Food and healthy eating
- Key points
- Introduction
- The Australian dietary guidlines for children
- Components of food
- The healthy food pyramid
- Carbohydrates
- What about sugar?
- Meal planning
- Proteins
- Fats
- Fibre: make sure your child has enough
- Fluids
- 'Free' foods
- Reading labels
- Artificial sweeteners
- Special diabetic products
- Advice for specific age groups
- Children's parties
- Healthy takeaways
- Adapting recipes
- Snack ideas
- Diabetes and coeliac disease
- Common questions and answers
| Key points |
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Introduction
THE diet or food plan for diabetes is really just a healthy way of eating- and it is good for the whole family.
This section of the site is all about food and diabetes. Your dietitian will go through all of this information with you to ensure you develop a good understanding of the food plan for diabetes. The healthy eating plan that is promoted for diabetes is basically the same that is promoted for all children. Throughout this section you will learn how easy it is to prepare and eat good food. The rewards for following a healthy eating plan will be that your child will feel fit and healthy and will grow and develop normally.
The Australian dietary guidelines for children
THE Australian dietary guidelines (from Australian Nutrition Foundation) are great for all people to follow- including children and adolescents with diabetes. They can be summarised as follows:
- Enjoy a wide variety of foods
- Eat plenty of breads- cereals- vegetables and fruit
- Eat only moderate amounts of sugars and foods containing added sugars
- Children need appropriate food and physical activity to grow and develop normally. Growth should be checked regularly
- Low fat diets are not suitable for young children under five years. For older children- a diet low in fat- in particular saturated fat- is appropriate
- Encourage water as a drink. Alcohol is not recommended for children and adolescents
- Choose low salt foods
- Eat foods containing calcium
- Eat foods containing iron
- Encourage breastfeeding
Components of food
FOOD comes in a variety of shapes- sizes and colours and has many different tastes and textures. Most foods are made up of a combination of nutrients.
A basic understanding of the different nutrients that are contained in the food we enjoy eating is important.
The main nutrients in food are:
- Carbohydrates: Carbohydrates are the most important source of energy for the body. Out of all the nutrients- only carbohydrates directly affect blood sugar levels. The amount and type of carbohydrate eaten are both very important. Examples of carbohydrate—containing foods are bread- pasta and milk.
- Proteins: Proteins are important building blocks in the body and are essential for normal growth and repair of body tissues. Examples of protein—containing foods are meat- fish and eggs.
- Fats: Fats and oils are also essential for growth and development and are an important source of energy. A certain amount is essential for good health but too much or the wrong type becomes unhealthy.
Other nutrients and components of food include:
- Vitamins and minerals: These are important for the normal functioning of many body processes. The best way to have a balanced vitamin and mineral intake is through a healthy variety of foods- especially fruit and vegetables.
- Fibre: An adequate intake of fibre is important for bowel health and is believed to have a number of long—term health benefits.
- Water: Water is the most common component of the body. Drinking plenty of fluids is important for general health. Your child should drink more if it is hot- and if they are more active or have high blood glucose levels. Water is the healthiest fluid of all to drink.
The healthy food pyramid
THE healthy food pyramid provides a basic guide to healthy eating for all people. It emphasises the type of foods that we should eat most- those that we should eat moderately and those that should only be eaten in smaller amounts. This advice applies to all children and adolescents- whether or not they have diabetes.
Carbohydrates
CARBOHYDRATES or ‘carbos’ are energy foods. During digestion- carbohydrates are broken down into glucose and are absorbed into the blood. Blood glucose is the fuel for our body just as petrol is the fuel for a car. Blood glucose levels go up and down throughout the day. They rise after eating carbohydrate and fall as we use the glucose in our blood for energy.
In people without diabetes- blood glucose levels are closely controlled by insulin produced by the pancreas in response to the food they eat. In people with diabetes- the amount and type of carbohydrate eaten is balanced with the amount of insulin given by injection. It is important to eat regular carbohydrate meals throughout the day to keep the blood glucose levels in balance. People with diabetes usually cannot go longer than three hours without eating carbohydrate during the day because the injected insulin is still being absorbed. For this reason three main meals (breakfast- lunch and dinner) and three snacks (morning tea- afternoon tea and supper) are usually recommended. Toddlers tend not to eat regular meals and need to have food containing carbohydrate every 2—3 hours — this is called grazing.
Carbohydrates: what type when and how much?
Understanding these questions is the most important part of the diabetes food plan.
The main points are:
- Think about the type of carbohydrate. Different carbohydrates have different effects on blood glucose levels. This concept is called the glycaemic index of food. It is important to try to include low glycaemic foods as much as possible as these will give smoother blood glucose control.
