University College Hospital Eating well with diabetes Children and Young People s Diabetes Service
Introduction Eating well is an important part of diabetes management. A well balanced diet is important for everyone. Following a meal plan based on healthy food choices helps to manage blood glucose levels. The foods you eat should provide all the nutrients you need to grow and develop, be a healthy weight and keep your heart healthy. There are no foods that need to be completely avoided, just try to make healthy choices most of the time. Foods provide us with: carbohydrate protein fat vitamins and Minerals It is important to know which foods contain carbohydrate in order to match insulin with these foods (carbohydrate counting). What is healthy eating? The foods we eat can be divided into five food groups. The Eatwell guide below shows you these groups. If you eat a variety of foods from across the groups, you will have a well-balanced diet. Eat more foods from the bigger sections. Try to have plenty of starchy foods (yellow), plenty of fruits and vegetables (green), some milk and dairy foods (blue), some protein foods (pink) and some healthy fats (purple). Carbohydrate is found in foods from all of the food groups.
Breads, rice, potatoes, pasta and other starchy foods Bread, rolls, crackers, chappatis and injera Breakfast cereals and oats Pasta, noodles, rice, couscous and other grains Potatoes, yam and plantain Products made with flour or other grains such as maize, millet or cornmeal These foods provide carbohydrate (energy), fibre, B vitamins and some minerals, such as calcium and iron. Have something from this group at all of your meals and most of your snacks. The glycaemic index (GI) ranks carbohydrate foods into how quickly they are digested and released and how quickly they impact blood glucose levels. Choose slowly released (low GI) options such as oats, granary/seedy breads, sourdough bread, pitta bread and wraps, sweet potato, new potato, basmati rice, pasta, noodles and other grains such as couscous. Including fruits, vegetables, milk, yoghurts, beans and pulses with meals also lowers the GI. Avoid carbohydrate foods with added fats and sugars, such as sugary cereals, fried rice and chips. Go for plain cereals, porridge, boiled pasta and rice or boiled or baked potatoes most of the time. Milk and dairy foods Milk Cheese Yoghurt These foods provide protein, calcium and vitamins. Calcium helps keep your bones and teeth healthy, which is very important when you are growing. Milk and yoghurt contain carbohydrate, cheese contains no carbohydrate. Have three portions of dairy foods each day. One portion is one pot of yoghurt, a glass of milk, milk on your cereal or a matchbox sized piece of cheese. From the age of 2 years, most children can have semi-skimmed or skimmed milk and dairy foods, unless your Dietitian has recommend otherwise Other ways to include more dairy foods could be custard, rice pudding, milk puddings or cheese sauces
Fruits and vegetables Fresh fruits and vegetables Frozen fruits and vegetables Tinned fruits and vegetables Salad vegetables Pure Fruit juice Dried fruits This group provides a variety of vitamins and minerals and fibre. Vitamins and minerals are essential to keep your body healthy and fibre looks after your digestive system. All fruits and some vegetables contain carbohydrate. Aim to have at least five portions of fruits and vegetables each day; one portion is about one handful (for each individual). Include fruits and vegetables at every meal. Try to include a wide variety of different coloured fruits and vegetables as different colours provide different vitamins and minerals. Only have a small amount of fruit juice with a meal, rather than drinking lots in between meals as the natural sugars can increase your blood glucose levels quickly. Fruit juices only count as one portion of your fruits and vegetables each day, however much you drink. It is best to eat whole fruits, which also contain fibre. When choosing tinned fruits and vegetables, go for those tinned in natural juice or water, rather than brine or syrup to help limit the salt and sugar in your diet. Here are some fun ways to include more fruits and vegetables in the diet: Make homemade vegetable soups Dip crudités like carrot, cucumber, celery and pepper into dips like soft cheese, tomato salsa, hummus or guacamole Freeze slices of banana and blend to make ice cream Thread pieces of fruit onto skewers to make fruit kebabs and dip into yoghurt or custard Add chopped fruit or dried fruit to cereal or porridge Grate carrot into sandwiches or wraps, it works well with hummus or grated cheese Mash squash, swede or carrot into mashed potato Cauliflower or broccoli cheese Grate carrot or courgette into tomato pasta sauces
