"Proper planning is really the key to making sure that Halloween is as fun a holiday for kids with diabetes as it is for all children," explains Lori Laffel, MD, MPH, chief of Joslin Diabetes Center's Pediatric and Adolescent Unit and an assistant professor of pediatrics at Harvard Medical School. "We emphasize to parents of youngsters with diabetes that their kids can fully participate in Halloween and other holiday festivities, but it does take planning ahead -- including counting the number of grams of carbohydrates in treats ("carb counting") and, if needed, using extra insulin such as the newer very rapid acting insulins to match the food intake."
Carbohydrate counting is one of several different ways people with diabetes can manage their food intake to keep their blood sugars as close to normal as possible. It entails determining the grams of carbohydrate (carb) in each meal and snack. The reason people with diabetes focus on counting grams of carbohydrate is that carbohydrates tend to have the greatest effect on blood sugar.
Most of the carbohydrates we eat come from starch (bread, cereal, rice, pasta), sugar (desserts), fructose (fruit), lactose (milk), and fiber. Vegetables also contain some carbs, but mostly as fiber, which has a minimal impact on blood sugar; foods in the meat and fat groups contain very few carbs.
While many think that people with diabetes should avoid all forms of sugar, in fact, most people with diabetes can eat foods containing sugar as long as the total amount of carbohydrate (carb) for that meal or snack is consistent with what their healthcare team recommends. For example, one might think that a small candy bar would make blood sugar rise faster than one-half cup of potatoes; but in fact, the potatoes will contribute about 15 grams of carb, while the candy bar only has 15 to 20 grams of carb. So, if a child's meal plan says that he or she can have 60 grams of carb for dinner, a small piece of candy can be incorporated into that calculation on a given evening.
Exercise is a good tool for kids and persons of all ages because physical activity helps the body use insulin better to keep blood sugars in control. Offering children with diabetes and their siblings candy alternatives like crayons, stickers or sugarless gum is another possibility.
Regardless of the time of year, Joslin's diabetes educators stress healthful eating that incorporates carb counting and teach parents about nutritious and tasty alternatives to sugary snacks. For school parties, parents can send in a treat called "ants on a log" (made with celery, peanut butter and raisins) or fresh apples. Small amounts of sweets also can be included for kids with diabetes. Most importantly, kids need to feel they can participate.
Children can and should enjoy trick-or-treating. Parents and kids can discuss together what the child's favorite treats are and work those snacks into the meal plan. "Another great option is to have parents buy back some candy so that kids can use the money to get a non-food fun treat, such as a game or a small toy," says Margie Lawlor, MS, CDE, coordinator of Pediatric Research and Education, who helps lead Joslin/Boston's children's programs. "We never want children to feel deprived or that they have to sneak candy."
Baby Ruth bar (2 ounces) 37
Butterfinger (2 ounces) 41
Hersheys almond bar (1.45 ounces) 20
Nestle Crunch (1.5 ounces) 28
Gummy Bears (11 pieces) 30
Milky Way bar (2.15 ounces) 43
Snickers bar (2.07 ounces) 36
3 Musketeers (2.13 ounces) 46
Heath Bar (1.4 ounces) 25
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