cook the ingredients without burning. It is a good idea to invest in a nonstick frying pan if you don’t have one!

Pasta. A food to eat more of and a great source of carbohydrate and B vitamins. Fresh or dried, the preparation is easy, lust boil in water until just tender or ‘al dente’, drain and top with a dollop of pesto, a tomato sauce or a sprinkle of Parmesan and pepper. There are many wonderful pasta cookbooks now available. It is definitely worth investing in one to find all sorts of exciting ways to prepare this fabulous low G.I. food. Pasta may appear in your menu as a side dish to meat, as noodles in soup, as a meal in itself with vegetables or sauce or even as an ingredient in a dessert.

Reduce the fat content of minced meat by browning it in a nonstick pan, then placing the meat in a colander and pouring boiling water through it to wash away the fat Return to the pan to continue cooking. It is a good idea to buy the better quality minced beef with less fat.

Stock. If you are prepared to go to the effort of making your own stock —good on you! Prepare it in advance, refrigerate it then skim off the accumulated fat from the top. Prepared stock is available in long-life cartons in the supermarket Stock cubes are another alternative. Look for brands that have reduced salt.

To saut?. Heat the pan first, brush with the recommended amount of oil or less, add the food and cook, stirring lightly over a gentle heat.

Vinegar. A vinaigrette dressing (1 tablespoon vinegar and 2 teaspoons of oil) with your salad can lower the blood sugar response to the whole meal by up to 30 per cent The best types of vinegars for this purpose are red or white wine vinegar or use lemon juice if you prefer.

Weighing. What’s the weight of the meat you’ve buying? Start noticing the weight that appears on the butcher’s scales and consider bow many serves it will give you. With something like steak, that is basically all edible meat,) 20 to 150 grams per serve is sufficient Half a kilogram is more than enough for four serves. Choose lean cuts of meat. Trim the fat off before cooking or before you put it away. Alternate meat or chicken with fish once or twice a week.

Yoghurt. Yoghurt is a valuable food in many ways. It is a good source of calcium, and ‘friendly bacteria’, protein and riboflavin and unlike milk, is suitable for those who are lactose intolerant Low-fat natural yoghurt is a suitable substitute for sour cream. If using yoghurt in a hot sauce or casserole, add it at the last minute and do not let it boil, or it will curdle. It is best if you can bring the yoghurt to room temperature before adding to the hot dish, lb do this, mix a small amount of yoghurt with a little sauce from the dish then stir this mixture back into the bulk of the sauce.

Zero hit is unhealthy, so speak with the professionals (dietitians) about bow to get just the right amount you need. Our bodies need essential fatty acids that can’t be sythesiscd and must be supplied in the diet Pat does add flavour—use it to your advantage.

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Children tend to lose their appetite during illness, whether it is a simple throat infection or a cold, or some more serious disorder. Perhaps vomiting may occur, or the child will be too nauseated to eat.

Carbohydrates must be given during illness

In ordinary circumstances the natural thing to do is to let the child take clear fluids (or whatever he feels like) and not worry about meals. In diabetes however, it is still necessary to balance the insulin with carbohydrates, as on no account is it safe to omit the insulin during illness.

So with a child with diabetes we cope with loss of appetite or nausea by omitting the proteins and fats from the diet, and giving the carbohydrates in an easily tolerated form. Perhaps the child will feel like dry biscuits, or fruit juice. Perhaps all he can take is barley sugar, or lemonade or coca-cola. In whatever form it is given it must still be equivalent to his usual dietary allowance.

See the doctor if vomiting persists

If vomiting occurs, it is wise to wait a little while and then replace with another, perhaps more acceptable form of sugar. Ordinary soft drink may be tolerated, and it may be better to give small amounts at a time over a period. Even if vomiting is repeated it is probable that some sugar is being absorbed, but it is important to consult your doctor if the vomiting persists or if your child appears ill.

If vomiting has continued over two meal periods you should certainly contact your doctor, but of course earlier if you are worried or if your child appears very ill.

