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Diabetes type 1 (young people)

Diet and diabetes

A healthy diet means having a balance of protein, carbohydrates and fat. It's important to include plenty of vegetables and fruit. A healthy diet is recommended for everyone. However, the most important thing for diabetics to consider is whether foods have carbohydrates in or not. It’s also important to be aware how quickly the carbohydrates are absorbed by the body. Understanding these things make it easier to know when and how much insulin to inject to cover the carbohydrate in whatever you are eating.

Foods like bread, pasta, and rice are high in carbohydrates, but it’s also important to remember that many fruits also contain a lot of carbs. If you are eating a meal with a lot of carbohydrate, you will need to inject more insulin to cover it. If you are eating something with little or no carbohydrate, you may need to avoid taking any quick-acting insulin at all.

Once an insulin regime is established it is possible to include such things as chocolate or a dessert so long as it is possible to work out the extra insulin that's needed to cover them. 

 

Says that his diet is healthy and that the main change he had to make after diagnosis was not...

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Age at interview: 16
Sex: Male
Age at diagnosis: 11
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How is your diet? Has it changed since you were diagnosed?

My diet has changed since I was diagnosed. Not so much about what I eat, but when I eat. Certain types of foods you just simply don't eat at particular times. Such as, like when I was quite young, because it was four or five years ago, if, like if you were hungry you'd eat some chocolate or you'd go into your, you'd go into your cupboard and you'd take out a packet of crisps and just eat it because you want to, regardless of what you thought before or like what you've ate before. Like just do what you want. 

But when you become diabetic it doesn't mean that you can't eat those foods, but you need to think about when you can eat it at particular times and how much you can eat to maintain a sensible diet. So when I first got diabetes I had the worst experiences about not being allowed to eat chocolate. It was actually horrible, horrible. And I thought I'd never be allowed to eat chocolate again. Which was a statement which one of the nurses who was with me at the time wrongly gave me. 

I eat, I eat certain things like sugary foods and things like that after dinner, like as part like of a dessert. Or at parties with all my friends, knowing that it will be there. And I compensate with, for it with insulin or with extra activity. But I can't just go to my cupboard and take one out whenever I feel like it. And if I do, you can see the consequences on your blood sugar. But it would be wrong to think that at certain times you have to exclude these things from your diet. Like things like Christmas and big, special occasions, like you know you're going to eat a lot and there'll be a lot of food, some of which will be like very sugary, like lots of pudding and things like that. And you can eat what you want, but you just have to make a note of it mentally and compensate for it accordingly. Yes. 

But in general some of the major changes to my diet have been, my meals have been more balanced. I usually find that I try to include some sort of protein and carbohydrate in each meal. So at dinner I usually have chicken with pasta or chicken with rice. Or meat, meat actually go, really stabilises your blood sugar. Which is a really useless statement for vegetarians. But it's true that, it shouldn't be, carbohydrate foods are the only foods that have a direct like effect on your diabetes, but it's not true that that's the only thing you should therefore be looking at. Because if you have a, if you have a healthy diet, your health will improve and, as will your control over your diabetes.

 

He says that his family always ate healthily and that the main change was to eat regular meals...

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Age at interview: 20
Sex: Male
Age at diagnosis: 10
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So was that easy or was it something that took time to adjust to or?

No because you know my parents always fed me well anyway so I knew about a balanced diet. And obviously it's more important when you're diabetic that you eat the carbohydrate. Whereas you know, you could skip, you could skip a meal if you're not diabetic and it, it would be fine. But now I just always make sure I eat, you know I eat regular meals at regular times and.

What do you mean by healthy food? Or healthy diet?

Just a balanced diet you know, just very balanced diet and obviously if you're diabetic you can't eat lots and lots of sugary, you know, sugary stuff but you know I do still, I will still eat some. I haven't stopped completely and I've always been fine so.

Tell me do you eat much you say that your sort of eating pattern has changed since you've been at university. But what about having fruit, vegetables?

I. You know I would say compared to quite a few students that I know that I eat healthier than they do. But I always, I always try to you know have fruit and vegetables you know, a few times a week or something and I mean I think the only thing I've done, started doing differently as well since coming to university I just take a vitamin tablet every day, multivitamin tablet as well. Because obviously I accept that I don't eat anywhere near as much fruit and vegetables as I do when I'm at home, like when my Mum's cooked. It's like that so.

And in which way has your diet become different since you are at, away from home and a student?

