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Type 1 Diabetes And Halloween Candy—Always a Bad Combo?

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Halloween is, once again, nearly upon us. Soon children will be walking the streets of our neighborhoods dressed as ghosts and goblins to collect candy. They’ll smile as they shout “trick or treat,” and continue to the next house care free. But for children with type I diabetes, Halloween is not often such a simple affair.

Type I diabetes is most often diagnosed in children and young teenagers, and is a condition where the person’s immune system attacks the pancreas for some reason that is not completely understood. The pancreas produces the body’s supply of insulin, a hormone that helps cells remove sugar from the blood and store it for later use. When the body attacks the pancreas it prevents insulin from being produced, which results in too much sugar in the blood and not enough being stored. If untreated, this will be fatal, but fortunately there is a simple treatment. The type I diabetic must take insulin with every meal and snack.

I was diagnosed with type I diabetes when I was two years old, and have handled the disease for as long as I can remember. When I was still young enough to go trick-or-treating on Halloween, it was always difficult to manage my blood sugars. Like many people who have grown up with type I diabetes, I often missed out on the fun of Halloween (as well as birthday parties, Christmas parties, and other occasions calling for sweets). Halloween can be a stressful time for parents of diabetic children, so I have written this guide to help them control their child’s blood sugars.

Since I was first diagnosed, much has changed in how diabetes is treated. Fortunately, all of these changes have made it considerably easier to control. When I was first diagnosed, the machines used for testing blood sugar levels took over a minute to process a blood sample that was nearly pea-sized; these days, it takes 5 seconds to analyze a sample that is considerably smaller.

When I was young I took pork insulin, which reacted so slowly that I needed to inject the medication at least an hour before I ate. These days, synthesized versions of human insulin such as Humalog begin working in as little as 15 minutes. Furthermore, pork insulin was less reliable at keeping blood sugars level over long periods. These days, diabetics have two ways to keep blood sugars level throughout the day. They can either use an insulin pump, which delivers a small amount of fast-acting insulin on an hourly basis and then delivers larger amounts to counter meals. Alternately, diabetics can take a daily injection of a time-released insulin such as Lantus, and then an injection of a fast-acting insulin with each meal. Both of these methods make it much easier for diabetics to control their blood sugars and to live more normally.

The most effective way of controlling a child’s blood sugar is to count carbohydrates. Through talking with your child’s doctor, you will know what base rate of insulin is needed, or how many units of a time-released insulin are needed, to maintain sugar levels if the child does not eat. The doctor can also figure out how your child’s body reacts to sugars and different doses of insulin. He or she can then give you the “insulin to carb ratio,” which dictates that for every number X of carbohydrates, the child should take 1 unit of insulin.

The insulin to carb ratio is different for every person, but mine is 1 unit of insulin for every 7 grams of carbohydrates. If I were to eat a banana, which averages approximately 20 carbohydrates, I would divide by 7 to see that I need 2 and 2/3 of a unit of insulin. The insulin pump gives insulin in half-unit increments, but insulin pens (which I use) only give insulin in whole-unit increments, so I would round to the nearest whole unit of insulin and inject 3 units.

Most candy wrappers have nutrition information panels on them which list a serving size and the total carbohydrates for that amount of the candy. Even if the nutrition facts aren’t printed, there are books with such information, such as The Calorie, Fat & Carbohydrate Counter, available from Family Health Publications. In this book you can look up the serving size and carbohydrates from many different foods, candies, and even for meals served at many restaurants. By monitoring how much your child eats, and how many carbohydrates are in that meal, you can accurately determine how much insulin the child will need each time he or she eats.

So how does a parent control blood sugars during Halloween? Monitor your child’s candy intake. Snack-sized candies such as one Reese’s Peanut Butter Cup or a Mini Snickers tend to average 10 grams of carbohydrates apiece. The Fun-Packs of Skittles and M&M’s average 20 grams of carbohydrates apiece. If you can’t find the nutrition information on the wrapper, check a book like the one suggested, or search the internet to find more accurate counts of carbohydrates, and base your child’s insulin dosage on that.

Once again, your doctor will tell you your child’s insulin ratio of 1 unit/X carbs. Thus, if I were to eat a normal-sized Almond Joy candy bar (28 grams of carbohydrates) after trick-or-treating, with my 1/7 ratio I would take 4 units of insulin. If I were to eat a King Sized Almond Joy (53 grams of carbohydrates), however, I would need nearly 8 units of insulin.

Once you know your child’s insulin to carb ratio and how to count the carbs he or she is eating, it is essential that you monitor intake. If the child eats more candy than you realize, or eats three pieces that you are aware of but sneaks three more pieces half an hour later, you won’t be able to control his or her blood sugar because you won’t be giving the proper amount of insulin. Thus, for small children, you should keep the Halloween candy hidden and dole it out in amounts that you can control. Once a child is older and more responsible, they may be able to be trusted to not sneak treats and take care of themselves; however, children generally don’t become responsible enough to take care of their diabetes until they’ve reached the point of being too old to go trick-or-treating.

Lastly, this article is meant to be a general guideline for parents who may be unsure of how to handle Halloween with a diabetic in the family. In most cases, it isn’t actually necessary to completely deny the child access to candy. However, I am not a medical professional. I am simply a diabetic writing from personal experience. It is extremely important that you listen to your child’s doctor; only a medical professional has the experience to know what is truly best for your child. If anything your child’s doctor says contradicts what I have said, it is important to listen to the doctor. Like many areas of medicine, what works for one person does not always work for the next.

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About Mike King