Q: Whenever our 10-year-old daughter goes over to a certain friend's house, she almost always comes home with high blood sugar. What can we say to the parents to get them to understand how important it is to monitor food intake?
A: It is really tempting to view this as an issue with the friend's parents, and it may be, but at 10 years old, a child with type 1 diabetes typically understands the basics of carb-counting and healthy food choices fairly well. So a good first step here, rather than pick up the phone to talk to the other child's parents, could be to sit down and have an honest conversation with your daughter.
Many times we see that children with type 1 who have very strict food rules at home rebel in less structured settings by eating junk food. This type of behavior is not unique to children with type 1, of course, but your daughter needs to understand that sneaking food can get in the way of keeping her blood sugar well managed. How does she feel about what she eats? Does she feel too restricted at home? If she does, could accommodations be made for her to have an ice cream cone or a few extra cookies when she's with her friend or for a special "treat night" at home?
Wanting your child to eat healthy is a good thing to aspire to for any parent, but when it comes to managing type 1 over the long haul, "Everything in moderation" is a good adage to follow. Even with type 1 diabetes, remember that nothing is truly off-limits with proper planning.
On the other hand, sometimes it does come down to talking with the friend's parents. How much do they know about your daughter's type 1? Have you ever made them aware of her care routine and the need to count carbs and check her blood sugar? With everyone's lives so busy these days, don't be surprised if other parents have forgotten which friend has type 1 or what this even means when the child is in their home. It may just take a quick friendly chat to remind them about your daughter's needs.
Come prepared to offer solutions as well. How about inviting the friend to hang out at your house for the next few visits? Or why not suggest that your daughter bring a snack to share the next time she heads over for the afternoon? It's a good social skill to practice, and who knows -- maybe this family will love snacking on hummus and carrot sticks and have you to thank for their healthier habits!
--Theresa Garnero, A.P.R.N., B.C.-A.D.M., M.S.N., C.D.E., is a clinical nurse manager for the Center for Diabetes Services at California Pacific Medical Center in San Francisco, California.
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