- Spread the intake of carbohydrate foods across the day. Mostly this will be divided into three meals (breakfast- lunch and dinner) and three smaller snacks (morning tea- afternoon tea and supper) at regular times each day.
- Aim to eat approximately a similar amount of carbohydrate at similar times each day- although some variation is natural. Using a simple system such as exchanges or serves can be a useful guide.
Type of carbohydrate and the glycaemic index (GI)
Different carbohydrates have different effects on blood glucose levels because of differences in rates of digestion and absorption. This concept is called the glycaemic index or GI. Foods with a high GI are quickly digested and absorbed and cause a rapid and large rise in blood glucose levels. Foods with a low GI are more slowly digested and absorbed and produce a more gradual rise and fall in blood glucose levels- which is preferable for children with diabetes. We usually consume a mixture of low- medium and high glycaemic index foods at meal times. It is important to know about glycaemic index and try to include at least one low glycaemic index food in each meal and snack for your child. This will help achieve more stable blood glucose levels.
| Try to include at least one low glycaemic index food in each meal and snack for your child. When the GI is low- the blood glucose rise is slower and lower. |
The glycaemic index is all about understanding the effect of different carbohydrates on blood sugar levels. There are a number of factors that influence how carbohydrates are digested- including fibre content- cooking and processing- amount of fat and protein- presence of sugar- type of sugar and type of starch.
A scoring system (called the glycaemic index or GI) allows this aspect of carbohydrate foods to be compared. This compares the blood glucose rise of a food to that of pure glucose which is said to have a GI of 100. More detail is available in a number of publications on the subject (eg- The GI Factor and The GI Factor Pocket Guide for Children with Type 1 Diabetes).
As can be seen in the graph below- the blood glucose rise after eating white bread is much quicker and higher than when pasta is eaten. White bread is a high glycaemic index food (GI = 70) and pasta is a low glycaemic index food (GI = 40). Information like this is available for many foods and listed in the references mentioned above and in the book list in section 21.
Comparison of blood glucose levels after eating white bread and pasta
Low GI foods (GI less than 55)
Carbohydrate foods that are more slowly absorbed and digested have less effect on the blood glucose level and are called low GI foods. Children with diabetes are encouraged to include at least one low GI food at each meal and snack. A diet that includes low GI foods produces a slower- more gradual blood glucose response- which is preferable in diabetes.
Low GI carbohydrates include pasta- milk- custard- rolled oats- apple juice- baked beans- wholegrain breads- fruit loaf- noodles and spaghetti- sweet potato- yoghurt- apples- pears- peaches- oranges- grapes- sultanas- All—Bran- dried apricots and low fat ice—cream. Adding lemon juice or vinegar to a meal (as a salad dressing) can also help lower the glycaemic index of that meal.
It has also been recognised that low GI foods have an important carry—over effect. The benefits of a low GI breakfast will carry over and benefit the blood glucose levels at the next meal. A simple change such as switching to low GI bread and having a low GI breakfast cereal has been observed to significantly improve blood glucose control throughout the day.
Intermediate GI foods (GI 55 to 70)
These include basmati rice- crumpets- bananas- regular ice—cream- Vita Brits- Ryvita- oatmeal and Shredded Wheatmeal biscuits- orange juice- pineapple- rockmelon and honey.
High GI foods (GI more than 70)
Carbohydrate foods that cause a rapid rise in blood glucose levels are said to have a high GI. The blood glucose response after consuming these foods is fast and high- indicating that glucose is entering the bloodstream rapidly.
High GI carbohydrates include puffed wheat- white bread- wholemeal bread- baked potato- mashed potato- calrose rice- waffles- jelly beans- watermelon- corn chips- cornflakes- Coco Pops- water crackers and Lucozade. High GI foods can be included as part of a balanced diet- but it is important to combine them with lower GI foods as well.
Many parents have already noticed that some carbohydrates seem to last longer or always produce a more desirable blood sugar level compared to other carbohydrates which seem to be used up before the next meal or snack. This is what the glycaemic index is all about.
The GI should never be used in isolation when making food choices for your child with diabetes. The dietary guidelines for children should always be considered when introducing new foods into your child’s diet. Remember that it is usual to eat a varied diet that includes low- intermediate and high GI foods. If you want to learn more about the GI ask your dietitian for more information.
When to eat
It is important to spread meals out evenly throughout the day so that the carbohydrate balances with the insulin levels in the blood and blood glucose levels stay as steady as possible. Going too long without carbohydrate during the day (longer than three hours) means the blood glucose level may drop too low.
If your child eats all of the carbohydrate for the day at one meal- the blood glucose level would rise too high after that meal- and then be too low later on. Overnight when your child sleeps and is not eating- the blood glucose level is maintained because of the carbohydrate eaten before bed- less activity- less insulin acting overnight and glucose output from the liver. A snack before bed (supper) is important in diabetes to help maintain the blood glucose level overnightinclude some low GI food such as milk.
