Healthy eating is important for all children, including those with type 1 diabetes. The Australian dietary guidelines for children and adolescents provide a basis for making healthy food choices. These guidelines recommend:

Encourage and support breastfeeding

Children and adolescents need sufficient nutritious foods to grow and develop normally
•  Growth should be checked regularly for young children
•  Physical activity is important for all children and adolescents

Enjoy a wide variety of nutritious foods

Children and adolescents should be encouraged to:
•  Eat plenty of vegetables, legumes and fruits
•  Eat plenty of cereals (including breads, rice, pasta and noodles), preferably wholegrain
•  Include lean meat, fish, poultry and / or alternatives
•  Include milk, yoghurt, cheese and / or alternatives - reduced fat varieties should be encouraged for older children and adolescents
•  Choose water as a drink - alcohol is not recommended for children

Care should be taken to:
•  Limit saturated fat and moderate total fat intake
•  Choose foods low in salt
•  Consume only moderate amounts of sugar and foods containing added sugars

Children with type 1 diabetes have the same nutritional requirements as other children. Food choices based on the Australian dietary guidelines along with the right balance of foods from the different food groups is important for managing diabetes.

Carbohydrates, proteins and fats

Food is made up of 3 main fuels:
• Carbohydrate
• Protein
• Fat
The right balance of foods from these different groups can assist with managing blood glucose levels (BGLs), maintaining a healthy weight and cholesterol control.

Carbohydrates

Carbohydrates are energy foods. Carbohydrates are broken down into glucose and are absorbed into the blood stream to provide the body with energy.

Foods containing carbohydrate include:
• Breads & cereals - including breakfast cereals, bread, noodles, rice, pasta
• Fruit - fresh, canned, dried fruit and fruit juice
• Starchy vegetables - including corn, sweet potato, potato, taro, cassava
• Legumes - including baked beans, lentils, chickpeas
• Dairy products - including milk, yoghurt, ice cream and custard
• Biscuits & snack foods - including muesli bars, potato chips, fruit bars, pretzels, crackers
• Sugars - including table sugar (sucrose), glucose, honey, malt, lollies, soft drink, cordial

All carbohydrate foods break down into glucose and directly affect BGLs. The amount, timing and type of carbohydrate foods at meals and snacks is therefore important for managing BGLs in children and adolescents with type 1 diabetes.

Counting Carbohydrates
The amount of carbohydrate at each meal and snack needs to be balanced with activity level and insulin dose to assist maintaining BGLs mostly within the normal range. There are several ways of measuring carbohydrate amount to ensure consistency from day to day. These include carbohydrate exchanges or serves.

Carbohydrate exchanges provide a way of estimating the quantity or amount of carbohydrate eaten. One exchange contains approximately 15 grams of carbohydrate. Exchanges don’t refer to the weight of the food, for example, a piece of bread can weight 40 grams but only contain 15 grams of carbohydrate.

Your dietitian can help you to work out an appropriate carbohydrate exchange plan based on your child's usual food intake, age, activity levels and appetite.

Click here for a list of carbohydrate exchanges.

Timing of meals & snacks
Regular meals and snacks are important for children with type 1 diabetes. Depending on your child's insulin plan, meals and snacks may be required every 2-3 hours to prevent hypoglycaemia or low BGLs. Ask your dietitian about timing of meals and snacks appropriate to your child's day to day routine and insulin plan.

Glycemic Index
The glycemic index or GI is a ranking of carbohydrate foods that provides information about the effect of different types of carbohydrates on BGLs and is an additional tool that can be used to finetune BGLs.

Foods can be classified as low, intermediate or high GI depending on the rate at which they release glucose into the blood stream. Low GI foods release glucose slowly into the blood stream and result in a slow, low rise in BGLs. High GI foods release glucose quickly into the blood stream, resulting in a fast, sharp rise in BGLs.

While counting carbohydrates exchanges or serves is essential for good BGL control, the GI is an additional tool that can assist with managing BGLs. Research in adults has shown that including low GI foods can assist with managing BGLs, weight and cholesterol. One study in children has confirmed some similar benefits for children with diabetes.

