How many carbs?

[rare]

I'm just curious for those of you who bolus your children whenever they eat, if you restrict their carbs or not. Do you allow them to have as many as they desire within a reasonable limit or do you try to limit to a daily recommended amount for their age and stage of physical development? The reason why I ask is because I called my son's school nurse's office today to ask about something and she brought up a concern she had.

She's concerned because I guess he's been eating double lunches at school. He's very honest about what he eats in school and gets the insulin for it. He always keeps track and tells the nurse so she can dose the carbs. But apparently she is still concerned because he will average as much as 188 carbs for lunch. I don't think he does this on a daily basis, by the way. He told her his doctors said he can eat whatever he wants as long as he gets insulin for it. That's partially true and also partially untrue.

To make a long phone conversation short, I pointed out to her that he's a growing boy who is extremely active, has a high metabolism, is thin and extremely muscular for his age. I mean, he's got a well defined 6 pack lol. He obviously needs the food or he wouldn't feel compelled to eat it, especially since I've been working extra hard lately to make sure his appetite isn't the result of hyperglycemia.

So... what say you? Is 188 carbs in one meal for a growing child a huge no-no? I say it's a lot, but not if the body metabolizes it. I just kind of shrugged it off because he normally averages 40 - 80 carbs at home whenever he eats. I agree the "I can eat whatever I want as long as I get insulin" attitude needs to change, but that'll come in time as he gets older.

[Nancy in VA]

I think the attitude of "I can eat what I want as long as I get insulin" needs to be replaced " I can eat whatever healthy (and sometimes unhealthy) a person of my age and size should be eating as long as I get insulin"

I don't think diabetes is an excuse to eat crap all the time, etc.

I don't have a teenager, but 188 carbs seems excessive for a single meal. I would think his entire day would be around 200 to 250, so that seems high to me.

[staciebco]

"I can eat whatever I want as long as I get insulin" attitude needs to change, but that'll come in time as he gets older.

I think that's a healthy attitude, and it's what we've told Caleb from the beginning. You CAN eat whatever you want as long as you take insulin to offset it. Also, I don't know how old your son is, but mine at 6 has eaten 100-150 carbs in one sitting if he's really hungry, so I don't think it's out of line.

[Twinklet]

I think it's fine. He IS a growing boy and he probably doesn't eat 188 carbs at EVERY meal.

Our CDE's son eats 300-400 grams a day (he's been T1 for 15 years) but he is very physically fit and works out a lot. He's also a teen if that helps. She is not worried about it and thinks it's normal.

It is not uncommon for my 10 year old to eat 250-300 grams of carb a day. We do not have junk food in the house, but she does love whole-wheat pasta and bread.

I remember eating like a horse when I was a teen--that is just a time of rapid growth. Now if only I can teach myself NOT to eat like that anymore! ;)

Our Endo doesn't believe in restricting carbs unless a problem is developing from it, such as obesity or high triglycerides. So, we simply cover all carbs in our house and don't have a problem with it.

[Twinklet]

I think that's a healthy attitude, and it's what we've told Caleb from the beginning. You CAN eat whatever you want as long as you take insulin to offset it. Also, I don't know how old your son is, but mine at 6 has eaten 100-150 carbs in one sitting if he's really hungry, so I don't think it's out of line.

I agree. One piece of Costco pizza is 110 carbs here. Most of the kid's menus in restaurants are well over 100 grams of carb. We've bolused for 150 grams in one meal many times. The trick with that is that the insulin needs to be delivered over a period of time, or 2 shots need to be given. But that's another topic.

[twodoor2]

If Elizabeth eats more than a certain amount of carbs at a meal where her dose ends up being larger than a certain threshold (~ 2.2 units in her case), the carb factor needs to go up slightly (i.e. 1/20 to 1/22). This is because studies have shown that larger the amount of insulin, the longer the duration of insulin action, and the higher the insulin peak. This has proven true with Elizabeth.

A larger than normal dose of insulin can sometimes cause hypoglycemia at the next meal. Therefore, we keep her carbs usually under 55 grams per meal, but if she has more, I know I have to be careful for the effect the larger dose of insulin will have. I don't believe in restricting her all the time (she usually can't finish more than 55 carbs a sitting), but I do make sure that she eats as healthy as possible with low GI foods. Parties, holidays, restaurants, are a whole different ball of wax.

