Peanut Butter Ritz Bitz and Teddy Grahams

[oregonmom]

It seems like when ever I give Sam these for a snack, it spikes his blood sugar up. They say a carb is a carb, so I don't understand. If I give him applesauce compared to crackers even if they are the same carbs there is alsways a difference in his bs.
Any suggestions or advice? It just makes it so hard to manage.
:confused:

[A&Ds Mommy]

I was having the same issues with pb and crackers, no matter what brand. We now save them for overnight lows as they work well. Teddy grahams are okay for him. I think I remember the dietician at our endo office saying something about the type of sugar in it or something about it being a refined sugar; sorry can't remember exactly. But she did say that some kids are affected differently by them.

[wilf]

It seems like when ever I give Sam these for a snack, it spikes his blood sugar up. They say a carb is a carb, so I don't understand. If I give him applesauce compared to crackers even if they are the same carbs there is alsways a difference in his bs.
Any suggestions or advice? It just makes it so hard to manage.
:confused:

Whoever said "a carb is a carb" wasn't talking about their impacts on BG.

Different carbohydrates will have different effects. Carbs containing mainly sugar and/or white flour will be "spikier" than carbs in items like whole-grain breads or brown rice.

A measure of how carbs will affect BG is given by the glycemic index. I've pasted in the entry on Gylcemic Index from the Canadian Diabetes Association website:



Glycemic Index - A new way of looking at carbs (Revised June 2005)


The Glycemic Index is a scale that ranks carbohydrate-rich foods by how much they raise blood glucose levels compared to glucose or white bread.

When you eat food that contains carbohydrates, the sugar (glucose) from the food breaks down during digestion and gives you energy. After you eat, your blood glucose level rises; the speed at which the food is able to increase your blood glucose level is called the “glycemic response.” This glycemic response is influenced by many factors, including how much food you eat, how much the food is processed or even how the food is prepared (for example, pasta that is cooked al dente – or firm – has a lower glycemic response than pasta that is overcooked).


Good carbs, better carbs

Canada's Food Guide to Healthy Eating recommends eating a high-carb diet with 50% of each day's calories coming from carbohydrates. Not all carbohydrates are the same, however.

The Glycemic Index (GI) ranks carbohydrate-rich foods according to their glycemic response. Foods that raise your blood glucose level quickly have a higher GI rating than foods that raise your blood glucose level more slowly. In general, the lower the rating, the better the quality of carbohydrate.

Not only do low GI foods raise your blood glucose more slowly and to a less dramatic peak than higher GI foods, but most low GI foods are all-around healthier choices. Low GI foods are usually lower in calories and fat, while also being high in fibre, nutrients and antioxidants. Choosing low GI foods more often may help you increase levels of HDL (healthy) cholesterol in your blood and might help you control your appetite, as they tend to keep you feeling fuller, longer.


Choose wisely

Try to choose low and medium GI foods more often than high GI foods. A GI of 55 or less ranks as low, a GI of 56 to 69 is medium, and a GI of 70 or more ranks as high. Use the chart below to help you make healthier choices.

Here are some tips to help you lower the Glycemic Index of your daily meals:

•  Base your food choices primarily on overall nutrition – including vitamins, minerals and fibre.. Don't dismiss healthy foods such as white potatoes just because they have a high GI. Their other nutritional benefits make them good choices.

•  Try to choose at least one low GI food at each meal.

•  If you choose a high GI food, combine it with a low GI food, for an overall medium GI meal. For example, half a bagel (high GI) with a bowl of chili (low GI) , or corn flakes cereal (high GI) topped with a spoonful of All Bran (low GI) and some strawberries (low GI).

•  Limit the amount of processed, refined starchy foods, as they tend to be low in fibre and other nutrients and have a higher GI.

•  Try new foods that have a low GI. Experiment with beans, legumes and lentils by including them in dishes such as chili, soups and salads.

•  Eat whole grain, pumpernickel and oat bran bread more often than white bread.

•  Eat fresh fruit and vegetables. Fruits and vegetables have a low GI, so they break down into sugar slowly in your body. Canada's Food Guide recommends five to ten servings of fruits and vegetables every day. Enjoy a variety!

•  Choose parboiled, brown or white rice more often than instant rice.

•  Eat pasta, rice, yams, lima beans or baked potatoes more often than mashed, boiled or instant potatoes. Eating potatoes cold, as in a salad, reduces their GI (but go easy on the mayo dressing).

•  Use vinaigrette instead of a creamy salad dressing. It's lower in fat, plus the acidity of the vinegar slows digestion, lowering the meal's GI.

•  Watch your portion sizes; the bigger the portion, the more it will increase your blood glucose, regardless of its GI rank. For more information about healthy portion sizes, see the Handy Portion Guide . [ http://www.diabetes.ca/files/plan_your_portions.pdf ]

•  Check your blood glucose level before eating and one to two hours afterwards to see how your body handles the meal.

•  For more information about the Glycemic Index and how to include low GI foods in your meal plan, see the Glycemic Index Tool [ http://www.diabetes.ca/files/Diabetes_GL_FINAL2_CPG03.pdf ] and talk to your diabetes educator or registered dietitian.

Remember that the Glycemic Index is just one part healthy eating. Don't forget to:

•  Eat at regular times
•  Choose a variety of foods from all food groups
•  Limit sugar and sweets
•  Reduce the amount of fat you eat
•  Include foods high in fibre
•  Limit salt, alcohol and caffeine.
•  Choose heart healthy fats such as canola and olive oil.



