I'm a school nurse (visiting several schools) who has been asked for help for a first grade teacher who has a student newly-diagnosed with Type 1 diabetes. He has a definite sweet tooth and will take sweets from others, etc. He does not respond to any of the usual positive reinforcers available to the teacher. The teacher is also concerned about what to tell his classmates, as well as how to allow his classmates to have special occasion treats from which he must be excluded. Probably what would help me best would be specific food compliance techniques and other general behavior modification tools that have had good success.
Sounds like a perfectly normal child! Some suggestions to consider:
- Get the videotape "It's Time to Learn about Diabetes" (free from Lilly by calling 1-800-545-5979) and show it to the class.
- Have the teacher teach good nutrition to the entire class (using the Food Guide Pyramid)
- Find healthy snacks for the whole class.
- Eliminate sweets at school for everybody except at specified times; then the child with diabetes (and his parents) can plan to participate with food choices that match his meal plan.
- Read the new webpages at Diabetes in School
Additional Comments from Dr. Lebinger:I think it is always a difficult situation for siblings and friends of children with diabetes to decide whether to avoid sweet foods their diabetic sibling or friend can't have. I would speak to the parents and ask them to get a list of treats the child can have. Usually a cupcake without frosting, a plain donut, plain ice cream, and many cookies can be fit into the child's meal plan. I suggest that there always be a choice of foods, for instance chocolate-covered donuts and plain donuts so all the children can have a choice, not just the child with diabetes. Of course, if you are going to do this, the child with diabetes has to agree to pick the plain donut. If the child won't do this, perhaps the class can serve "treats" the child with diabetes can have. Of course, it is good to schedule these treats around the child's usual snack time or meal time if possible.
Sometime I find the child with diabetes actually has problems in school if the school focuses too much on avoiding sweets. For instance, many schools do not allow cookies for snack in school, but insist on fruit. For many children with diabetes, fruit alone (without milk or some protein) doesn't last long enough to prevent low blood sugars a few hours later and a few plain cookies work better.
Although many dietitians and physicians feel all "candy" should be avoided, I suggest to children at special occasions such as parties that they exchange in a few miniature peanut butter cups (each one has only 4 grams of carbohydrate), so if the child can limit it to 2 - or 3 miniatures, their blood sugar is usually okay.
I think the most important thing is to work with the parents and the child's diabetes team to make sure the child is included in all festivities.
Original posting 12 Sep 97
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