I don't believe in restricting carbs if they're healthy carbs. 188 grams of carbs in junk food is a lot different than 188 grams of fruit and whole grains. Again, also be careful how to dose for larger than average amounts of food.

[sweetpea]

School lunch is so high in carbs and fat. My dd consumes about 100 grams of carb when she eats school lunch and she doesn't even eat everything that's offered. I agree that he should not have to limit his carbs. If I were in your place, I might be tempted to point out to the school nurse that combinations like pizza and corn for lunch is the real problem.

[Twinklet]

If Elizabeth eats more than a certain amount of carbs at a meal where her dose ends up being larger than a certain threshold (~ 2.2 units in her case), the carb factor needs to go up slightly (i.e. 1/20 to 1/22). This is because studies have shown that larger the amount of insulin, the longer the duration of insulin action, and the higher the insulin peak. This has proven true with Elizabeth.

A larger than normal dose of insulin can sometimes cause hypoglycemia at the next meal. Therefore, we keep her carbs usually under 55 grams per meal, but if she has more, I know I have to be careful for the effect the larger dose of insulin will have. I don't believe in restricting her all the time (she usually can't finish more than 55 carbs a sitting), but I do make sure that she eats as healthy as possible with low GI foods. Parties, holidays, restaurants, are a whole different ball of wax.

I don't believe in restricting carbs if they're healthy carbs. 188 grams of carbs in junk food is a lot different than 188 grams of fruit and whole grains. Again, also be careful how to dose for larger than average amounts of food.

Really? We never change our ICR for amount of carbs eaten. We just do a combo bolus for the amount over a period of time. And really don't experience hypoglycemia from it, either. If there are that many carbs on board, it will take awhile to digest and enter the bloodstream.

We were told in our classes to use a combo bolus or give 2 shots (one before the meal, one after) for any meal over 80 grams. It's always worked well for us.

[momtojess]

We dont restrict Jessi anymore then our boys. They all pretty much get to eat whatever they want, within reason of course.

Example.. In the summer, they each have a snack basket. They get to put 3 snacks of their choice in the basket each morning. They can eat the snacks any time they want but when they are gone, they are gone. So if they are all gone by 10a, not more snack till tomorrow.

For dinner, if they want to eat 4 helpings then we let them.

[Lee]

We do limit my 10 year old DD to 200 - 225 carbs a day - most days...she goes over, and anytime we are under 250 I feel pretty good. We do not do this for diabetes reasons...we do this becuase she is close to the top of the chart BMI...

This is not something that I whole heartedly buy into...my 12 year old - I can't even begin to count the # of carbs she has just between getting home and supper being ready - right now she is a eating machine! So I am sure we will have to update Coco's range when she goes through her eating spell...

BTW - she isn't chubby or fat - just dense - does that make sense? I am also dense (weight wise - not brain wise :rolleyes:) and have always weighed a good 20 or 30 lbs heavier than anybody guessed - great at carnivals! That is why I am not whole heartedly on board with the limit thing ~ it is just one thing to compromise with.

[rare]

Interesting guys. Thanks for sharing your thoughts. :) As for his attitude... we don't encourage eating unhealthy food. We encourage healthy eating, but he's 11. He's entering puberty and has the whole "tween" attitude going on. I'm sure those of you with kids his age know what I'm talking about it. ;) He gets so much conflicting information from everyone telling him "You can do this" - "You can't do that" or "You can have this" - "You can't have that" that he gets angry and cops an attitude.

I'd say 50% of the people who open their mouths to him have no business doing so in the first place - like for instance, my stepfather's sister. Say there's a family bbq and she brings dessert. He might go for dessert and she'll tell him he can't have dessert because he has teh ~diabetes~ (she's type 2 herself). That type of thing upsets him and it upsets me because it's not her place to make those decisions when I'm standing right there.

That ends up translating to "The doctors say I can eat whatever I want as long as I get insulin." when people get on him and I'm not around.

[alismom]

We do not count or limit our daughter intake of carbs. She is a very active 12 year old and just recently diagnosed. Our main concern now is that she is honest and bolus accordingly. I don't want her to have to feel as though she needs to "hide" her carb intake. Also, my non-d son, now in his twenties, would often eat double lunches at school. He was a thin, muscular athlete also. A teenage boy's appetite is unreal. I wouldn't worry unless it became an issue with his endo.