Well obviously you're cooking for yourself so you can't always be bothered to cook something, you know, a proper meal so more ready foods, more sort of eating out, sort of I guess fast food or, lots more alcohol [laugh]. Yeah, that kind of thing. 

Type 1 diabetes and coeliac disease sometimes occur together and therefore patients with diabetes are sometimes screened for coeliac disease shortly after diagnosis. The test is done by measuring a particular type of antibodies (antiendomysium). One young woman we spoke to had been diagnosed with coeliac disease.
 

She is restricted in the choice of carbohydrates she can eat following a diagnosis of Coeliac...

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Age at interview: 17
Sex: Female
Age at diagnosis: 12
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Tell me when you were first diagnosed, did you have to make a lot of changes to your diet?

I think I did, yeah, because mum - we didn't have any low sugar stuff, or diet stuff - because it was not what we thought about. And mum just sort of made the swap one day, when she went shopping, so it was like low fat milk, low fat cheeses, and low sugar everything. We had no sugar drinks and stuff. It was good for the whole family's health, really, I think. It was very healthy and - I did have to change it, and I had to watch what I ate, because if I was out with my friends, they all go round and get boxes of soup and stuff. I'd eat them, but not as I would before. But it's not too much change.

A few years after that I was diagnosed with coeliac disease - I can't eat gluten, which is found in, like, wheat and barley and oats and stuff, and mum helped me a lot with that, because we talked to the dietician, and she - mum is amazing. She likes cooks and we make our own bread, because you get a lot on prescription, but then we do make a lot of our own stuff. It's hard at first, but then once you get to know and you get in a pattern it's okay.

So you can't eat'?

Gluten.

Gluten. So that's eating bread, cakes?

Well it's quite a lot of bready stuff. I know it sounds a lot, like bread, pastries, pizza, pasta, but you can get substitutes for everything, and I rely on potatoes for my carbohydrate a lot [laughs] I eat crisps and potatoes and jacket potatoes, boiled potatoes [laughs].

It was helpful that I could still eat proper carbohydrates and stuff, when I was diagnosed. Because I would have found it more difficult if I had Coeliac, but the fact that it came in stages it's ok.
 
In general the young people we talked to felt that they had a healthier lifestyle than other young people their own age group who weren't diabetics. They feel that one positive outcome of their diabetes is their healthy outlook to diet and lifestyle in general. Many young people diagnosed during their teens said that they've made changes to their diet and life style. They hadn't realised how unhealthy their lifestyle was until then. Many had given up smoking and cut down on ready meals, while eating more vegetables and fruit and taking more regular exercise.
 

A talk with the dietician made her realise that her diet was unhealthy and that some changes...

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Age at interview: 19
Sex: Female
Age at diagnosis: 17
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I had a dietician come to see me about my diet. And they didn't realise that I was pretty unhealthy really. 

What do you mean?

Just in the sense of like just the way I cook things. Just like the ready-made sauces, and like I'd eat a chocolate bar without even thinking about it' just stuff like that. I wasn't like major unhealthy but I could be a lot better. So she just explained to me how I'd have to be more careful with what I ate. That if I had, if I want to eat chocolate or anything like that, I'd have to have it in small portions or like with a big dinner. So that was really good.

What did you have to change in terms of your diet?

Cut out a lot of sweets. I don't actually cut them out completely just have them in smaller portions. Just eat a lot more healthy and make sure that I eat regularly like have my breakfast, make sure I have my lunch and my dinner because if I hadn't, if I didn't eat for about 4 hours then I'd gradually feel my sugars dropping and I'd need something to bring me up again. Just, yeah, just eating well. Like for breakfast, cereals rather than Frosties, anything sweet, I would have like proper Weetabix or Bran Flakes. Something which releases the least sugar, yeah, energy rather than being really, releasing loads in my blood at once, just releasing it quite gradually. Just cut out a lot of sweet things and just lowered my fat intake as well. Eat, I eat quite well. When I had takeaways I'd always get the healthy option. Just, it really improved my diet. That's one thing really positive that's come from this is that I've got quite a healthy diet now. I eat all my fruit and everything. Yeah.

So you haven't had problems, getting used to eating fruit and vegetables?

No, I'm quite, I like all my fruit and veg. So it's quite handy that I do. For, if someone like my brother he'd probably struggle because he loves his chocolate. Not that I don't but'
 
 

She dislikes vegetables and has the impression that healthy eating is expensive.

