There is, however, no need to turn our backs on progress. We have sufficient knowledge of food and nutrition to let the pendulum swing back just enough to suit our needs. But we need the facts. We need answers. In this section we set out the facts about some of the most frequently asked questions about carbohydrates, diet and the G.I. factor to dispel any lingering doubts.

The sugar/fat seesaw. Did you know that fat and sugar tend to show a reciprocal or seesaw relationship in the diet? Studies over the past decade have found that diets high in sugar are lower in fat, especially saturated fat. Restricting sugar is frequently followed by higher fat consumption, and many fats are poor sources of nutrients. Thus a low sugar diet is not necessarily more nutritious. In some cases, high sugar diets have been found to have higher micronutrient contents, especially of calcium and riboflavin. This is because sugar is often used to sweeten some very nutritious foods, such as yoghurts, breakfast cereals and milk. A low sugar (and high fat) diet has more proven disadvantages than a high sugar (and low-fat) diet.

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Repeated injections of insulin at the one spot cause the fat at that spot to swell up and cause a lump. Children who develop lumps or swellings have usually done so because they have got a favourite spot which they use all the time, perhaps because it is less painful after repeated injections at one area. Lumps of this sort can be avoided by moving the injection site from leg to leg and to different places each day. If a lump has developed it will disappear again provided no more injections are put into that area. These swellings are sometimes called ‘insulin tumours’ but they are harmless and are not growths or real tumours.

Is there anything wrong with injecting insulin into the swellings at injection sites? They hurt less.

It is better to avoid injection sites that have become swollen, even if they are less painful. If you keep injecting there, the swelling may get larger and become embarrassing. The longer you inject into a lump, the longer it will stay swollen. Sometimes insulin injected into a swelling is absorbed less well, so that you may get erratic diabetic control.

Repeated injections into a swelling can increase the risk of an infection developing there, though this is unlikely.

Why can’t I take a bit more insulin and have sugary things in my diet?

Theoretically it should perhaps be possible to do this, balancing your taste for food with an increased amount of insulin. In practice it often just does not work out and the reason for this is that it is difficult to judge each day when you give your injection how much food you are likely to have that day. Also insulin injected beneath the skin works slowly and evenly over a period of hours and cannot cope with a sudden surge of glucose through the system that would follow something like a big piece of cake or can of ordinary soft drink.

Can young people with diabetes have tablets instead of insulin?

In general, no. Almost all children with diabetes require insulin. Tablets occasionally may be added to assist the action of insulin but can’t be given successfully instead of insulin. Some children, in the first few months of their life with diabetes, do respond to tablets, but no form of tablet treatment available at present is suitable for children in the long run.

What would happen if I did not have my insulin injection one morning?

If you missed having an injection for one day you would obviously develop high blood glucose levels and you might become very thirsty and pass excessive quantities of urine, much the same way as you probably did when you first got ill with diabetes. If you did forget your insulin and you realized this during the day you should consult your doctor at once, as he will probably advise you to have a supplementary dose of quick acting insulin to replace some of the insulin you missed. If you do this no harm will be done. If you do not it may take a few days to get re-stabilized.

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