Was your child placed on a fixed meal plan at diagnosis?

When my daughter was diagnosed we were sent home with a fixed meal plan. We gave a set amount of insulin at each meal for a fixed number of carbs, adding an additional amount of insulin based on a sliding scale for correction.

So her meal plan looked like this:

Breakfast: 4 exchanges (60 carbs)
Morning snack: 1 exchange (15 carbs)
Lunch: 5 exchanges (75 carbs)
Afternoon Snack: 2 exchanges (30 carbs)
Dinner: 4 exchanges (60 carbs)


I found out this week that our local Children's Hospital still sends kids home on the fixed meal plan. I was wondering how common that is?

 

I was put on a fixed dose of NPH/regular premix. I wasn't able to adjust my dose, but I also wasn't told to eat a fixed number of carbs. Basically, I was taught to eat whatever I wanted but take a fixed dose of insulin. As we all know, that really doesn't work...

 

Yes. We were put on NPH/Humalog. 15-30 carbs at snacktime and 45-60 carbs at meals, with a sliding scale for corrections. It only lasted 2 weeks at which time I begged the endo to do something else. We went to Lantus/Humalog at that time.

 

yes, we were put on a fixed meal prog. it didn't help us at all. it was crazy.

 

We were sent home with a meal plan similar to yours. I was told it was a temporary measure to make it easier to determine appropriate insulin dosages. After about 6 weeks, we were given the freedom of an insulin:carb ratio.

I had actually been on the Atkins diet about 5 years prior to DD's dx, so I was already quite familiar with counting carbs, but I was still not as accurate at it as I am now. Luckily the honeymoon helps cover mistakes as you're learning, but still, the fixed plan helps identify the places where an adjustment is most needed a lot quicker. DD's dosages changed almost daily at first, then every 4 or 5 days, then weekly... after the same dosage seemed to be working for about 3 weeks straight, then we made the switched to a more liberal meal plan.

 

He first two weeks we counted meal carbs and snacks were supposed to be 15 grams. He was WAY too hungry and after a few days the doctor let us give him larger snacks so he could eat whatever every 2 or 3 hours.

 

We were on a fixed insulin and mealtime/carb plan for exactly one year. It wasn't easy, especially at the beginning, but my daughter and I both feel that it taught us discipline and helped us become really aware of the impact of nutrition on our bodies. When you get only a certain amount of carbs at each meal/snack it makes you think carefully about the value of what you're putting in your mouth. We have been pumping for 3 weeks now and would never want to relinquish this wonderful freedom we've been enjoying to eat what we want when we want, but we did learn some good things from the strict plan we started out with.

 

absolutely NOT. We were told time and time again, almost beat into our heads, NOTHING is off limits to matt. Use the insulin for the carbs, no matter what he wants. His Drs couldnt stress it enough, he is a little boy first and formost, he has D secondary.

 

So did you drop the fixed carbs when you switched to Lantus/Humalog?

From what I've seen, everyone comes home from Children's on a fixed meal plan regardless of what insulin regimen (NPH or MDI) they are using.

When I called in and asked to be taught how to adjust her insulin based on how much she was going to eat, we were told that we would have to wait until our 1st app't which was almost 2 months away So I got a copy of Using Insulin and an app't with a new endo.

I think that the fixed meal plan was one of the most difficult parts for us at diagnosis. I was worried about telling the new endo that we had set up our own carb ratio and had been adjusting insulin on our own for several weeks. She was actually glad we had because she thought it was cruel to send families home with all the meal restrictions.:cwds:

 

Yes and it was quite confusing because before we left, the endocrinologist came in and gave us about 20 minutes on MDI and sent us home wondering why they'd spent so much time imposing the fixed meal stuff on us and teaching us that approach only to send us home with Novalog/Levemir and completely unclear whether we should exploit the flexibility they made possible.

I suppose it was a case of the hospital having a policy of teaching fixed carbs/insulin at dx via their educators and its definitely easier for the nurses and food services... but as with many things, we were very confused after our initial hospital stay.

 

Steven was on NPH/Humolog with schedule for 4+ years when he went to Lantus/Humolog and counting carbs

 

Yes,
Eight years ago they sent me and my three year old home with a fixed plan, using exhanges. Two shots a day of NPH and Humalog.

Most vivid in my memory was the instruction for insulin for BG corrections.

At lunchtime I wasn't to give any humalog at all unles BG was OVER 300. Then it was a 0.5 unit. Maybe a a few months into it I started estimating a 0.25 unit with the syringe and giving that if she were over 260.

