The days of “sit at that table until you’ve cleaned your plate” are fading fast. We’re learning that the way many of our parents treated food was… problematic, to say the least. Now, many parents lean more towards encouraging children to listen to their bodies. Eat when you’re hungry, stop when you’re full. No force-feeding, no using food as a punishment. It’s much more natural and causes fewer power struggles. But then, T1D throws a wrench in the whole process. All of a sudden, you go from having an empowered child who listens to their body to a picky eater who isn’t eating the food that they’ve gotten insulin for.
I am not a doctor or medical professional. This article is for informational purposes only. If you are thinking about changing the way you treat your diabetes, consult your medical team for assistance.
First, is picky eating the real problem?
Picky eating itself isn’t a bad thing. Children and adults alike have problems with the tastes, smells, and textures of certain foods. Ideally, our children get to choose which foods they put in their bodies and how much of that food they want to consume.
So, if mealtimes and snacks are causing stress in your household, instead of trying to adjust the way your child is eating, let’s talk about a few ways that you can change the situation to alleviate that stress.
T1D is stressful and complicated. There are various ways to manage T1D, different comfort levels, and dozens of factors that affect bg numbers. That also means we have choices when it comes to type 1 diabetes management.
Take a look at your situation. Do you need to adjust the way your child eats? Or could something else get tweaked so that their diabetes management and their eating habits complement each other?
Kid First, Diabetes First
For general info and guidance on kids and eating, I highly recommend Kids Eat In Color. It’s a fantastic resource for any parent.
I firmly believe in letting kids being kids. T1D or not. If you would allow something prior to diagnosis, I believe that it’s not only possible, but extremely healthy, to do the same thing after diagnosis.
So, if you’d allow your child to skip meals, that’s fine. If they want to graze, that’s cool too. Picky eating (in all of its forms) is ok.
The trick is dealing with T1D as well.
I don’t believe that we should just let kids be kids without a plan for how to manage their diabetes. Diabetes is extremely important and shouldn’t be overlooked. However: Everything is an experiment. And everything can be figured out.
It can be difficult to deal with T1D while encouraging healthy eating habits in children. So let’s go over some of the main situations that can arise with children who are picky eaters.
Sliding scale: a picky eater’s worst enemy
A sliding scale is an older form of insulin therapy, but it’s still used quite widely by endocrinologists. Especially for newly diagnosed children.
If your child is on a sliding scale, that means they only get insulin at designated meal times. They usually have a carb “target” (often an unrealistic one for young children). Then you have 3 or 4 chunks of bg numbers to cross-reference to get the dosage amount.
When Jordan was diagnosed, it looked like this:
- Breakfast: 30g of carbs. If bg is 4-9, give X units of insulin. When bg is 9-15, give X+ units of insulin. If bg is 15+, give X++ units of insulin.
- Morning snack: 15g of carbs, uncovered.
- Lunch: 45g of carbs. If bg is 4-9, give X units of insulin. When bg is 9-15, give X+ units of insulin. If bg is 15+, give X++ units of insulin.
- Afternoon snack: 15g of carbs, uncovered.
- Dinner: 45g of carbs. If bg is 4-9, give X units of insulin. When bg is 9-15, give X+ units of insulin. If bg is 15+, give X++ units of insulin.
- Bedtime snack: 15g of carbs, uncovered.
I don’t recall the insulin amounts, but look at the carbs!! He was not even 3 years old and he was being loaded with over 150 grams of carbs a day. No wonder it was impossible!
Even a lot of adults don’t eat this amount of carbohydrates every day. I’m not a low-carb person. We aren’t a low-carb family. But that was an unreal amount to feed our toddler.
If this is the insulin regimen that your child is on, it’s unrealistic, especially for a child who is often a picky eater. Talk to your diabetes team about switching you to MDI so that you have carb ratios and an insulin sensitivity factor to use. Staying on a sliding scale with a picky eater is bound to cause repeated power struggles, tears, and frankly, unhealthy eating habits.
Missed meals
I often see people who are concerned about missed snacks and meals. If their child doesn’t eat on time, or misses an entire meal, they’re worried that their child will drop low.
Let me tell you: this shouldn’t happen!
If your basal rate is set accurately, whether your child is on an insulin pump or MDI, they should not drop or rise significantly even if they don’t eat for an entire day.
How do you know if your child’s basal is accurate? You do a basal test. Basal is the foundation of diabetes management. When it’s set correctly, everything else is much easier.
Missing meals isn’t really a T1D problem. In fact, it’s a great time to gauge how your child’s basal is doing. If they’re dropping or rising when they miss a meal, their insulin needs to be adjusted. Don’t worry about forcing meals, you can get great info from times that your child misses or delays a meal!
