GloucesterTimes.com, Gloucester, MA

March 26, 2007

Diabetes in children: A call for the whole family to eat better

By Julie Kirkwood , Staff Writer

Danny Plunkett used to be the picky eater in the family. He typically refused to eat what his parents and older sister were having for dinner, such as stir fry and rice, so his mother allowed him to make himself a bowl of cereal or a peanut butter and jelly sandwich instead.

"I believed that if you fight with your kids, you're going to create problems," Laura Plunkett said.

Then at age 7, Danny was diagnosed with type 1 diabetes. It's the kind of diabetes caused by an immune system disorder, not the kind related to poor diet and lack of exercise, and Danny's nutritionist told his parents not to worry too much about changing his diet. The important thing was for him not to feel deprived of anything.

The nutritionist drew up a meal plan for Danny based on his favorite foods - pancakes with syrup, grilled cheese sandwiches, macaroni and cheese - and calculated doses of insulin to compensate for all that refined sugar and flour. They even sent him home with a flier that said, "Don't let diabetes slow you down - you can still eat fast food."

Laura Plunkett quickly had misgivings, though, when they got home and followed the plan. Danny's blood sugar numbers were all over the map, she said. He seemed to be eating even less nutritiously than before, and he had stomachaches and was gaining weight.

"We were shoveling the pancakes into him," she said. "His blood sugars, they were just crazy on the kinds of foods I was trying to feed him."

When a diabetes patient's blood sugar spikes too high or too low, the person can fall into a coma and die.

It took several months of trial and error for Plunkett to figure out that when Danny ate more nutritious foods, his blood sugar was much more stable. She hesitated at first, but over time her confidence grew. She became determined to do the exact opposite of what her medical team had told her: to completely change Danny's diet.

"Everyone has to find their own way," Plunkett said. "They don't have to eat the way we are. It's just what's working for us."

The approach may be outside the mainstream, but Plunkett is not the only local mother who has turned to nutritious food as the cornerstone of her child's diabetes management.

Julia Hart of West Newbury, co-founder of a type 1 diabetes family support group called Highlow Diabetes, said she too discovered through trial and error that her son Austin was much more stable when he ate whole grains rather than processed foods.



"We ate his usual plan as we left the hospital," she said, "but as a parent I understood - I was beginning to realize what these foods were doing to him."

At a time when diabetes educators were telling parents not to worry about processed food because "a carb is a carb," Hart started reading about glycemic index. Processed foods, like white bread, dump sugar into the bloodstream faster than unprocessed foods, like whole wheat bread. It made sense, she said, that white bread would cause her son's blood sugar to spike and wheat bread would not.

She tested it out by feeding Austin, who was only 3 years old at the time, different breakfasts and watching what happened to his blood sugar.

When Austin ate frozen waffles for breakfast, his blood sugar would be high. When he ate a slice of whole grain bread with extra fiber and some peanut butter, a banana and a cup of milk, his blood sugar would be right on target.

"That's how I got very good control of Austin and his diabetes," Hart said. "People sometimes don't agree with my meal plan because I'm restricting him, but that's not the case."

Hart is very careful to allow Austin to eat junk food when he craves it, and has become a master at knowing how much insulin to give him to balance out potato chips, McDonald's french fries, or cake and ice cream at a birthday party. The difference is that these foods are now only for special occasions or for special circumstances. She gives him a treat of a Snickers bar or Reese's peanut butter cups when he needs a boost of sugar before exercising.

"It gives him enough of a treat so he can say, 'I have my candy today,'" Hart said.

Austin is now 7, and his blood sugar management is, in his mother's words, "phenomenal." There is a laboratory test called hemoglobin A1c that gauges how well a person's blood sugar has been under control for the previous two to three months. The target number for keeping diabetes under control is 7 or lower. Austin's number is typically between 6 and 6.5.

He seems to have internalized the message, Hart said.

"He goes to a friend's house and the kid's pounding down half a package (of Peeps) and he goes, 'That's really unhealthy for you. Doesn't that give you a headache?'" Hart said.



Both Hart and Plunkett have had to change doctors and nutritionists for their children more than once to get the right amount of support for what they're doing.