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Age at interview: 19
Sex: Female
Age at diagnosis: 3
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[Laughs] I think everyone is tempted by fast foods but I don't eat it that much, only socially, I never go in to like Macdonalds on my own and say I want a meal, I only go in there with friends, so if I'm out with them lunchtime, whatever, I've got money, do you want to go to Macdonalds, okay, it's not a regular thing. With normal foods, I don't, I don't eat what you're supposed to, in that, you're supposed to eat a lot of vegetables and fruit and everything I'm not a big vegetable fan so I don't eat a lot of vegetables don't know, eat chips and stuff, most things you're not supposed to have apart from I don't eat a load of sweets.

So would you say that you, your diet is okay or you need to improve your diet? What would you say?

The last time I was at hospital, I saw a dietician and she wanted me to eat more vegetables and I think I eat enough fruit already but as I said I'm not really keen [laughs] on vegetables but at the end of the day it's your choice what you eat, if you want to, want to keep your diabetes under control then eat more-more vegetables and fruit.

I'm trying to but you know, when you get into a routine of going your whole life not eating many vegetables and then [laughs] you come in, your nineteen years old and someone comes up to you and says eat more vegetables, it takes time, you can't just go in there.

I suppose what you just seeing what you can and can't eat I suppose that's kind of easy but it can be hard at the same time, if you're not extremely well off or not really, have a lot of money, it's difficult because of things that you're supposed to eat, for example, vegetables, they're not always cheap, you know you have to go out and buy them and it's very expensive, so that can be hard.

So one thing, one thing is for the doctors to say eat lots of vegetables but'?

It's another thing about the price of the food you buy.

Okay.

For example, if you see going into health food shops, you see how much the stuff is in there and that's health food, so, you know.

And so the reason is sort of financial'?

Yeah, I think.
Food and insulin

The type of insulin regimen that you are on influences the kind of eating routine you have. Those on two injections a day said that they have to have fixed meal times and remember having to have their insulin injections 20 minutes before eating. People thought the main disadvantages of this regimen was the rigid meal time routine and having to eat snacks in between meals even when they're not hungry. Those who were on this regimen since childhood describe their childhood diet as 'very restricted'. Some remember that they were only allowed to have sugar when doing PE at school. Some young people, however, preferred this routine because it provides a structure to their day and they find that it is easier this way to remember to take their insulin.

 

Describes his fixed routine as a pain but at the same time recognises that it has made his life...

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Age at interview: 17
Sex: Male
Age at diagnosis: 14
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How long do you think it has taken you to get used to your life with diabetes?

That's quite difficult actually because to be honest you get used to it but it never really. You get used to it if you know what I mean. You tend to think, 'Ok you know, I've got diabetes. I've got to deal with it.' And you get used to the everyday routine but there's still that point in the back of your mind and I think it'll always be there. You know you're slightly different to everybody else. You have to be home in certain time for meals. Do you know what I mean? You can't just leave until like eight, nine o'clock at night and go in and have your tea. You have to be in at certain times and it's a routine that you have to live with or obviously you won't survive. Do you know what I mean?

So you find sort of the routine is one of the limitations perhaps or'?

I think the routine actually made my life better. Because before I was eating whenever I wanted to. You know what I mean. I was pigging out quite a lot during the day and stuff like that but when I got the routine it actually helped me to bring my life together sort of thing. I was in at certain times to eat. I wasn't late home and stuff like that, you know. Because I had to, obviously I have to have a snack in the evening time so I can't be too late in coming home in the, of an evening. And to be honest it actually helps a lot.

Well when I first became a diabetic I was on breakfast then I had a snack before breakfast and dinner. Then I had my dinner, then I had a snack before dinner and tea and then after tea I'd usually have a snack about 9 o'clock.

And which type of insulin was that?

That was on I was on Novamix30 in, before breakfast and before tea and then I was on another Mixtard20 at night.

Why do they change the insulin?

They had me on those two because well those two because I think it was better for me at the time. Just finding that I had diabetes they wanted to get it as low as possible as quick as possible which is why they put me on that. And then after that they started changing my insulin to see what I would do most best on. I mean from that I went on to NovoRapid which was before, every time I ate I had to do an injection which I found horrible basically. I didn't like it whatsoever.

Tell me more about it because some people have a different experience and that is what this project is all about. I mean tell me about that?

