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?

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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.

Maurie

My DD is 8 yrs old. She was dxd 6 months ago with an A1c of 15. In January that was down to a 6.8...her drs were pleased...and so was I. Did she have lows and highs, yes, but they were not wild swings. We have not had any restrictions on her carb count. It is my personal belief that kids need more carbs. I do find if she eats say 80+ carbs at a meal...her bg is high 2 hrs + meal. Your daughter's A1c sounds good to me. Here are some links that might help: http://www.childrenwithdiabetes.com/d_0n_040.htm or http://www.ehow.com/facts_5564909_normal-ac-levels-children.html

Nattysmom, you sound like a terrific mother!

If I were you, I'd keep on doing what you're doing for your daughter. That 6.7 A1c is great for a child. I wouldn't take anything the ADA has to say as gospel. They are more interested in furthering the interests of their funding sources (food and drug companies) than in what's actually the best thing for adult diabetics.

I would look into finding a pediatric endocrinologist, if there's one available anywhere near you. I'm a strong advocate of a very low-carb diet for adult diabetics, but children are a whole other story. The nutritional needs of a growing child are bound to be very different from those of an adult! I do know that there are a number of terrific blogs written by the parents of T1 children. You might find it helpful to read them and get in touch with other parents who are dealing with similar situations.

Hi nattysmom, I have so much respect for you and the other parents of Type 1 children. I was diagnosed Type 1 at the age of 27 so didn't have to deal with diabetes as a young child. I think you're doing an awesome job and your daughter is so lucky to have you to guide and support her. I think her A1c is great for a child!

I agree with those who say that you should keep doing what you're doing. It's all about balance with kids I believe. After 25 years with diabetes, I think it's important for parents of children to remember that it's a marathon not a sprint. If you severely restrict your daughter's food at a young age to the point where she feels deprived, I believe you're more likely to see her rebel with food choice as a teenager or young adult.

My sister-in-law would not allow her (non-diabetic) kids to eat sweets growing up, they only ate organic and very healthy at home...but when those kids were away from home, I saw them dive into a plate of cookies with both hands and mouths stuffed.

While I personally low carb as an adult because that's the only way I can get stability these days, I did not always. In my younger years it was much more predictable for me and I could handle eating more carbs while still getting decent numbers.

Now answer me this: if you are eating very low carbs are you eating more protien? or more fats? cause with to much protien I would then start worrying about the weight issues.... give me some ideas about low carbs and what else in place to you guys eat?

I'm not eating "very" low but maybe 90-100/ day, a bit less than rx'ed for me. I've replaced a lot of carbs w/ stuff like eggs for breakfast, carrots (which have carbs...), lower carb bread, etc. I think carbs are more likely to cause weight issues than protien, or at least they did in my case? As I've reduced carbs, I've lost weight. I plateau and cut out some more and lose a bit more. I've gone very slowly at it. I'm not sure my own kid would be a huge fan of that sort of plan either but we all enjoyed burgers w/ low carb buns and veggies instead of fries the other night and were ok.

A few thoughts (trying not to reiterate what others have said):

