Managing Diabetes During the Holidays

The holiday season is a time when many people bond over traditional recipes, sweet treats and comfort meals. However, mealtime can be challenging for kids who have type 1 and type 2 diabetes. Suzanne (Maggie) McKay, pediatric clinical dietitian & diabetes educator at Ann & Robert H. Lurie Children’s Hospital of Chicago breaks down the Dos and Don’ts of planning meals for children with diabetes so they can enjoy this special time of year, just like any other child.

For those with type 1 diabetes, the pancreas can no longer make insulin. Insulin must be given via injection for the body to be able to correctly process the carbohydrates eaten and to prevent the blood glucose levels from becoming too high.

When a person has type 2 diabetes, the body’s cells are not as sensitive to insulin, which also leads to high blood glucose levels. Achieving a healthy weight and being physically active can help the body become more sensitive to insulin. Insulin and oral medications may sometimes also be needed.

Planning Meals

Planning meals for children with both types of diabetes is really not that much different than planning meals for children without diabetes. The goal for everyone – even for those who do not have diabetes – is a balanced plate: Half of the plate filled with non-starchy vegetables (about the size of fists), a quarter with starch (about the size of 1 fist), a quarter with lean protein (the size of the palm of your hand), and a serving of low-fat dairy (or dairy alternative) on the side. If a patient requires insulin for diabetes management, a few extra steps must be taken. It is important to use measuring cups or a food scale to help quantify the amount of carbohydrates in the food. This allows for an accurate calculation of how much insulin should be given for a particular meal.

Often, holiday meals have more high carbohydrate-containing foods than typical meals and have high amounts of added sugar, making accurate carbohydrate counting essential to maintaining in-range glucose levels.

Kids with diabetes can eat all holiday foods, including desserts. The only thing McKay recommends avoiding is sugary or caffeinated beverages, including:

• Juice (even 100% fruit juice)
• Soda
• Gatorade
• Lemonade
• Sweet tea
• Energy drinks
• Coffee/Lattes

Sugary beverages cause blood sugar to rise rapidly, and routine consumption can lead to excessive weight gain. Caffeine is not recommended for children and teens, as it can increase heart rate, negatively affect sleep and promote anxiety and stress, among other things. Instead, try fruit-infused water made at home, such as with cucumber and mint! Or choose sparkling water without sugar. If your family chooses to use diet beverages, do so in moderation. 

Other ideas for lower-carbohydrate and lower-sugar alternatives include:

• Mashed cauliflower instead of mashed potatoes (or a 50/50 mixture of the two)
• Fresh vegetables instead of casserole
• Roasted sweet potatoes with cinnamon instead of candied yams

What about treats?

“It’s fine to enjoy a treat during the holidays. My recommendation for children with diabetes is the same as for children without diabetes: Consume an appropriate portion size, with the caveat to provide insulin if that is part of your diabetes regimen,” says McKay. “Consuming the treat/dessert with a meal that contains fat and/or protein can help prevent blood sugar levels from rising too rapidly.” 

Another thing that can help manage blood sugars during the holidays is the order in which you eat your food – at a meal, try eating the non-starchy vegetables and protein first, then go for the rest! This can help reduce blood sugar spikes. 

When going to holiday parties, it can be difficult to know the exact ingredients in every recipe. McKay advises using phone applications (such as Calorie King, Figwee and Cronometer) when estimating the carbohydrate content of unfamiliar foods. If measuring cups are not available or convenient to use, use your hands to help you estimate portion sizes. The size of a child’s or woman’s fist is about 1 measuring cup (about ½ fist for teenage boys and adult men). “One key thing that patients with type 1 should remember is that carbohydrate counting is not an exact science. So, try your best, but it is ok if your carb estimations are sometimes a little off, such as at parties.  The most important thing is to monitor your blood sugars, give insulin before meals, and provide correction insulin doses according to your diabetes regimen” says McKay. 

Over the holidays, remember to include regular physical activity. Activity can play an important role in improving overall blood sugar control. Participating in winter-related activities with the family, such as ice skating, having fun in the snow or going on family walks to look at holiday decorations, are healthier alternatives to sitting in front of the TV. If it’s too cold to go outside, try free exercise videos on YouTube, workouts for kids on the Sworkit app (https://app.sworkit.com/collections/kids-workouts), or Nike workouts on Netflix. Aim for 30-60 minutes of physical activity daily, even over holiday break.

“The holidays are a time to enjoy spending time with friends and family. There is no reason that a child’s diabetes should get in the way of that,” says McKay. 

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