How to set boundaries with food when living with type 1 diabetes

Family gatherings are often a chance to enjoy each other's company over a meal or catch up while noshing on a spread of delicious foods. But for people living with type 1 diabetes (T1D) — like me — these situations can sometimes be tricky to navigate.

We don't want our condition to get between us and our family, but carbohydrate counting is a serious part of diabetes management. Thankfully, I've found success with several tips and tricks. Here are five helpful strategies for setting boundaries with food at family gatherings.

1. Make a game plan

Before you even get in the car to drive to grandma's house, give yourself a head start on difficult food conversations by having a game plan. If you like to stick to a certain carbohydrate target during the day to keep blood sugar steady, think about how you'll pair your needs up with the event in question.

For instance, I know my Aunt Charlene makes a delicious cheese spread every year, so I'm going to dedicate my snack carbohydrate portion to a few crackers and cheese instead of blowing the budget on a bunch of cookies or spiced cider. And my guilty pleasure is mom's mashed potatoes, so I'll be sure to trade that extra roll for a more generous portion of the good stuff. Working through this plan before showing up will give you more confidence to follow through when the time comes.

2. Politely decline

It sounds easy to do on paper, but politely declining a homemade holiday staple can be difficult in practice. If these types of interactions ramp up your anxiety, try to give yourself some runway for preparation.

Think about who has the pushiest personality or the most fragile appetite for rejection. I've even generated a fake conversation in my head before arriving at the gathering, focusing on the best phrases to use when politely declining. The last thing you want is to get into a family argument over food!

3. Respectfully educate

Diabetes can feel a bit foreign if it's not something you deal with every day. The condition is discussed in the media as just numbers and statistics — but this is your chance to give diabetes a face and convince your relatives that there are real people living with this condition and thriving.

I've found the best success comes when my educating is rooted in respect. You can start by acknowledging that it's OK to be unfamiliar with the mechanics of the condition, with a comment like, "I'm so thankful you don't normally have to think about the logistics of diabetes or prepare meals with diabetes in mind."

Also, make a point to use simple but personal explanations. For example, "I try to target 40 carbohydrates for each meal because I've found this gives me the smoothest trend line," or, "Keeping my blood sugar stable by sticking to a standard carbohydrate routine helps me feel my best."

If you're comfortable, illustrate your points by walking through the last few hours of continuous glucose monitor (CGM) data, "You can see here my blood sugar started going up in response to eating breakfast, but I timed out my insulin dosing well because the peak wasn't over my 'high' threshold." You can also just keep things high level and explain, "Diabetes requires a lot of careful carbohydrate counting and timely insulin delivery to mimic a person with a perfectly functioning pancreas!"

4. Indulge in extreme moderation

Traditional holiday food is typically loaded with carbohydrates, but I've also found that some relatives try to overcompensate and feel they need to offer a separate, sugar-free or low-carbohydrate menu. Food is a personal choice, but for me, I would rather have a smaller amount of the real deal than be stuck in a corner with my sugar-free version.

If this situation arises, use your response to educate again, "Thank you so much for considering my diabetes, but actually, I can eat the same chocolate pie like everyone else, as long as I count the carbohydrates and give insulin appropriately." You're no stranger to practicing moderation, and you deserve to enjoy all the things that make family gatherings so sweet.

5. Offer alternatives

As a mom of two toddlers, I've recently perfected my "pivot" game. This is also a great tactic to use when uncomfortable interactions regarding food pop up. Instead of sitting around the kitchen eyeing all the appetizers and sweets, suggest a walk around the block or whip out some pictures of your adorable kids to show off.

Have a few generic questions ready to steer the conversation away from food if it makes you uncomfortable. For example, "How is that new job going?" or, "What activities are your kids involved in these days?" You might be surprised at how quickly a craving can pass when your mind is preoccupied.

Preparing to politely decline generous food offers is the first step toward setting boundaries, but family and friends unfamiliar with diabetes may not know how to react in these situations. As people living with type 1 diabetes, managing food and carbohydrate intake (and selectivity) are second nature, but it's on us to realize that not everyone has the same, sometimes sterile relationship with food and snacks. Recognizing this fact — and practicing empathy — will help smooth the conversation so a relative doesn't take your "no thanks" personally.

Want to share a resource for more diabetes information with your relatives? Point them to the library of articles on Health Insights for diabetes tips and education.