Well it was, it was weird actually. When I was on the insulin before I went onto the Novorapid I had a routine. And although I hated that routine it was a routine that I got used to. Then when I went on to Novorapid my routine went out the window. I could, I could, well relatively eat when I wanted to again and I found that, that just didn't work for me. I didn't have the routine of remembering to do my injection if I, if I had a Mars bar I had to inject with it. Whereas before if I had a Mars bar after dinner I didn't have to inject with it each time. Do you know what I mean? I, it was all included in my dinner and I just didn't like doing that many injections a day [laugh]. It was, I just didn't like it so I went back to the Novamix 30 which is twice a day which works for me.

 

In her early teens she found it difficult to have the snacks required by her fixed insulin...

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Age at interview: 20
Sex: Female
Age at diagnosis: 2
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Anything else significant?

I guess like when we were doing PE or games I usually had to have like something to eat beforehand. And like I kind of didn't like that because it wasn't at a time when everyone else was eating something. And, yes, I kind of had issues by then about eating anyway and so I didn't really feel comfortable with that.

How old were you then?

I think I only became like aware of that kind of when I was 12. I mean I'd had to have snacks and stuff before then, but I didn't really mind that.

When you say 'issues about eating' what do you mean?

That was kind of when my eating disorder kind of started to develop. But it wasn't kind of anything major then. I think like the insulin regime that I was on like required me to have like kind of very controlled like times of when I was eating, and I felt like I was eating constantly all day and I didn't like that. 

Which type of insulin?

I can't remember what type I was on then. I know I was on four -

Four?

- four injections a day by that point I think.

Ok.

And I was on, oh, what was it? The long-acting one, I was on -

Lantus?

No, I've only, I'm on that one now. But I was on, what was it? Novolog (NovoRapid?) or something for a while and Insulatard for a while. 

And those were the ones that require you to eat four times a day?

Yes. And like I was having like breakfast, snack, lunch, like afternoon snack, then a late afternoon snack, then dinner, then something to eat before I went to bed. And I stop, I like stopped having my snacks because I didn't want to be eating so much. So then my blood sugars kept going low all the time. And so that was the kind of, when we went like back to the diabetes clinic and reviewed things with them and they then put me on the Lantus and Humalog.

When was that?

I'm trying to think.

Take your time.

Three and a half years, it might have been more than that, four. I know they switched my insulin around several times before they put me on the Lantus.

Most of the young people we talked to were on a combination of long acting and short acting insulins. They inject the long acting insulin in the morning or before they go to bed and take an appropriate dose of the short acting insulin each time they have something to eat. Young people find that this regimen gives them much more flexibility about mealtimes, suits their lifestyle better and allows them to control their diabetes better.  A number of young people, however, pointed out that the sense of freedom they find with this regimen can also bring problems. For instance, some young people found that they started eating more sugary and/or fatty food. (See also 'Finding the right insulin regimen for you', 'Insulin Pumps' and 'Obesity and other eating problems'.)
 

Says that the fast-acting insulin works 'fantastically' well for him. And thinks that a fixed...

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Age at interview: 24
Sex: Male
Age at diagnosis: 16
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Right yeah I changed from two injections a day to four injections and day. When I spoke to my, like the diabetes team and they were telling me it was a sort of more flexible regime, that I could sort of get up when I was, like get up when I wanted, I was a student at the time and so it kind of, it meant that I was going out, I was like sleeping in late, I wasn't doing everything regimented, I wasn't up at 8 every morning, I wasn't going to bed at the same time, I wasn't eating at the same time every day, I wasn't having lunch at the same time, I wasn't having the same amount to eat at lunch time, I didn't really know what I was going to do, I mean I might be going out playing football, going for a run, something, and I found that the two injections a day meant that like the middle of the day it was quite, quite often I'd end up going low or I'd have too high blood sugars. 

So I spoke to the team about this and they suggested moving onto four injections a day which was really because you inject every time you have food and it means that if you're not having food then you don't need to inject so it worked quite well for me because it meant that I could get up when I wanted and just gave myself an injection when I woke up. So if I was getting up at 12, 1 o clock you know it wasn't so bad, I could just make sure I gave myself my injection with my food. That, I mean and that regime has just worked, so much better for me because I can now cope, I know exactly how much insulin to give myself for the food that I eat. If I eat a small meal give myself a small injection, if I'm eating a big meal again I need to just increase my insulin and it just helped me to keep my like blood sugar levels much, much better monitored and it just helped, helped me hugely. Now with this regime again I just, I know that if I'm, I give myself one injection before bed and I just know that it like again if I've been out I probably need to give myself a little tiny bit more just to make sure that I'm right when I wake up. 

