Discussion Forum
Hello!
I am the mother of an 8 year old girl that was diagnosed with type 1 in July. I have come to this board after trying to find better information on nutrition and diabetes. I loved reading your story Ken and it gives me a lot of hope because what keeps me awake at night is worrying about the long term complications of type 1 diabetes that my daughter could experience. Our doctors have been wonderful with supporting us and providing care, but most of our management seems to rely on insulin and not as much on diet changes. Perhaps because they work with so many diabetic children and diet changes are the hardest to get people to do.
My main concern are the highs that we experience after meals, especially breakfast (over 300) on a daily basis. My daughter is very sensitive to insulin and it seems like we are on a roller coaster of ups and downs. I'm starting to think insulin is only part of the picture and that we, as a family, are overrelying on insulin care and not looking enough at our diet and activity routines. I liked, Ken, in your story how you said the doctor in the emergency room said that you have to take charge of your health. This whole diabetes process has made me feel so helpless as a parent. There seem to be so many things out of our control, such as insulin calculations. But if I can start taking charge with a healthy diet maybe we will see less peaks and valleys with her BG. When she was diagnosed she had an A1C of 12. Three months later in September it was at 9.1 and this past visit it was at 8.1. We are headed in the right direction but I'm not happy with her A1C. We started on a dexcom three weeks ago and that's when I realized how poor her diabetes management really is. She is consistently going above 300 after meals and sits in the 200's at night. Our doctors are working with us to change her insulin but I think we need to cut out things like ice cream at dinner every night. I know even typing this that sounds obvious but changing diet is not so easy, especially with a child. Things like school parties and what other kids have for snacks really affect her. She already feels different because of her diabetes and wants to eat the junk everyone else is eating.
We also have a lot of fear around her lows and so the school nurse has recommended things like skittles for lows. My husband and I love mejdool dates so I really like seeing what natural ideas there are for combating sugar lows that don't depend on candy with artificial dyes.
I have downloaded your early log and am going to start using it. Hopefully that will help with starting to see trends on how foods affect her blood sugar. I added a column on post meals highs so I can compare the spikes with what she eats. Instead of the "finger prick location" label I put "insulin shot" location as she uses the dexcom but she does have problems sometimes remembering to rotate her insulin shot sites.
I'm gong to clean out all the white flour breads, white pastas and ice cream. Do you have a list of foods you use to combat hypoglycemia that could sit in a school nurse's office or in my daughter's little backpack that she carries everywhere? Any healthy dessert ideas for a kid that loves dessert?
As far as the fat content goes, my understanding is that children need healthy fats for brain and body growth and development. Perhaps the fat recommendations are different for adults vs children. Does the forum have any information for that? Any books or articles you all recommend will be helpful.
Thank you again and you've given me a lot of hope and concrete things I can do to keep my daughter healthy.
Stephanie
Hi Stephanie,
An important item that I failed to mention previously is that I use long acting Lantus insulin to create a continuous downward blood-sugar bias throughout the day. I take it every evening between 8PM and 9PM. That is a major component of synchronization. When a meal is eaten, Humalog is taken at a predetermined time before the meal so that it's action aligns with and cancels the meals glucose rise. That holds blood-sugar near flatline for about 2 to 4 hours, then the Lantus induced downward bias comes into play. The Lantus dose is determined by the daily trend found in the log. If blood-sugar climbs between meals, then a larger dose is needed, and vice versa. The downward rate is determined by frequent testing, providing a prediction to when the blood-sugar will drop below 70mg/dl. If the calculation indicates it will drop below 70mg/dl in 30 minutes, I will have a fruit that matches the start time and rise rate. My target is 80mg/dl, so I take the fruit the number of minutes prior to the calculated 70mg/dl time for the goal of holding it at 80mg/dl. The fruit's timing has to be determined by logging as fine-tuning changes from time to time. Generally, however, apples are one of the lightest, oranges are faster and stronger (higher magnitude), melons and peaches are somewhere in between, except for watermelon, which is almost benign. Dried fruits are slow but have a really high magnitude.
I thought I should also mention that my Synchronous Push-Pull (SPP) Type-1 Diabetes (T1D) control method was developed by my personal experimentation in search for the best possible T1D control. The SPP method is not endorsed, recognized or approved by any medical organization or doctor. I have only witnessed one medical doctor that did not disapprove of the method. All of the others warn of its dangers. Indeed, it does require constant attention, much like driving a car requires constant attention. In my opinion, however, the traditional method is far more dangerous. With the SPP method, normal non-diabetic blood-sugars and A1C can be maintained. Over these past three decades, I have not suffered any of the dangers they warn against, nor have I suffered any of the diabetic complications that reliably occur with traditional methods. What I am offering is simply to share the control scheme that I believe in - base my life on. Using my method is entirely at the discretion of the user.
Hi Stephanie,
I'm afraid that I haven't had time to write the intended blog on my T1D control method. As a sole proprietor in my small business, time is scarce. Sorry for the delay. In the meantime, these older blogs might be helpful, if you haven't already seen them:
https://www.drcarney.com/blog/condition-related/ken-s-type-1-diabetes-journey-control
https://www.drcarney.com/blog/condition-related/ken-s-type-1-diabetes-journey-control-part-2-when-things-go-amiss
https://www.drcarney.com/blog/condition-related/ken-s-type-1-diabetes-journey-logs
Note: the log example should not be used as something to follow. There are simply too many variables. Duplicating one day to the next wouldn't even work for me. The log is only presented as an example, not something to try to duplicate.
I call my method, "Synchronous Push-Pull Type-1 Diabetes Control". Synchronous means to align the insulin timing and strength with the food timing and strength. The conventional T1D method is to find a perfect insulin dose that will keep blood-sugar in a "safe" range until the next meal. Personally, I don't think that is possible. I see that as like trying to drive a car with no brakes. Either you go very slow or you risk a crash. Additionally, I do not believe the traditionally accepted "safe" blood-sugar levels are safe.