Your dietitian will usually advise that your child have three main meals each day (breakfast- lunch and dinner) and three snacks (morning tea- afternoon tea and supper). Infants and toddlers don’t always have set meals and tend to graze throughout the day on small meals and snacks. Each meal and snack should contain carbohydrate- but also have a healthy balance from other food groups. More information is given in the section on meal planning later in this section.
Some teenagers and young adults- especially those on very short—acting insulins or insulin pumps- may require little or no between—meal snacks. Your diabetes team will advise about any particular circumstances like this.
How much to eat
The aim is to eat approximately a similar amount of carbohydrate each day. In the past it was thought that measurement of carbohydrate foods needed to be very precise and people weighed or measured exact amounts. Now we realise that this can be more approximate and factors like the type of carbohydrate (especially the GI) are also important.
Even though there is less emphasis on exact quantities of carbohydrate- people will often use a system to help guide the amount of carbohydrate to be eaten at each meal. There will always be some variation in carbohydrate intake from day to day- depending on appetite- activity levels and other factors. As long as the variation is not large- blood glucose levels should remain satisfactory.
Two systems are in common use. You will find that your dietitian may recommend one of these- but either will work well as a simple guide to carbohydrate amounts.
The exchange system (or portion system)
In this system one exchange of a carbohydrate food is the amount that contains approximately 15 grams of carbohydrate. Some examples are given below- but more information can be obtained from the food package label or in books such as The New Traffic Light Guide to Food. Your dietitian will suggest an approximate number of exchanges for each of your child’s meals or snacks (eg- three to four exchanges for breakfast) and you can then choose from a variety of carbohydrate containing foods to make this up. When choosing the foods- you would also think about the type of carbohydrate and choose at least some low GI foods.
The following foods all contain about one exchange (15 grams) of carbohydrate: one slice of bread- one medium banana- 250 ml of milk- one medium potato- one large orange- two scoops of ice—cream- two plain sweet biscuits.
The serves system
This is another type of system that can be used to ensure appropriate carbohydrate distribution over the day. It is not based on a specific quantity of carbohydrate but rather an individual’s preferred serving size. Therefore a serve of a particular food is likely to be different for different children and at different ages. This does not matter- as long as you remain consistent from one day to the next.
The number of serves of carbohydrate that your child eats at each meal or snack should be based on their usual intake- activity level and appetite and may vary a little from day to day. Your dietitian will suggest an approximate number of serves for each of your child’s meals and snacks (eg- three to four serves for breakfast) and you can then choose from a variety of carbohydrate—containing foods to make this up. When choosing the foods- you would also think about the type of carbohydrate and choose at least one low GI food at every meal and snack.
A typical serving size may correspond to a slice of bread- a glass of milk or juice- one piece of fruit or simply the amount that fits into the palm of the child’s hand. The key is to be consistent with serving sizes of particular foods from day to day.
Serves and exchanges are often similar- but not always the same. It is best to get used to one system or another and then follow that. The system that you follow may depend on the local preference in your diabetes centre. Remember that both systems will work well. Your diabetes dietitian will advise.
| As a guide to the amount of carbohydrate for meals and snacks- think about exchanges or serves. |
What about sugar?
SUGAR (or sucrose) is a type of carbohydrate. It is not true that children with diabetes cannot eat sugar.
Sugar or ‘sucrose’can be included as part of a normal healthy diet as long as it is eaten in moderation- especially if included as part of a meal. Foods containing sucrose often do not raise blood glucose levels as high as some common starchy foods. Using the glycaemic index- sugar itself has a GI of 65 which is intermediate and many sugar—containing foods such as milkshakes and yoghurts have low GI values. Foods that contain added sugar are often higher in carbohydrate and fats so it is important to read the nutrition information on the packet so that you can decide if it is a suitable food and estimate how much to eat. This will be covered later in this section.
Meal planning
FOOD is a mixture of carbohydrates- proteins and fats. We need all of these every day in balanced amounts. The amounts required vary for different children- depending on age- appetite and activity levels. There is more detail on proteins and fats later in this section.
Everybody is different- so we need to find out more about your child’s usual diet so that we can work out how much carbohydrate- protein and fat would normally be consumed. Your dietitian will ask what your child and the family usually eat so that a suitable meal plan that fits in with your usual routine can be suggested. Most children and their families are relieved when they find out that their food plan remains basically the same.
Your dietitian will help make sure your meal plan will match your child’s appetite and activity level and promote normal growth and development.
At least half of the food eaten each day should be carbohydrate. Carbohydrates will become the main part of each meal and snack- but it is still important to choose food from all the other food groups to ensure the diet is varied and nutritionally adequate.
