I dont have my daughter on that tight of a meal plan, her Endo and Nutritionists have said to me " if she wants it give it to her" Grant it she can no longer grab a bag of chips or banana or whatever whenever she wants it all has to be acconted for, but for lunch today for example she had: turkey and cheese sandwich on whole grain white bread, a gogurt, and 13grams of sunchips, it was a total of 64 carbs, when she was first Dx she was on a 60 or less carbs per meal... but if she wants 80 i give it to her... and her #s are still good and bad... but her A1C is 6.7.. its been as low as 6.3.... am I making mistakes?
I agree with you Type1Gal. I would be super careful setting too low of an A1C target with a young child. My daughter is 7 years old and her endo looks at her pump data closely. She does not pay much attention to her A1C; she is mostly looking for trends in high or low blood sugars. Her current blood sugar target is 140. I know this is probably much higher than many adult targets, but her endo feels like this is safe. I tend to shoot for a little lower blood sugars when she is with me as I feel like I could catch and treat a low better than others would. It is super scary having low blood sugars in young children (not to go into details but Vivian has met a few paramedics while at school). For a while I was a little too agressive with her treatment and she was having lows almost every day. I had to back off a bit because she became unaware of her lows. She has since gained back her awareness, but it took some time. The other thing is that my daughters' blood sugar can drop very quickly. The other day she dropped over 300 points in a little over an hour and a half (for no reason that we could find). I am not sure how common this is with adults or even other kids, but have learned that it is really important that she recognizes the symptoms before she goes too low. I feel like having a strict target for an A1C is not a great idea (especially for kids). It is more important to look at the overall data and try to minimize the highs and the lows.
I dunno if A1C is the "target" as much as the result of all the other targets added together and adjusted for the vagaries of the data reporting. I agree the overall BG goal should be sort of conservative. One way to smooth out the curves and reduce the margins of inevitable errors would be to cut out some of the carbs?
If your ratio were 10G/U and you eat 60G of carbs, the chances of the food being exactly 60 are sort of slim, as there might be a big piece of meat (+3G) or a bubble in the bread (-2G) or junior might peel the crust off (my kid does this @ 13, it drives me nuts, I save it for some other battle...), maybe -5G? I think a little bit off can really give the insulin some "teeth" and drive it down or help the carbs blow up an afternoon number. By eating a few less carbs, maybe 45G of carbs, not exactly "starving" (inevitable kid complaint...), the there's only 4.5U of insulin so there's not as many teeth to "bite", as it were?
I agree with you acidrock. I think the only way to decrease the number of outliers in blood sugar is to manage carb intake. Right now I am trying my best to substitute better carbs that tend not to spike blood sugars; more whole grains and mixing protein with the carbs. This really does help. There are certain foods that I just don't keep in the house anymore because they cause high or unpredictable blood sugars (such as cereal). I am not exactly choosing a low carb diet for her, but more of a moderate carb diet. As she gets older, I am hoping that she will see the benefits of a low carb diet and together we can continue to lower the amount of carbs in her diet. Right now, I am just doing my best to provide a somewhat balanced lifestyle for her and as much as I wish it weren't the case; food is an important part of being a kid.
Aimee: wow about the paramedics, we have not had that at school luckily... and she has been as low as a 29 while at school and she was ok, she was pale and shaky but awake and talking!!! she seemed fine, dont know for how long she would have stayed fine! is your daughter newly DX? my daughter started realizing her lows really early on, some dont though, my daughter as well has dropped quickly too, sometimes even if she has been very active in a day it will linger all day and sometimes into the next day, and make her #s low. Im having a hard time going back to work, I just coincedently was laid off 4 months before she was hospitalized, and now its getting to the end of my unemployment and I need to go back to work, I have been looking but no luck! Im not sure how I can with her Diabetes,And most daycares are not qualified to have a type1 in there daycare. now do i want someone elses maintaining it... I need it maintained like I would so later on she dont have problems due to the lack of care. eventually she will be able to all of it but for now she dont. do you feel the same about working? well anyways good luck to you!
Vivian was diagnosed at 3 years old. The school called the paramedics twice her kindergarten year. I think that they may have been a bit safe as I don't think I would have called them under the same circumstances. I think she did not recognize the lows sooner because school was still new for her (and she was distracted) and also she had a bit of unawareness of her lows at that time. We were also trying to figure out how to adjust her insulin for school so she was having more lows than she had previously had. It sounds like she was semi-conscious both times and able to drink juice, so no glucagon was necessary. Both lows hit her very quickly in the late morning time. Since then she goes to the nurses office to check her blood sugars mid-morning to prevent this from happening and there has been nothing like this in the last two years.
My husband and I both work full time and we have since the diagnosis. We have been extremely lucky to have great daycare. She has been at three different daycares since she was dignosed. All three were at home day cares and all three were trained in diabetes care by us. One already had a type 1 child in their care, so the training was minimal. The other two were very open to learning, so I spent some time training them. At first they would call me frequently so I could verify how much insulin they should give her and then after a while they would only call me if they had questions. I think it helps to have specific instructions in writing. I detailed when to check blood sugars and also how to calculate insulin all in writing. Feel free to contact me any time if you have questions about anything!! Best of luck.
When she was hospitalized they had her on a 60 carb or less meal plan, And she ate hotdogs, pizza, mac and cheese, basically whatever, as long as it was 60 or under.... its kinda hard when from the get go u are taught its ok for this or that....and i thought A1C is good under 7 ? for diabetic...? its been about a year and a half.... so its a long learning process....I think ill try to start lowering the carb amount per meal.... thanks for the input...also my son is 18 and has always been a very picky eater... always and one day I hope that changes but it hasnt yet.... so its very very very hard grocery shop.... hes so picky he wont eat anything new..... so its hard to tell him to bad we cant have this food in the house anymore..... I almost need a cabinet for him and fridge with a lock...... RRGGGG..... frustrating...
With Diabetes, less is best, less carbs, less insulin equals better control and less roller coasters.
many people eat carbs (and not less carbs) and take insulin. that's best for you, not for everyone else and certainly not for a growing, young child.
Right on! There is a reason that there are pediatric endocrinologists. Kids have different needs than adults and trying to treat a young child just like an adult is just wrong headed.
I almost always have at least 3 kinds of carbs when I eat. I think of it as a form of diversification. The cracker up front might hit pretty quickly but the apple comes 30 minutes later and hits pretty slowly (for me at least) so that everything tends to balance out.