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Why is a diet necessary?

Children in good health and without diabetes, who are provided with plenty of good food, tend to eat enough to satisfy the needs of their body to maintain their good health and to grow properly. Appetite (or a feeling of hunger) and satiety (or the feeling of having ‘had enough’) operate to ensure that the body’s needs are met by determining the amount of food taken at meals. The mechanisms which control appetite and satiety are complex and not fully understood, and if a child has an excess of some foods at one time he tends to compensate for this by eating less at other times.

Appetite may be erratic

Appetite, particularly in children, is not always directly related to the immediate needs of the body. Perhaps pocket money and a visit to the milk bar – or a particularly nice pudding or cake or a party may lead to an excessive intake of carbohydrate on some occasions, while an unpopular dish or an illness may lead to an inadequate intake on other occasions.

The body copes with irregularities of eating in this way by storing the excess foods and using these stores at other times. To do this, insulin is produced by the pancreas to match the intake of food and to allow its storage, as one of the functions of insulin is to store energy, mainly as fat, in the tissues of the body.

The person with diabetes cannot cope with a varying food intake

In diabetes the pancreas cannot meet the needs of the body in this way and it is seldom convenient or possible to judge the varying amounts of insulin, perhaps several times a day, needed to cope with a varying food intake.

Food must be regular

So it is that children with diabetes need a regular amount of food each day. Naturally appetite will still determine the basic amount of food to be taken, and naturally it is important that a child’s healthy hunger is satisfied. However eating binges and large quantities of concentrated carbohydrates are no longer possible but could lead to a return of the illness, due to diabetes.

A diet keeps meals regular

In fact it is generally felt that the safest way to provide a child with diabetes with regular quantities of food is to work out a definite diet programme so that we can be sure that the needs of the body are met and the daily insulin injections are balanced with the correct amount of carbohydrate foods.

A diet is designed to suit the needs of the child The dietitian will judge the diet, taking several factors into account. The most important factor is your child’s appetite – if he has a big appetite and likes plenty of food then (provided he is not getting fat) presumably he needs the food, and the diet must supply it.

Another important factor is knowledge of the basic needs of children of varying ages for growth. Clearly, we want your child to have plenty of food for him to grow properly.

Likes and dislikes, family customs, and family preferences for certain foods or cooking are also important, and are taken into account.

Meals must be regular in quantity and time

In addition to regulating the meals in quantity and type of food, it is also necessary to have them at regular times. These meal times can be adjusted to suit the family, and school or work hours, but they should be at the same time each day.

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Many parents rather dread their children’s adolescence. They have probably heard about rebellion, poor diabetic control and difficult behaviour. They know that they won’t have the same control over their child’s health and diabetes management as they become increasingly independent.

This is true to some extent. On the other hand the teenage years can be fun for the family, and there will be more freedom for parents, especially mothers, who previously had to be responsible for their young child all the time.

The rapid growth that occurs during adolescence and the changing hormone levels in the blood that accompany this growth and sexual development may make diabetes more unstable. Moreover, the teenager tends to have a more variable life-style than before – very vigorous sport one day, sitting around watching television the next. Out late for a party one night, impossible to get out of bed the next day. Too busy for blood tests but plenty of time to monopolize the family telephone.

Naturally all this leads to variable blood glucose levels and less perfect control.

Adolescence is a time when most girls put on weight – often more than ideal. This may also lead to poor diabetic control, but then they think they are too fat (even when they aren’t) and try ‘diets’ which don’t coincide with the diabetic diet they are supposed to be on.

All these factors may upset diabetes control for a while, but they are a natural part of adolescence and neither parent nor teenager has much control over the body’s physical and physiological changes at this time. Regular medical check-ups will help to reassure you and your teenager that things haven’t got out of hand.

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There is more than one type of diabetes, and you may hear things from your friends or relatives about diabetes and its treatment that apply to a form of diabetes that affects older people but not your child or yourself.