I take three injections during the day, one with breakfast, yeah with rapid insulin which is fast acting which again like I said before which was to com, which was to bring me down after whatever the food I eat. So I have, one injection with breakfast, one with lunch and one with dinner and then just one injection before I go to bed which is a long lasting insulin, like before I go to bed. I mean that regime has worked just like fantastically well for me because like I said I can eat what I want when I want and just inject accordingly at the exact time when you're eating. I used to inject twice a day and used to have to inject have an hour before you ate or before, and so things would happen like I'd wake up at people's houses, friends' houses and say to them, 'Is it alright if I get some breakfast?' because again like you need to eat food quite regularly. I'd say, 'Is it alright if I have some breakfast?' and they'd say, 'Yeah, yeah that's fine I'll sort you out, so go and do your injection,' and then suddenly you've done your injection and then they're like, 'I've got no food, I've got no bread, got nothing in the house,' and you're just like, 'Great nice one, thanks a lot for that.' so you're just, and then you're panicked, you're worried about well it was a mixed insulin so that some of it was acting, fast acting to combat the food that you were about to eat and you know that if you're not going to eat then you have the potential to go, like have low blood sugars. 

So that was one of the, one of the drawbacks of two injections a day, just the injection before you eat. And again if you're injecting before you eat you don't know exactly what you're going to eat and how much you're going to eat so maybe you're thinking right I'm going to have a big meal and you give
Physical activity and carbohydrates

Young people who do physical work or are engaged in exercise on a regular basis said that they tend to need a diet that is high in carbohydrates. Some young people noted that a reduction in physical activity and/or an increase in eating sugary or fatty food will affect their weight and overall control. (See also 'Obesity and other eating problems'.

 

He has a diet high in carbohydrates because his job is very active and he plays football once a...

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Age at interview: 19
Sex: Male
Age at diagnosis: 14
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And about your diet, tell me about - because diet is really important?

Yeah. I have a high carbohydrate diet, full of carbohydrates. My job - I'm very active, so I need a lot of carbohydrates to keep me going through the day, and also a lot of protein. I tend to - I don't eat enough fruit. I should eat more fruit. I only really eat apples and grapes, whereas - I don't really like oranges and bananas, but I wish I could eat them, but I don't like them, so I tend not to. So fruit's probably the one area where I could improve my diet quite a lot. I'm quite good with vegetables - I eat varied sorts of vegetables, so I get a good source of vitamins but yeah, not enough fruit. That's - I could eat more fruit.

And you are a sporty person?

Yeah, yeah.

Did you learn that you need to have more carbohydrates?

Yeah, that's what they told me, that although you don't produce insulin - because your body doesn't produce it, when you inject insulin it just keeps on going, so if you're doing an activity where you're using a lot of energy, your insulin won't stop, if your energy is increasing. So they told me that if I had a football match to have a sandwich or something - a carbohydrate snack beforehand, just to give me a little bit of a boost, and then I've carried on sort of playing football and that, and then to have a lucozade drink, or energy drink, just like they say on the bottle, sort of, before during and after sport, just little sips all the time, and then once I'd finished an activity then again just have a little sandwich or carbohydrate snack, to stop me going low, maybe an hour after my activity has finished. Yeah, but normally for me, quite often if I've played football it would be in the afternoon, so I'd have lunch afterwards. Or at night, then I'd have my dinner, so I was always close to having food. I'd never play a match and then go a long period without eating.

Yeah, it was good, yeah. I've always tended to have good control as well, so my HbA1C results have always been quite good. Recently I've had a few high ones but I have had a HbA1C of 7.1 before - mostly they're around 8 - 8 - 8.1., like that. Recently I've had one that was 9.2. I was going a bit off, off the boil slightly.

How did it make you feel?

Just a bit sort of angry with myself, because I know that I was sort of letting my diet slip. I was having more sugary things and stuff. I knew I shouldn't have done, but I was jut going through a period where I got lazy really. So my HbA1C went up, but now I'm in the process of getting it back down. I know - I know I can get it back down, so it's no real problem.

 

In his teens he was eating a lot but did not have a weight problem because he was doing lots of...

