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Feedback on a dinner episode

Discussion in 'Parents of Children with Type 1' started by DavidN, Feb 6, 2013.

  1. DavidN

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    We typically eat dinner around 5:30pm or 6pm and bed by 8:15pm on a school night, but today was hectic and we sat down for dinner out at a restaurant at 6:30pm and ate at 7pm. My son with D orders a good sized adult cheeseburger, side of fries and another side order of mac n cheese.:eek: We guessed the carbs at 45, 40 and 45 respectively for a 130 total. I suspect we guessed low but that's our tendency when running late and heading to bed. The above meal is not our norm, maybe once a week. We waited 45 minutes, bolused 30% up front and extended the remainder for 3 hours. I'm expecting a long night with several checks and a correction or two because of the carb count (guess) and food type. Anyway, here's my question(s) ...

    How does the above scenario strike you? Any comments are welcome! Examples could be ...

    - What the heck are you thinking giving him a meal like that right before bed? There is no way I would do that.

    - We would have bolused as follows .... (keeping in mind YDMV)

    - I see no problem with what you did. We do it all the time.

    - Or anything else.

    I'm just reflecting on the meal and my oncoming night and am wondering how other parents handle busy school nights, hungry children and food choices, etc ...

    Thanks.
     
  2. Ali

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    Just as a cute aside. As the one with T1 and an adult I would say "Yipee eat away let someone else stay up all night checking" When I was a kid I would have said "ah did u parent folks really have to do much...", as an outsider I say try and actually write down what was eaten what was dosed and the results and after four or so nights like this I would figure out a plan. Sounds fun and I bet u guessed pretty accurately on numbers.:)Ali
     
  3. sooz

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    I'm a little confused about your statement about waiting forty five minutes. When did you wait 45 minutes? I don't have any criticism of what you did just amazement that your nine year old son could eat so much lol. My granddaughter is ten, and often her eyes are bigger than her tummy. We let her order what she wants, but if I think it is too much, I will portion it when it comes to what I think she will actually be able to finish, bolus for that, then, if she wants more, we will push for it. We have to be careful, because if we bolused for everything and then she couldn't eat it we would be in trouble. As long as he ate everything you bolused for he will be fine. I see no problem with what you did, we do it all the time. :)

    Also, when you say you estimated the carbs, how did you do that? Did you use something like Calorie King, or just wing it? 45 carbs for a cheeseburger surprises me. It must have been enormous!

    Let us know how it turns out!
     
    Last edited: Feb 7, 2013
  4. deafmack

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    I'm curios as to how things went. I think you did the right thing to
    spread out the insulin dosing since most restaurant meals are loaded with
    fat and so will slow down the release of glucose into the blood stream.
     
  5. coni

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    I think you'll probably find you underestimated the carbs. Restaurant food typically has up to 30% more carbs. For us, 30% upfront wouldn't be enough, but each person is different.

    We all have to make decisions on how to manage D with the rest of our life. Over time, we have greatly reduced eating out. Part of it is money, but part of it is D; it's sometimes a big hassle. I plan simple meals a week ahead and cook some things (like Mac and Cheese) ahead. It seemed like a pain at first, but it really cuts down on the crazy, hectic feeling about meals with a busy schedule.

    I think you did fine. Let us know how the night went!
     
  6. nebby3

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    It sounds to me like you estimated carbs and bolused appropriately. We do find that restaurant food requires more insulin that one woudl think (even if we have carb counts) and that repeated exposure to it produces a need for more insulin overall, ie insulin resistance. So I wouldn't eat out like that a lot but once in a while is fine.
     
  7. DavidN

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    Not our best effort. He's been running on reduced insulin the past week following a really rough stomach virus, but I think his insulin needs are almost back to normal so coverage ratios last night were likely too low. Plus I think we underestimated carbs. The result? A 295 at 11 pm that we fought all night.

    Notwithstanding the changing I/C ratios, as someone else already mentioned, I'm just not sure these types of dinner's are worth it. Maybe if we can eat earlier in the evening, but a late high carb / high fat meal never turns out well.

    Anyway, I'm sure we'll do it again soon with a mid-week baseball game with little time to get home to prepare dinner.

    We'll make a note of this one and do better next time.
     
  8. hawkeyegirl

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    Many people find that they have to dose for more than 100% of the carb total with high-fat meals. We tend to do a 70/50 split, and extend the 50% out over 4.5-6 hours. We also find that we usually need another "straight" bolus around hour 3-4 or so, when the first straight bolus is wearing off. I have no scientific basis for the amount of the straight bolus I give, but it usually ends up being around 2 units, which would usually be roughly about 20% of the total carbs eaten in these situations.

    It's hard. It took us about 2 years of logging and complete failures to come up with something that's even close to working, and in this context, "working" means not a disaster, as opposed to particularly good.
     
  9. DavidN

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    Can you clarify this? How do you know you need "another" straight bolus? I'm assuming it's because BG are running high, but what about concerns of stacking? If you extend out 4 hours, don't you have to wait another 4 hours after the final bit of insulin is given to do another correction? How do you know the second straight bolus will not be too much when the extended bolus hasn't finished doing its work? Hope that makes sense. Thanks!
     
  10. hawkeyegirl

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    If we don't do another "straight" bolus, BG will start to climb and will not come down, even with repeated corrections for hours. In our experience, the extended portion of the bolus should keep BG steady. If BG starts heading up while the extended portion is still running, it is NOT coming back down with just the remainder of the extended bolus. Not even close. I don't consider it stacking, because the additional straight bolus is not a correction - he's still digesting the high fat food at that point, and the straight bolus is covering that food. He is often at a number like 110 or 120 when I give the straight bolus. Because I know, based on experience, that the rise is coming.

