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Mealtimes and balancing T1D and non-D kids' needs

Discussion in 'Parents of Children with Type 1' started by samson, Jun 2, 2016.

  1. samson

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    How do people change their routines in response to T1D, especially around mealtimes?

    We used to have a rule of no snacking after dinner, especially if you only picked at your meal. This kept our slow older son from dragging mealtime out for 4 hours.
    But now we sometimes give snacks to the younger one after dinner to prevent lows. But then our non-diabetic child asks for snacks too.
    Do you change the rules for everyone? We've tried framing the fast-acting carbs as "medicine" but our older one still gets jealous.

    This is also hard on him because we're eating very few treats and processed carbs such as muffins, scones and biscuits and we're sticking with a more limited range of foods for now. Our non-D son seems to feel deprived by this healthier but somewhat monotonous diet. Our T1D child also misses those treats of course, but we feel it's necessary right now to maintain good BG to limit those to occasional treats for special occasions.

    How do you balance the needs in the family so no kid feels deprived or singled out? And so you're not making four different meals? It's hard enough carb-counting one meal!
     
  2. kim5798

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    In the beginning, we got rid of all the sweet stuff. Over time, we have gotten more flexible. I think the age of the children plays a big part. My child was age 3 at diagnosis. One thing we did was always have bread and milk at every meal. No matter what the other parts of the meal, if she refused to eat something, she would always eat bread & milk, so we could get the carbs in. Sometimes we would add a fruit to the table at dinner...so then it didn't matter if you "didn't like" what we were having, fine, don't eat it. drink your milk & eat your bread. We really tried to not have a short-order situation going on. If the non-d kid wanted to not like what we had for dinner, fine. drink your milk, eat the bread & we would just not make a battle over it.
    It took a while for us to get to this point. Many a night in the early days...we had a tired girl, fighting to NOT EAT dinner, falling asleep at the table or holding out for fruit chews. Not happy times for any of us. We have lived to tell the tale:)

    Not sure how long you have been dealing with diabetes or how old your diabetic child is, but they can eat anything a normal person with a healthy diet can eat. You just have to learn how to cover it.

    I do remember in early days, taking my non-d child out for treats...a candy bar on grocery store trips, etc. when the non-d child did not go with.

    As far as fast acting carbs as "medicine"...I see no problem with the non-d sibling having grapes or whatever it is you are treating the lows with. Plan accordingly. If the diabetic child is getting skittles & you say no to the other non-d child, yes I think that is wrong. But if we are treating with glucose tabs or milk & the non-d kid actually wants that, then fine, say yes. The appeal will go away.

    I think keeping a limited range of foods is fine in the short run, but you have to live your life. Otherwise I think you are setting yourself up for eating disorders, and that is no picnic either.
     
  3. jenm999

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    Kim has brilliant advice.

    It's a family diagnosis. My daughter is 13 - she was 11 at her brother's diagnosis - and has generally been handling things beautifully. Of course, she's old enough to be reasoned with and she can postpone gratification! But some things have recently come to light - she's in therapy for unrelated reasons - that has made me take stock of how this disease affects her. We need to make sure our non-D children don't suffer collateral damage. Her therapist thinks she's holding back expressing legitimate frustrations to us because she knows what a burden D is, and that bottling up is causing some anxiety. That was hard to hear.

    In the last few months my husband and I have made a point of going out with her alone to a movie or concert followed by a ridiculous meal that is not at all D-friendly (her favorite: Cheesecake Factory!) but it's not just about food. She needs to feel her problems are real even if they aren't as serious healthwise as D. And sometimes she needs to be the priority.

    I have generally been doing the research, support forums, JDRF events etc. on behalf of the family because I enjoy it, but am planning to bring the whole gang to the next event. There was some sibling programming at the last JDRF event that might be really cool.

    Sorry for answering a food question with a mental health answer! :) But it's timely for our family.
     
  4. samson

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    Thanks for the suggestions. I know everyone says my son can eat anything others can but at this point, when even 1 gram of carbs can spike him 30 points, it's hard to imagine getting there. I guess we just have to hang in there and wait for him to get a little bigger. F
     
  5. Snowflake

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    For a while, we held firm and didn't give in to "it isn't fair" requests from her little brother. But he's only 4, and he barely understands what diabetes is (it was even harder when he was 2!)

    Over the past year, we've gotten way more laissez faire and often do say yes when he asks for a juice box or a glucose tab or an equivalent treat to a low treatment, unless we're out in public and only have a limited supply. At all other times, we're pretty consistent about limiting snacking to prescribed snack times, so I figure the occasional off-schedule treat can slide. He doesn't realize it yet, but he also lives with effects of his sister's diagnoses (distracted parents, family-wide sleep deprivation, eating GF, etc, etc), so I figure the occasional little treat is a little reward for all that. Ever since I loosened up about this, he doesn't even ask half the time when we're treating lows.
     
  6. forHisglory

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    This post is timely for us as well. Our D child is the picky one. Always has been. I've tried methods similar to Kims advice. Problem is, my D son is now flat out refusing to eat period if I don't make the "meal" he wants. I shrug my shoulders and tell him that's too bad but in a large family of 6 I cannot short order cook. Always have good bread, rolls, or fruit on the table. There have been several meals lately that I have had to turn down his basal and when he comes begging for food in between meals or snack time I have to say (it's incredibly tough), "Our next meal is in an hour. You are hungry because you chose not to eat at lunch."

    The family wide sleep deprivation is what's really taking a toll lately though (like Snowflake said). I don't know if any of this helps except I just want to say I am thankful to know we are not alone.
     
  7. Lakeman

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    Throw away any concept that fair is equal or same. Fair is everyone in a family gets what they need. Fair is: rules are based on who a family is and who the people in the family are and different people may hot have the same rules. As long as the rules are followed things are fair. When you play Monopoly fair does not mean no one wins and no one loses - fair means everyone follows the rules. But the youngest in the family might get some special accommodations like being able to take twice as long to figure out what to do or being able to re-roll if the dice fall off the table.

    Unfair is when everyone gets the same outcome regardless of who they are or what their needs are. Unfair is when some people do not get what they need because we must all be the same. Unfair in a family is making all rules apply exactly the same to everyone. Unfair is making rules then making exceptions all the time.

    Lastly, some rules are more important than others and important rules supercede less important rules. Fairness is way down on the list of rules compared to the rule that lows get treated with carbs.

    Fairness is way over-rated in general every time someone is making comparisons about who has or gets what. Just like in Monopoly where fairness requires that someone will win and others will lose fairness in real life means that some people will get more than some other people. A fair grade on a math test means that those who understood the concepts more get a better grade. Fair in the work world means that those who produce more get paid more. The landscaper who works 60 hours a week may earn more than the landscaper who only works 30 hours a week - and should not pay a higher tax rate either for his extra efforts.
     
    Last edited: Jun 3, 2016
  8. samson

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    Opinions on taxation policy aside, I agree in theory that fair doesn't mean same -- but that doesn't really give you practical tips on how to enact a truly fair system in practice. In this situation, are you saying fair means the kid who needs the snack for life-saving reasons gets it, while the other doesn't because he doesn't need it? Or does it mean the other one gets to bend the rules a little because his life is being negatively impacted by diabetes even though he does not have the disease?
     
  9. Nancy in VA

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    Our eating rules didn't change because of diabetes. We generally don't snack between meals and that didn't change. Treating a low is not snacking, even if it looks like snacking, and honestly, I didn't change the rules for the others because we may need to be treating the diabetic. As far as "not fair", I'd stack their not getting a snack up against years of shots, etc, anyday. Ours got worse because Emma also has celiac and there are restaurants that we just don't go to anymore if she's with us for that reason, but they get it. It has sucked at times, and there are times we've also split up so the others could go somewhere else, but again, there is always the alternative, not able to eat gluten, so it is what it is. That's our practical application of Lakeman's philosophy
     
  10. kiwikid

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  11. Mimikins

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    Honestly, though this might be because I was diagnosed in my late teens, my family made no modifications to mealtimes. I have a sister a few months younger than me who lives off pizza, bagels, cheese fries, potato chips, noodles, and ramen/instant soup, a high-maintenance grandmother who is picky for the sakes of being picky (she'll eat frozen spaghetti dinners but not the spaghetti my mom might make), and a sister 5-6 years younger than me who is on the autism spectrum (and has pickiness associated with her sensory issues, though she is significantly less picky than the other two). Unfortunately, the food that everyone in my family is able to eat causes insane spikes with me (200s+ for stuff like chicken fingers, potatoes of any kind, spaghetti), and the food that work well for my diabetes are "no way in h*ll!" foods for everyone else. It pretty much means that I'm often cooking for myself (or am highly modifying the meals so that they work better for me, such as substituting rice with shredded broccoli/cauliflower if we're having chili), or if there's nights where I'm preparing dinner for the family anyone who doesn't want to eat what I'm making will have to fend for themselves.

