Moving to Secondary School

• Start the day with something for breakfast. Choosing slowly absorbed (low GI) carbohydrate foods, helps to manage glucose levels. Include a small amount of protein with breakfast for example a boiled egg, some milk or yogurt. If you can’t face breakfast immediately then have it 1-2 hours after you wake up. If you wake up late at the weekend, try not to miss meals. 
• Eat three meals a day which include some starchy carbohydrate foods. Try and include fruit, vegetables and wholegrains as part of your meals.  
• Try and leave a gap of at least two hours in between eating during the day. Try not to eat overnight. Having a balanced meal pattern with a period overnight without food is important for a healthy body weight. Leaving 2-3 hours between food also allows glucose levels to return into range.   
• Limit treat foods to after meals and try not to have them every day.  
• Include three portions of low-fat dairy foods each day.  
• Include a small amount of unsaturated fat (good fats) from vegetable oils, oily fish, nuts and avocados each day.  
• Try to limit processed foods as these tend to be higher in refined sugar, salt and less healthy fats.   
• Have water to drink with every meal and snack and keep a water bottle to sip throughout the day.  

It is important that you eat the right about of carbohydrates, protein and fat to ensure that you can grow properly. This is especially important during the teenage years as you are growing rapidly. 

There are many factors that impact how much carbohydrate you need, including your age, your size and activity levels. We can work out your carbohydrate requirements for you.

• Carbohydrate counting is a way of adjusting fast acting (bolus) insulin based on the amount of carbohydrate you eat. 
• Carbohydrate counting allows you to decide how much carbohydrate food you eat as part of your meal and adjust your insulin dose to match your meal or snack. 

If you have just been diagnosed with type 1 diabetes, then the team will have taught you how to do this. If you have had diabetes for a while, until now your parents may have been in charge of carbohydrate counting and you may have started to learn from them. 

• Start practising carbohydrate counting at home so you can ask an adult if you get stuck - they can check the calculations with you. 
• In Year 6, if you have someone that helps you at lunchtime, start by carbohydrate counting together. Gradually take over from them as you get more confident– they can watch or check the carb count for you if you’re not sure.  
• Over time you will become an expert carb counter – ready for secondary school!

You may need to take on the job of carbohydrate counting when you are at secondary school. There could be more choices for lunch and lunchtime may be later or shorter than at primary school.  

Here are some tips to help manage food and diabetes at school: 

• Most schools use standard portion sizes for their meals so you might find that the amount of carbohydrate you eat each day is similar. 
• Some schools offer a larger snack at morning break such as panini, pizza slice or sandwiches. You will need to carbohydrate count these foods and take insulin for them.
• Use the bolus calculator on your app or pump, to work out the insulin dose for you.  
• If you don’t know how much carbohydrate you are going to eat, tell the pump a minimal amount 10-15minutes before you eat (maybe on the way to the canteen or at the end of the lesson before lunch). You can add in more carbohydrate if you need to. 
• Watch out for sugary drinks as the high sugar content can cause your glucose to rise quickly. Try to choose sugar free drinks or water. 
• Watch out for high fat or high sugar foods such as sweets, crisps or pastries, try to choose fruit instead.  
• Some young people find it helpful to take photos of their meals. You can write the carb value on the picture and save it on your phone. 
• If you have the Carbs & Cals app, you can save meals in the diary and then it is saved for the next time you eat that meal. 
• If you have PE or games straight after lunch, you might need less insulin to prevent hypoglycaemia.

It is usual to feel hungry after school. If you regularly have a snack at this time then try to go for a healthier option such as fruit, dried fruit or popcorn.

If you have a long journey to and from school, it is a good idea to carry snacks in case of any emergencies or delays. Remember always carry hypo treatment. 

If you are going to start walking to and from school, then your pump settings may need adjusting.

If you are away from home on a school trip or a sleepover there are lots of places where you can find the carbohydrate content of food and drinks: 

• Carbs & Cals ® app (Android/Apple) or book 
• Food labels and packaging            
• Café, restaurant and other food outlet websites   

If you don’t have any of these then you can use handy measures to help estimate carbohydrate:

    1 medium slice of bread = 15g 

  Golf ball size piece of fruit = 5g 

  1 scoop mashed potato = 10g 

  1 egg sized potato = 10g

  1 tablespoon pasta or rice = 10g 

  Tennis ball size piece of fruit = 15g

  3-4 chips = 10g

You can make your own list of foods that you like to eat and the carb count for a handy guide. If you want more help with this then let the team know.

This is called pre-bolusing. It will reduce the glucose spike you might see after eating.  

This can be easier to do for some meals than others. Even if you manage 5-10minutes before eating, this will help.  

If you don’t know how much or what you are going to eat, you could bolus for a smaller amount of carbohydrate 10-15 minutes before and then give the rest once you know what you’re eating.

It happens! If you forget to bolus, your glucose will start to rise.  If you use a hybrid closed loop system, it will try to help and increase insulin delivery.   

You can still bolus if you remember afterwards, you should adjust the bolus to reduce the risk of hypoglycaemia.

As you grow it is normal to be hungrier and want to eat more. As your portion size increases, remember to check the carbohydrate content.

Five to 18 year olds should do at least 60 minutes of activity a day.   

This might be from PE or games, walking to and from school, after school clubs, sports clubs or playing with friends. Being active helps you to have a healthy body, healthy weight and helps to manage diabetes. Being active throughout the day can reduce your insulin requirements. 

Movement after mealtimes is helpful for example, walking to school can help reduce the glucose spike that can occur after breakfast. 

If you are changing the type of activity or increasing the amount of activity you do, then the settings in your pump may need adjusting. Please contact us if you want help with this.

There is a lot to learn about diabetes! As you get older you will learn more and take on more responsibility but for now it is important that you have the support of an adult.  

It is their job to make sure you are safe and to help you manage diabetes. This can sometimes be a bit annoying but remember they are there to look out for you and some young people find it helpful to share the diabetes tasks from time to time.

Most importantly food and eating should be fun and enjoyable. Enjoy eating with your friends and family. It can also be fun to try new foods together or start to learn to cook simple meals or snacks. This will help you to be healthier and get into good habits as you get older.  

If thoughts or feelings about food and counting carbohydrate become overwhelming or mean food and eating become less enjoyable or more stressful, please talk to the team. 

If you would like further information or an appointment to discuss carbohydrate counting or managing food, activity and diabetes at school please contact the diabetes dietitians at uclh.cddietitians@nhs.net

• Digibete: https://www.digibete.org/schools-teachers/key-stage-3-4/ 
• Digibete: https://www.digibete.org/wp-content/uploads/2023/06/TopTipsforSchool_2006b.pdf 
• Managing mealtimes using your hybrid closed loop system
• Managing mealtimes with multiple daily injections

Emergency mobile: 07940 476811 

Email: uclh.cdorange@nhs.net 

Email: uclh.cddietitians@nhs.net 

Further information and fact sheets can be found on our Children and Young People’s Diabetes web page.