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Do u still give a snack if BG is 398?

Discussion in 'Parents of Children with Type 1' started by Carseatmama, May 30, 2009.

  1. Heather(CA)

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    The only thing I see as being different is attitude, again, your assuming a lot. I didn't quote you or Darryl, I just gave my opinion and left it at that;)
     
    Last edited: May 31, 2009
  2. emm142

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    I'm kind of torn on this one. Although I've had a couple of much higher numbers in recent weeks,in general, a 398 would be a "wow, what happened?" moment for me. However, I would still eat a normal meal, and take the appropriate insulin or correction. This might also be because of the speed at which novolog seems to work in my body (faster than most carbs). If I was someone who spiked 150 points at 2 hours post-meal, I wouldn't eat a meal at 400. But because my BG is usually stays flat-ish (sometimes a little lower) after a meal, it wouldn't bother me as much.

    Usually, I wouldn't feel like eating if I was 398. Generally that kind of number makes me feel nauseous as it is.

    I think that withholding snacks encourages "sneaking" and lying about numbers. JMO. If there is a carb free alternative, and the child is happy, then all the better, but if they're desperate for a carby snack, I'd give the correction and cover it.

    (Did I waffle a little there? :p)
     
  3. RosemaryCinNJ

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    Yes I would give her a snack if she is asking for it...Did she not get enough insulin with her last meal maybe? Or is she getting sick?? I hate days like this too...
     
  4. hawkeyegirl

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    Okay. Let me try this again.

    First off, I'm sorry, Heather. I know that you and Seth have very good control, and although it was not clear AT ALL from my post, I was not assuming that you have regular OMG highs, or that Seth eats crap. I assumed you were speaking generally about a child waking up in the 300s, and my response was predicated on that. I was also making the distinction between a snack that would skyrocket an already huge BG reading and a snack that would not. You have been at this far longer than I have, and I know you know the difference. But from my post, you would not have been able to tell that I know you know the difference. So, I am very, very sorry that my post offended you. I see how poorly it was worded, and I truly apologize. :(

    Lost in my inartful post was my real point that avoiding the 394 and the 300s is really the issue, as opposed to whether to feed the kids at those numbers. I feel crappy that my way of doing that was offensive, and will try to be more careful about making my point in the future. I know I'm tough to take sometimes, and need to filter my thoughts better.

    If I can risk going on, however, my opinion does remain the same. If Jack wants ice cream before supper, I tell him no. Why? Not because he has D, but because if he fills up on ice cream, he doesn't get the nutrients from supper. Maybe that will cause him to resent me someday, but I guess when he's an adult he can eat dessert first all he wants and deal with the consequences. Same with our D care. If he resents me for asking him to eat a low carb snack when he's high, and "rebels" against it someday, that's out of my control. All I can do is teach him WHY I don't want him to eat ice cream before supper, and WHY a high carb snack might not be best at 394, and hope that he internalizes that and makes good choices someday. Who knows? He may rebel against healthy eating entirely someday and subsist entirely on pizza rolls and Cheetos. That wouldn't be too far off from my college diet. :rolleyes:
     
  5. Mary Lou

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    As you can see -- there are as many opinions as there are posters :cwds:

    For my boys, they feel very hungry when high, especially Brian. We are trying to help them figure out when they are genuinely hungry, and when when they are high/hungry.

    When we think it's the high feeling, we have a sugar-free gum jar that we encourage him to pick something from, or get them busy so the feeling can pass.

    If it is a regular meal or snack time, we encourage a low-carb, healthy snack like other posters have suggested (veggies, popcorn, berries & nuts, etc.).

    Here's the key, though -- we bolus a good 30 minutes before eating to allow the insulin time to work before throwing more food into the mix.

    I would hesitate to truly deny a child a snack for all the reasons Heather and others have mentioned, but these kids do need to learn to work through it, at a level that isn't frustating and is approprorate to their age/situation. I consider it a life skill, but one that needs the cooperation and understanding of the child, too.
     
  6. Heather(CA)

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    Thank you, apology accepted:cwds:
     
  7. Darryl

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    I think you already have your answer!

    If correcting from 300-400, give 1u
    If correcting from 400-500, give 1.5u

    In other words, these corrections don't have to be given only at meal time, they can be given any time as long as it's been at least 2 hours since the last meal, and 3 hours since the last correction.

    You will find out by trial and error how these corrections are working (your endo can't figure that out for you). If you try a correction of the amount you listed, say 1u for a high of 350, and the BG still does not come down enough, then you just have to try a little more the next time.

    You should also ask your endo about correcting in the 200-300 range, because even that is too high. I suspect based on what you listed above that they will recommend 0.5u.
     
  8. Darryl

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    Unfortunately this is not reality. If you examine CGM data, it is evident that carbs
    stack up just like insulin does. If starting from a high BG, the additional carbs push
    the BG higher, and then you have a large drop from the high BG down to normal range.

    Pursuing this approach, not only does BG reach a higher and more dangerous level,
    but the glycemic variabliity (swing in BG) is increased when the BG drops. There is
    ample evidence from the 20-year DCCT study that glycemic variability (large swings)
    are at least as damaging as is A1C (average blood sugar).
    http://www.mendosa.com/minimal_variability.pdf

    Any notion that pushing BG higher, just so it falls faster, directly contradicts the findings
    of the DCCT study and would lead to a higher risk of retinopathy.
     