Type 1 diabetes mainly affects children and young people, particularly those under the age of thirty. This type of diabetes requires insulin for treatment because the pancreas makes insufficient insulin. It is called ‘Insulin Dependent Diabetes Mellitus’ (shortened to I.D.D.M.) for this reason.

Children may get insulin dependent diabetes

Diabetes affects about one in a thousand children, more in some countries and much less in others. It is most common in Caucasian people and is much less common in Asian people. We now believe that some people are born with an increased risk of developing this type of diabetes. This risk is inherited and helps to account for the fact that diabetes may occur in families and is more common in certain races than others.

The risk to develop diabetes is related to a system in the body called the immune system. The immune system is responsible for the body’s defense against infections and other foreign substances that can invade the body.

The immune system has genetic factors that are inherited — like everything else in the body — by a series of particular genes. There are a number of inherited factors that are concerned with this immune system. These factors are called human leukocyte antigens (HLA for short).

Everyone has a set of HLA factors — there are many different factors and we inherit a set rather like we inherit a blood group.

Certain HLA factors (the important ones are called DR3 and DR4) are linked with a risk to develop insulin dependent diabetes. We sometimes think of them as ‘genetic markers’ because they help us identify whether there is a risk for diabetes or not.

Those people that have the HLA factors that are linked with diabetes risk do not necessarily get diabetes though they have a much stronger chance to do so. We believe that something has to happen to bring on diabetes in such people.

We don’t really know what the precipitating factor is. Probably there are many factors which can do it. We do know that some viruses can precipitate diabetes in children and perhaps there may be other factors in the environment that we haven’t yet identified.

What happens then is that the body’s immune system may turn on its own pancreas and gradually damage the cells that make insulin. This process is called an auto-immune process.

When this process of damaging cells has proceeded to a point where most of the cells have been destroyed or damaged (about 80%) then the body can’t make enough insulin and diabetes develops. This process may take many years.

Older people may get non-insulin dependent diabetes

The other important type of diabetes is sometimes called Type 2 diabetes. This type of diabetes rarely affects children. It is common in older people (usually over thirty years of age) and it particularly affects people who are overweight. It probably occurs in 2% of people in our society though not all people who have this form of diabetes know that they have it in the early stages. In some other countries it is very much more common. This form of diabetes occurs, not so much because there is insufficient insulin, but because the insulin that is produced does not work properly. For this reason it is not dependent on insulin treatment so that it is called Non-Insulin Dependent Diabetes Mellitus (N.I.D.D.M.). It can often be treated by diet, weight reduction and tablets. Occasionally people with this type of diabetes however will benefit from insulin treatment.

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You may need less insulin when you are active

Strenuous exercise also increases the efficiency of insulin, so that when people take regular exercise they may be able to have a lower insulin dose than when they are inactive. Some children – especially those who play vigorous sport – find they need to reduce the dose on days of intense physical training or sport. Knowing how much to reduce the dose comes from your own experience, but discuss it with your doctor if you play sport.

The effect of exercise on the action of insulin may last for many hours (up to 12 hours) afterwards. Thus, someone may have a hypo in the evening after playing sport in the afternoon. It is wise to do an extra blood test before bed if there has been strenuous and unusual exercise during the day. Have extra carbohydrate if the test is low.

The blood glucose level may occasionally rise with sport

Some young people with diabetes find that their blood glucose values rise after sport even though they may have a hypo some hours later. This could be due to taking too much extra carbohydrate before the sport but there is another possible

The body needs energy for exercise and during the intense activity of competitive sport, glucose is released into the bloodstream to provide this energy. This may be in part due to the adrenalin that is released when the body is keyed up for sport. The release of extra glucose may be greater than the body’s need. This could account for the rise in blood glucose values for some people after sport.

Strenuous exercise may be unwise if diabetes control is poor

If blood glucose levels are high and ketones are present in the urine, strenuous exercise may make diabetic control worse. Before embarking on any strenuous sporting activity be sure your diabetes control is satisfactory. This is particularly important for prolonged exercise as the risk of dehydration will increase.

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