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pizza is the devil

Discussion in 'Parents of Children with Type 1' started by steph, Jul 9, 2012.

  1. steph

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    I am new to T1D, DD is just turned 2yo and we are 7mos into Dx. I assure you that she normally eats a very healthy diet full of veggies and fiber, however, there have been a few times recently that she has had pizza. The first time, I thought maybe the high bg was a fluke and I didn't count the carbs correctly. The second time (at a birthday party) i figured it was pizza, and that is when I researched and found out about fat spikes. At her last endo appt I asked about fat spikes, and the CDE said to give her a little more insulin for fatty meals. So when my picky eating father and 3 other fmily members showed up unexpectedly and then suggested pizza for dinner, I thought I could try out our new fatty meal ICR. But even giving her insulin at 1/35 instead of her usual 1/40, she spiked to over 400 3hrs later and needed a correction, and then stayed high into the next morning. Plus she woke up and wouldn't go back to sleep bc she felt crappy I presume. Is there any way to avoid these spikes ather than to just avoid junk foods all together? (which I am not opposed to) If we do run into a situation where I don't want to deprive her of a fatty treat, like a birthday party, how should I bolus on MDI?
     
  2. Christopher

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    Pizza and pasta can be tough. There are several ways to handle it on MDI. I would suggest trying to eat thin crust whenever possible. I would also suggest figuring out the carbs in one serving of pizza and then weighing each serving out. As for the spike, if you determine that her total pizza meal is, say, 80 carbs, and her total amount of insulin is 4 units, you could try giving a certain amount (let's say 1 unit) upfront and then the other 3 units 2-3 hours later. Also, I never pre-bolus when she has pizza, I give insulin after the meal. It also sounds like you need to lower her ratio for pizza.

    The issue many people have is giving the total amount of insulin at the meal time, and then the person goes low because the pizza is delayed acting on the bloodstream. Then, hours later, when it does start acting, the insulin has worn off and then you see high bg's. But it seems like you are not seeing any lows.

    It really is a trial and error situation. Keep good documentation on carbs, insulin, type of pizza, etc. That will help you each time you try this.

    I am sure that other people who have experience with 2 year olds will chime in and give better advice. Things can be tricky with a child that young who may be very sensitive to insulin.

    Good luck!
     
    Last edited: Jul 9, 2012
  3. steph

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    Thanks. I know there will be much trial and error in getting doses closer to hitting the mark. In hindsight, I would have given her more insulin a few hours after she ate. Her 1/2u correction just wasn't enough to bring that high down. I think that I might not be correcting aggressivley enough bc we had some pretty scary lows just after diagnoses. Not just with pizza but in general. Her endo doesn't want us correcting unless she is over 300, and her bg hovers around 150 most of the time. I try not to be too uptight about the numbers, but reading about how other parents are managing their kids, I feel like I should be doing better.

    With bolusing maybe 1/4-1/2 right after the meal and the rest 2-3 hours later, does that prevent the spike, or just make it of shorter duration? Do you also use a combo bolus for ice cream bc of the fat? I have been wanting to take her out for ice cream this summer. She's never had her own serving before, just a few bites here and there.
     
  4. Christopher

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    I know it is tough but try not to compare with other parents. Each child is unique and will have their own progession as they get older. You are in the very early days and you need to cut yourself some slack. :cwds:

    I have a problem with not correcting until over 300. If the Endo is worried about going too low then try a smaller correction. I don't normally split the doses for ice cream, but I think you need to just try it and see how she does, and then go from there.
     
  5. Jaedima

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    We're almost as new to T1D as you are, since 4yo DS was diagnosed barely two weeks before your 2yo. But we've been able to let him have pizza on occasion, as long as we (1) dose before he eats and/or throughout the meal (rather than at the end of the meal); (2) avoid letting the total carb count for the meal go too high; and (3) watch his BG closely after the meal.

    I'm not familiar with all the abbreviations so my apologies if I'm missing something important (not knowing what ICR and MDI mean). Since moving to an insulin pump we've seen a huge improvement, being able to dose-as-we-go during a meal. We generally estimate pizza as being ~30% carbs, although I know that the USDA's numbers are more like 24-28%. I think the reason that works for us may be because meals with pizza tend to have higher carb totals, which exaggerates any errors in the dose ratio.

    As for junk food more generally (I don't consider pizza junk food, as I do cookies, chips, and candy-- just my personal categorization), we've had much more success in controlling BG levels by avoiding processed sugar at dinner. Desserts at dinnertime are now almost always fruit. We've occasionally indulged in ice cream at dinner, which I think is less difficult for us to manage compared to cakes, cookies, and other desserts that are high in starch as well as sugar. But I have to admit that I think we had better control when we stayed with fruit.

    With regard to correcting high BGs, we've also found that we need to be more aggressive at high levels than with low levels-- that is, we need to use more insulin to lower a 300+ reading than to lower a 200+ or a 150+ reading. That could be due to the mathematics (if the insulin ratio is slightly conservative, the errors become more obvious with larger doses) or the biology (how insulin acts on glucose in the body), I don't know.

    I think if her BG hovers around 150 most of the time you are doing fantastic!
     