Instead, I take insulin to match the foods initial blood-sugar surge. That's the "Push". With matching insulin dose and timed (injection before the meal time) for the match (no spike or rise), there will be a post blood-sugar downward taper a few hours after. Knowing that, I have a matching fruit snack to fill the dip. That is the "Pull". It seems that most people trying this is surprised by the dip, sometimes resulting in panic. The dip, however, should be anticipated and filled before dropping below 70mg/dl. After a meal, I know a fruit snack will be needed 2 to 3 hours after the meal, but I always test at least a half hour before the dip is expected for fine tuning. It's never exactly the same. That is the reason for frequent testing. My blood-sugar testing is always for the purpose of prediction; to know what I need to do in the future; 15 minutes to an hour or more. I always want to stay ahead. Traditional T1D methods are after-the-fact based. I find that if you stay ahead, instead of behind, then blood-sugar can be controlled even better than a healthy non-diabetic.
To learn the insulin sync timing: test every 15 minutes after a meal. If the blood-sugar rises, then falls; the insulin injection precede time needs to be increased (number of minutes the insulin is taken before eating). If the blood-sugar falls, then rises; the precede time needs to be less. If it makes an upward taper, passing 100mg/dl, then the dose volume needs to be increased. When the timing and dose volume is in sync, there should be no spike, dip or swell after a meal out to about two to three hours. After that, it should start a downward ramp, of which are leveled out with fruit snacks.
Regarding "crash" recovery, I would not recommend skittles because they contain oil - worse yet; hydrogenated oil. Oil increases insulin resistance making synchronization extremely difficult to near impossible. Sorry to sound like a broken record, but I think that is important: with low insulin resistance (high insulin sensitivity) it is possible to maintain 70mg/dl to 100mg/dl blood-sugars at all times; before, during and after meals, no spikes, dips or swells. Fats disrupts synchronization for weeks or more.
If a low is already in progress, below 70mg/dl, I find nothing works better that apple juice, because apple juice contains a high percentage of glucose - the very sugar that is needed. Other types of sugars have to be converted to glucose, which is not very efficient thus taking much longer to fix the low. Also, apple juice dissipates within one or two hours and does not contribute to insulin resistance. I have found that apple juice even out performs glucose tablets. However, apple juice should not be used routinely. "Crashing" lows should be considered a mistake; missed snack, miscalculation, etc. Apple juice is not a healthy food for routine consumption. Apple juice stops an in-progress "crash" and whole fruits prevents it from happening in the first place. For me, fruits are taken about 30 minutes before the expected low. I suspect that may vary from person to person.
Hi Stephanie,
I just stumbled across your post! Thank you for joining us. Please try to teach your child that being different is not something to be ashamed of. It is something to be proud of. I firmly believe that Type-1 diabetes can be a health advantage. I avoid saying that it is hard, but it is "busy". It requires intimate, perpetual control.
I would also like to point out that you are not alone. There seems to be a growing number of families in the exact same boat. I do wish to help. Thus far, my blogs are a scant overview of the control scheme that I have adopted. I have recently come to realize that for me to offer any significant help, a more detailed description of my management method is required, and so, I am going to get to work on documenting it. I can't be sure how long that will take, but I will post it as soon as possible.
Yes, you are indeed correct, insulin is only part of the effort. The effect magnitudes and effect rates of foods, activities and insulins are vital. It is certainly hard to change / control a child's diet, but it is paramount to their life and absolutely worth the struggle.
Insulin resistance is a major monkey-wrench in T1D control efforts. Unfortunately, a single spoonful of animal protein or high fat item will ramp up the resistance over a 48-hour period, then last for a month. It is cumulative, so, it will take a while before the struggle becomes easy. These timings may be different for an 8-year-old, but it will still be a monkey-wrench none-the-less.
Do not dispare, it is controllable, she can have normal blood-sugars and she can have an above normal life.
Ken
Dear Stephanie,
My heart goes out to you and I am glad that you found my website. Yes, Ken's blogs are incredibly helpful.
There is so much hope we can offer, if both parents are willing to adopt a vegan oil-free diet. The ideal would be if the whole family adopted the starch-smartest way of eating, because then your 8 year old will not feel so different and all alone.
Try the desserts from www.StraightUpFoods.com, but substitute chestnuts for any nuts in the recipes. Chestnuts have less than 8% of their calories from fats. Chia seeds, though expensive and high in fat, will probably be an acceptable substitute until you can order chestnuts from online.
No child needs oil in order to thrive. Thye do not even need nuts to develope normally. Flax and chia seeds may be used in small amounts like 1 oz. less than once per week. Water is a better beverage than plant-based milks, although at first she may need to use a diet higher in fat just so that she does not completely rebel over the whole diet issue.
Garbanzo beans contain 16% percent of their calories from healthy fats, Whole oat groats contain up to 20% of their calories from healthy fats, so regular use of these will ensure that your daughter is getting all the fats that she needs.
Eating beans, greens, squash, and yams for breakfast each day before 8 AM will help to prevent crashes from hypoglycemia, becaause the resistant starches in beans will stabilize her blood sugars.
Try to ask the whole family to read and adopt these guidelines:
https://www.drcarney.com/starch-smart-system/starch-smartest
Carry little cans of apple juice, and bananas with you where-ever you go. Teach your daughter how quickly she can swing too low once she adopts a starch-smartest way of eating, so that she can learn to monitor and prevent those crashes. Help her to learn that being different can mean being smarter, not inferior.
Your family will be in my thoughts,
Dr. Carney
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