By Julieanne Wilson, clinical dietitian and certified diabetes and education specialist at CHOC
Here at CHOC, the endocrinology department sees a lot of patients with Type 1 and Type 2 diabetes. One of the most common reactions from parents upon hearing their child has diabetes is to try to cut out all carbohydrates from their child’s diet.
Often this very low-carb diet is called a ketogenic (keto) diet by our families. There are a few reasons this would not be recommended for children with diabetes.
Why keto is not the best diet choice for kids with diabetes
Carbohydrates give children energy.
Especially if you have an active child, they will likely need a snack containing some carbohydrates and protein prior to intense exercise or play.
Carbohydrates provide fuel for the brain.
If we completely cut out carbohydrates, your child may struggle to concentrate in school.
Keto products are often higher in fat and calories.
Often products labeled as “keto” will substitute carbohydrate-containing ingredients for fat. 1 gram of fat has 9 calories when compared to 1 gram of carbohydrates with 4 calories per gram. While the fat should not spike the blood sugars like carbohydrates would, it could lead to weight gain and higher cholesterol and triglyceride levels. These are things we monitor in the endocrine clinic.
Diet sodas, diet syrup, and sugar-free drink mixes are not included in this “keto” group and we do recommend that your family choose these options rather than the full sugar beverages.
Sugar alcohols can cause an upset stomach.
Many of the keto products on the market utilize sugar alcohols and other sugar substitutes. Large amounts of these can stomach pain, gas, and diarrhea.
No foods should be considered “bad.”
Children and adolescents with diabetes are at higher risk for disordered eating and eating disorders. By making carbohydrates “evil,” we increase the risk of children sneaking them because they are forbidden or fixating on them.
Protein can raise blood sugars.
When carbohydrates are not consumed in the same meal as large amounts of protein, the body is able to break protein down for energy. If your child is on an insulin-to-carb ratio, you may need to calculate insulin for their protein in a very low-carb meal or if they are having a low-carb, high-protein shake.
Often a person with diabetes will need to give insulin for half the grams of protein. For example, if a teen is having a protein shake for breakfast that is 5 grams of carbohydrates and 30 grams of protein, they may need insulin for 20 grams (5 grams carbs + 15 grams from the 30 grams of protein). This may be different for every individual.
What dietitians recommend instead of a super low-carb diet for kids with diabetes
Include whole grains in diet.
Not all carbs are created equal. You will likely notice more stable blood sugars when choosing whole grains like wheat bread, brown rice, and whole grain pasta as the source of carbohydrates in the meal. The higher fiber content of whole gains slows down absorption, prevents rapid blood sugar spikes, and will keep your child fuller longer.
Consider adding a piece of fruit.
You were likely told not to allow your child to drink juice or regular soda (except to treat low blood sugars) when they were diagnosed. This is because juice and soda and very sugary without the fiber and other benefits of fruit. Adding a piece of fruit to your meal can help balance your child’s plate as well as providing a sweet source of fiber, vitamins and minerals.
A great snack before sports or exercise could be a piece of fruit with cheese, nuts or peanut butter. This will give them the carbohydrates they need for exercise as well as protein to help maintain them through their play.
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Count carbs for treats.
Sweets like cake, ice cream, and cupcakes should not be part of every meal. However, there are special occasions like birthdays and holidays, when all the other children will be enjoying these festive foods.
For our children with diabetes who are taking insulin, we recommend counting the carbohydrates in the “treat” and giving appropriate insulin. This will allow your child to feel included in the celebration and lessen the feelings of isolation that some of children with diabetes feel.
Include a carb with high protein meals.
Earlier in the article, we discussed calculating insulin for protein. This can be challenging for some families. Often it is easier to add a piece of fruit or some other carbohydrate into the meal. With this additional carb source, you will likely not need to calculate insulin for protein.
If your child is being followed by the endocrinology department at CHOC and you have questions, please ask to speak to a dietitian at your child’s next appointment.
Learn more about CHOC’s Clinical Nutrition Program
At CHOC, we specialize in providing a full continuum of pediatric nutrition services, including inpatient and outpatient services, depending on our patients’ needs.