- advertisement -

A little depressed at the grocery store...

Discussion in 'Parents of Children with Type 1' started by kirsteng, Jan 4, 2013.

  1. Turtle1605

    Turtle1605 Approved members

    Joined:
    Jan 6, 2012
    Messages:
    353
    My first trip to the grocery store after diagnoses took about 2 hours and I cried the whole time. I was sooooo overwhelmed. I think I worked too hard to go "healthy" too fast. We did have to make some hard choices toward the beginning until we went through some trial and error as to what foods made him spike more than others, but after about 3-4 months, we were into our routine and it was much easier. If it is possible, go to the store by yourself or with a friend (and leave the children at home). This was not always possible for me in the beginning, but it certainly helped if I could arrange it!

    We usually choose whole wheat bread, natural peanut butter, yoplait light and fit yogurt, fruit cups with "no sugar added", ice cream with "no sugar added" that is lower in fat. In the summer time, they actually started preferring popsicles made of diet green tea or sugar free fruit juice over ice cream :). Basically, if there is a choice between two similar items, I get the item with fewer carbs and/or more fiber. We also get all sorts of cheese, beef jerky, raw veggies that he loves (carrots, broccoli, etc.) and fruit (apples, bananas, oranges, pears, peaches, etc.). I did continue let them having their treats...I just made the rule that nobody is allowed frozen slushies, pure sugar candy like that fun dip stuff and pixie sticks, etc. because they are simply not worth the trouble they cause for us. Candy bars, chips and such don't seem to bother us as much. Although popcorn is a pure nightmare (I haven't figured that one out yet but maybe I will in a few years).

    Luckily, we tend to be creatures of habit and eat the same things a lot. My endocrinologist told me this before we left the hospital and I have noticed that it is true. This helps a lot in planning meals :). I started with five or six planned meals that I alternated and once we got good at those, I expanded by adding one or two meals.

    Good luck...it will get easier!
     
  2. Mimi

    Mimi Approved members

    Joined:
    Dec 19, 2008
    Messages:
    1,906
    I'm going to respectfully disagree with this. I think it's important to remember that the OP's child has only been dx'd for 2 weeks. I'm sure we all remember the many fluctuations in insulin needs during the first couple of weeks. Keeping within a carb target for each meal/day eliminates one variable when trying to determine the correct dosage of basal and/or bolus during the first couple of weeks.

    ^^ This also comes in to factor with school age children.

    To the OP, it is all very overwhelming in the beginning. As you become more comfortable you will learn there is nothing you son cannot have. If this insulin regime is difficult for you, work with your team to make adjustments or find something that does work. :cwds:
     
  3. TheFormerLantusFiend

    TheFormerLantusFiend Approved members

    Joined:
    Sep 10, 2006
    Messages:
    4,925
    It's the NPH that sticks you with a regimen, not the Regular. I use Regular and I do MDI and carb counting. Regular, at least in my experience (I switched from Novolog) is pretty fast acting.

    The issue is that NPH forces you to eat at some times of day in order for you to have enough of it around as a basal at other times of day. NPH sets minimum amounts on what you can eat at meal times. However, even with Regular and NPH as your only insulins, you should be able to adjust the Regular upwards in order to accomodate more carbs for the following meal.

    I recommend allowing all the foods you'd think were healthy for yourself, but to really think about what is healthy. Don't restrict a food because your child is diabetic, but because your child's diabetes may you rethink what a healthy diet is.
    I eat lots of junk. But diabetes did make me a lot more aware of what's in my foods so that I can make more intelligent choices, and it got me to actually read about more of the various recommendations- a process that is still going. For instance, the new American Diabetes Association guidelines for 2013 had no carb recommendations except that they recommend counting carbs if you are type 1 (that is, using a basal/bolus regimen). But they do have recommendations for avoiding saturated and trans fat, which I have started looking at more closely in my diet (and I was very surprised by how much saturated fat was hiding in my diet).
     
  4. JamieP

    JamieP Approved members

    Joined:
    May 30, 2012
    Messages:
    77
    I used to cry at the grocery during those first few months. For me, I think it was just a time that I was alone and able to think too much! There were a few times I had to put my sunglasses on!! It does get better- promise. It so overwhelming in the beginning and so exhausting- emotionally, mentally and physically. Reach out to groups like this- it really helps a lot.