    I simply wish I wouldn't get as much slack from my grandmother about having to eat differently. I constantly receive comments about why I'm not eating what everyone else is eating, why I have to eat healthy, that I'm going to get fat eating all the food I am (I'd say that 50-75% of my total food volume comes from fruits and nonstarchy vegetables), and implying that I'm being a snot for not eating the same as everyone else (I would, but I feel awful experiencing those huge BG swings, and nothing in my diabetes arsenal is able to contain them). Then again, she eats Klondike bars for breakfast and lives off candy and meal replacement shakes. I don't mind that everyone else eats differently, because I know that if I ate like them I would feel terrible from the BG swings (and because most of the food doesn't have much nutritional value).

    ...Phew. That feels really good to get that off my chest.

    OP, could you try only offering certain foods as snacks (cut vegetables, a piece of cheese or a portioned baggie of nuts, fruit, yogurt, things that he might not grab unless he was actually hungry versus wanting a treat)? The snacks could then also be used for bringing up BG levels before bed so that there's some fairness with it (older son isn't stuck eating kale while the younger son is eating a cupcake, for example). Could you also find fast-acting carbs that aren't too appealing so that the jealousy with having those carbs isn't as bad (glucose tabs... though my one sister likes to eat them, juice in a so-so flavor, packets of sugar)? If those treat foods often cause huge PITA spikes, could you find recipes that modify those treats so that the spike might not be as bad (I find that making waffles with whole wheat flour and Greek yogurt to be less spikey than plain Eggo waffles for example, or I bake mini-sized treats with Splenda versus full-sized real-sugar treats)? The big thing to remember is that the ideal "diabetes diet" is simply a plain-old balanced and healthy diet that every member of the family will benefit from.
     
  12. nebby3

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    Sometimes I let the other kids eat something too, sometimes I don't. I have 1 with D and 3 non-D two of whom are gluten free (and one used to be off dairy and soy too). We just accept that everyone has restrictions and different things they have to deal with. They know D sometimes means treats but other times means restrictions so they don't get too jealous. And if they ask too much I've been known to say "if you want a treat get yourself a chronic illness."
     
  13. sugarmonkey

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    We didn't change our eating much after D. We suddenly had candy and juice in the house for lows, which we'd never had before. Other kids learnt quickly that if Phillip had candy for lows, it was because of Diabetes. Even my little nieces and nephews knew by the age of 2 that they didn't get any candy when Phillip had some. No, it's not fair that they don't get it, but like someone else said, it's not fair having diabetes either.
     
  14. Lakeman

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    My thinking is to stop trying to be fair and stop acting as if when people make a claim based on it that it even matters. You just get held hostage when you cave in to people's demands that things have to be fair. I really don't care what is fair when it comes to what some people get that others do not, I care that people get what they need. You asked if it is fair that one kid gets a snack WHILE the other kid does not? Take out the word "while" because I really don't care to make comparisons. One kids gets a snack when he needs it and the other kid gets snacks when she needs it. Regarding bending the rules that is never right. Rules should be followed consistently - but should also not be created to rigidly to begin with. So why is there a rule that one kid does not get snacks? Is it time to re-evaluate the rule?

    It's cool that you are asking questions. I'm sure you will come up with something that works for your family. And it might be completely different than what is right for mine.
     
  15. quiltinmom

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    I have a way I explain this to a young child, that they can really grasp. I say, fair means everyone gets the exact same thing. That means you would have to wear your brother's shoes, clothes, sleep in the exact same bed, if he eats something, you have to eat it too (even if you don't like it) have all t he exact same toys, go all the exact same places, etc. I've also included diabetes related things in the discussion, depending on age of the kid. Suddenly they get it and go, "oh." You can see the "lightbulb" moment. :). They rethink wanting everything to be "fair."

    I can also tell them he gets it because he's low, and if you're low (or "when" you have diabetes), you can have some too. Which means having shots, testing all the time, etc. this may not be a good strategy for a 4 year old, but it works wonderfully with my older kids, ones who won't think they "will" get diabetes by my saying that.

    Other times I just hand out a package of fruit snacks ( or whatever) to everyone. It's ok for all kids to have a snack or treat sometimes. So much for consistency, right? Lol.

    Remember that young kids get hungry quicker than adults, generally, and imagine what it would be like for a hungry child to see his brother getting something to eat.

    Another thing I might do is say you can't have what he's having to treat his low, but you can have something else (a cheese stick or apple or piece of bread...whatever. Something he doesn't get all the time, so it feels like a splurge, but is a little healthier than pure sugar.)

    I agree with not letting kids have treats if they didn't eat a decent meal before, although you have to take age into account. I think 4 is old enough to understand this somewhat, Although I am not that strict with my 3 year old.