Insulin has been given, and your child changed their mind about eating
Most people give insulin prior to eating. Many will even pre-bolus by 15 or 20 minutes, depending on the food and what bg is doing prior to eating. But what do you do when you’ve given that insulin and then your child decides they aren’t hungry!?
I know you don’t want to replace the healthy meal carbs with candy and sugar. I know. But sometimes, you might have to.
There are a couple of options when this happens:
- Depending on how much insulin was given, and how closely you can watch bg (if you have a CGM or FGM), you can wait and see. Maybe they’ll be hungry in 5 minutes and everything works out. Maybe bg was going up and the bolus actually only covered the rise so no food was needed. Of course, this only works if luck is on your side.
- Have foods that you know they like and make sure they have a decent amount of carbs as a replacement just in case. My kids (the 2 non-T1 kids) go-to is “peanut butter banana wraps”. We just smear peanut butter on a tortilla, throw a banana in there, and wrap it up. That replaces most meals that they dislike. Chicken fingers and apple slices? Cheese and crackers? Sure, it’s not the best meal ever, but it has some nutritional value and it’ll take care of the insulin that’s already in their system.
- If they’re seriously not eating and you need to get glucose into them, you want a high concentration of glucose/ carbs. Take juice boxes for example. There are some that have 25+g of carbs in a juicebox. While others are low in sugar and have less than 10g of carbs in the same size. This is a situation where you’d want the higher sugar choice. This way they don’t have to eat/ drink much to cover the insulin.
Yes, you can try to force them to eat what’s been put in front of them.
But it’s a power struggle that you’re very likely to lose. Especially with the insulin clock ticking. It just causes extra stress and tension for everyone involved and it’ll often end in tears and/or yelling.
Yuck, no one wants that.
When this is a once in a while occurrence, just try to feed the insulin and move on. Making a big deal about it often causes it to happen more frequently instead of stopping it from happening again.
Inconsistent eating habits
Maybe you have a toddler or a child who is constantly changing their mind about which foods they like. They’re very picky about tastes and textures. They’ll often get a few bites into a meal and suddenly decide that they’re done.
You don’t want to give insulin after they’ve eaten, because that causes unnecessary highs. But if you give it before they eat, and they choose not to eat, you end up with some scary lows.
Consider splitting the dose. Give insulin for the amount of food you’re confident that they’ll eat or that you can cover with other carbs if they don’t eat what’s been provided. Then after they’re done, calculate how much insulin is required as a top-up (if any) and give that amount at the end.
This helps to avoid high numbers, while also taking some of the guesswork out of your calculation.
Of course, on a pump, this is easier to do. If your child is MDI, that means an extra poke. Maybe your child is like mine and doesn’t mind that. But if they are quite needle-phobic, you can try an i-Port Advance from Medtronic. It reduces MDI pokes to as little as 1 every 3 days, regardless of how many times you have to bolus.
But what if they’re so picky that it’s IMPOSSIBLE to predict whether they’ll eat at all?
Absolute worst-case scenario, you roll with the punches and start giving insulin after your child is done eating instead of before. Usually, this is just a phase and you can start pre-bolusing once they get more predictable with their eating habits.
Yes, this can cause unnecessary high blood sugar numbers sometimes. If this sounds familiar, you might want to ask your doctor about trying an ultra-fast-acting insulin (Fiasp for instance) if you’re having to bolus post-meal. Fiasp starts working within 5 minutes rather than the 20 most other insulins take, so it can help avoid (or at least curb) the higher numbers.
Unfortunately, when a child is extremely picky and their tastes change often and unpredictably, this is usually the safest choice. Avoiding frequent lows is very important, especially with toddlers who might be non-verbal or don’t understand enough to tell you when they feel high or low.
The bottom line
It’s not the end of the world if your child is a picky eater. Most of the time, there’s a way to navigate any situation in a way that is positive for your child while also taking care of their T1D.
And remember to take a breath. Most situations are not so urgent that you can’t take a moment to calm yourself. Take a step back and look at the big picture. Often, there’s a simple solution that everyone can be happy with.
There are so many devices, different types of insulin, and different management styles. You just have to look at your situation and see what would be best for your lifestyle.
Children with T1D are more prone to eating disorders than children who don’t have T1D. Whenever possible, try to adjust your diabetes management instead of potentially damaging your child’s relationship with food. Find a way to make your insulin work for you, not the other way around.
Happy Carb Counting!
~Leah
Do you have a picky eater at home? Have you tried any of these tips to make T1D management a bit easier? Has something helped you that I haven’t listed in this article? Share your thoughts in the comments!
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