  9. Ellen

    Ellen Senior Member

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    I do not have the same philosophy as Darryl. I don't focus on each high blood sugar as doing irreparable damage to my child, nor do I want my child to react with any fear about a high blood sugar on the meter, and certainly not that it's a life threatening situation. I want my child to react calmly, treat it and bring it down, and feel well. That said, I would not give food that would raise blood sugar when it's already so high...but if my child felt very hungry at that point, I would offer something like scrambled eggs and a tall icy drink without calories.
     
  10. Darryl

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    Ellen,

    I am not sure which "philosophy" you are referring to. No one here reacts with fear about high blood sugar. I think you are making assumptions that being aware of the consequences of high BG, and taking the steps to have good control, must be stressful in some way, but in reality it is completely the opposite.
     
  11. Ellen

    Ellen Senior Member

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    These are the lines that stood out for me as being reactive and instilling fear.
     
  12. Nightowl

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    I don't think Darryl's comments reveal a philosophy of "instilling fear." The initial question was would you feed carbs to a child with a BG of 398. The obvious answer is no. That was also your answer. My guess is that you would not feed a carb snack to a child with a BG of 398 for precisely the same reason that Darryl wouldn't - because blood glucose levels that high and higher are dangerous. Because some people are confused as to the best answer in this situation, I think Darryl was simply pointing out the reason they would want to avoid more carbs. Children with Type 1 Diabetes are entitled to know what is at stake if they have high blood sugars. This knowledge isn't instilling fear - it is empowering them. We teach very young children that they need to wear a helmet when they ski and ride bikes. Rather than instilling fear, these common sense safety rules teach children how to protect themselves. When we teach children how to cross the street, we want them to be very much aware, and at a young age, what the consequences are of failing to look both ways. Children with diabetes need to establish common sense management rules that they follow as a matter of habit. One good rule would be that if your BG is 398 - don't eat carbs.
     
  13. Darryl

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    Ellen,

    If this was a forum on kids driving cars, and a parent asked "my kid drives at the speed limit
    55 MPH but wants to drive at 80 MPH, what should I tell him", I'd say "You should say no.
    At 80 MPH he has a bigger risk of injuring himself". Would that be "instilling fear"?

    I presented the appropriate medical information to back up the concept that feeding a 398
    is not a good idea. If that creates fear, denial, or defensiveness, that is unfortunate.
     
  14. Heather(CA)

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    I didn't think you would agree Darryl, we deal with a lot of things differently, so I knew you would quote me and disagree...To each their own.
     
  15. Heather(CA)

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    I agree...
     
  16. GaPeach

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    As a previous poster said, this is one that we will not all agree on. We should do well to agree to disagree.

    Obviously, YDMV plays a huge role in this decision. Also, individual age; personality; personal strengths and weaknesses; and character qualities of your child are factors.

    My child is very skinny. She is a very picky eater. High BG makes her very hungry - to the point of tears. There are very few "free foods" that she will eat. Our solution has been to have what we call a "half-snack" (7-8g). Popcorn works well because it filling.

    She is the 4th of 6 children. I do not treat them all the same. Each one of them is unique. What I may or may not allow one child will differ from another for many reasons.

    This is really not a good comparison. From 55mph to 80mph represents a 45% increase. A small snack should not result in a 45% increase of BG. And driving at any rate of speed is a danger in my metropolitan area.


    I agree with this point. D must be managed. It cannot be the enemy.


    Well put.

     
    Last edited: May 31, 2009
  17. moco89

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    Can we please set our differences aside, please?

    I thought the point of this thread was to give some insightful advice to the OP, not to argue about or to impose on how certain people handle D issues.

    I don't have a problem with contoversy, as it lets others get different point of views. But, could we all please try to be a little bit more understanding and accepting of our management approaches.

    These are not black and white situations, and there are multiple factors that play in to each person's individual case, such as age, growth, setting of the incident, time of the incident, food consumed prior to the incident, etc.

    No particular situation is ideal for an x y or z approach, it just depends on the individual and other variables.

    I will state my opinion once, and that's it. There has to be some middle ground where the child does not feel restricted or overwhelmed due to management issues-either from intense management or out of control blood sugars which are at opposite ends of the spectrum. That is what should be a fair and a reasonable expectation for a child living with d.
     
  18. GaPeach

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    Wonderful thoughts!

    If you run for President of the U.S., I'll vote for you!
     
  19. Darryl

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    I don't see a point in why some people seem to answer my posts just to point out we have to agree to disagree.

    The OP asked a question, and I answered it. My answer is "no, don't eat carbs if BG is 398", backed up with
    medical studies to show what my advice is based on. Other people say "yes, eat more carbs".

    The OP asked the question and I am sure she can take all of our input and make the decision that is best for
    her, without all this personal distraction.
     
  20. Tigerlilly's mom

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    Well said!

    Thank you for putting into words so nicely what I have been wanting to say (not so nicely);)
     

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