    On a side note, my son loves sourdough bread too. Good news- it is actually better than whole wheat bread with respect to its effect on blood sugar. It has a lower glycemic index that whole wheat bread meaning that it causes less of a spike in blood sugar. It's a good choice!

    Hang in there!
     
  5. Christopher

    Christopher Approved members

    Joined:
    Nov 20, 2007
    Messages:
    6,771
    Understood.

    I guess I don't understand why endo's prescribe something like NPH that is so restrictive and makes life so much harder (usually), when there are other insulins like Humalog and Apidra that would make your life (and your child's life) MUCH easier.

    I realize you are newly dx and are still getting your bearings.

    I would echo the other members who recommended that you talk to your child's endo about switching to other insulins that will work better with your lifestyle.

    Good luck
     
  6. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451
    I think the OP needs to clarify if she means Novolin R or novorapid. Novolog is called novorapid here. And Novolin R is usually called Toronto. So she likely means Novorapid aka Novolog
     
  7. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451
    When you say NR do you mean novorapid ?
     
  8. kirsteng

    kirsteng Approved members

    Joined:
    Dec 30, 2012
    Messages:
    170
    Yes, novorapid and nph are what they are calling what we have. Sorry, didn't realize NR could mean two different things. I don't know what nph stands for, all I know is that that's the long acting one that we get twice a day that is supposed to peak after 6 hours or so.
     
  9. kirsteng

    kirsteng Approved members

    Joined:
    Dec 30, 2012
    Messages:
    170

    I just looked at the vials that we have... don't know why it's taken me so long to figure that out! :rolleyes:

    We use:

    Novolin GE NPH and
    Novorapid
     
  10. selketine

    selketine Approved members

    Joined:
    Jan 4, 2006
    Messages:
    6,057
    Jonas I absolutely right - NPH was our problem. The peak with NPH is variable in both when it peaks and how strong the peak is. Sometimes we were eating lunch an hour earlier than I would have because the insulin was peaking. The point of using NPH was to avoid a lunch time shot. Also my son - at first - only needed a morning shot of NPH because his numbers were beautiful overnight. Be aware that NPH is peaking overnight also - but people are usually eating in the middle of the night! When we had to add that 2nd nighttime shot of NPH we usually gave him some drink yogurt with corn starch mixed in to help raise the blood sugar slowly to counteract the peak of NPH.

    If you need a basal insulin 24 hours a day then an insulin like lantus might be easier and safer as there is no peak like NPH.

    With many little kids (under age 5 especially) the parents like a fast acting insulin because they wait and see what the kid eats and then give the insulin shot afterwards so they can match the insulin to the carb count eaten. It looks like you are on a rapid acting bolus insulin if I understand correctly what novorapid is!
     
    Last edited: Jan 6, 2013
  11. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451

    I was prescribed NPH and Regular when I was diagnosed in 2001, but was switched to humalog about a week later. However, you have to consider that humalog was relatively new then.

    Although the practice of prescribing newly diagnosed children, NPH is common practice in Canada. The practice of prescribing regular is much less common. I do not really see any justification of prescribing Regular over rapid acting insulin.

    (Sadly, some doctors in Canada do consider the cost of the treatment when prescribing medications. They prescribe NPH and Regular because it is considerably cheaper than analog insulins. They do not take into account the type of drug coverage the person has when using this approach. )

    Momofone makes a valid point. If a child with Cancer was being treated with a drug that originated in 1936 there would be a public outcry. Somehow, it is okay for a child with diabetes to be treated using a 77-year-old treatment protocol.

    The fact that NPH peaks to accommodate a meal at lunch hour is convenient the problem is that NPH is notoriously unreliable in how it behaves. It is very sensitive to things like movement. In fact storing it in the fridge door has been shown to make its action and peak times unreliable from day to day.
    There has to be a better way to accommodate the carbs consumed at lunch than treatment with NPH.
     
  12. TheFormerLantusFiend

    TheFormerLantusFiend Approved members

    Joined:
    Sep 10, 2006
    Messages:
    4,925
    Novorapid = Novolog

    Actrapid = Novolin R = Novolin ge Toronto = Regular
    Humulin R = Regular, but with slightly different additives.

    So the original poster's son is not on Regular at all. He's on Novolog. But my point- that he just has a minimum number of carbs he can eat, to deal with the NPH, but can add Novolog to have more carbs at breakfast or supper, is still valid.