  6. Lovemyboys

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    She's already using a 1/2 unit correction, it's hard to go much smaller than that. For my 2 year old 1 unit will bring him down 400 points. With a pump we are usually giving him .05-.1 correction. You cannot do that on MDI without diluted insulin.
     
  7. tracygthomas

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    pizza is evil

    Good for you that you so quickly figured out the "pizza is evil" thing. We, too, have had this challenge with pizza and it was baffling and frustrating. Since we finally figured out pizza is a big problem, we have had some luck recently in preventing what previously seemed uncontrollable, long-lived highs after pizza consumption. I got our new strategy from a friend of a friend who is an adult with Type 1. What we do is similar to that suggested in the previous post: We dose all throughout the meal (after each small piece is consumed), we limit intake relatively (he's not allowed to have five slices, for example; he usually has two, though we cut them into smaller pieces to make it seem like he's having much more), and we also add one full unit beyond what typical pizza carb count is disclosed/suggested/usually demands, though we add this supplement only after he is completely finished. We also watch his BG very closely thereafter (in case he gets low from the extra dose). This has really, really helped keep his BG in range during pizza meal times and also during those five or six long hours afterward when, before we started this new approach, we felt powerless to reduce his BG almost at all. Oh, and of course, activity always helps; we almost always incorporate some type of outdoor, high energy, super-sweaty activity conveniently after pizza consumption.

    As for desserts, we pretty much proclaimed ourselves a "no dessert" family even before Luke was diagnosed. When we have what most people consider "dessert," it's usually for special occasions only. Otherwise, fruit, homemade low-sugar/whole grain muffins, low-carb waffles with peanut butter or low-sugar dips, or sugar free popsicles are about as brave as we get. (The whole family is healthier as a result, not just our Type 1 guy :)

    I hope this helps!

    P.S. Processed Mac and Cheese (or other processed products with artificial cheeses) creates similar "evil" results as pizza.

    Tracy
    DS age 7; diagnosed 2008
     
  8. valerie k

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    matt is probably odd one out, pizza-no matter how hard we try, crashes matt every time we have it. We have even barely bolused for it, and he will go low. Pasta isnt much of a problem for him. Pizza, does us in every time.
     
  9. nanhsot

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    You may need to tweak the amounts and timing, but the general trick with pizza on mdi is to give some of the insulin with the meal and the rest a few hours later, basically splitting the dose into two and simulating what a pump does for an extended bolus. I read an article once where they showed that an EIGHT hour extended bolus was effective with pizza! Crazy to think about that.

    Try giving half with the meal and the other half 2 hours later and then play around with that.

    Ice cream is a very easy food for my son and poses no problems, I say just go with it and see what happens. It's an easier to digest food so does not cause the wackiness that pizza does; pizza is tough because of all the hard to digest crust that stays in your system for so long, in combination with the high fat of the cheese. Ice cream is pretty simple, or has been for us. I do buy the lower fat type, but that's so I can eat it too!
     
  10. steph

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    Thanks everyone. I think next time I'll try a ratio of 1/30 and split it in half and see how that works. I don't really want to give more than 2 shots bc she is starting to protest shots telling me "no mommy, it hurts, your turn, mommy" Ugh...it breaks my heart.
    We are pretty much a junk food free family most of the time. No cookies, chips, soda or juice in the house. So far the only sweets she has had have been at birthday parties and Easter. I want to try ice cream for a fun outing. Going to get ice cream cones on a Saturday and going to the park or the lake. Not for an after dinner dessert. I'll try bolusing normal for it. She's never spiked from mac n cheese that I've noticed. We use Annie's brand. We usually eat spaghetti squash or quinoa instead of other pasta.
     
  11. Jaedima

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    Just reflecting on this further-- I have to admit that I'm a bit puzzled about the "pizza-is-evil" reputation. Is it the combination of a large quantity of refined starch with a moderately large quantity of fat, and relatively less protein and fiber? Is the effect reduced by having more meat and vegetable toppings on the pizza, or by eating a big leafy salad along with it? Wouldn't many other kinds of foods have similar issues, such as quesadillas, grilled cheese sandwiches, cheese tamales, lasagna, noodle kugel, potatoes au gratin, potato salad, etc.? Likewise with meals that have similar nutritional profiles even if they don't contain those actual foods.

    Or is it because pizza is a mixture of high- and low-carb foods, and it's just really hard to estimate? (Like fried rice and noodle dishes.)

    I'm just wondering why pizza is so problematic and how to generalize from pizza to other food, so we can be alert to how to manage them all better.
     
  12. emm142

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    In my experience, I have a similar experience with all high fat food eaten in reasonably large quantities. Digestion is delayed and there is a spike later.

    There are three main solutions:
    1. Extended boluses (can be used whilst pumping, basically the insulin delivers slowly).
    2. Splitting the bolus (giving one shot with the meal and another a couple hours later).
    3. Using an insulin with a slower action profile such as Regular or even NPH.
     
  13. Christopher

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    For her, it is the dough, which takes a long time to digest and hit the blood stream, in combination with the fat from the cheese, which also slows digestion. Pasta causes similar problems for her.

    Emma has good solutions above.

    It is really a trial and error thing. Some kids eat pizza and have no problems at all.
     

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