To lower the GI of the diet, one low GI food at each meal is recommended. Low GI foods include:
• Wholegrain breads - including Tip Top 9 grain, Burgen Soy-Lin, Performax
• Low GI white bread - Tip Top Energi, Wonderwhite Low GI
• Fruit loaf or raisin bread
• Cereals - including Special K, All Bran, Rolled Oats, Guardian
• Corn and sweet potato
• Pasta - all types
• Rice - Basmati or Doongara
• Legumes - including baked beans, lentils
• Dairy Foods - including milk, yoghurt and custard or non-dairy alternatives
• Fruit - including apples, oranges, banana, pears, plums, peaches, grapes

What about sugar?
Despite what many people think, some sugar can be included by children and teenagers with diabetes as part of a nutritious diet. We know that sugar found naturally in, or added to nutritious foods such as high fibre breakfast cereals, low fat custard and yoghurt should not adversely affect BGLs if included in the overall carbohydrate intake. Foods which have sugar as a main ingredient (eg. soft drinks, lollies) or are high in sugar and fat are not good everyday choices.

Proteins

Proteins are the building blocks of the body. They are important for growth and development, repair of body tissue and can also be used as a source of energy by the body. Protein foods are essential every day, however it is not necessary to eat them in large amounts.

Foods high in protein include:
• Meat, chicken & fish
• Cheese
• Eggs
• Nuts & seeds
• Legumes eg. baked beans, lentils, chickpeas
• Meat substitutes eg. nut meat, tofu
• Dairy foods or non-dairy alternatives

Protein foods can be high in fat, so it's important to eat only moderate amounts of foods from this group and choose lower fat options such as lean meats and low fat dairy foods. Most foods are a mixture of proteins, fats and carbohydrates. Remember that legumes and dairy foods are high in protein and may also contain carbohydrate and need to be counted as part of your child’s carbohydrate exchanges or serves.

Fats

Fats are a normal part of a healthy diet and are essential for growth and development. There are three different types of fats in food:
• Polyunsaturated
• Monounsaturated
• Saturated

The polyunsaturated and monounsaturated fats are found in vegetable oils such as canola, sunflower and olive, poly and monounsaturated margarine, nuts, seeds, avocado and fish. These fats are the healthiest choices.

Saturated fats are mainly found in animal foods such as fatty meats, butter, full fat dairy foods as well as many snack and takeaway foods. These fats can raise blood cholesterol levels and should be limited.

It’s important to remember that all fats are high in energy and eating too much can lead to excess weight gain. Choose poly and monounsaturated fats for cooking and spreads and choose foods that are low in saturated fat.

Making healthy food choices

Reading food labels and comparing food products can help with making healthy food choices. You can use the nutrition information panel to check the fat and carbohydrate content of foods. The ingredient list can also be used as a guide to the type of fats and sugars added to a product. A typical nutrition panel is shown below:

Ingredient list: Foods are listed in order of most to least. If sugar or fat are listed first or second, the product may not be a good everyday choice.

Serving Size: This is the average serving size suggested by the manufacturer. This may not be the same as the serving that your child eats. Use the nutrition panel to estimate your child’s serve size.

Fat: Use this information to compare different products. Look for foods that are low in fat.

Saturated fat: Use this information to compare different products. Look for foods that are lowest in saturated fat.

Carbohydrate (total): This includes starches and sugars present in the food. Use this figure to work out the number of carbohydrate exchanges in the product. Remember that one exchange contains 15 grams of carbohydrate.

Look at the label for the amount of total carbohydrate in the per serving column. Compare how much your child will eat with the manufacturers serving size. Calculate the carbohydrate exchanges in your child’s serve. To work out the exchanges, use the following ranges:

7-10 grams total carbohydrate per serve = ½ exchange
11-19 grams total carbohydrate per serve = 1 exchange
20-25 grams total carbohydrate per serve = 1½ exchanges
26-34 grams total carbohydrate per serve = 2 exchanges

For example using the panel above, if your child eats the suggested serve (200g) this will be equal to 2 exchanges (31.8 grams) of carbohydrate.

