{Diabetes Management} Birthday Cake?

by Leighann on September 1, 2014

Please remember that I never give medical advice. Ask your endocrinologist or pediatrician for advice about your own child. Make your own informed decisions for your own child.

Birthday Cake

A question I see very frequently of d-parents during that first year after their child’s diagnosis is whether their child can have birthday cake, should they only have a tiny slice, and should it be made sugar-free.

Can my child with diabetes have birthday cake?

The short answer is: “Yes, your child can have cake!”

When our daughter was diagnosed, her brother’s first birthday and that of two friends were within the next few weeks. When I asked the nurse what we should do, she told me not to treat her any differently just because of diabetes. It’s advice that we’ve lived by ever since.

In those days, my daughter was on multiple daily injections (MDI) so she needed an extra injection if the cake was not at regular mealtime. But birthday cake is totally bolus-worthy!

Now that she has an insulin pump, she has the freedom to eat at any time without having to get another injection.

Of course you need to ask your own endo or CDE for advice about your child, but here are my thoughts:

Can my child have birthday cake?

Yes. Did your child have birthday cake before she was diagnosed? Do siblings and other family members get cake on their birthday? There is no reason to change your tradition based solely on the diabetes diagnosis. Your child may feel different if she’s the only one who doesn’t get a birthday cake on her special day.

Also, I don’t think the child with diabetes should be left out of birthday celebrations or be given an alternate dessert. If you are serving cake, everyone should get cake.

Should I serve my child with diabetes a tiny slice of cake?

Do you want a tiny slice? I know I don’t want a tiny slice. Give everyone the same serving. Don’t treat your child with diabetes differently. Give the insulin needed to cover whatever size piece of cake your child gets.

Tip: Cupcakes are great because it’s easy to give everyone the same portion and quicker to serve at parties. I bolus for 30-40 carbs depending on the icing.

Should I make a sugar-free or “diabetic-friendly” cake?

Ick! No. Did you know that many sugar-free foods actually have the same or more carbs as their regular counter part? Why not enjoy real food made with real ingredients? Your taste buds will thank you. Not to mention that artificial sweeteners and sugar alcohols can cause major gastro upset in little kids. And that’s no way to spend a birthday!


I often hear parents say they’ll let their child “cheat” on their birthday. I caution that calling it cheating may create a not-so-good mindset about food. Is everyone else in the family cheating on their birthday? No, they are not.

By saying that eating a certain food is cheating or that a certain food is off limits, we can create a scenario where a child sneaks food (usually without insulin!) so they don’t feel deprived. Because diabetes management is so tied to food, it’s important not to create food issues by making certain foods off limits or by making them taboo, vis-a-vis calling it “cheating.”

My philosophy?

Delicious birthday cake + insulin to cover the carbs = a really great birthday

Now that’s some diabetes math I don’t mind doing!


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