Being the parent or caretaker of a child with diabetes means, quite literally, being their acting pancreas. You must learn not only what each type of insulin is and how it functions (fast acting, short acting; long duration, short duration), but also what each food means and how each reacts in your child's body. It's a lot to know, and it's no small feat to conquer this challenge. But with information, study, and practice, you can.

The Art of Carb Counting and Dosing

Notice the word “art” in place of what you may think of as “science.” While figuring out the actual carb count of a food or meal is indeed scientific, knowing how your child's body reacts to each type of carb is truly art.

Some foods cause huge spikes for some kids, but not for others. It takes time and practice to figure out the average expectation of a food's reaction in a body, weigh that against what you see happening in your child, and then assess and learn from each experience.

Carb counting and dosing takes time — and expert advice — to figure out. You should be working with your diabetes team to do this. Even if you've been dealing with diabetes for years, remember: A body changes, and so does its response to foods and insulins. Break out the log book again if you've been at it for a while and watch closely, again, for how your child's body responds in its own unique way to different foods.

Let's say you notice, three times in a row, that when your daughter eats pasta, she spikes three hours later. After observing this pattern you will be able to make an insulin decision to match that information (such as a square wave bolus on a pump or an added shot a couple of hours later for those on shots). In other words, you learn and react based on experience.

What About Sugar?

You've heard it so many times you can almost laugh: “Can't you just stay away from refined sugars?” This myth most likely comes from how people with Type 2 diabetes tend to battle their disease.

The fact is, while sugar does spike the blood sugar, kids with diabetes can have it just like other kids can (that means, within reason and in a healthy amount). The common perception that (1) your child needs to stay away from jelly doughnuts and (2) if he just does that he'll be fine, is simply not true. Because again, with understanding and planning, a jelly doughnut or any other treat is not out of the realm of possibility.

Letting your child know this and allowing him treats may help keep him from feeling different, left out, or wanting to sneak something you could have let him have anyway.

Spikes and How to Deal with Them

There will be no avoiding the fact that some foods — most foods, in fact — will make your child's blood sugar spike in one way or another. It's the knowing, though, that will help you manage this while still serving some great meals and treats.

When rapid-acting insulin came on the market, parents cheered because finally, instead of having to give kids a shot at least a half hour and sometimes hours before a meal and then demanding the child eat exactly the carbs they'd been given the shot for, parents could now wait to see what the child wanted to eat and give a shot just for that.

In some cases, parents would even wait until a meal was done, count the carbs the child had ingested, and then bolus (or give a shot) for that. But soon, doctors and parents realized something was happening: While this method gave more freedom, a child who was eating without any rapid (meal-covering) insulin on-board would spike to a point that would not be corrected by the usual dose.

Some parents split the difference and give half a meal bolus before the meal (usually about ten minutes before helps the insulin get ahead of the food) and the remainder needed at the end of the meal. Of course, you need to talk to your medical team before trying anything like this.

You may discover, too, that there are some red-light foods for your child that make her blood sugar go high no matter how carefully you measure out the food and the insulin. For some children, it's syrup. For others, it's slushes.

If you find a food that makes your child spike high no matter what you do, you may want to consider limiting it to a very rare usage. Try to find replacements your child likes, and explain to her why you are looking to limit that food. Point out, too, that she can still have many other foods, just not that one.

Why is it important to avoid spikes? Because science now shows that even a child in good control can suffer long-term complications from too many spikes. Once in a while is fine, but certainly not on a daily basis.