    I happen to think the evidence for NPH is pretty good. There is no evidence whatsoever that Lantus or Levemir provides better A1cs. The two big advantages to Levemir and Lantus over NPH are a reduction in overnight lows (seen especially in type 1 diabetics) and patient satisfaction (which I suspect is related to the idea of being on a newer medication). I personally use Lantus instead of NPH for the overnight lows reason- dealing with a NPH peak in the middle of the night isn't my idea of fun. For some people it works out well because it coincides with an early dawn phenomenon. You have to remember that the same insulin can have really different action times in two different people- and that's true of every single insulin on the market.

    Using a newer medication just because it's newer is not good medicine.
     
  13. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451

    I am surprised you concluded that NR meant regular.

    If her kid was on humulin R she would likely abbreviate it as R not NR. In Canada, clinicians teach patients that Novolin R is called "Toronto" so patients usually develop the same nomenclature. The OP probably uses the abbreviation NR because that is how her CDE wrote it out for her in the instructions.


    What is the difference between patient satisfaction and quality of life?
    Remember the discussion is about children. The average child is not going to be biased toward being more satisfied because their medication is newer. I do not even think a typical child would be aware of that sort of thing.


    ( Even when nurses dilute Novolin R in saline to run it IV they write Novolin Toronto on the label. )

    You should actually try NPH and report back . I would be interested in your take on it. You could always take Levemir as your nighttime basal.

    The major problem with all the older basal insulins - lente, ultralente, and NPH is that they were/are prone to behaving inconsistently.

    it was the norm for T1s to inject 1 injection (a single injection for the entire 24 hour day) of regular mixed with NPH right up until the 80s. . The fact that they did not develop ketones or DKA makes you wonder how they claim the duration of NPH is 15 hours.

    You can also ask Carbz how the NPH is working out for him.
     
    Last edited: Jan 6, 2013
  14. momofone

    momofone Approved members

    Joined:
    Jun 28, 2011
    Messages:
    206
    I think patient satisfaction has more to do the restrictions imposed with NPH in terms of "feeding" the insulin and the strict carb intake. The flexibility that other regimens provide definitely in our case made us feel like we were much more in control rather than feeling like diabetes controlled us. It meant he was able to eat when he wanted, however much he wanted instead of having to eat a set amount of carbs at a set time, even if he wasn't hungry. At our first followup a month after diagnosis they refused to put us on MDI, even though I work from home and was able to go to the school and give him his shot. They told me that I couldn't do this (really?). I contacted Gary and did it anyway.
     
  15. Melissata

    Melissata Approved members

    Joined:
    Feb 19, 2009
    Messages:
    1,650
    I just wanted to add to what one other poster answered about sourdough bread. It is lower glycemic and therefore a great choice for your family.
     
  16. kirsteng

    kirsteng Approved members

    Joined:
    Dec 30, 2012
    Messages:
    170


    Yay! :D


    Thanks everyone for all your support and obvious expertise regarding the medications - I've learned a lot here already. We are going to ask about switching to Levemir and/or MDI in the near future.
     
  17. Helenmomofsporty13yearold

    Helenmomofsporty13yearold Approved members

    Joined:
    Oct 5, 2008
    Messages:
    702
    I recommend not switching too early. Your child's honeymoon has not kicked in full gear yet. Six months after diagnosis, DD was down to only 1 unit of NPH a day and no Novorapid for a short time. She only needed one shot a day (mixed with Novorapid to cover breakfast) for 3 years. As much as NPH was a pain in that she had to eat at certain times, I would never trade in the 1 shot a day for 3 years, for a regime where she needed a shot every time she put food in her mouth or to wear a pump 24/7 and have to change sites every couple of days. Once puberty hit, her honeymoon ended and her insulin needs increased dramatically, NPH became too hard to work and we switched to Lantus and then Levemir.

    It is important to keep carb counts and foods similar at the beginning, but it won't be long until you figure out how to accommodate all your child's favourites.
     
  18. kirsteng

    kirsteng Approved members

    Joined:
    Dec 30, 2012
    Messages:
    170
    Wow, I didn't realize their requirements could become so low for so long in the honeymoon phase... I agree, in that case I would want to remain on the current system.

    Thanks for the information...
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice