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Please explain the concept that patients with diabetes who have an insulin pump can eat whatever they choose (including treats high in sugar content), provided they treat themselves with insulin before they indulge. I find the idea of unhealthful eating confusing.
---- M. Angelopoulos, MD Lecanto, Fla
The answer to whether sugary treats can be healthful is the same for all patients with diabetes--regardless of whether they are receiving therapy via an insulin pump. Diabetes management has changed greatly over the past 20 years in many areas. No change has been more important to children with diabetes than those involving food management. Eating healthfully is important, but as long as overall macro- and micro-nutritional goals are being met--and as long as there is no concern about overweight or obesity--foods high in sugar pose no more problem for a person with well-controlled diabetes than they do for anyone else.
Behind this new flexibility is a shift in methodology and a new understanding of how different carbohydrates affect persons with diabetes. Carbohydrate counting has supplanted exchanges for meal planning. We now understand that carbohydrates, regardless of the source, have a similar total effect on blood sugar. The pattern of blood sugar excursion is different when simple carbohydrates (such as sugar and fruit) are consumed, compared with complex carbohydrates found in starchy foods. However, with use of rapid-acting insulin, the difference in the pattern of excursion is not as significant as it was with regular insulin. The rapid-acting insulin analogs (Novolog, Humalog, Apidra) start working within 15 minutes and last 3 to 4 hours. This increases flexibility regarding the timing of meals and snacks because insulin can be given for exactly the amount of carbohydrate eaten, along with extra insulin needed to cover for a high blood sugar level. Rapid-acting insulin can be given by subcutaneous injection via a syringe or pen, or via insulin pump subcutaneous infusion. Therefore, the patient with well-controlled diabetes can eat foods high in simple carbohydrates as long as insulin is adjusted accordingly.
One could make the case that allowing high-sugar "treats" occasionally (or even regularly) can improve overall diabetes control by reducing the amount of ongoing "cheating." Also, most of the general population consumes high-sugar treats regularly: entirely omitting these food choices for people with diabetes "excludes" them and poses unnecessary stress.
No pediatric endocrinologist would support the concept of eating in an unhealthful fashion. Nevertheless, eating high-sugar foods can be done in a manner that supports physical and psychological health.
---- Kathleen C. Moltz, MD Assistant Professor, Pediatrics Pediatric Endocrinology and Diabetes Wayne State University School of Medicine Children's Hospital of Michigan Detroit