The key message is that the physical state of the starch in the food is by far the most important factor influencing the G.I. value. That’s why the advances in food processing over the past two hundred years have had such a profound effect on the overall G.I. factor of the food we eat.

The degree of starch gelatinization. The starch in raw food is stored in hard compact granules that make it difficult to digest. This is why potatoes might give you a pain in the stomach if you eat them raw.

Most starchy foods need to be cooked for this reason. During cooking, water and heat expand the starch granules to different degrees, some granules actually bursting and freeing the individual starch molecules. This is what happens when you make a gravy by heating flour and water until the starch granules burst and the gravy thickens.

If most of the starch granules present have swollen and burst during cooking, the starch is said to be fully gelatinised.

The swollen granules and free starch molecules are very easy to digest because the starch-digesting enzymes in the small intestine have a greater surface area to attack. The quick action of the enzymes results in a rapid and high blood sugar rise after consumption of the food (remember that starch is a string of glucose molecules). A food containing starch which is fully gelatinised will therefore have a very high G.I. factor.

In foods such as biscuits, the presence of sugar and fat and very little water, makes starch gelatinisation more difficult, and only about half of the granules will be fully gelatinised. For this reason, biscuits tend to have intermediate G.I. factors.

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No. It is probable that your child will have the usual childhood infections, and that he will become sick in the same way as other children. The main problem that you may encounter is the need to adjust the insulin dose during infection; usually a child’s insulin requirement increases when he is sick. Your doctor will tell you how to do this, and you will be guided by the blood glucose and urine ketones. Be sure to adjust the insulin dose back towards its previous level as soon as the illness is over and the blood tests are normal.

Also during an illness it is likely your child may lose his appetite. It will then be necessary to replace his ordinary meals with emergency fluids and other replacements for the carbohydrate part of his diet. You should consult the dietary section for details.

I want my child to have as good an education as possible, but he wants to leave school early and start earning. Should the fact that he has diabetes influence his decision?

It is always hard to generalize on such an important subject as a career or life occupation for a child. However we should realize that in the long run training and skills gained from education can lead to more interesting and better paid jobs with greater security. A child who is tempted to leave school because he is impatient to be earning may find he is worse off as an adult because of lack of education for advancement and promotion. Having diabetes may make the problem more difficult as he may require time off for illnesses as he gets older; security in one’s occupation is important for a person with diabetes in later life. Certainly skills may be learnt on the job and leaving school to become apprenticed may well be the correct decision for your child. Having diabetes should not affect this.

At all events it is wise to discuss the very important business of employment very fully with your child and perhaps discuss it with his schoolteacher and with his doctor. Sometimes it is helpful to have an interview with a vocational guidance officer who will assess both your child’s abilities and his inclinations. He can then make recommendations and suggestions about the type of work for which he is most likely to be suited, and the best way to become trained for it.

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