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Bernstein's Book

Discussion in 'Parents of Children with Type 1' started by Lakeman, Aug 8, 2012.

  1. Lovemyboys

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    Here's a real life example.
    If Owen has 40 carbs for breakfast and we happen to be off 20% (lets say on the higher end) on the amount of carbs. With his breakfast ratio of 1:15 he would get .53 units too much. With his ISF at 400 that .53 units would drop him 213 mg/dl.:eek:

    On the other hand if he has 10 carbs for breakfast, and we were off 20% still, he would get .13 units too much and a drop of 53 mg/dl. Still not great, but a lot better than 200mg/dl.

    I know that this will change as he gets older and his ISF changes, but right now that makes for a scary situation.

    It's getting late and I was up early, so I hope all this math is correct.:eek:

    Agreed. There are many ways to manage this disease and no "right" way. What works for one family might not work for another.
     
  2. Ali

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    Lovemyboys,
    You have said so well what I tried to say earlier. I am sensitive to insulin, but nothing like your very young child. Those small numbers do matter. Just another note, when I went from one or two shots a day to MDI the "older Doc" working with me could just not wrap his head around the idea that 1/4 unit of insulin caused so much problems for a 23 year old. But it did, and luckikly someone a bit more open to new ideas helped me out. :cwds::cwds:Ali
     
  3. Lee

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    Sometimes, a .05 increase in Basal is enough to send Coco in a tale-spin. Her Endo is adamant that such a small amount shouldn't make a difference, but it does.
     
  4. Ali

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    Lee
    You are so right. Even as a 120 pound grown up a .05 basal change impacts! I always just so wish I could hook my Docs up to an Insulin pump and let them see that it "all" does really matter for many of us.
    Ali
     
  5. mmgirls

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    So I might of missed it, but how many carbs on an average day does your kiddo consume?
     
  6. mmgirls

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    I have not read all of your post, (going back now to read it all)

    But I would ask you if you have read also about insulin action and the link between I:C ratios and correction factors?

    The breakfast ratio of 1:15 and at the same time a correction factor of 1:400 seems way off.

    I wonder how is it that you are giving so much for a meal and so little to correct an already high number before a meal that needs so much insulin?
     
  7. miss_behave

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    To me, having to eat low-no carb would make me flat out miserable. Its absolutely not worth it for my quality of life.

    Health-wise; you may have better diabetes control but what about the cholesterol & kidney (from high protein) problems, higher risk of bowel cancer etc etc that come from eating a lot of meat and not enough fruit. Young kids need carbs for energy and brain function.

    Also the psycho-social aspects of putting a child on a low-carb diet would concern me greatly. I would never put my child on such a restrictive diet. There is enough emphasis put on food and nutrition with diabetes as it is, as well as a mountain of evidence showing teens with D are much more likely to develop an eating disorder. I would not want to IMO increase this risk by forcing major dietary restrictions and basically suggesting that carbs are "bad". Socially, I can't imagine what it would be like for a kid to have to eat low carb whilst their friends are eating cake, ice cream and pizza at a party etc. Thats just asking for D resentment. Its one thing for an adult to make the decision to eat low carb to improve their control, but for a child, particularly such a young girl, I think the negatives vastly outweigh any benefits.
     
  8. Lisa P.

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    Not negating your opinion at all, but from another point of view, I just read a blurb on how seratonin may be linked to eating disorders. I strongly believe eating disorders are anxiety-based and probably chemically based, they manifest as eating disorders rather than OCD or depression potentially because of the environment of the young person, but the root is physical. If that is the case, then seratonin and carbohydrate consumption can be linked. So a lower carb diet might, in fact, prevent eating disorders in some people. Long shot speculation, but you can see what I mean -- there are other ways of looking at it.

    I do get the idea that you have two factors, long term complications vs. immediate lifestyle needs. Here's my concern, though. Selah has no sweet tooth. She has all her life been inclined to only eat half of the dessert put in front of her, etc. I doubt this is diabetes related, but at the same time there's no doubt that if she eats a dessert in full she is likely to spike into the 300s and there is no doubt that in the 300s she doesn't feel as well. That's about right now, lifestyle, etc., not long term complications.

    But -- life moves on, and she runs up against all sorts of peer groups, social events, mom eating a bowl of ice cream in front of her. . . .and now she is more inclined to eat more sugar and desserts and carbs. It's like if everyone else begs for candy, she'll catch on and start begging for it, too. And I think her body has acclimated so that she doesn't react as strongly to feeling crummy from the highs of a spike. When she was 2, if she hit 350 after ice cream she let everyone know it!! But now that she's nearly 6, she has developed more self-control and just kind of holds it in, just accepts that she feels crummy and maybe gets a little cranky but doesn't have a temper tantrum.

    So here's my take, I think it's good for parents to not completely trade quality of life now for potential future safety from complications. But I'd caution that:

    1. It's not all about the future -- high carb diets for many of our kids reduces quality of life right now.

    2. Just because we consider a certain kind of eating "normal" doesn't mean it intrinsically is what our kids would want themselves to eat if they were left to their own instincts -- we train our kids to want more carbs than they need, often, and once that training happens their new level of "need" is probably set for life. The call we make now about carbs may make it very hard for them, at the age of 25, to make a decision about diet that is different from the one we are making for them.

    3. Every thread I've seen that goes there assumes the child would rather have her cake now and risk complications later. I've never actually seen a thread where a child was straight out asked -- which would you rather? I know that is hard, because it means we have to bring up things with our kids we'd rather they not know. Maybe it's often not the best thing, to ask. But I think it's wrong to just assume a child would choose to "eat like everyone else" if she knew all the future potential risks. If (and this is extreme and not always the case) the choice were between "eat like your peers now and shorten your life by 5 years" and "eat much more moderately and have 5 extra years on your life", why do we assume a 10 year old would always choose the former?