Each meal and snack needs to be based on carbohydrate foods. To ensure children are eating a similar amount of carbohydrate each day- you can use one of the systems mentioned earlier as a guide—exchanges or serves. Your dietitian will advise approximately how many exchanges or serves of carbohydrate your child should have at each meal and snack. You will find after a while that estimating the amount of carbohydrate for each meal or snack will become second nature.
At first the dietitian may give you a larger version of a chart like the one below which they will fill in with you as a guide. After a while you will become much more confident about planning meals and may not need to refer to this. Remember that this is an approximate guide only and can be varied a little according to your child’s appetite and activity levels. The meal plan should be reviewed with your dietitian at least yearly.
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Meal |
Foods and amounts |
Carbohydrate exchanges or serves |
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| Breakfast | ||
| Morning snack | ||
| Lunch | ||
| Afternoon snack | ||
| Dinner | ||
| Supper |
Often when children are first diagnosed with diabetes they have lost weight or have not gained weight for a period of time. Once they start on insulin- they soon regain their appetite and often eat more food than usual until they regain their body weight. For this reason- children will eat more carbohydrates at meals and snacks for the first few weeks. It is important that this is reviewed by the dietitian over the first few weeks so that the food plan is adjusted as the appetite settles back to normal and so that the insulin can be adjusted accordingly.
In the longer term as children grow and develop- their carbohydrate intake may increase and insulin is adjusted to match.
Proteins
PROTEINS are important building blocks of the body. Proteins play an important role in growth and repair of body tissue and can also be used as a secondary source of energy by the body.
Protein foods include meat- chicken- fish- cheese- eggs- nuts- legumes and seeds. Some protein foods also contain carbohydrate and fat; for example- milk and yoghurt.
Protein foods can be quite high in fat so it is important to eat foods from this group in moderation as the healthy food pyramid suggests. Choose lower fat options such as lean meats and low fat dairy foods.
Fats
FATS are an important part of our diet and a certain intake is required for healthy growth and development. There are different types of fat in foods- and we now know that polyunsaturated fats (vegetable oils)- monounsaturated fats (canola and olive oils) and omega—3 fats (fish oils) are much more healthy than saturated fats. It is also important to remember that all fats are high in energy- and if too much fat is eaten- excess weight gain may occur.
Why should we eat less saturated fat?
It is important to establish good eating habits from an early age. We know that there is an increased risk of elevated cholesterol and vascular disease in diabetes. Reducing saturated fat in the diet is recommended not only for people with diabetes but for the general population to reduce the risk of vascular disease. A high intake of saturated fat is strongly associated with high cholesterol and increased risk of heart disease.
How can we eat less saturated fat?
The best way to reduce saturated fat in our diet is to reduce the intake of fat from meat and dairy foods and from fats used for frying and baking. Many children’s snack foods are high in saturated fat.
Substituting ‘healthier’fats such as monounsaturates and polyunsaturates will help to control blood cholesterol levels and reduce the risk of heart disease.
Suggestions:
- Try selecting reduced or low fat dairy products in place of traditional full fat products.
- Replace saturated spreads like butter- with monounsaturated and polyunsaturated spreads and oils.
- Try to select low fat options when buying takeaway- and select those that are cooked with oil low in saturated fat.
- Avoid deep frying. Oven baking or grilling is preferred.
- Trim visible fat from meat. Buy lean cuts of meat and lean mince.
- Try to limit takeaways to once or twice a week.
- Watch out for snack foods which are high in saturated fats (eg- chips- cream biscuits and savoury biscuits with a dip).
- Ask your dietitian about suitable snack foods or read the snack section in this site.
- Try canola- olive or sunola oils which are high in monounsaturates- but these may also need to be limited if your child is overweight.
- Avocados are high in monounsaturates but may need to be limited if your child is overweight.
If you would like to read more about fat- a good reference is Rosemary Stanton’s Fat and Fibre Counter which is available in bookshops and newsagents.
Fibre: make sure your child has enough
FIBRE refers to material in food which is generally not absorbed- but is very important in keeping the bowel and digestive processes in balance. It also helps keep our bodies healthy by helping to prevent some diseases- keeping our bowels regular and making us feel full. Fibre is only found in plant foods such as wholegrain and wholemeal breads and cereals- brown rice- wholemeal pasta- fresh fruit and vegetables- legumes and pulses (eg- baked beans and lentils)- nuts- bran and dried fruits. Soluble fibre is linked to reducing cholesterol- and other forms of fibre (eg- resistant starch) are linked with disease prevention.
Think about fibre when you are selecting your carbohydrate foods.