[twodoor2]

Really? We never change our ICR for amount of carbs eaten. We just do a combo bolus for the amount over a period of time. And really don't experience hypoglycemia from it, either. If there are that many carbs on board, it will take awhile to digest and enter the bloodstream.

We were told in our classes to use a combo bolus or give 2 shots (one before the meal, one after) for any meal over 80 grams. It's always worked well for us.

Not for Elizabeth, if she gets a larger dose of insulin, it seems to work too well. We've had this pattern show up in her logs many times, so now I watch for it, and am leary of giving really large doses. When she gets less than 1 unit, her duration of insulin action is around 3.5 to 4 hours, when it's between 1 and 2.2 units, it's goes to 4.5 hours, and if she's above 2.2 units, it's at least 5 hours. Since that tail end is in her so long, that's what ends up giving her the hypoglycemia. She has long absorbed the food, but the insulin is still going strong. We don't do the combo boluses except for when she eats high fat (which is very rare).

How do you split up your combo boluses and what percentage goes in what part?

[Charmed7]

I didn't read the posts, but my son is 9 y/o and eats a 110 carb breakfast. If he had enough time he would eat a large lunch (at home he'll eat about 100-150) but at school it's at 75. And dinner is usually a little lower because we have a high protein dinner, but he still eats about half a chicken with rice and veggies, or 2-3 pork chops, or a whole steak...and he's 9!

Skin and bone 75 lbs no need to worry about being over weight. He's too active and high metabolism.

I would just have his cholesterol checked next time you see a doctor (my son's was had elevated levels but nothing to be concerned with, so says my doctor) and he sounds fine to me.

My other opinion, is what other kids in that school are counting their carbs? Just because its out there for us to see, we may hesitate to think they are over eating, but I bet all the other kids are right there with him. I used to eat a bagel for breakfast, frenchfries for lunch and a box of pasta for dinner. :) I was a swimmer, and I burned it all, but man, have I had to learn how to eat since I stopped swimming.

Good luck,

Charmed

[Jacob'sDad]

Jacob is 7 yrs old and his insulin to carb ratio is not constant with higher carb meals. It is on a curve, not a straight line. The more carbs he has the harder it is to get the dose right and the more potential there is for error. However, he is not extremely active.

I think I read that that Mr. Universe Doug Burns, who is type 1, normally does not take insulin for food. He calculates how many calories he will burn with his workouts and then eats accordingly. He is so active that consuming enough carbs to keep from going low is more of a concern than not getting enough insulin and going high.

Someone who is very active and has high metabolism may very well have no problem consuming 200 carbs at a sitting and then burning most of it off. There would then be far less of a concern that skyrocketing BG's could occur from all those carbs. Preventing lows could be a bigger problem.

[Twinklet]

Not for Elizabeth, if she gets a larger dose of insulin, it seems to work too well. We've had this pattern show up in her logs many times, so now I watch for it, and am leary of giving really large doses. When she gets less than 1 unit, her duration of insulin action is around 3.5 to 4 hours, when it's between 1 and 2.2 units, it's goes to 4.5 hours, and if she's above 2.2 units, it's at least 5 hours. Since that tail end is in her so long, that's what ends up giving her the hypoglycemia. She has long absorbed the food, but the insulin is still going strong. We don't do the combo boluses except for when she eats high fat (which is very rare).

How do you split up your combo boluses and what percentage goes in what part?

It's always amazing to me how different the disease is for everyone!

For combo boluses, the duration and percentage depends on what she's eating. If it's pizza, we do a 70/30 over 8 hours (after much trial and error to get to this!). If it's something like Jamba Juice and it's over 80 grams, we start to infuse it 15 minutes prior and run it over 15-30 minutes. Most of our combo boluses are for higher fat items, though, like restaurant food. We always add in about 30% more insulin in the way of carb amount and run it in usually at 70/30 over 6-8 hours. But that's just what works for us. I've learned that pizza is TOTALLY different for everyone!

[staciebco]

Really? We never change our ICR for amount of carbs eaten. We just do a combo bolus for the amount over a period of time. And really don't experience hypoglycemia from it, either. If there are that many carbs on board, it will take awhile to digest and enter the bloodstream.

We were told in our classes to use a combo bolus or give 2 shots (one before the meal, one after) for any meal over 80 grams. It's always worked well for us.

Yep, same here. We never change (and we're never told to) ICR unless it's a "permanent" change. Also, I bolus the large carbs in a combo or extended bolus depending on the food.

[twodoor2]

It's always amazing to me how different the disease is for everyone!