  1. I think your flexible approach is good.  It's very common for people diagnosed with T1 as children to develop "food issues" because of the intense focus on food.  By not making a big deal of things if she wants more, you are setting her up for healthy eating habits as she gets older.
  2. That said, help her understand the impact of certain foods on her BG. It's ok for her to have a treat now and again, but "treats" (i.e., things that make her BGs wacky) should not be a regular occurrence.  If you do this, she will hopefully learn to correlate feeling better with better food choices. 
  3. Make sure to have lots of low-carb snack items handy, as well as other "safe" foods.  There may be some foods that have lots of carbs in them, but are safe for her to eat regularly in moderation.  For me, fruit and non-fat frozen yogurt are two such foods - they have lots of carbs BUT they cause a very predictable rise and fall of my BG.  I can easily bolus for them and usually wind up within range. Help her make low-carb choices whenever possible, as this will decrease the fluctuations in BG levels. 
  4. An A1C of 6.7 is awesome!!  Even the low 7s would not be bad (IMO).  Keep in mind that children tolerate slightly higher BGs better than adults do.  At her age, persistent lows could interfere with brain development.  And you also don't want her developing hypo unawareness.
  5. Does your daughter use exercise at all to help control her BGs?   When I was a kid, treats or food excursions were used as rewards for intensive exercise.  It was the one time I knew I could eat something without my BG going haywire!  Phil Southerland writes about this in his book as well. It was a common management tool back in the day, one that we have unfortunately moved away from.
  6. Do you know what foods are most problematic for your daughter?  For me, my "problem" foods are white flour, bread, pasta, and rice.  Because these foods cause me so much trouble, I really try to stay away from them as much as possible.  To the extent you can, help your daughter identify her "problem foods" and encourage her to make choices that don't involve these foods whenever possible.  Again, this doesn't have to be absolute.  I will eat rice from time to time, but I do so rarely and I know when I do, I'm going to possibly be in for a long night. 

 With T1, it's hard to balance everything - keep the A1c but don't become so rigid with food that you create emotional issues.  You want her to have a normal childhood but the obsession over preventing complications can stand in the way of creating a "normal" environment.  It's all a balancing act and it sounds like you're doing a really good job.

I think this is a great response.

I would add, if it is possible give your daughter as much control and autonomy in managing her diabetes as possible. At 9 they are quite independent little people. Make this something she manages with your help rather than something that is imposed on her and she has to go along with. She and you could research on this and make it a special project so that she fully understands the whats and whys of management (age appropriately).

Maybe also set up a reward system that such that if she achieves mutually agreed goals for a certain period of time she will then get something / or get to do something special.

I just checked my pump to see how many carbs I eat in a day, man it is a lot, but I believe what I have learned and why I think I am low carbing, is that I avoid carbs that I know will result in a definite high (and a long lasting high.)

Autonomy is important for many reasons. Before you know it, she is going to be staying away from home for stretches of time, whether she's staying after school for activities or hanging with friends. You need to make sure that she knows how to handle her diabetes in those settings without your guidance. At her age, she should definitely be operating the pump herself (under your supervision). Also, things happen and (I think) as a parent it would be reassuring to know that if you were separated from her for any reason (i.e., she got lost in a mall or you were hospitalized for a period of time) that she could take care of herself.

yes she know hows to give herself boluses, she knows how to get info from the pump!! but she doesnt know how to change her pump, nor does anyone else in my household know... whick i know needs to change, and soon enough she will be able to change it hersef!! I do take alot of the responsiblity and I think thats the control freak in me.... but I know I have to make some changes!! but right now in my household theirs alot going on... So as soon as evertyhing stablaizes assuming it does I will need to teach others how to change her pump!!!!!!

My daughter is 7 years old and is always hungry; especially for carbs. I have to say that the lunch you describe sounds really similar to what we feed my daughter, although Vivian would usually even add a fruit to that for a typical lunch of 60-80 carbs total. Those A1C's also sound great for a child as well. My daughters have always been in the 7's. I should proably be asking you for advice! But I will go ahead and share with you my latest strategy for my daughter's meals.

My latest strategy is to focus on food groups. I talk to her about how it is important to eat some fruits, vegetables, meats, dairy. If she eats a meal and is still hungry (which is about half the time) I ask her to pick something from a food group that she did not eat already (I leave out the sweets food group altogether for meals). This typically leaves her with only really healthy options. This gives her some choices so she doesn't really complain or try to talk me into non-healthy food like she used to.

As she gets older we may decide together to decrease carb intake, but right now I am just trying to strike a balance between keeping her healthy and letting her be a kid. I think it is important for her to be educated about her disease, so I will continue to teach her about how food (as well as other factors). With this knowledge she may decide to go on a lower carb diet at some point (which I would completely support), but I want to wait until she has some understanding and say in the matter. I am hopeful that with this approach, she will be a little less likely to rebel once she is out of the house.

I wish you and your daughter the best!!
Aimee

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