If you want to calculate approximately how much fibre your child needs each day- use the following calculation:
age + 10 grams = grams of fibre required per day
If you would like to read more about fibre- a good reference is Rosemary Stanton’s Fat and Fibre Counter which is available in bookshops and newsagents.
Fluids
HAVING enough fluid intake is part of a balanced healthy eating plan for all people. One of the best fluids to drink is water. Fresh fruit and some other foods contribute to daily fluid intake. Fluids such as milk and juice contain carbohydrate and need to be counted in your child’s carbohydrate intake. Fruit juices should be limited to no more than two glasses per day and consumed in combination with a mixed meal. Diet soft drinks and diet cordials are fine in moderation and will not affect blood glucose levels.
Plenty of fluids are especially important in hot weather and when exercising. During sick days (see section 10)- fluid intake is very important especially if the blood glucose levels are high (water or other carbohydrate—free fluids). When not feeling well- carbohydrate—containing fluids are easier to tolerate than normal foods.
‘Free’ foods
FREE foods are foods that contain minimal amounts of carbohydrate and fats and do not affect blood glucose levels very much- or don’t cause other problems.
The following free foods list includes some vegetables- some fruits- beverages- condiments- spices- flavourings- spreads and sweeteners.
Foods containing protein and fat are not free foods because they are often high in calories. Meat- chicken- eggs- cheese and fish are protein foods that don’t contain carbohydrate. These foods contain some fat and are recommended to be eaten in moderation- not as a free food. A serve the size of your child’s palm can be used as a guide for the amount of meat to eat each day. Also- some free foods (eg- soy sauce- Vegemite) are very high in salt- so large amounts are discouraged.
If your child is asking for free foods regularly- perhaps you need to contact your dietitian about increasing their carbohydrate intake to satisfy their appetite. Eating very large amounts of some free foods can affect blood glucose.
Free foods list
- Vegetables: All vegetables are free except potato- sweet potato- corn- taro- yam and cassava.
- Fruits: Strawberries- lemon- passionfruit- small amounts of kiwi fruit.
- Beverages: Broth- tea- coffee- herb tea- low joule or diet cordial and low joule or diet soft drinks. Limit diet drinks to two to three glasses per day in general. Coffee and tea are generally not recommended for young children.
- Flavourings: Cocoa- coffee- diet toppings- vanilla and other essences.
- Spreads- dressings and seasonings: Vegemite- Promite- Marmite- fruit spreads or jams (small amount) and fish paste- salad dressings and mayonnaise.
- Seasonings such as herbs and spices- garlic- parsley- mint- mustard- tomato sauce- tomato puree- vinegar- Worcestershire sauce- stock cubes- soy sauce- pepper and lemon juice.
Note: Eating too much of some free foods can affect blood glucose
Reading labels
LEARNING to read food labels will be of great help in making food choices. Different products will suit different people- depending on the amount of food they eat- body weight- blood glucose control- blood cholesterol and the amount and type of exercise.
The two main issues to consider are:
- the total amount of carbohydrate (which includes sugar)- and
- the amount and type of fat.
Food labelling standards for Australia and New Zealand have recently been revised and will be implemented over the next few years. Overall- these will lead to more comprehensive labelling of food; and labels will contain at least as much information as they do now. Total carbohydrate will continue to be shown and- beneath this- the amount of the total carbohydrate that is made up of sugars. Total fat will be shown as currently and- below this- the amount of that fat that is saturated fat. Remember that foods lower in saturated fats are generally healthier.
The glycaemic index (GI) of food is not currently listed on packaging- but this will gradually be introduced on some foods as part of the GI symbol program- starting in 2001.
Information to look for
Look at the following information in the nutrition panel:
- Serving size: Compare this with the amount your child will be eating or drinking. Is your serve size the same as that stated on the package? The serving size is the average serving size of the product but your child may eat more or less than this amount.
- Fat: Try to avoid foods high in saturated fat. For snack foods- choose lower fat productsaim for less than 5 g fat per serve or less than 10 g fat per 100 g serve.
- Carbohydrate total: The total carbohydrate includes all sugars and starches- both natural and added.
- Sugars: This tells you how much of the total carbohydrate is sugar. This will include added sugar as well as naturally occurring lactose (milk sugar) and fructose (fruit sugar). For example- sugars can include milk- fruit and fruit juice. It is important to consider the type of the sugar when deciding whether a product is suitable (eg- if a breakfast cereal contains dried fruit then a higher sugar content is acceptable).
- Ingredients: When the ingredients are listed on a product- they are listed in order of ingoing weight. The ingredient which is used most is listed first- and that used least is listed last. If sugar or a type of fat is listed first- this may not be a good everyday food choice. Look for added fats and sugars!
Examples of labels
Here are examples of nutrition labels from two products- and a guide to the information they contain.
