Table 5.

Parent quotes from interviews illustrating the qualitative themes regarding healthful eating for children with type 1 diabetes

Quote no.	Respondent/age	Youth age (yrs), sex, HbA1c (%)	Quotes
There are differences in a healthful diet for children with or without T1DM
12	Mother, 32	5, boy, 8.7%	“One that has a good balance of like the fruits and vegetables, but also for him specifically we try to make sure there's a good ratio of carbs and protein to help sustain the carbs. Obviously, you can't avoid carbs, but it's nice to limit high carb foods- breads and crackers.”
95	Mother, 32	3, boy, 6.9%	“The rest of the family has conformed to eating like him, so that he is not singled out; everyone is on the same page.”
119	Mother, 27	6, girl, 7.7%	“And so she eats what her sister eats [be]cause otherwise it's not fair to her sister...or it's not fair to her that her sister gets to eat sweets and she doesn't.”
64	Mother, 34	5, boy, 8.3%	“I don't know if you're at other people's houses or other, you know, I guess when they see the way other people eat, but they get to have donuts and fruit roll-ups and this and that, you know, and so like I said, we have it for special times and if we're somewhere they definitely can have it at somebody else's house.”
77	Mother, 32	6, girl, 8.7%	“Yeah, it's always been her choice and, you know, my other kids, I would have never allowed that, you know, what I serve for supper that's what we're having and if you don't eat you're just...that's it. But with her, obviously, I didn't feel like that's a good alternative. Why battle it. But when she doesn't eat her supper and she has a peanut butter sandwich, she doesn't get a snack.”
81	Mother, 33	5, girl, 7.8%	“If she is extremely high and the rest of us are having spaghetti she's in the 300s or even pizza or something and she's in the 300s, we will sometimes vary what she's having for dinner because of that.”
84	Mother, 40	3, boy, 7.9%	“I mean you say I'm not going to cook special food for the kids, but bottom line I always make sure that I have something that I know the kids are going to eat. And I think one of the things that was a real comfort, kind of gave me some comfort feeding meals, especially when they were a little younger and I just was worried, you know, I think when you first start dosing and, you know, you're like punching in that we're going to eat 30 grams of carbohydrates and are they really going to eat it and it made me feel good if I had one of those chocolate whips in the fridge because they've got a bunch of carbs in them and the kids love them and so I would know that if the whole meal was a flop, I could also be like, and I would always try to be kind of subtle about it so they wouldn't realize, ‘oh, you didn't eat my new rice dish that I made, you know, so you get a chocolate yogurt in place.’ I know I can be aggressive with my dosing because I've got a high carb thing as back up.”
Parents perceive barriers to healthful eating for children with T1DM
72	Mother, 29	3, girl, 7.1%	“It's easier to do stuff prepackaged because it has the carbs already figured for you. Even recipes online and stuff now have all of that info. However, you never know if it's true and you never know who came up with that and that sort of thing.”
69	Mother, 35	5, boy, 8.3%	“I think the biggest barrier is the time. Because being a single parent on the go, it's hard to have the time, you know, adequate time to really plan, really shop, and really think about those meals and what would be best to serve me son.”
58	Mother, 42	5, girl, 6.8%	“The fact that she just doesn't like certain... she doesn't like vegetables. That's our biggest challenge.”
63	Mother, 32	6, boy, 8.3%	“Um, school. School and day care and just like the standard child diet. And like just the type of stuff that people bring in for parties or for just their school lunches are so unhealthy. I would never let him eat a school lunch, but that's like the standard that everybody expects.”
67	Mother, 36	4, boy, 8.3%	“The world. School. Birthday parties. But he doesn't want to feel left out. And we don't want him to be and we don't want him to ever resent what he has.”
124	Mother, 35	5, boy, 8.3%	“He sees his classmates eating other foods that he wants to eat, or drinking other juices and he feels, at times, left out. So really trying to balance that between letting him be a kid and still experience the joys of childhood, but then also managing his diabetes at the same time.”
136	Mother, 32	5, girl, 7.6%	“She probably gets more sugar now and just for emotional reasons. I don't want her to feel left out and me saying no, she thinks it's... I don't want her to think it's because of her diabetes that I say no. Because it's not true.”
142	Mother, 43	5, girl, 7.6%	“It's tough though because we want her to feel like a normal kid, number one.”
143	Mother, 42	3, girl, 6.8%	“So that everyone can have the same thing, that's really really important. I think more important to me than it is to her, but I don't want there to be any kind of questioning or different... you know, like well why is this kid getting to have something and I'm not getting to have that.”
How parents practice meal planning based on the nutritional education they have received
122	Mother, 40	3, boy, 7.9%	“We learned in the hospital, when [child] was diagnosed, just kind of the general idea that you need to count carbs and then there was a one hour class, maybe a couple, 2 or 3 weeks after that I went to that, you know, further told you about label reading. And then really a lot of stuff that I'm doing I was not taught in class or I just had to teach myself.”
127	Mother, 42	3, girl, 6.8%	“I think being a good role model. Like the healthier I eat, if she sees me eating things and enjoy eating things that maybe she doesn't particularly like, it will encourage her to continue to try them, because maybe someday she'll like that.”
131	Mother, 34	5, girl, 8.3%	“I think that I have changed what I eat because once she was diagnosed I realized that everything that I do she's going to copy and so I made an effort to be healthier and so I'm especially conscious of what I'm doing in front of her and what I'm eating in front of her. I find that I don't drink soda anymore. I drink water or hot tea or coffee or, you know, Diet Coke now. Never drank Diet Coke in my entire life, ever. But we don't keep any sugared drinks in our house anymore, so that was a big change.”
134	Mother, 35	5, boy, 8.3%	“Educating him on what healthy foods are, what healthy foods are not, what that looks like, why he shouldn't eat it and then if he does eat an unhealthy food letting him talk about, you know, how is it making you feel? You know, showing him the high blood sugars that may result and so he can understand and see the consequences of his meal choices and from the things that he eats.”
107	Mother, 40	3, boy, 7.9%	“When we're dosing he usually gets to decide for meals how much he eats. Are you hungry for 25 carbs or is it more of a, you know, I'll usually try to give a guideline, like I think it's about a 36 carb meal, but you know, do you want a whole bunch of noodles or a little bit because that might make us go back to 30 or it might make us go up to 45. And so with meals, I kind of talk, but with snacks, I kind of dictate what he needs to eat.”