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Common Medical Conditions Requiring Dietary Modifications 219
such as sweets and confectionery, have a very high Young children may not be able to describe any of
glycaemic index as the blood sugar rises high very these early symptoms but parents, teachers or
quickly when these are eaten on their own. To keep carers might notice a child becoming confused or
the glycaemic index of a meal or snack low so that uncooperative. A young child might say he feels
the blood sugar rises slowly a balanced diet as funny or has shaky or wobbly legs. The older child
described in Chapter 1.2 should be offered, may be able to clearly recognize their early signs of
including foods with fibre at each meal: hypoglycaemia.
●● Include fruit with breakfast and at least one fruit To treat hypoglycaemia a child needs to be given
and one vegetable with the other two meals. some carbohydrate that will be rapidly absorbed to
restore the blood glucose levels to within the normal
●● Offer a mixture of white and some wholemeal range. Carbohydrate that is rapidly absorbed will be
varieties of bread and cereals (e.g. wholemeal glucose or sugar or a sugary food or drink.
bread and porridge).
Examples are:
Hypoglycaemia
Hypoglycaemia (low blood glucose levels) may ●● glucose tablets or sweets to suck
occur when:
●● about 50 mL of a glucose drink or non-diet
●● a child has not had enough carbohydrate to squash or
eat – he or she may be late for a meal or a snack
or may have refused to eat ●● 2–3 teaspoons of jam or honey or syrup.
●● a child has had extra exercise without eating If a child becomes confused or uncooperative it may
extra carbohydrate or reducing the insulin dose be preferable to squeeze a glucose gel into the mouth
or rub it on the gums. The glucose will be absorbed
●● too much insulin has been given or it may have rapidly to raise blood glucose levels out of the danger
been given at the wrong time zone. Glucose gels are available over the counter
from pharmacies and can be prescribed. A store can
●● food may not have been absorbed because the be kept handy for hypoglycaemic emergencies.
child has diarrhoea or has vomited
If hypoglycaemia happens frequently then it is
●● alcohol has been consumed – one effect of alcohol time to reassess the child’s insulin regimen and
consumption is to lower blood glucose levels. carbohydrate intake. The solution may be either to
increase the daily carbohydrate intake or reduce
During hypoglycaemia blood glucose levels become the insulin regimen.
too low for the brain to function properly and a child
will not always be able to indicate that they need Coping with food refusal in children
more glucose to correct the hypoglycaemia. with diabetes
General symptoms of hypoglycaemia are: As discussed in Chapter 5.1, toddlers and young
children may at times refuse to eat or they may eat
●● pallor much less of a food than expected, particularly if
they are going through a phase of food refusal.
●● mood swings Food refusal can cause more anxiety for parents of
diabetic toddlers who are concerned about
●● irritability hypoglycaemia. If parents begin to offer alternative
foods, a child soon learns to manipulate the parent
●● headache through food refusal. Force feeding should never
be used and parents can try to minimize their
●● hunger anxiety, relying on the child becoming hungry as
their blood glucose level falls. One solution is to
●● fatigue
●● becoming uncooperative
●● becoming confused
●● finally losing consciousness and fitting.