    It's not an easy situation to navigate, and it's one where I believe in following your gut based on he nuances of the situation. In other words, I think it's ok to give in sometimes. :)

    Hope this helps!
     
    Last edited: Jun 4, 2016
  16. MomofSweetOne

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    I've been watching this thread and debating what and how to articulate what I want to say. This is a very, very hard balancing act. I know T1D as a mom and as a sibling, though my experience as a sibling started before blood meters, even sliding scale, pumps, cgm, etc. The quality of life my daughter has is so much better than what was possible in the early 80s. What has not changed is that D affects everyone in a family, and only recently have the effects of D on siblings begun to be researched. One study I found said the emotional affects of diabetes are harder on the siblings than on the child with T1D because they have less control and knowledge than the parents or child and thus higher anxiety. I know personally, the first time I was ever asked how I felt about it was during the psychiatrist session at my daughter's diagnosis. It was so freeing to finally be able to express how hard it was being a sibling, how much I never, ever wanted T1D to ever invade my family again, how hard I'd tried to prevent the risk of it by breastfeeding my daughter past a year, etc.

    I remember all desserts disappearing from our home. Up until then, I'd loved to bake and spent at least one evening per week doing do. The stress of having such in the house after dx caused me to stop. Candy also disappeared other than for lows, and I remember sitting and watching my sibling eat candy while being told it was "medicine". Yes, it's needed for lows, but such a rigid approach didn't create good family dynamics when we had given up much because of D as well, both dietary and parental time and focus. My sibling also wasn't disciplined because of having D, which was very unhealthy for relationships. I've realized how much it affected me emotionally, because I've often grabbed a fruit strip or whatever along with my daughter often when she has a low. I also realize there is a huge difference in lows, that a upper 60s or low 70 just needs a boost whereas 50s or lower create an urgency. But, if we have supplies to spare and there are kids around, I think sharing is good, that it can create teaching/learning without resentment. I guess what I'm trying to say is that a rigid rule approach may create other problems, whether intended or not, that mild lows can be an enjoyed joint snack time for everyone who deals with life with D rather than splitting families into divided parties.

    My daughter counsels at a diabetes camp. One summer, she had a sibling in her group that she really enjoyed. The final day, both that girl and her sibling with T1D each won a cardboard racecar that Charlie Kimball or whoever provided. The mom refused to let the sibling take her car because she didn't have diabetes whereas her sister did. My daughter and other staff attempted to comfort the sibling as she sobbed. In our car on the way home, my daughter cried and said, "It can be awful to be the sibling, can't it, Mom? I always thought you were just jealous when you told me things, but you lived this, didn't you?" It was heart-breaking for me to have observed what happened, knowing the damage that was being wrought in relationships by a decision to leave behind one cardboard race car and not the other.

    I guess I'm trying to say that sometimes the issue is much bigger than whether or not a sibling should be able to understand a snack is needed and that siblings also need acknowledged for how D affects them, even though they're not the ones stuck with needles.

    Edited to add: As far as a child refusing to eat a healthy meal, that is something that should be addressed whether D or not, in the choices given and the non-eaten meal could be offered as the choice. But having grown up with rigid, no snacking between meals, I really don't see what the issue is with eating something healthy in a reasonable quantity other than mealtimes. If apple slices are healthy choices at mealtime, does it really matter if everyone has apple slices offered an hour before a meal? Or strawberries or blueberries or whatever?

    Our kids with T1D are not oblivious to quickly figuring how to attempt to use D to manipulate situations. Shortly after dx, my daughter was eating with her fingers repeatedly during a meal. Finally in exasperation, I told her she could eat with her fork or go to her room. She confidently informed me that I couldn't do that or she'd go low. I told her that she obviously knew what her choices were and that she would be allowed to choose to go low. I was inwardly hoping she wouldn't call my bluff as I really didn't want her to go low, but after studying me for a moment, she picked up her fork and ate the rest of the meal appropriately. It was a pivotal point that discipline and appropriate behavior were still the norm in our home despite D.

    Our kids with T1D have the ability to get a snack when they want one. A few minutes on the trampoline, a bolus on the pump...it works to send the BG down and can be effectively used for showing they can get away with things like mid-meal snacks their siblings can't. Just food for thought.
     
    Last edited: Jun 5, 2016
  17. wilf

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    I don't really have much to add. Just want to thank everyone for these insightful and compassionate posts. :cwds:

    We made a significant shift in diet as a family after DD was diagnosed (in order to allow us to manage the D better), and have since shifted further (but not for D-related reasons). It is certainly important to think about how siblings are doing over time, and to recognize the sacrifices they make.
     

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