Halloween and Hyperglycemia Concerns
The leaves are changing color and have begun to populate sidewalks and grassy areas heralding one of the most exciting holidays of the year for both adults and children: HALLOWEEN! I must admit that the Halloween holiday has murky memories for me: trick-or-treating in bizarre costumes (I never had any of the cool ones), and being scared of masks and strangers at my door. To some extent, I am still a bit anxious about the holiday for the same reasons. Now, I am a bit nervous about my patients who go trick-or-treating through the neighborhoods and attend Halloween parties for two reasons:
1. Potential to develop hyperglycemia and ketones due to candy consumption
2. Potential to develop hypoglycemia with potential neuroglycopenia (behavioral and neurological symptoms)
For those reasons, I try not to be "on call" for my diabetes team on Halloween eve. I would rather participate and directly observe the kids in their quest for booty.
Naturally, along with sleepovers, most parents and caregivers are a bit edgy about their children with diabetes when it comes to a holiday devoted to the consumption of mostly empty carbohydrates. Therefore, I am devoting this discussion to kids and caregivers in anticipation of a fun and safe Halloween 2009.
It is important to develop a strategy to tackle Halloween. No child or teen should be deprived of the fun of the "hunt" and subsequent enjoyment of candy collection. Some caregivers allow their kids to go trick-or-treating, but do not allow them to consume any of the treats (an unfortunate trick). The key is planning ahead and moderation. If your child is on three shots/day with conventional split-mixed insulin with NPH/regular or analog, you can be creative and add a bit of extra regular or analog with dinner to include several of the collected treats (assuming your kid went trick-or-treating in the afternoon). If the collection occurs at night or at a Halloween party, there is no reason your child cannot participate. Consider giving an extra hit of fast or rapid acting insulin if necessary to cover the extra carbs based on your diabetes team recommendations. Please check blood sugar first.... because your child may actually be low and not require extra insulin. If your child is on basal/bolus therapy or the insulin pump: no worries ! A bit of extra analog (along with good carb counting) should do the trick. Be prepared and have diabetes-related supplies available if your child attends a party so that he can partake in the eating festivities. Also, be prepared for surprises.
Trick-or-treating is exercise! Usually a lot of walking and revelry accompany house visiting and concerns for hypoglycemia are real. The good news is that there should be rapid acting carbohydrate immediately available in the child's booty bag! Keep in mind that chocolate may not be the ideal carbohydrate choice to treat hypoglycemia; a better choice might be something akin to "Smarties" that would increase the blood sugar more rapidly. I would encourage blood glucose monitoring fairly often because you may not recognize highs or lows in these situations.
In the evening, after trick-or-treating/Halloween party, check blood glucose frequently to treat hyperglycemia and potential post-exercise induced hypoglycemia. What happens over the coming days and months with all those delicious candies stashed in your home? Most families have different strategies to deal with all this stuff in your house regardless if your child has diabetes. One good idea is to empty all contents on the kitchen table with siblings or buddies and divide up the candy based on each kid's preferences. You may be surprised at some of the excellent choices made by your child. You also may get rid of some of the more offending offerings. Another method is for the caregiver to "pay" the trick-or-treater for the goodies in a sort of bartering arrangement. I will trade 10 chocolate bars for 10 "itunes," for example. (This may not work very well for a smart teen that may want you to trade for a new set of car keys!) However, cash does work well for teens that may parlay the candy for currency instead. By all means, be creative and allow your child to choose something meaningful to him/her. Plan on doling out the sweets over the coming days and include the carbs in your meal plan if using a conventional split-mixed insulin regime. In insulin regimes that allow for more flexibility (basal/bolus or insulin pumps), set the appropriate limits for candy consumption based on your beliefs. The rules should not be different for any child/teen in the family.
Most importantly, have fun and enjoy the holiday safely!