For combo boluses, the duration and percentage depends on what she's eating. If it's pizza, we do a 70/30 over 8 hours (after much trial and error to get to this!). If it's something like Jamba Juice and it's over 80 grams, we start to infuse it 15 minutes prior and run it over 15-30 minutes. Most of our combo boluses are for higher fat items, though, like restaurant food. We always add in about 30% more insulin in the way of carb amount and run it in usually at 70/30 over 6-8 hours. But that's just what works for us. I've learned that pizza is TOTALLY different for everyone!

That makes sense since if food is high in fat, like restaurant food or pizza, it does take a really long time to digest, hence the long combo bolus. If Elizabeth eats 70 grams of fruit and whole grains and low GI foods (most of what she eats), she digests it much more quickly, and so that tail end of the insulin that goes beyond the 4.5 hour mark really affects her. However, if she eats something high in fat, we have to combo bolus, or the fat spike will get her later on. I'm still learning to do that with trial and error. It's kind of scary because some high fat things don't affect her like other ones. If I give her a high GI food, I sometimes run a smaller temp basal for a short period of time (like an hour). It's similar to a combo bolus, but I never did it for a huge amount of high GI, low fat carbs, it's probably a good idea though. She hates juice & soda and refuses to drink anything but kefur (drinkable yogurt) and water. The pickiest child!!

[thebestnest5]

I don't think healthy carbs should be restricted in a hungry child. However, I think restricting junky carbs for all kids is just fine and most likely necessary in a lot of instances. My kids just went to 2 birthday parties and we had 100 carb per slice cake for Easter--I am fine with those situations. But, I personally, would not feed my kids several Pop Tarts for breakfast---it's just not something I am comfortable with for everyday meal eating. My older kids are the first ones to say that they could eat 2-3 entire meals on McDonalds, but one healthy meal made at home and they are full. So, it is the quality of food that's eaten that has an effect on the total number of carbs consumed.

For example:

I can see myself eating a pound of Tortilla chips/Doritos...etc.

But, would I eat a pound of raw veggies with such gusto?! Umm, no.:o

How about a pound of raw fruit compared to a pound of cookies/brownies.

[Amy C.]

An 11 year old boy should be allowed to eat as much as he wants. My 14 year old eats between 350-500 grams of carbohydrates a day. Some days it is at the low end, but most days, over 400 grams.

The only reason to restrict the carbs is to lose weight. At 6'2" and 139 lbs, my son needs to fill out.

[rare]

Wow! He's a tall boy! He must be a walking stick. :D Ty is 4'7.5" and 80lbs. He's a little thing. I doubt he'll ever be tall. :D

[Hollyb]

I agree. The proof is in the pudding, so to speak. Your son is an appropriate weight for his height, he's fit. Obviously at this point in his life he's able to self-regulate the amount of food his body needs for healthy growth. And he's eating lunch, not three bags of Dorritos.

Another consideration: I found with my boys that 11-13 was the peak of junk food allure/consumption. Some of their friends consumed insane amounts of pop, chips and candy at this age. Start restricting an 11-year-old's healthy food, and he might begin filling the gap with Cheese Doodles and Jelly Babies on the way home from school.

I think it was good that the nurse let you know he does sometimes eat this much, just in case there were concerns. And now that she knows it's not an issue for you, she can relax and stop worrying about it!

[blbrocky]

My son eats anywhere from 60 to 180 carbs a meal and sometimes more.

Miles is very thin (way to thin) and was told he needs to eat 500 to 600 carbs a day. He never even comes close.

[rachabetic]

I think that it is ok. Especially if he is eating cafeteria foods. Those usually have a lot more carbs and sugar, so it would seem like he was eating a lot more than he actually is. He is also a growing kid, so he needs a lot of food!

[Scotty]

An 11 year old boy should be allowed to eat as much as he wants. My 14 year old eats between 350-500 grams of carbohydrates a day. Some days it is at the low end, but most days, over 400 grams.

The only reason to restrict the carbs is to lose weight. At 6'2" and 139 lbs, my son needs to fill out.

I agree.:) My 15 year old son regularly eats 400 carbs a day, and while he is not 6' he is well on his way and also needs to fill out.

[momof3sons]

The initial meal plan outlined by the dietician while we were in the hospital was 285 carbs for the day. We use a ratio for dinner, which was set at 60 carbs, but that is about what he usually wants.