Meat, fish, eggs, beans and other non-dairy protein foods Meat (beef, pork, lamb) Meat products (sausages, burgers, meatballs) Poultry (chicken, turkey) Offal (liver, kidney) Fish and shellfish (fresh, frozen, tinned) Eggs Beans and pulses (baked beans, chickpeas, lentils) Nuts Vegetarian meat alternatives These foods provide protein, iron and other vitamins and minerals. They are important for growth. Aim to have these foods with two-three meals each day. Some of these foods can be high in saturated fats, try to eat less high fat and salty processed meats, such as salami, sausage and beef burgers and fried fish and meats. Remove the fat and skin from meat and go for more lean meats and fish. Try to replace some meat with beans and pulses. For meals made with mince like lasagnes, bolognaise, cottage pie or shepherds pie, try using turkey mince sometimes, or swap half the mince for a can of lentils or beans Lentils and beans also work really well in curries, soups and stews and make the meat go further You should try and have some fish once or twice each week. Try to have oily fish such as salmon, mackerel or sardines once each week. Oily fish contain omega 3 fatty acids, which are good for your heart. Try fish cakes, fish fingers or fish pies as a way of introducing fish into the diet. Oils, Fats and Spreads Butter, margarine, spreads Cooking oils Fats are important for a healthy nervous system, but too much can cause you to gain weight and increase blood cholesterol levels It is better to have more unsaturated fats from vegetable oils like rapeseed oil or olive oil, cook with small amounts of oil (up to 1 teaspoon per person) and use thin spreads of spread Include other sources of unsaturated fats such as nuts, oily fish and avocado in the diet Limit saturated and trans-fats found in butter, ghee, cakes, biscuits, pastries and fried foods. Saturated fats increase insulin requirements in Type 1 Diabetes
Foods and drinks high in fat and/or sugar Mayonnaise and salad dressings Biscuits and cakes Puddings and ice-creams Chocolate and sweets Crisps Sugary drinks Sweet and savoury pastries These foods are not essential to good health, but we all enjoy them. Eating too many of these foods can lead to you becoming overweight and cause tooth decay, therefore include these foods occasionally in small amounts Sugar and Sweeteners Diabetes does not mean you need to eat a completely sugar free diet. It is important for us all to eat less sugar as part of a healthy diet. Sugars are a type of carbohydrate. Glucose; is the simplest sugar, it makes your blood glucose rise quickly. You need to avoid foods which contain lots of glucose unless you are treating low blood glucose levels (hypos) or preventing low blood glucose with exercise. Sucrose or table sugar makes your blood glucose rise but not as quickly as glucose. It also causes tooth decay. Sucrose will give you energy, but does not provide you with any other nutrients o Sugar 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 that contain added sugar are often higher in carbohydrate and fats and should be limited as part of a healthy diet. o Foods containing sugar often do not raise blood glucose levels as high as some common starchy foods. Sugar (sucrose) has a medium glycaemic index, many sugar-containing foods such as milkshakes and yoghurts have low GI values. Lactose and Fructose are the natural sugars found in milk and dairy foods and fruit. They produce a slow and steady rise in your blood glucose. You can eat plenty of fruit and have low fat milk or fruit juices to drink at meal times To eat less sugar: o Do not add sugar to food and drinks. You can use an artificial sweetener in place of sugar e.g. Canderel, Splenda, Sweetex. Artificial sweeteners should only be used in small amounts. o Always have no added sugar or diet drinks. o Limit sweets and chocolates to after meals and try not to eat them too many times a week. o Have reduced sugar options e.g. reduced sugar jams, sugar free jelly, fruit in natural juice o Try and offer plain, less sweet biscuits and cakes. Avoid chocolate coated and cream filled biscuits.