Danny's current nutritionist, Jan Hangen at Children's Hospital in Boston, said it's wonderful how his mother has used nutrition to manage Danny's diabetes.

"Laura's pretty savvy," Hangen said. "She wants to feed her family well. She said, 'Wait a second, I don't think a carb is a carb.'"

It's not something every family can do, though, she said, especially right after a type 1 diabetes diagnosis. Typically, a family is overwhelmed by learning to give insulin injections, a fear of the potentially fatal disease and the weight of responsibility that managing diabetes requires.

They can be forgiven for wanting to let the child eat chicken nuggets and pancakes, if that's what he wants, Hangen said.

"If the kid's not eating kale at that time, I would not say, 'Let's look at the kale,'" she said. "I believe in slow, kind change. The 'slow' is the patient's pace, not mine."

Also, she said, there's still controversy within the diabetes community over whether glycemic index matters and whether a carb truly is just a carb. But that shouldn't hold back anybody from trying to eat more nutritious foods, she said.

"This is just healthy eating for the family," Hangen said. "This is what everybody should be doing."

Laurie Higgins, a pediatric and adolescent nutrition and diabetes educator at the Joslin Diabetes Center in Boston, agreed.

"There are times when the families are so overwhelmed at the diagnosis that they can't change too many things," Higgins said.

Still, she personally is not a fan of the "carb is a carb" philosophy, and she does encourage families to try to slowly convert the food in their house to whole grains and more fruits and vegetables.

"It is a family affair," she said. "The parents even take the onus to say, 'We want to eat healthier; I want to be healthier.' We're not saying we're doing this because Johnny has diabetes."

That's exactly the approach Plunkett has taken in her household. Danny, who turns 13 today, has consistently had hemoglobin A1c levels at or below 7, but that's not why they eat the way they do, she said.



"We're doing it because day to day, Danny feels better," Plunkett said. "We're finding that when we're exercising and eating this way, life is better. We're really doing it for overall health."

Mary Ann Lidrbauch of Beverly said she plans to use the type 1 diabetes diagnosis her 9-year-old daughter received last month as the impetus to take her whole family the final step toward eating whole foods.

She and her husband had been planning to do it anyway when their two daughters got older. They belong to Appleton Farms in Ipswich, which supplied them with organic vegetables all summer, and were already eating whole grains like brown rice and quinoa, sprouted grain breads and organic yogurt before the diagnosis, so it wasn't a very drastic change.

In fact, Lidrbauch was so troubled by the artificial sweeteners and partially hydrogenated soybean oils in the hospital food served to her daughter that she asked her husband to bring in some almonds and natural peanut butter from home.

"When we got out (of the hospital) that Tuesday, we basically got rid of anything that wasn't on a whole foods diet and just started in right away with it," Lidrbauch said.

In the few weeks she has been working on it, Lidrbauch said, she actually finds the intense focus on nutritious foods calming. Amid all the conversations with doctors and nutritionists over blood sugar levels and insulin amounts, and in the face of the diagnosis itself, she said, the nutrition feels like the one thing she can do something about.

"So much is out of your control," she said. "It seems like it just hits a child suddenly. ... But the food part, I feel like that's the part that we have some control over. That's the part we're trying to focus on."

Try this at home:

Diabetes may have been what motivated these families to improve their eating, but it took hard work and creativity to actually accomplish the goal. Here are some of their strategies:

* Decide to eat better as a whole family. Don't single out one child because he or she has diabetes or a weight problem and say you're doing it because of the child.

* Involve children in the learning process. Talk about the studies and articles you read and things you learn about nutrition as you learn it.



* Put out a veggie plate every day after school. Don't ask the kids if they're hungry or if they want it, just put it next to them within arm's reach.

* Give your children lots of choices. Julia Hart routinely offers her son five nutritious choices at each meal and lets him choose.

* Don't be hesitant when introducing new foods, said Jan Hangen, a Boston clinical nutrition specialist. The parent's attitude is important. If you hesitate and fret, the child is less likely to try it than if your attitude is "of course you'll like it."

* Don't be overly restrictive. Let the child have fast food, a trip to the ice cream stand or junk food at a birthday party once in a while. Just limit it to special occasions.