 

For the first week or two we did a fixed plan. It looked like this:

Breakfast=60 carbs 4units
Lunch=75 carbs 5 units
Supper=75 carbs 5 units
2 Snacks=15 carbs each

Then we realized how annoying a fixed plan was LOL! There were times Ashleigh wasn't hungry enough to eat 75 carbs, and we felt like we were force feeding her.

It's so much nicer now to just let her eat how much she wants and dose for appropriate amount of carbohydrates.

 

YES! It's one of my biggest complaints. He was always hungry for more at meals and started thinking he HAD to have a bedtime snack (even when he was high) because he needed it when he was low.

We were told to give him 75 carbs per meal. This was a 13 year old boy that had been starving (down to 83 lbs at dx) for a couple of months. Ugh.

I finally started the sliding scale when one of the endos on call told me if he couldn't eat as many carbs as needed (he was sick and not eating) to adjust it: 15 carbs per 1 unit of novolog. Can't believe it didn't enter my head before that - I knew he needed 75 carbs and got 5 units of novolog at meals. Guess I was just too overwhelmed with it all to put my brain to work on it.

It's cruel to send kids home on a fixed plan like that IMHO.

 

Wow! I was shocked to see the results of the poll!

The children's hospital/endo team we are privileged to go to was adamant about letting children be children and not limiting their diet. Make wise choices, yes, but to not deny things or put them on a strict schedule or diet.

Their philosophy is to make Diabetes fit into the child's life, not make the child's life fit into Diabetes.

I think that is a very healthy perspective and one which I think has shaped our thinking and attitude about Diabetes. Sure, she (we) have our bad days with D, but overall, it is a manageable condition, and with the tools we now have at our disposal, it just becomes a part of life, but not an all-consuming part of life.

I've read posts here at CWD about those who struggle with diets/schedules/insulin regimes and have been soooo thankful that that has not been our experience.

 

Yes, for those who were dx'd years ago I get it. We were told at dx that just in the last five years (6 now) how far MDI had come.

But I'm seeing recent diagnoses being sent home with rigid food and therapy plans. Again, I am thankful that we are near a cutting-edge pedi-endo place!

And thankful that parents can come here and see different options that they may not know are available to them because their doc simply doesn't know.

 

I'm not sure how to vote. I was sent home with the understanding that I was TEMPORARILY on a meal plan.

For the first month, I was supposed to eat 90 carbs at breakfast, lunch and supper, and I was supposed to eat them at particular times. I was supposed to call the numbers in, and I was supposed to dose a certain amount based on the blood sugar plus we were trying to figure out doses. About halfway through the month, we added in a 20 carb snack I was supposed to half in the afternoon if my blood sugar was below 150.
This was supposed to let us see patterns, although I can't say I thought it actually did.

After about two months, I was set loose to eat whatever whenever.

 

We were on a fixed plan at first (we were on Humalog and NPH ten years ago) because I beleve they said more consistent amounts at first helped get the insulin amounts needed a little easier.

We were counting carbs but they didn't want 100 carb meals one day and 40 carb dinner the next until they got the levels adjusted.

 

I wasn't giving a fixed meal plan. At WRAMC while in the hospital they allow you to go down to the cafeteria (with a calorie king) to get whatever you want to eat, so we were taught carb ratios in the first place. But I was also taught exchanges. They spent a lot of time just on the carb ratios and how to work diabetes around your lifestyle.

 

Same with us! We are also from middle Tn so most likely we are seeing the same group of folk

My brother-in-law was dx 36 yrs ago. He spent 2 weeks in the hospital while the staff drummed calorie counting and set insulin levels into his mother's head; only to see all they had learned go right out the window when he was no longer in a hospital bed

I am thrilled that we are not on a restricted diet. We have 4 children and I would hate to single out Matt and make him feel even more "special" because of this disease by limiting what he eats. Now this is not to say he eats chips and ice cream all day We already eat lots of fruits and veggies and good for you snacks/meals.

Not restricting has let me point out that when I say no I am NOT saying no BECAUSE he is diabetic. Instead I am saying no because this is what I have always done. I have always watched what he ate and said no to inappropriate choices. With all the changes we've seen in the last 3 weeks I say THANK GOD we are not also changing what we have to eat.

Also he is still able to have his once a week afternoon with Gran at Dairy Queen! Yes it means an extra shot but he is glad to take it if it means he gets a blizzard with Gran.