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Age at interview: 23
Sex: Male
Age at diagnosis: 7
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When I first got it I put on weight, because I was getting used to the insulin. Yeah, so there's, there's school photos of me - one was quite skinny, next one I had diabetes I was really fat, like you know, puppy fat, and then again after, I lost it again. But I was doing quite a lot of sport - I used to swim and play rugby. But, yeah, you, I think when you first get it you do, you probably, you get fat because of the insulin and then you lose it again, so that's not an issue really. Well, it might affect people when they get older, I don't know what it's when you, you know, like at my age getting it, I don't know, but it's a bit of a pain in the arse, but yeah, I mean, fat, I, the reason I got fat before was because I was eating loads, sitting around doing, giving myself masses of insulin. And I stopped doing sport - I was doing loads - so.

And that was around what age?

I started getting fat [pause] I suppose really round about nineteen when I started going out with my ex-girlfriend.

But when I, when I first got it, though, I was doing loads of sport, so I don't know what it would have been like if I wasn't. And then I've stopped, due to injuries and stuff, and then I just got fat like anyone would, I suppose. I wouldn't say it was because of diabetes. I did put a bit of weight on, but then lost it, because of diabetes when I was younger, but then I got fat it wasn't due to diabetes, it was due to what I was eating. 

But at the same time you had to sort of do a new kind of management of your diabetes in order to lose that weight and to put'?

Yeah, you just change your diet and lower your insulin, which, at the time I was eating loads of rubbish and giving myself loads of insulin and not doing any exercise, as a normal person would I suppose, so. I wouldn't say I got fat just as a direct result of diabetes, it was because you know, I was eating loads of rubbish and not doing any exercise. 

And you didn't put on weight before because of all the sport you were doing?

Yeah, so I can't say if I would have put on weight if, because of diabetes, because I would have, I was doing, I was burning it off. So I might, I might have done, but I don't know. 

Yeah. And you had a diet that worked?

Well, I imagine you will probably put on weight because the, it's a hormone stimulant and insulin is a thing that is making you fat. The more insulin you give the more fat you get, so, yeah, I'm sure when you first start doing it, when you're sorting out your levels and what-not, you're going to, yeah, you're going to put on weight. 

Did you find it difficult when you were starting to be a teenager to control your diabetes because I have been talking to other kids who just find it very difficult around the ages of fifteen'?

Yeah, you see, because you go through puberty that's why I had those, those fits that I had and, yeah, it messes you up. But again, I mean I suppose, yeah, but that was I doing, I suppose I was doing blood tests at that point. It's just, yeah, it's just one of them things, you sort of go through it and then you get out the other side and you're alright again. I've got to be honest, I can't remember.

Were you doing sport at that time?

Yeah, I was doing loads. Loads of sport. I was eating like a horse - something like six Weetabix in the morning and, oh, I was eating obscene amounts but I did not get fat because I was doing
Carbohydrate and insulin ratio

Young people said that in addition to eating the right type of food the key to a good control is to fix the insulin dosage around what you are eating. Most of the young people we talked to know about carbohydrate counting but few felt the need to apply it rigorously to calculate the carbohydrate/insulin ratio of each meal. Many young people do 'well-informed guesswork' and said that they have learned through 'trial and improvement'. (See also 'Insulin pumps'.)

 

He has learned to do the carbohydrate/insulin ratio by 'trial and improvement'.

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Age at interview: 24
Sex: Male
Age at diagnosis: 16
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No the type of insulin I'm on is Humalog.

Yeah which is a fast acting insulin. Yeah they gave me information about counting your, like counting the calories and the carbohydrate count sorry to do with how much, how much you eat. I found it easier to work out myself really with sort of trial, trial and improvement, I don't know, I call it, don't call it trial and error, trial and improvement because what was important for me was to make sure that I'd eat a fairly starchy, fairly carbohydrate filled meal, give myself an injection and then a couple of hours later test my blood sugars so that I'd know whether I'd done the right amount of insulin. And if I hadn't done the right amount of insulin that time then I'd know for next time how much to give myself and like the next time I have a similar meal. I find it a little bit too complicated to try and work out all this carbohydrate counting all the time it was, you know it's great in theory but in practice you eat three meals a day and you're not going to, every time you have something to eat you're not going to go to your booklet and say right I'm having a sandwich that's two slices of bread, right that's however many carbohydrates. 