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Ski " d'Lite Reduced Fat Fruit Yoghurt 200g |
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Nutrition information |
Per 100g |
| Energy | 382 kJ 91 Cal |
| Protein | 5.4 g |
| Fat | 0.99 g |
| Carbohydrate (total) | 14.9 g |
| Carbohydrate (sugars) | 13.9 g |
| Sodium | 70 mg |
| Potassium | 223 mg |
| Ingredients: Concentrated skim milk- whole milk- skim milk- fruit- live acidophillus bifidus- culture- halal gelatine- thickener (1442). | |
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Arnott’s" Barbecue Shapes |
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|---|---|---|
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Servings per package: about 6 |
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Nutrition information |
Per serving: approx 16 biscuits | Per 100g |
| Energy | 725 kJ 173 Cal |
2070 kJ 495 Cal |
| Protein | 3.9 g | 11.1 g |
| Fat | 8.5 g | 24.3 g |
| Carbohydrate (total) | 20.1 g | 57.5 g |
| Carbohydrate (sugars) | 0.8 g | 2.3 g |
| Dietry Fibre | 1.3 g | 3.7 g |
| Sodium | 378 mg | 1080 mg |
| Potassium | 102 mg | 290 mg |
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Ingredients: Wheat flour- vegetable oil (palm)- tomato powder- salt- skim milk powder- yeast- parsley- Worcestershire sauce- spices- baking powder- vegetable extract- flavouring- flavour enhancer (E635). |
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Questions to ask yourself when reading food labels
This example uses the two food labels above.
- How much yoghurt is my child going to drink or eat?
Your child will eat 200 g if he or she eats the whole tub. Note that the nutrition information is given per 100 g of yoghurt- whereas the usual serving for most children would be the whole tub or 200 g.
- What is the total carbohydrate in this tub of yoghurt?
Since there is 14.9 g per 100 g- there will be 29.8 g in the whole tub (200 g).
- What about the sugars in the yoghurt?
The ingredient list does not contain sugartherefore there is no added sugar in the yoghurt. The sugar indicated on the nutrition panel is the naturally—occurring lactose.
- What is the main ingredient in the yoghurt?
Concentrated skim milk- since it is listed first in the ingredient list.
- Is the yoghurt high in fat?
No- it is very low in fat. The fat content is only 0.99 g per 100 g.
- Does the yoghurt have a low- medium or high glycaemic index (GI)?
This is not shown on the nutrition label. Brief lists of foods and their GIs are given earlier in this section. In general- dairy products have a low GI. To know about the GI of foods in detail- ask your dietitian or obtain one of the references mentioned earlier.
- Are the ‘barbecue shapes’ an appropriate carbohydrate food for everyday eating?
The shapes do contain carbohydrate which is important in diabetes. However- they also contain 24.3 g of fat per 100 g (ie- they are 24.3% fat). Foods with more than 10 g per 100 g should only be eaten occasionally and in moderation. The fat in the shapes is a saturated fat which should be kept to a minimum in the diet. The shapes are also high in sodium (salt). Thus- the shapes should be regarded as an occasional food to be eaten in moderation and not an everyday food.
Ingredients in disguise
Fats and sugar are sometimes called by other names in ingredient lists. Use the following lists to see how many different fats and sugars are contained in your food choices.
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Fat is also known as: |
Sugar is also known as: |
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Nutrition claims on food labels
Food packaging and advertising use a number of terms to make claims about the product. Some of these are explained here: they may not always mean what you think. If in doubt- read the nutrition panel which helps you work it out for yourself.
- Lite or light: May refer to colour (eg- light olive oil)- salt content (eg- lite chips) or to fat content. This can be confusing- so check the nutrition panel.
- No added sugar: May still contain fruit sugar (fructose) or milk sugar (lactose). Check the nutrition panel for the carbohydrate content.
- Cholesterol free or low cholesterol: Cholesterol free does not mean fat free. Cholesterol is only found in products of animal origin. Avocados- for example- are cholesterol free- but not fat free.
- Low joule: The food or drink has been artificially sweetened- but may still contain carbohydrate. Check the nutrition panel.
- Diet: Products that have a lower energy content (kilojoules or kJ) than other similar foods (eg- diet yoghurt).
- Carbohydrate modified: A sugar alternative such as sorbitol is used. Check the nutrition panel for carbohydrate and fat content.
- Low fat: The food contains less than 3 g of fat per 100 g.
- Reduced fat: The fat content has been reduced but the food may still be high in fat (eg- reduced fat cheese). These may still be fine to eat- but consider how much and how often you eat them.
- No added salt or reduced salt: There has been no salt or less salt (sodium) added to the food.
- High fibre: The food must contain at least 3 g of fibre per average serve.