LOW GLYCEMIC INDEX FOODS (55 or less)
(choose most often vvv)

Skim milk
Plain Yogurt
Soy beverage
Apple/plum/orange
Sweet potato
Oat bran bread
All-Bran™
Converted or Parboiled rice
Pumpernickel bread
Al dente (firm) pasta
Lentils/kidney/baked beans
Chick peas

 

MEDIUM GLYCEMIC INDEX FOODS (56-69)
(choose more often vv)

Banana
Pineapple
Raisins
New potatoes
Oatmeal
Popcorn
Split pea or green pea soup
Brown rice
Couscous
Basmati rice
Shredded wheat cereal
Whole wheat bread
Rye bread



HIGH GLYCEMIC INDEX FOODS
(choose less often v )

Watermelon
Dried dates
Instant mashed potatoes
Baked white potato
Parsnips
Rutabaga
Instant rice
Corn Flakes™
Rice Krispies™
Cheerios™
Bagel, white
Soda crackers
Jellybeans
French fries

[oregonmom]

Thank you so much for your reply. It really helped me to understand the
way carbs are absorbed.
That is really great information.
I do have a question regarding the carbs. If you eat a carb with a higher GI will you need to increase the insulin than if you eat a carb with low GI? (both with the same amount carbs)
We are on NPH and Nov at Breakfast and dinner, and say I give a snack in the middle of the day or at lunch with a high GI carb. It tends to keep him high for the rest of the day. aposed to giving him say applesauce for a snack. Then he doesnt spike and stays fairly level.

[Hollyb]

Hi,

The problem you're experiencing is partly because of your insulin regime. The benefit is only two shots a day. The drawback is you have to match the food to the peak in the NPH -- that's how you're covering lunch and bedtime snack.

So part of what you're finding is that certain carbs peak before or after the insulin does.

This is a little easier to manage on MDI (when you take Rapid insulin at lunch as well) because once you learn how different foods affect your son, you can play a bit with the timing of the shot (so fast spiking food, take the shot 15 mins or so ahead of the meal if his BG is high enough to do it safely, to give the insulin a "running start"; slow carbs with a lot of fat, take the shot after the meal or even split it in two. It's easier still on a pump because you can program the insulin to deliver in different ways (though the learning curve goes on and on). But whatever method you use, there will always be foods (I think) that are hard to predict or just cause problems. (see previous post "Hamburger Helper is evil"!)

[wilf]

Thank you so much for your reply. It really helped me to understand the
way carbs are absorbed.
That is really great information.
I do have a question regarding the carbs. If you eat a carb with a higher GI will you need to increase the insulin than if you eat a carb with low GI? (both with the same amount carbs)
We are on NPH and Nov at Breakfast and dinner, and say I give a snack in the middle of the day or at lunch with a high GI carb. It tends to keep him high for the rest of the day. aposed to giving him say applesauce for a snack. Then he doesnt spike and stays fairly level.

hey oregonmom, we manage to get through the day here with 3 injections (NPH and NovoRapid before breakfast and supper, and NPH at bedtime).

Like us, you are using the NPH to cover lunch. This can work, but you want to be using carbs that are lower in glycemic index, as well as containing lots of proteins and fats. That way the lunch takes longer to digest, and there is no spike of BG to overwhelm the gentler NPH peak curve.

Our DD is 11, and here is a typical lunch (which we pack and she eats at school):
- milk to drink;
- salami and cheese sandwich on heavy brown bread;
- small portion of fruit (eg. grapes)
- almonds;
- baby carrots;
- low carb (diabetic) chocolate.
This is maybe 30-40 carbs, but it takes a long time to digest and thus she never goes above 130 or so (we've measured to check)..

If your little one is going high and staying high after lunch, then lower GI foods will help. You may also need a higher NPH dose with the morning injection.

[wilf]

one other thing I'd suggest oregonmom is to get yourself some "Regular" insulin. It's time of peak effect is 2-3 hours, between that of the NovoRapid (1-2 hours) and NPH (4-8 hours).

You may find that certain supper-time meals (eg. deep fried foods, pizza, chinese food) can better be covered by Regular than by NovoRapid..

[oregonmom]

Wow, thank you, for that great information. I have played around a bit with the breakfast and dinner shots. Usually if he is high at dinner test, I will give him the shot 15-20 min early to help start bringing him down before he eats. I never really thought of it by the type of Carb he was eating. Actually, I take that back. One time when I gave a spagetti dinner sam dropped to a low about 1 hour after eating. My educator said to try giving the shot about 15 after he eats because the insulin was working before the carb.
It just makes it really hard when you don't have a cgms. unless you test every 1/2 its hard to know how the carbs are reacting. I cant wait to get on the pump.

[wilf]

Wow, thank you, for that great information. I have played around a bit with the breakfast and dinner shots. Usually if he is high at dinner test, I will give him the shot 15-20 min early to help start bringing him down before he eats. I never really thought of it by the type of Carb he was eating. Actually, I take that back. One time when I gave a spagetti dinner sam dropped to a low about 1 hour after eating. My educator said to try giving the shot about 15 after he eats because the insulin was working before the carb.
It just makes it really hard when you don't have a cgms. unless you test every 1/2 its hard to know how the carbs are reacting. I cant wait to get on the pump.

The spaghetti dinner is a classic case of where giving Regular would have solved your issue. It peaks later, more in sync with the time that the spaghetti was being digested.

You want to keep records, and over time you'll find that you see patterns developing that allow you to better adjust the insulins to the foods being consumed..

[deafmack]

It seems like when ever I give Sam these for a snack, it spikes his blood sugar up. They say a carb is a carb, so I don't understand. If I give him applesauce compared to crackers even if they are the same carbs there is alsways a difference in his bs.
Any suggestions or advice? It just makes it so hard to manage.
:confused:

Believe it or not, I was having the same problem. They have High Fructose Corn Syrup in them, so I switched to an organic brand and have not had the same problem. Makes one wonder.