Q: Our 13-year-old is about 20 pounds overweight. She wants to go on a diet, but I'm worried about how this will affect her blood sugar management. How can a teen with type 1 safely lose weight?
A: Losing excess weight by eating a healthy diet and exercising can have a positive effect on blood sugar management. The key is to take a gradual approach while paying close attention to changes in insulin needs. And of course, you should consult your doctor before your child starts any kind of weight-loss effort.
As for what kind of diet to follow, first make sure your daughter's meals and snacks contain well-balanced nutrition. Is she getting enough fresh fruits and vegetables, whole grains, quality sources of protein, healthy fats, and calcium-rich foods? And at the same time, is she avoiding processed foods and trans fats?
Once you see that she's filling her plate with nourishing foods, start paying attention to portion control to cut calories without sacrificing nutrition. Start reading labels, not just for the carbohydrate count, but to figure out what a serving of a favorite food really looks like. It could be that instead of having a whole bagel in the morning for breakfast, she has half a bagel (with some cheese and fruit to round out the meal). When you eat out at a restaurant -- where portions are typically huge -- can the two of you split an entree? Plan menus together and meet with a registered dietitian for additional help.
Of course, making these kinds of menu changes means paying more attention to insulin dosing. As your daughter eats new foods or adjusts the portions of her normal meals, you will need to determine carbohydrate counts and then calculate insulin requirements accordingly. To keep blood sugar levels on an even keel and avoid lows, don't let her skip meals or snacks. Things like an individual-sized yogurt, a handful of nuts with a glass of milk, or a piece of fruit are good choices for on-the-go kids. As your daughter loses weight, her body may become more sensitive to insulin, and you might find yourself making a few extra adjustments to fine-tune dosing, even if her diet is more or less the same.
This goes for exercise, too. Regular physical activity burns calories and offers many other health benefits, but it can also create changes in insulin needs. When your daughter exercises, even if it's just a brisk walk around the block, make sure she has an easily absorbed carbohydrate with her in case she feels a low coming on; checking blood sugar more frequently when exercising can also help to head off a low. If she does experience a low, make sure your daughter knows that it's important to have a snack – it's not the time to worry about "wrecking her diet." Her body needs the carbohydrates to get her blood sugar back to where it should be.
Before starting a diet, it's a good idea to check in with your diabetes educator and school nurse as well as your doctor to go over your daughter's plan and get any additional feedback.
And don't forget to give your daughter lots of positive motivation to reach her goals. Join her for walks, reinforce her efforts by making sure everyone in the family is eating healthy, and let her know you're proud of her for taking such good care of her health.
--Mario I. Brakin, M.D., medical director of the Endocrine & Diabetes Center at Miller Children's Hospital Long Beach in California.
How Other Parents Deal
"There are so many things that only my daughter has to do because of her type 1 diabetes, but eating healthy and exercising is something that every member of the family can take part in. We love our after-dinner family walks!"
--Stephanie, mom of 14-year-old Amber
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.