- All natural: A very non—specific claim. Read the nutrition label.
- Toasted or oven baked: Check the fat content of these foods. It may still be quite high.
Artificial sweeteners
A number of different artificial sweeteners are available and widely used in products such as diet soft drinks and cordials and other ‘diet’ or ‘low joule’products. These include aspartame (Nutrasweet and Equal)- saccharin- Splenda- isomalt and cyclamates.
Artificial sweeteners have been widely used and are generally believed to be safe if taken in moderation.
Products such as diet soft drinks and cordials are very popular with people who have diabetes- since non—diet drinks do result in major elevations of blood glucose levels.
Sugar can be enjoyed in moderation as part of a well balanced- low GI diet- making the use of artificial sweeteners mostly unnecessary. Where sweetening is required in a mixed food or recipe (containing carbohydrate- protein and fat)- sugar can often be used. This is because in mixed foods- the absorption of the sugar is slowed down by other ingredients.
Products containing the sweeteners isomalt- sorbitol- mannitol- xylitol and maltitol can have a laxative effect if too much is eaten.
Special diabetic products
THE labelling of food can be confusing. Some foods are labelled as ‘suitable for people with diabetes’or ‘no added sugar’- but they may not be recommended by your dietitian. If you come across confusing food labels- ask your dietitian.
Reasonable choices would be food products labelled as:
- diet or low joule cordials and soft drinks
- diet or low joule jelly
- no—oil salad dressings.
Diabetic confectionary and biscuits are an unnecessary part of the diet and are not encouraged. These ‘special diabetic foods’ are often expensive- offer no benefit over the real thing and may contain compounds such as sorbitol which may have a laxative effect.
Try to avoid:
- diabetic cakes
- diabetic chocolate
- diet biscuits
- carbohydrate—modified jams and diet jams.
Advice for specific age groups
AS children grow and develop- the initial meal plan will require adjustment. The management of diabetes varies greatly at different ages and stages of development.
Infants and toddlers (under five years)
Breastfeeding is encouraged for infants with diabetes. Breast milk or human milk substitute formula remains a major nutrient source until one year of age. Solids may be introduced at four to six months.
Fussy eating- food fads and food refusal are common in toddlers- and when these occur in a child who has diabetes this can cause great anxiety for parents. It is not unusual for a toddler to eat erratically and be unpredictable with activity- and therefore rigid plans of three meals and three snacks are often impractical.
A grazing style diet is promoted- with small frequent snacks containing a variety of carbohydrates throughout the day to prevent hypoglycaemia. The food environment is important- and parents are encouraged to avoid focusing on food or force feeding as this may further contribute to ‘food strikes’. Toddlers are encouraged to participate in the family’s usual eating pattern with extra snacks whenever they are hungry. As healthy eating habits for life are being established by the whole family- a variety of food colours- tastes and textures should be promoted. To guard against parents becoming slaves in the kitchen- toddlers should be given a simple choice between one food or another rather than asking ‘what would you like to eat?’.
School—age children
Children’s energy needs are constantly increasing with rapid growth and activity. Energy intake nearly doubles from six to 12 years of age. Regular review of meal plans is therefore essential. Eating patterns tend to be more regular at this age and most children adapt well to having three main meals and three snacks during the day. School—age children are encouraged to carry ‘hypo food’and be aware of the need for extra carbohydrate for exercise. School—age children need to be guided about choices from the school canteen. Also be careful about swapping of food at lunchtime- which is common.
Adolescents
Adolescence is a natural period of establishing independence and of rebellion- and diabetic management is one more thing to rebel about. Growth is rapid- lifestyle is more irregular and there is often more snacking- eating out and fast foods. The issue of alcohol use may also arise. The desire for independence can cause resentment of any kind of restrictions- particularly if food is the focus.
Adolescents on multiple insulin injections or insulin pumps enjoy the flexibility of being able to adjust daily routines to match their lifestyle. Special attention should be given to girls on multiple injections due to the risks of gaining too much weight. Undesirable practices such as skipping insulin or over—restricting food intake to reduce weight- or episodes of binge eating are not uncommon in this age group.
Children’s parties
WE all love eating out- parties and celebrations. They are important for childrens’ social development- and diabetes is no reason to miss out. For these occasional times- the meal plan can be relaxed without affecting overall diabetes control.
- The number one rule is HAVE FUN! Parties are special for all children.
- Before the party- chat to your child about what foods may be there and what they may choose.
- Allow high sugar foods- but encourage savoury food choices. There are plenty of suitable party foods (eg- chips- Twisties- corn chips- popcorn- fairy bread- ice—creams- dried fruit and nuts- party pies and sausage rolls).
- Provide the host with simple instructions about ‘hypo’management- and reassure them that high sugar foods occasionally will do no harm.