So I just found that I just worked out myself and it was, much, much easier to manage things, things like, you just have to be aware of thing, different types of potatoes raise your blood sugars higher than others, you know chips and mashed potatoes send your blood sugars higher rising quicker than sort of jacket potatoes and things like that. And that's the sort of thing that you just, you find out really just, just through doing it and just through testing your blood sugars after you've done an injection and making sure that your know your own body, that's the, that's probably the main thing because everybody, everybody acts, everybody is different and you need to find out yourself but just make sure that, especially in the first sort of year, couple of years, make sure that you know your own, you try and think about what you're doing and think about learning from your own experiences so if you do go, if you do have a meal and then you give yourself an injection then you test your blood sugars and you're particularly high again and you know and you've got to just make sure that next time you're going to inject a little bit more in the future so.
 
A few of those we interviewed consider themselves lucky because they have been able to attend training sessions to help them calculate more accurately the carbohydrate/insulin ratio. They said that participation in training courses such as DAFNE (Dose Adjustment for Normal Eating), TIFA (Torbay Insulin and Food Adjustment) and Insight has made them more confident in solving problems regarding food and insulin dosage (see also 'Patient education courses').
 

She found the TIFA training course most helpful because now she knows what to do when she has...

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Age at interview: 19
Sex: Female
Age at diagnosis: 3
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And now I then went on a TIFA course a year ago which they're introducing in some areas of the country where it teaches you how to fix your insulin dosage around what you're eating. Say now I'll make a rough estimation of how much carbohydrates at each meal I have and the fit my dosage to suit the meal that I'm eating which means what I eat is a lot more flexible and also the eating times are more flexible with the regime.

How do they teach the TIFA course? what did you learn?

Oh there's various structures of courses you can go on, sometimes you can go on a course where you'll maybe stay for a week and actually have it as a residential course as well and stay in on location. Whereas the way I did it was with a group pf young people where about six or eight I think, and we came to a weekly course for maybe about three hours on one weekday evening for I think it was four or five consecutive weeks. And we'd eat dinner there together so that we'd be practising the method with the food that was in front of us and discussing with the healthcare team what our dosage was, and what sort of ratio we should use for the amount of carbohydrates in the food to the insulin dose we were giving ourselves. And we had a lot of support that we had to keep a food diary so they'd check up on our progress over the weeks. And they weren't they weren't there to sort of say you're doing it wrong, you're not getting the right results. It was just to give you support and we also discussed various issues relating and to puberty and that sort of age. And then perhaps how diabetes fits with alcohol or driving or things in the future even pregnancy, issues like that you want to find out about. 

Who organised this?

It was organised by our local healthcare department. I think they've run a lot of courses like this I think around the country particularly Bournemouth, I think, I'm not sure, for adults. And they're just introducing this for young people at the moment. But they've done it in a few areas around the country I think for young people.

Did you have to volunteer or were you asked to take part?

I was asked to take part in it because at that stage I think I'd been on the NovoRapid/Glargine regime for maybe a year or so and my healthcare team said to me it would be a really good way of getting in control of it more myself and getting to meet some more young people my own age in the same situation also on exactly the same regime. I think as much as it was useful on the diabetic side, it was also really useful to just have a nice social event and get to meet some other people my own age in the same situation. 

I think we had to discuss a lot obviously about changing your dosage, as you're growing up how diet changes and the best sort of diet you should be having. How you can fit your insulin around the diet or visa versa. How to gain long-term control, sort of fibrous foods, all the sort of things you learn when you're initially diagnosed. But it's just good to have a bit of a recap a few years on. 

And since then they've adopted it' they adopt it initially for adults in my area and then they brought it in for young people. And they've had really good feed back from it because I mean at least now, now that I've done It I know if I'm going high I'll be able to say, 'Right, that was exactly because I did that, that I'm high'. So even if your levels still aren't perfect 100% of the time, at least you feel in control and you know where you're going with it. Or if you go low, you can think, 'Okay, well I did that like that', I probably over did the dosage for what I ate or ma
GI diet and diabetes

Some of the young people mentioned the GI (glycaemic index) diet and how they and their parents became interested in finding out more about the effects that certain types of foods have on blood glucose. They learned that certain foods will make your blood glucose go straight up and then an hour later it will go straight down again and cause you to have a hypo. Other foods such as brown rice or brown bread have a very long-lasting effect but it is very gradual. Eating a mixture of rapidly absorbed with slowly absorbed carbohydrates gives you better control over your diabetes. Some young people are routinely including low GI (glycaemic index) food in their diets. One young woman indicated that she could see the benefits of a GI diet as she began to achieve a smoother control of her blood glucose level as well as losing weight over a period of time.