Other things to consider: Salt Too much salt in the diet is not healthy and can cause high blood pressure. Try not to add salt at the table, and flavour with herbs and spices when cooking instead. Much of the salt in our diet comes from salty processed foods. Limit salty processed foods such as ready meals, pizzas, baked beans, soups and processed meats. Check the labels of products and choose the ones lower in salt Drinks It s important for all children to drink enough, staying well hydrated keeps you healthy and helps you to concentrate at school Sugary drinks damage your teeth, can cause you to become overweight and cause your blood glucose levels to rise quickly. Avoid sugary drinks, such as fizzy drinks, sports drinks, fruit juice and squash, unless you need them to treat a hypo Go for water or semi-skimmed milk most of the time, remember milk contains carbohydrate. Limit fruit juice to a small amount with a meal up to once a day Sugar-free fruit squashes or diet fizzy drinks are OK to have sometimes, they do not affect your blood glucose levels, however they can damage your teeth Diabetic Products Diabetic products are not recommended; they are often high in fat, expensive and contain sugar alcohols, which act as a laxative and may upset your tummy. If you would like a treat, go for a small amount of normal food occasionally and count the carbohydrates. It can be easier to manage your blood glucose levels if they are included as part of a meal, rather than between meals. Vitamin D Most of us can meet all of our nutritional needs from foods alone, without the need for supplements, but speak to your Dietitian if you have concerns. Vitamin D has many important functions in the body, including enabling you to absorb calcium, to ensure you have strong healthy bones. Vitamin D is found in small quantities in some foods, but it can be difficult to get enough from our diet. We also make vitamin D in our skin from sunlight; however in the UK this is limited during the winter months. We now recommend that all children over the age of one should take a daily vitamin D supplement of 10 micrograms per day in the winter months. Children who spend little time outside, have darker skin tones or always wear clothes that cover most of the skin may need the supplements all year round
Summary Everyone should try and make healthy food choices. We know that eating more wholegrain and low fat foods can help with diabetes management. To eat well across the day we recommend: Always start the day with something for breakfast. Choosing more slowly absorbed carbohydrate foods helps to manage blood glucose levels. Include a small amount of protein with breakfast for example a boiled egg, some milk or yogurt. Eat 3 meals a day which include some starchy carbohydrate foods Try and have at least a 1.5-2 hour gap between meals and snacks, only snack between meals if you are hungry and stick to small snack items (no more than 15g carbohydrate). Remember snacks may need insulin. Encourage fruit, vegetables and whole grains at mealtimes Avoid drinking milk and fruit juice between meals as these will push your blood glucose levels up. Do not give younger children drinks just before meals as they will spoil the appetite. Limit sweets and treats to after meals and try not to include them every day of the week. Include three portions of low-fat dairy foods each day Include a small amount of unsaturated fat from vegetable oils, oily fish, nuts and avocados each day Having less processed foods and cooking from scratch makes it easier to follow a healthy diet Have a drink with every meal and snack and keep a water bottle to sip throughout the day Avoid diabetic products Consider a vitamin D supplement Limit eating time at mealtimes to no more than 30minutes. Avoid distractions at mealtimes and if possible eat as a family.
Here are some meal ideas to try: Breakfasts Bowl of breakfast cereal served with skimmed milk and dried apricots and chopped banana Bowl of porridge served with dried fruit and honey Bagels with peanut butter and banana Scotch pancakes with strawberries Crumpets with jam and a fruit smoothie Beans on toast with a glass of fruit juice Pancakes & maple syrup Fruit smoothie & low fat cereal bar Wholegrain toast with honey or jam Sourdough bread toasted with poached or scrambled eggs Chopped banana or frozen berries, topped with yoghurt and oats or granola Midday meals Oat cakes with low fat cream cheese and ham Homemade vegetable, lentil or bean soup and crusty bread Sandwiches made with granary bread and a Muller rice or corner yogurt Filled wraps or pitta bread (try egg, tuna, hummus, chicken, ham, cheese or low fat cream cheese with salad) Jacket potato with filling (try baked beans, tuna or cheese) Pasta in low fat sauce/pasta pot Fruit, low fat cereal bars, low fat cake bars as extras Water or sugar-free squashes Fruit juice or milk to drink if extra carbohydrate needed. Main meals Baked fish, served with couscous and oven roast vegetables Burritos served with mixed beans and tomato salsa Ciabatta or pitta pizzas make your own pizza s using ciabatta or pitta bread as the base. Chicken and broccoli gratin served with crusty bread Pork/chicken/tofu and vegetable stir fry served with noodles Risotto or Paella served with salad Pasta meals with low fat sauces and lean meat or fish or poultry in sauces (try tuna pasta bake with tomato sauce) Curry (prawn, chicken, tofu and lentils/vegetables) & basmati rice Cottage pie made with turkey mince and topped with mashed sweet potatoes Baked salmon with new potatoes and frozen peas Egg, potato and vegetable tortilla, served with salad Look for healthy recipe ideas online at: - Change for life - http://www.nhs.uk/change4life/pages/change-for-life.aspx - Diabetes UK - https://www.diabetes.org.uk/guide-to-diabetes/recipes/ - Healthy food guide - http://www.healthyfood.co.uk/recipes/
Making changes to your diet If you feel you need to make changes to your diet, don t try to do too much in one go. Set yourself small, achievable goals and once these have become habit, try another change. Speak to your Dietitian if you would like further advice and support. Contact Details: You can contact the Childrens Diabetes Dietitians on childrensdiabetesdietitians@uclh.nhs.uk Expert advice and information about children and young people's type 1 diabetes can be found at www.uclh.nhs.uk/t1 If you need a large print, audio, braille, easy read or translated copy of this document, please contact us on 020 3447 9364. We will try our best to meet your needs. First published: July 2013 Date last reviewed: September 2017 Date next review due: September 2019 Leaflet code: UCLH/S&C/PAED/CYPDS/HE (WEBSITE VERSION)/1 University College London Hospitals NHS Foundation Trust