- It is easy to have diet soft drinks and diet cordials at parties for everyone to enjoy.
If blood glucose levels are high after the party- dinner can be smaller than usual but test the blood glucose level before bed and always give supper.
Sometimes children eat less food at parties because they don’t think they can eat party food or they are too busy playing. If this is the case and there have been lots of active games- it is important that your child has a good supper before going to bed to avoid overnight hypos. They may need to eat extra supper if they ate little at the party.
If you are holding the party you can easily control the food provided. Remember to plan lots of active games. Children don’t expect all high sugar foods and anything that is a novelty is fun enough. Try a theme or dress—up party with foods to match (eg- American baseball and hot dogs- Mexican tacos or a Hawaiian pool party). It is also possible to adjust insulin to cope with your child’s party needs talk to your educator or doctor if needed.
Healthy takeaways
TAKEAWAY food can be a part of a healthy eating plan for your child- particularly if you select foods lower in fat and sugar such as the following:
- Sandwich bar: Rolls- bagels- foccacia- pita bread- sandwiches and so on- filled with lean meat- chicken- fish- egg- baked beans or cheese and salad.
- Pasta or pizza parlour: Pasta with tomato—based sauces; lasagne; thin—based pizza; vegetarian pizza topped with tomato- onion- capsicum- pineapple- mushrooms and a light sprinkling of cheese.
- Salad bar: Fresh salads such as coleslaw- potato- tabouleh- pasta- bean and rice; low fat yoghurt; fruit smoothies; fruit salad; pita bread- rolls and sandwiches; milkshakes.
- Chinese: Steamed rice or noodles- stir—fried dishes- steamed dim sims.
- Lebanese: Kebabs with meat or chicken and salad- felafel rolls.
- Hot food or takeaway shop: Hamburgerplain with extra salad- steak sandwich- grilled fish- BBQ or charcoal chicken- chicken burger- baked potato- chunky potato wedges- mashed potato and gravy- soup with a roll- toasted sandwiches.
Adapting recipes
YOU will still be able to use your favourite recipes for meals and snacks. Some modification may be necessary to reduce the fat or sugar content. Discuss this with your dietitian if unsure.
Suggestions in cooking
- Halve the sugar in your usual cake recipes (eg- if the recipe usually has one cup sugar- change it to half a cup). Sugar is still necessary for taste and texture and it doesn’t cause a big rise in blood glucose levels if included as part of a balanced diet.
- Try to use polyunsaturated or monounsaturated margarine- canola or olive oil in cooking in place of butter- lard or dripping.
- Try to use low fat ingredients where possible (eg- low fat cheese and milk).
- Try to incorporate some low GI foods in your ingredients whenever practical (eg- oatbran- dried apricots- muesli- yoghurt- fruits).
Snack ideas
IT is important to have some variety in the foods that your child eats. Some children get into a habit of very limited choices- which they then tire of.
Here are some ideas
- Fresh fruit salad try it with yoghurt or low fat ice—cream.
- Bread- muffins- raisin bread- crumpets or bagels.
- Baked beans or spaghetti on toast- jaffles.
- Currant buns- scones or fruit scones- pancakes or pikelets.
- Microwaved popcorn- or on the stove with a tiny amount of oil.
- Pretzels plain or flavoured.
- Bagels or pitta crisps.
- Dip and crackers or raw vegiesmix low fat yoghurt- creamed cottage cheese or ricotta with french onion packet soup mix or peanut butter.
- Fruit smoothiemix low fat milk- low fat yoghurt and fruit.
- Hot chocolate drinklow fat milk and cocoa mix (eg- Nescafe Chocolate- Jarrah Choco’lait or Diet Swiss Miss) or a couple of teaspoons of Milo in milk.
- Plain biscuits: Milk Coffee- Golliwogs- Full O’Fruit- Date Bar- Malt O’Milk- Marie- Butternut Cookies- Nice- Shredded Wheatmeal- Spicy Fruit Roll- Tea Cake- Tiny Teddies.
- Crackers: Vita Weet- Sao- Salada- Rye Cruskits- water crackers- Cruskits.
- Low fat yoghurtsput a container in the freezer for about an hour to make a delicious frozen snack- or try Vitari or Glis frozen yoghurt while out and about.
- Ice—cream: Vitari- Peter’s ‘Light & Creamy’- Blue Ribbon Light- Oak Light- Frozen Fruche etc.
- Ice—blocks: Billabongs- Paddle Pops.
- Lite flavoured milk or milk with flavouring
- Fruit snack packs.
Ask your dietitian for more snack ideas!
Diabetes and coeliac disease
PEOPLE with type 1 diabetes have an increased risk of developing coeliac disease. Coeliac disease affects approximately 3—5 per cent of children with di