    Each individual person is different, and while I do believe Christopher and others are right that many things need to be taken into account when considering a move to lower carbs, I think psycho-social aspects can be highly individualized and parents need to keep that in mind.
     
  9. MomofSweetOne

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    My daughter and I were shocked two weeks ago to walk into the county fair and learn that she had taken the "Best of Show" on her rather pathetic looking bag of dehydrated green beans in the food & nuitrition category. We make them regularly and munch away on them rather than potato chips. I am convinced that the BOS was because of all the information she was able to give the judge on carb counts of green beans vs. potato chips, what each does to her BG, how she feels with a high spike from potato chips, etc. She does like potato chips occasionally, but she will also look at foods and say "No thanks, I don't want the spike." I think it is important as parents to teach our kids to listen to their bodies and that it is OK to not eat everything others might even if the endo/CDE says to just dose for it when it makes them feel wretched.
     
  10. Lovemyboys

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    I'm not really sure, I can go look at his pump if you really want to know. We don't really restrict the amount in a day, mainly just the "type" of carbs (mainly very little refined carbs). Even when I say "no" or "little" refined carbs, that for what we eat at home. We also restrict some high glycemic fruits. So we choose apples instead of bananas, prunes instead of raisins, etc.

    I know, it's crazy! But it is what it is, I guess it's a YDMV thing. His lunch and dinner are at 1:18. I just looked at his pump to double check and our ISF is now 350. I forgot we changed it a while ago. So those numbers would be 185 and 45. I suspect as he grows we'll have to keep bringing down that ISF.

    I totally respect your decision and understand where you're coming from. I would never say that this is the right way for any other family, we all have to make our own decisions about how to feed our family. As our little guy gets older I'm sure we'll be constantly revisiting this plan and changing it. For us, eating a hamburger sans bun with say, re-fried beans (with cheese and sour cream, yum!) instead of french fries works for us. I don't see that as overly restrictive and in my opinion a little healthier even. For breakfast we'll have yogurt (plain, full fat) and maybe a sausage patty and an apple and peanut butter for a snack. Many days we have eggs and bacon or sausage for breakfast. Every once in a while we'll even have cereal, but I'll mix high fiber with high protein with almond milk and whipping cream. We have cakes, zucchini bread, cookies etc; except I've learned to cook them with different ingredients that don't spike his blood sugar.

    This is how we eat at home, which we eat at home most of the time. You said that "Socially, I can't imagine what it would be like for a kid to have to eat low carb whilst their friends are eating cake, ice cream and pizza at a party etc." Well, what about a kid that has an egg allergy? They can't eat the cake. What about someone that has a celiac dx, that child would not be eating the cake or the pizza? That said, we will be going to a birthday party in a few weeks and there will be cake and ice cream. We'll probably just let him have cake and then be hyper-vigilant about bgs for the rest of the day.
     
  11. MamaLibby

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    I agree, I found that chart once looking for an a1c to glucose conversion and it makes me sick. It's harsh and I found his strict almost condescending attitude all over his website. Maybe I'm just being to sensitive, but he is NOT a doctor I'd want to work with, or want my kid to work with.
     
  12. Lovemyboys

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    Congratulations to your daughter on the best of show and thanks for a new snack idea. Did she use a dehydrator or can you dehydrate them another way?
     
  13. MamaLibby

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    Okay read the whole thread now. I love the dehydrated green beans idea! We've dehydrated fruits and veggies forever but I never thought about green beans.

    There are so many reasons we've personally chosen not to go low-carb for Ella. We always tried to choose healthier carbs like fruit instead of candy, whole grains instead of white. And after her celiac dx we're eating lower-carb just because we can't always find gf versions of tortillas, cookies, or whatever. But she already has so many diet restrictions with food allergies (her own and her siblings) and our family being vegetarian. But like others have said, everyone's diabetes is different and everyone's family is different. :)
     
  14. mmgirls

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    So I have to ask, what would you say is his average BG daily? and does his A1C reflect that?

    I would not be able to do this with our famil and applaud you for finding a way that works for you guys, but I wonder if you are seeing your hard work paying off with stellar numbers. I mean the carbs are allot of the issue, but not the only thing. We are talking about a grwoing and changing body.
     
  15. MomofSweetOne

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    Thanks. We use a dehydrator, but I imagine they could done in an oven set on low with the door propped open.

    I think we must eat somewhat similarly in our households, but in part for us, it was here prior to D because of allergies and sensitivities.
     
  16. Lovemyboys

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    No we don't have stellar numbers, but they are reasonable. His 90 day meter average is 122. His 30 day is a little higher, around 135 or so. I'm not sure what his next A1C is going to be, but I think around 6.0? His A1Cs are usually between 6.2-6.5, before we started eating this way, so I think it'll lower it a little bit. The main payoff for us is the reduction in the big swings in bg. One very scary scenario comes to mind. His dex went off and it said around 120 one or two arrows down (I can't remember), I think it was one because I don't remember being too alarmed at this point. I test him with the meter and he's 100 with extra 0.2 on board. I gave him some carbs, but he was dropping so fast that the carbs didn't kick in quickly enough. I kept testing him every 5 minutes and giving him more and more carbs, panicking because I couldn't stop the fall. He went down into the 20s. Thankfully he didn't pass out or have a seizure, but it sure traumatized me. What if he didn't have the dex? What if I hadn't heard it? We still get highs, we still get lows but they aren't like that, they are more gentle. So for us it's not about achieving a great Ac1, it's more about keeping him safe.
     
  17. mmgirls

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    Well I would call those stellar numbers!!!!

    good job!
     

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