* Slowly decrease the variety of junk foods in the house (only one kind of cracker and one kind of cookie, for example), while increasing the variety of fruits and vegetables, suggests diabetes educator Laurie Higgins of Joslin Diabetes Center. The junk food will seem less appealing.

* Keep introducing new nutritious foods. Studies show toddlers needs to try a food 12 to 16 times before they develop a taste for it, Higgins said. If you want your child to eat something, just keep offering it.

A typical school day in Danny Plunkett's life

6:30 a.m Test blood sugar, dose of insulin

Breakfast - Fruit shake made with banana, frozen blueberries, frozen strawberries, soy milk, sliced almonds, vanilla extract

7:30 a.m. Off to school

10 a.m. Test blood sugar, dose of insulin

Snack - Apple and bag of popcorn

Snack-time recess outside

Noon Test blood sugar, dose of insulin

Lunch - salad bar with chicken and water

Lunch recess outside

2:30 p.m. Test blood sugar before after-school activity

Snack, if needed - granola bar

3:30 p.m. Home

Snack - plate of cut vegetables, fruit and nuts

4 to 6 p.m. Homework

6:30 Test blood sugar, dose of insulin

Dinner - salad, steak tips and broccoli

After-dinner walk with Dad

9:30 p.m. Test blood sugar, dose of insulin



Snack, if needed - peanut butter and apple slices

Bedtime

11 p.m. Test blood sugar before parents go to bed (Danny doesn't wake up).

2 a.m. Danny's mother or father gets up to test his blood sugar. If it is high, they give him insulin. If it is low, he gets honey, glucose tabs or milk.

4 a.m. If Danny was too high or too low at 2 a.m., his mother or father checks his blood sugar again.

Note: Many children who have type I diabetes wake up on their own when their blood sugar gets too low or too high, so there is no need for parents to check them during the night. Danny does not wake up on his own, his mother said. There have been times when he was sound asleep with blood sugar as low as 40 or as high as 350 because of an insulin pump failure. At bedtime, whole blood sugar should be between 100 and 140.

A mother and daughter connect

When Laura Plunkett found out her 7-year-old son had diabetes, one of the first people she turned to was her mother, Linda Weltner, who lives right around the corner from her home in Marblehead.

"Laura came in hysterical, and I was the first one, I think, to hear that Danny had been diagnosed," Weltner said. "I'm an OK listener, but I tend to interrupt and I tend to, as a mother, try to fix things."

When Weltner wants to keep quiet and just listen, sometimes she embroiders. In this case, she quietly went to the computer and started taking notes. Weltner is the author of four books and a former newspaper columnist, but she said she wasn't thinking of this as a writing project when she began.

"I would just listen," she said.

It became a ritual between mother and daughter. Whenever Plunkett felt overwhelmed over the next two years, she would go to her mother's house and talk. Weltner wrote.

Plunkett said she thought of it as a journal and hoped that someday her children would read it and understand, from an adult's perspective, why this time in their lives was so stressful.

It wasn't until a year passed and they had accumulated about 250 pages that they began to wonder if the journal could be the basis for something bigger. And when Plunkett struck upon a technique for controlling her son's blood sugar, she and her mother decided to write a book.



"That's when we thought we had to share this," Plunkett said.

The book is not just about how the family learned to manage Danny's blood sugar levels. It's a story about what a family goes through when a child is diagnosed with a chronic illness, how the parents struggle to stay connected, how it impacts siblings and how it ultimately can bring a family closer together.

Weltner and her daughter tried to get a publisher interested in the book, but the American Diabetes Association told them it generally doesn't publish books written by parents, only medical experts. Also, the book describes the family's use of acupuncture and other alternative therapies that are not endorsed by the diabetes community.

So they decided to pay for publication themselves through iUniverse. The book, "The Challenge of Childhood Diabetes: Family Strategies for Raising a Healthy Child," is available through some local independent bookstores and at www.challengeofdiabetes.com.

Plunkett, along with her mother and daughter, will be giving a talk called "Raising Wholesome Children in a Fast-Food World: A Framework for Family Health" Tuesday, May 22 from 7:30 to 9 p.m. at the Cape Ann Waldorf School, 668 Hale St., Beverly. The event is free and open to the public. Call 978-927-1901 for more.