    Keep in mind that we have a CGM and can see all of this happening in real time. And again, I do this based on 5 years of CGM data. Kids' insulin needs with high fat foods seem to vary wildly, so I can't tell you that our way is the right way to do this sort of thing. I'm more telling you how we do it so you know to keep an open mind when you're trying to figure this stuff out. In our experience, the normal "rules" just don't apply when it comes to high fat, high carb meals. :)
     
  11. Christopher

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    No real detailed advice, just wanted to say that every once in a while things like this happen. You go out and have a meal that maybe isn't the greatest thing to eat, but you also have to balance mental/emotional health as well as physical. Sometimes it is fun to just go out and gorge on junk. Yes, you will probably pay the price later that night, but if your child had fun or it fit into your schedule for that particular day, then it is what it is. You should be commended for being involved enough to be trying to analyze the situation and try and manage "real life" as best you can.

    The only warning is this: Make sure you don't get wrapped up too much in the minutia of trying to control/understand every aspect. Not saying you are, but it is easy to do with this disease.
     
  12. DavidN

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    What you are describing seems to be exactly what we are experiencing. Thanks. Hopefully we will soon be armed with our own CGM that will enable us to formally evaluate and possibly introduce strategies such as this. Thanks again.
     
  13. DavidN

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    You said something earlier that resonated with me. A couple weeks ago I dissuaded my son from a dessert solely on the basis of an already high carb count. But if he's still hungry, then he's still hungry and I just need to figure the insulin thing out.

    As for getting too focused on the minutia, it's a good warning and one I'm sensitive to. Not always successful, but trying. Thanks.
     
  14. Momontherun

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    Helpful post or "case study" for us,we are also starting out and my son often has 100 plus carbs a meal and wanting to eat a meal near bedtime happens. I think logging his response is vital and Hopefully someday, I 'll see a pattern.

    Good luck.

    I am as a parent having a hard time not being consumed by managing diabetes and trying to learn everything I can.
     
  15. shannong

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    Your post really got me thinking about our own situations like these. During the week, we always eat at home. But weekends are crazy busy for us, with the kids in all kinds of sports. It usually means eating out at least a couple of times. Places like subway are easy to bolus for, but restaurants serving high fat foods, tend to have a prolonged effect on my DS's bg. On MDI, I bolus for the full amount of carbs, this usually puts him in range at the 2hr mark, and then he begins to rise again, requiring a corrective bolus. I usually can go ahead and just bolus him at this point, but sometimes I like to see the rise first before I do so - however, I have found that if I let the bg get too high, it can mean a lot of insulin resistance.

    Anyway, I realized thinking about your post, that we eat out for convenience, but in reality it makes the nights hard for me -lots more night time checking and corrections. So is it worth it? I'm starting to think perhaps it is not. Maybe we will just have to do with simpler meals that night, even just cereal and milk! I have found that it is much easier for my DS to have higher fat meals earlier in the day, rather than in the evening, so perhaps we should save eating out for that time of day. My DS already knows the rule about ice cream - only during the day, not in the evening. I have found ice cream impossible to bolus for late in the evening. My DS accepts these rules, so if we have a treat at night, he knows he can choose other things like cookies. It's not like he can never have ice cream - just needs to have it earlier in the day. Thanks for getting me thinking about these things. I think I might start trying to move any restaurant eating to lunch meals, rather than dinner meals.
     
  16. Traci

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    Just another thought, but for us, different fried foods react VERY differently. For example, a small fries from some places can be treated with just a straight 30 carb bolus, while the same exact amount of fries from other places will cause ds to shoot up and stay high all night long seemingly regardless of the corrections given. I've come to the conclusion that its the oil, but I have no idea why some have practically no effect while others are reason enough to avoid a restaurant in the future! It's trial and error...I'd make a note of what you did and what the results were and try to "fix" whatever didn't work this time.
     
  17. MomofSweetOne

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    It could also be gluten. The fries at some places have it; others don't.
     
  18. quiltinmom

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    A). I disagree, I think you put in a very appropriate amount of effort. Just because the result was a high number it doesn't mean you didn't try. :). It's just a process of figuring out what works for your individual child's needs.

    Maybe you could take a crack at using the ol' slow cooker. It is great for those nights when you are short on time. Or plan something that can be prepped the day before on days you know will be busy. I find that meal prep is stressful if I'm trying to figure out what to make at 4:30. But if I have it all figured out by 10 am it goes much better. Not that I think a cheeseburger once in a while is bad. I'm not judging you for your choice of meal/mealtime. I'd probably do the same thing in your shoes. (We try to eat healthy but once in a while we have something bad for you and we're not going to say no because of d.). But if you're trying to avoid the "cheeseburger effect" there are a few ideas.


    Good luck. :)
     
  19. Traci

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    Sorry to go off-topic on this thread, but my son doesn't have celiac and doesn't have an issue with any other gluten items, why would fries with gluten cause his bg to go high and stay high? I ask because there doesn't seem to be a correlation, but just wondering if I'm missing something. Nothing else causes this phenomenon with him...just fries from specific restaurants (Pappadeaux's and one specific On the Border to be exact)...that's why I was thinking it had to be the oil.
     
  20. MelissaAL

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    I think this is really good advice. Sometimes you just need a 100+ carb meal! At least for my daughter, most meals are 30-60 g- we aren't rigid on it, that's just what they end up being. So it is always shocking when we go somewhere and her meal is 100+ g. No big deal, just bolus accordingly. DD is fairly new on her pump and we have not tried any extended boluses, but one option her endo shared with us at her last app't was instead of an extended bolus, do a 150% basal for a few hours. Have not tried it yet personally, but thought I'd throw that out as an option.
     

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