Sugars: This tells you how much of the total carbohydrate is sugar. This includes sugar such fructose in fruit, sucrose in biscuits and lactose in milk.

Sodium: This refers to the salt content. If possible, choose products that are reduced in salt or have no added salt.

Healthy snacks & lunchbox ideas

Healthy lunches and snacks are important for good nutrition, optimal growth and development and keeping your child’s BGLs mostly within the normal range.

A healthy lunchbox
Ensuring nutritious choices at school can sometimes be difficult. Allowing your child to help make healthy food choices and assist with packing their lunchbox can help encourage good habits. Labelling food choices or separate lunchbox compartments can help your child to identify carbohydrate foods and spread their food choices appropriately between recess and lunch.

Try some of these healthy lunchbox ideas:
• Sandwiches
– try different types of breads like rolls, grain bread, Turkish bread, bagels, lavash or pita bread
– fill with salad, low fat cheese, vegemite, ham, chicken, tuna, salmon, egg, baked beans, spaghetti or banana
• Pasta, potato or rice salad
• Fresh pieces of fruit eg. apples, pears, mandarins, oranges
• Chopped fruit eg. rockmelon, pineapple
• Fruit in zip lock bags eg. grapes, cherries
• Fruit snack packs (plus a spoon!)
• Crispbreads, rice cakes or corn thins
• Pikelets, scones or low fat muffins
• Low fat yoghurt or dairy desserts
• Dried fruit boxes eg. sultanas, apricots
• Low fat milk tetra pack
• Rice crackers or rice crisps
• Mini cans of baked beans or spaghetti

Lunchbox swaps
Swapping lunches is a popular thing for kids to do. If you find your child doing this, talk to them about appropriate swaps eg. a sandwich for a sandwich, to ensure that they have enough carbohydrate at recess and lunch to avoid a hypo.

Skipping meals
Sometimes at school, kids are too busy playing at meal times to think about eating. For children with diabetes this can put them at risk of a hypo or low BGL. Encourage your child to eat all of their recess and lunch and explain the reasons why this is important. Teachers may be able to assist by supervising (without singling your child out or embarrassing them). If your child is throwing their lunch away or not eating what’s provided, it’s important to find out why – is the food boring, are they too busy at lunchtime, are they too slow eating their food? Involving them in food choices or providing quick and easy to eat foods can help.

The school canteen
Canteen foods can be included by kids with diabetes. Many canteens are now providing healthier choices that are lower in fat, salt and sugar. Discuss the best canteen choices with your child and allow them to buy their lunch occasionally (once a week is plenty) just like their friends.

Healthy snacks
Snacks provide a valuable source of nutrition for kids, so making healthy choices is important. For kids with diabetes, snacks are also important to help keep BGLs mostly in the normal range.
Try some of these healthy snack ideas:
• Fresh fruit eg. apple, pear, banana, orange
• Chopped fruit – rockmelon, pineapple, honeydew
• Fresh fruit salad
• Grapes or cherries in zip lock bags
• Canned fruit snack pack eg. two fruits, peaches, pears, fruit salad, apricots
• Dried fruit boxes eg. sultanas, fruit salad, sultanas and apricots
• Low fat yoghurt and dairy desserts
• Low fat custard
• Corn on the cob
• Baked beans
• Spaghetti
• Breakfast cereal
• Pikelets or scones
• Fruit loaf, fruit bun or hot cross buns
• Crispbread or rice cakes with low fat toppings eg. tomato, low fat cheese
• Popcorn
• Crumpets or English muffins
• Rice crackers with low fat dip
• Rice crisps
• Low fat fruit bars
• Fruit smoothies
• Low fat flavoured milk / milkshakes

Food for sport

Sport need to be carefully planned for kids with diabetes, this includes regular blood glucose testing, insulin adjustment and adequate carbohydrate foods.