 

Explains what a GI diet is and what benefits she has had from it.

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Age at interview: 17
Sex: Female
Age at diagnosis: 2
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And it was more regarding to this GI diet?

Yes. It was just looking a lot at the GI diet and how it works. And I just heard that it would be a really useful thing for people with diabetes to eat low GI foods. So I just went and looked up about it.

Can you explain to us what low GI diet is all about?

It's foods that have more complex carbohydrates, which are carbohydrates that get released more slowly into your system than foods that, say wholegrain foods, foods with oats in. They'll get released into the blood slowly. So you're not going to feel hungry quickly. And it's going to last, the energy is going to last a lot longer than say chocolate or something that will get released into the blood very fastly and will give you more of a high and then a low straight after.

So it's sort of brown rice? 

Yes.

Brown bread?

Wheaty, oaty foods.

Like porridge?

Yes.

When I was, when I was about I think between 14 and 16 I just started putting on some weight. And I wasn't particularly so much overweight, I was just more over the weight that I wanted to be. I was a bit, I wasn't slim, put it that way.

So you were a little bit plump?

Yes, just a bit. And so I just tried to change my diet a little. I didn't, I don't think I actually made that many changes. It doesn't feel like it anyway. But I made enough so that I ended up losing it. And in the end I lost about a stone I think. And now I'm perfectly happy with the way I am. And, well, I'

And this is mostly to a change of diet?

I think so, yes. I don't recall doing any more exercise than I used, than I did. I might have walked the dog an extra time for a week or something. But I didn't start going to the gym every day or anything. So it was just more of a change in diet. I stopped snacking so much, stopped eating loads of crisps and biscuits, and just stuck to regular meals. And I lost it. I'm happy now.

So you would say it was a gradual process?

Yes.

So you didn't do anything-

It wasn't like a dramatic.

you didn't do anything drastic?

No. I just changed the way I ate. And it worked.

Did you talk to anybody at the clinic?

No. It was just a thing I decided to do. And my dad was losing weight at the same time. So we, we all changed our diets really.

It was a family effort?

Yes.

Illness and diet

The young people we talked to emphasised that having regular meals does help to keep blood glucose under control. They described how that control is 'messed up' when you are ill and don't feel like eating.

 

Talks about what he does on those occasions that he is ill and cannot eat regular meals.

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Age at interview: 16
Sex: Male
Age at diagnosis: 11
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When you're ill, your diabetes goes completely out of control. It's quite difficult, because when you're diabetic you have to inject yourself and you have to eat a certain amount of food in a day. Not what you'd normally eat. You don't need to eat three proper meals in a day if you inject. You can still inject a lot less and eat a lot less. But you need to have something. So if you're really really ill one day and like you're throwing up and things like that, nobody's in the mood to be eating anything. But you have to eat something and you have to inject some amount of insulin. As a result, your diabetes is very difficult to control. But my general technique when I'm feeling very ill and I don't want to eat much is you buy like bottles of Coke and you sip them if you know you have to be eating something. And it's just liquid, so it's nothing too heavy. And it has a strong effect on your diabetes, so you don't need to be drinking that much. And then you get, eat like half a slice of bread and it will keep you normal, keep you, keep it going for a fair bit of time. Yes, you can expect, you could expect bad control on a day when you're feeling ill.

There are five illness 'rules' that every type 1 diabetics needs to follow in order to cope with an illness:

  • 1. Never stop taking your basal (background) insulin.
  • 2. Check your blood glucose every 2 to 4 hours and if you cannot do it yourself ask a relative or friend to help.
  • 3. Use Ketostix to test your urine. If you have ketones it is likely that you are lacking in insulin. Please do not ignore this because ketoacidosis may develop. Diabetes ketoacidosis is serious and needs immediate treatment.
  • 4. Drink at least five pints of sugar free liquids especially water and particularly if you have a temperature or diarrhoea or vomiting because you can easily become dehydrated.
  • 5. Try to eat your normal diet but if you are unable to do this, replace your meals with sugary fluids such as milk, fruit juice, flat lucozade or cola.

For more information see our resources section.

Last reviewed December 2017.
Last updated December 2017.

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