Experience of Caring for a Child With Type 1 Diabetes Mellitus in a Food-Insecure Household: A Qualitative Evaluation

Abstract

Food insecurity is a stressful experience for caregivers that intensifies after their child develops type 1 diabetes. Families sacrifice food quality or quantity of other household members to prioritize the needs of the child with type 1 diabetes. Diabetes teams can provide support by asking about food security, adapting management plans and referring families to resources for support.

ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional management in children and adolescents with diabetes

“…The challenges of diabetes management are increased for families facing FI and the associated risks are amplified in children with diabetes, where nutrition plays a vital role in management 22 . Limited budgets lead to purchasing cheaper, energy dense foods, inexpensive poor‐quality carbohydrates (refined grains and added sugars), lower nutrient dense foods which may increase dietary glycemic load, and therefore, worsen glycemic outcomes 91,92 .…”

“…3,4,8 Young people living with food insecurity (FI), should be offered strategies to alleviate the challenges and stresses experienced which make achieving dietary recommendations for diabetes difficult. 22 Energy requirements change with growth and regular reviews of their food intake, particularly in younger children, are essential so families can retain flexibility with their meal plans. 4,23 Energy prediction equations are a useful guide to estimate energy requirements in young people, however, these calculations must be individually tailored to an eating plan that is achievable and nutritionally adequate.…”

“…When a child or young person is diagnosed with diabetes, a specialist pediatric dietician should assess the food intake and eating patterns of each family and offer advice to help them develop a routine meal plan that meets their child's nutritional needs and provides adequate energy for an active lifestyle 3,4,8 . Young people living with food insecurity (FI), should be offered strategies to alleviate the challenges and stresses experienced which make achieving dietary recommendations for diabetes difficult 22 …”

“…90 The challenges of diabetes management are increased for families facing FI and the associated risks are amplified in children with diabetes, where nutrition plays a vital role in management. 22 Limited budgets lead to purchasing cheaper, energy dense foods, inexpensive poor-quality carbohydrates (refined grains and added sugars), lower nutrient dense foods which may increase dietary glycemic load, and therefore, worsen glycemic outcomes. 91,92 A study conducted in Jordan reported that individuals with diabetes who were severely food-insecure had a significantly higher average BMI, even though they consumed fewer calories than mildly foodinsecure or food-secure individuals leading to the "obesity-hunger paradox."…”

ISPADClinical Practice Consensus Guidelines 2022: Management and support of children and adolescents with diabetes in school

“…If school staff are not trained to administer insulin, this can create a barrier to accessing food supports like breakfast programs for students with diabetes. 28 Students who do not receive lunchtime insulin will require both a midday meal and snacks to prevent hypoglycemia and match the action profile of insulin injected at the beginning of the day (see Chapter 10, Nutritional Management in Children and Adolescents with Diabetes). Thus, the level of support required at school will vary depending on the student's regimen and level of independence, from ensuring the student consumes their meal on time, to assisting with counting carbohydrates to determine insulin doses.…”