Extra carbohydrate foods may be required before, during and after physical activity. This is very individual and depends on factors such as type of activity, duration, your child's individual response to the activity and BGL.

Lower GI foods such as fruit, yoghurt, milk or raisin toast prior to exercise may assist in maintaining BGLs during physical activity. As a guide, one additional serve or exchange of carbohydrate may be required for every 30 - 40minutes of exercise.

Try these carbohydrates before sport:
• A piece of fruit
• A small flavoured milk
• A muesli bar
• A fruit snack pack
• A crumpet or slice of raisin toast
• A ‘fun size’ chocolate bar

To top up during sport, try:
• A 100% fruit juice popper
• A cup of sports drink
• A piece of fruit eg. banana, orange

After sport or physical activity your child may be at increased risk of a delayed hypo. Hypos can occur 12-16 hours after exercise, so testing BGLs later in the day, before bed and sometimes overnight is recommended. Extra carbohydrates later in the day or evening may also be needed to prevent delayed hypos. If you find that your child’s BGL always drops as a result of sport or physical activity, talk to your diabetes team about changes you can make to your insulin dose that might help.

Don’t forget to pack extra carbohydrate foods / drinks and a hypo kit with hypo foods for sports.

Parties

Parties are an important part of socialising for your child. Kids with diabetes should be allowed to join in and have as much fun as everyone else and enjoy some special treat foods. Parties can have different effects on BGLs depending on factors such as activity, excitement and food choices. Testing your child’s BGLs can tell you more about how they respond to different situations.

The following tips can help you and your child manage their diabetes and enjoy parties:
• Ensure that your child eats regular carbohydrate foods while at the party. Talk to them about what choices will be there and remind them of how often they need to eat.
• Ensure that your child has a hypo kit with them at all times. If you are not staying at the party, make sure an adult knows what to do if your child has a hypo.
• Pack some diet soft drink or ask the host to provide diet drinks for everyone.
• Have fun!!
• Test your child’s BGLs later that day or night. If they have been more active than usual, they may need extra carbohydrate foods to prevent delayed hypos.

The following foods can be included as fun party treats:
• Mini pizzas – with chicken, ham or vegie
• Pikelets – plain, banana or sultana
• Chunky chips or potato wedges
• Crumbed chicken strips or fish fingers
• Chicken skewers
• Popcorn
• Ice blocks eg. Billabongs, Paddlepops
• Ice cream in a cone
• Fairy bread
• Crisps or pretzels
• Muffins – try berry, banana or choc chip
• Frozen fruit blocks
• Yummy yoghurt cups
• Fruit kebabs
• Crackers and dip
• Fancy fairy bread
• Chocolate mousse cups
• Diet jelly cups
• Sushi

Eating out and takeaways

Many takeaway foods are high in fat, sugar and salt. To be healthy, it’s recommended that the whole family limit takeaway foods to no more than once a week.

When eating out or choosing takeaway, try and look for choices that are lower fat, salt or sugar like:
• Lean meat or chicken salad roll / wrap
• Doner kebab with lots of salad
• Plain hamburger with lots of salad
• A grilled chicken burger with lots of salad
• Baked potato (skip the butter)
• Toasted sandwich
• Corn cob
• Sushi roll
• Vegie pizza or gourmet pizza
• Toasted sandwich or focaccia
• Small bowl of pasta with tomato based sauce
• Stir fried vegetables & noodles or plain rice

Take care with choosing drinks - avoid regular high sugar soft dinks, choose diet or low joule drinks instead. Look for 100% fruit juice and choose a popper or small bottle.

Lots of takeaways are also very high in carbohydrate (eg. pizza, fries, smoothies). Many takeaway chains eg. McDonalds, Subway, Krispy Kreme now have nutrition information available for their different products. Look for foods that are lower in fat and have about the same amount of carbohydrate as your child would normally eat. If you adjust your child’s insulin depending on what they eat, use the information on carbohydrate content to decide on an appropriate insulin dose.