Managing holiday foods and routines with type 1 diabetes

Holidays can bring large meals, family gatherings and late dinners – and each can affect your child’s blood sugar.

“With a little advance planning, kids with type 1 diabetes can eat the same foods as everyone else and enjoy the holidays as much as anyone else,” says Soumya Adhikari, M.D., Pediatric Endocrinologist at Children’s Health℠ and Professor at UT Southwestern.

Dr. Adhikari shares tips for planning ahead, counting carbs, dosing for long meals and keeping blood sugar steady when routines change.

Preparing for holiday gatherings

• Ask about the menu and the timing. Knowing what's being served and when you'll eat helps you plan insulin and snacks. If dinner is late, plan a snack to tide your child over.

• Bring a dish you know. A side or dessert you've made before, with carbs you've already counted, gives your child at least one easy choice.

• Keep long-acting insulin on its usual schedule. If your child takes a daily long-acting (basal) insulin shot, give it at the usual time, even if the day runs late.

• Pack more than you think you need. Include your child’s usual insulin, fast-acting sugar, glucagon (emergency medicine that raises blood sugar quickly), ketone strips, a backup meter and extra pump or continuous glucose monitor (CGM) supplies.

• Tell one other adult where the glucagon is and make sure they know how to use it. This is especially important if your child will be playing away from you.

Carb counting at a holiday table

Holiday plates are typically harder to carb count than a school lunch.

But it's OK to estimate the carbs.

Tips for counting carbs at holiday meals to better manage blood sugar levels include:

• Serve your child’s whole plate at once. This allows you to count everything together.

• Ask for the recipe. If that’s not possible, you can compare the dish to something similar you already know.

• Count seconds and dessert as their own carbs.

• Remember that sugar-free isn't carb-free. Sugar-free pies, cookies and candies can still contain plenty of carbohydrate and raise blood sugar.

• Check the label on anything store-bought.

According to USDA FoodData Central, typical carbs in common holiday foods and dishes:

• 3 oz of roast turkey: 0 grams

• ¼ cup gravy: 3 grams

• ½ cup green bean casserole: 8 grams

• ½ cup corn: 16 grams

• ½ cup mashed potatoes: 18 grams

• ½ cup stuffing: 20 grams

• ½ cup mac & cheese: 27 grams

• ½ cup sweet potato casserole: 22 to 50 grams (more with marshmallow or brown sugar topping)

• ¼ cup cranberry sauce (canned or jellied): 28 grams

• 1 dinner roll: 15 grams

• ⅛ of a 9-inch pumpkin pie: 43 to 55 grams

• ⅛ of a 9-inch apple pie: 43 to 56 grams

• ⅛ of a 9-inch pecan pie: 62 to 79 grams

• 12 oz regular soda: 38 grams

• 8 oz apple cider: 28 grams

“A little calculating before the meal can go a long way,” says Dr. Adhikari.

Insulin dosing for long meals

Holiday meals often mean kids and families are eating appetizers, then dinner and then dessert – over many hours. This “grazing” can make it hard to match insulin to food. Your care team can recommend the best plan for your child during these longer meals, which may include that you:

• Set a window for snacks and count everything in that window.

• Count and dose for each round of the meal.

Insulin dosing for rich, high-fat meals

Rich, high-fat casseroles, gravies and pies can raise blood sugar several hours after eating, much longer than after a more typical meal.

“Fat slows digestion and can temporarily make the body less responsive to insulin,” says Dr. Adhikari.

Your care team can recommend the best plan for your child for eating higher-fat foods. Common approaches include:

• Checking your child’s blood sugar two to three hours after the meal – and again before bed.

• Using a split or extended insulin dose, if your child uses an insulin pump.

The effects of play, excitement and travel on blood sugar

Holidays often bring changes in a child’s typical routine that can affect their blood sugar levels.

So it’s important for parents and caregivers of kids with T1D to remember:

• Activity lowers blood sugar. A backyard football game or a long walk after dinner can lead to lower blood sugar, sometimes hours later – or overnight.

• Watch the night after a big day. A busy, active day followed by a late bedtime is a common setup for overnight lows.

• Be extra prepared for travel. Excitement, stress, lack of sleep and travel can push blood sugar up or down.

When to seek help

It’s time to call your care team if your child with type 1 diabetes:

• Has ketones that measure “small” or higher

• Is vomiting and can't keep fluids down

If your child is awake but unable to eat or drink, rub glucose gel inside their cheek.

Call 911 if your child has trouble breathing or trouble waking up.

If your child is experiencing severely low blood sugar that causes a seizure or fainting (unconsciousness):

• Give glucagon and call 911. If you don’t have glucagon, seek immediate emergency care.

• Turn your child onto their side.

• Do not give them anything to drink.

Download the Diabetes Advisor App

For around-the-clock diabetes care, download the Diabetes Advisor App. Text "diabetes" to 77444 to download. Learn more about the Pediatric Diabetes Advisor App.