fasting with diabetes

[HollyB]

My son wants to participate in a high school fundraiser for World Vision called "The 30-hour Famine." Basically nothing but juice and water (and "if you feel ill, one cup of white rice) for one school day and an overnight party while you all hang out in a gym together.

Anybody something similar? We'll be asking his clinic for guidelines/concerns too, but I'd be interested in personal experience. He's on a pump, so can adjust his basal if needed as he goes along, but it still makes me nervous!

[fgummett]

I understand you being nervous about your 16 year old (my son is 17 but thankfully he does not have Big-D)... I don't think you need be too concerned especially as he is on the pump. The basal control should allow him to fast safely and it sounds like a good cause and I'm sure it is important to him... good on him for caring so much... I'm sure you are proud :)

I'd be interested to know how good is his control..? How long has he had a pump..? Has he already tested his basals by missing/delaying meals..?

Is the whole fast at school? Will it be supervised?

So long as he is willing to test extra frequently (especially over the night) and knows how to correct with food... I'd give him a hug (if he still let's you :) ) and send him on his way.

[Subby]

Definitely he should try a few shorter fasts first to see how he goes. It should be doable and safe if he is prepared to keep with it. On the other hand, he might find that fasting a long time is a problem, I find that I sadly get shaky and feel ill in my stomach quite quickly when fasting. I do not know if this is related to diabetes or insulin somehow.

As far as what input he can have, I think that having only the same options as non diabetics may be unfair. Up to me, he would be allowed the corrective foods he is comfortable with if required, so that he can successfully complete the fast like everyone else. That to me may put it on an equal grounding and be more reassuring for all involved. If he deals with juice and rice comfortably as corrective/predictable foods, then this may be a moot point. I suppose my point is I'd hope there was consideration for his condition and simultaneously no fuss was made of it, partly up to the school/teachers I guess.

[PepsiLvr]

I am currently on the pump and have no problems skipping meals (sometimes all day) without adjusting my basil rate unless I doing more physical activity than uaual.

I think he'll be fine too. The pump is what is going to make this easier. I agree with Subby that a few shorter fasts will help determine his individual reaction to fasting and being on insulin. The good thing is that juice and rice are both good sources of carbs in case he starts to go low.

I think a lot of the rhetoric we've heard about eating at the same time every day, etc. is more true for type 2 people than type 1. That is not to say that people should not be on a regular eating schedule.

[HollyB]

The first day of the fast is just a regular school day, but after that it is supervised at the school. I'm sure they will be willing to make accommodations, and he will definitely be taking some food with him in case he needs it. Also we'll be on call to pick him up if he gets ketones or other trouble and needs to bail.

His control is good (last A1c 5.8) though like most teens his numbers bounce up and down more than you'd like. Also he's smart and responsible about his d care -- I know he'll be on top of the testing. His night basals are solid -- we did a pretty good test just a week ago. (Not that he's likely to sleep much !)

Day basals are another matter. We haven't done systematic daytime basal testing. Funny how a kid who's willing to fast with his friends for a good cause is not at all interested in missing a meal when everyone else is eating!

The trial run is a good idea. I'm mostly concerned that the juice will spike him up and down like a yo-yo...

And yeah, I am proud of him for wanting to take on this challenge.

[fgummett]

We haven't done systematic daytime basal testing. Funny how a kid who's willing to fast with his friends for a good cause is not at all interested in missing a meal when everyone else is eating!
A teenager missing meals! :D I'm sure someone will correct me but could you test this by delaying for example, your evening meal an extra hour or two... so he still gets to eat with the family but you will have tested his basal over that regular meal time? That is always assuming you have regular meal times with a teenager in the house... :D Best of Luck and please let us know how it goes!

If ever I feel that maybe the World is not that great, I just look to my son and his friends and I'm filled with hope for the future :)

[xMenace]

I'd be interested to know how good is his control..? How long has he had a pump..? Has he already tested his basals by missing/delaying meals..?


If he's already done lots of basal testing, he should be fine. If not, he may trend high or low as time goes by. I assume he can handle either. If it were me, I'd test every two hours or less.

If he has basal tested, he should watch for unexpected basal dumps and for the opposite, body shutdowns.

I think it will be a very worthwhile event for him on many levels.

[HollyB]

If he has basal tested, he should watch for unexpected basal dumps and for the opposite, body shutdowns.



Hi John,

I'm not sure what you mean by either of these terms. I gotta say, a "body shutdown" sounds scary!

[Alice]

I'm probably being too "old school" here...but I think this needs to be looked at with caution. Have you talked to his doctor about any ideas to handle the 30 hour stretch? I hate to tell any child to "not do something" because they are diabetic. I really, really hate that personally. But a 30-hour fast (w/juice, I know) worries me. Not big worry, just on the edge of caution.

Same way I don't like it when non-diabetics fast for "diet" reasons.

Are they going to be dancing? Or just sitting around listening to IPODS? Try to envision what the 30 hours will really contain...also...will he have access to the juice at all times?

[Emm]

I really can't imagine that lows would be a problem, fasting tends to put our blood sugar UP, and the 40 hour famine (is it 30 hours there?!) still means lots of fruit juice and lollies! He will need to be careful and drink water, space out his juice and lollies (Matched carefully with insulin of course) so he doesn't end up uncomfortably high.

He sounds like a wise young lad, and as long as he's willing to do lots of testing and possibly lots of injections, it shouldn't be too big a deal.

Will there be teachers around who are confident & capable with his diabetes? Will you be there at all?

[HelenM]

Like Alice, I would advice caution , I don't think that you should prevent him but I do think he should have tried and tested means of getting through a hypo and be able to bail out without feeling that he has let either himself or the group down. With all the other kids around I doubt that he will get much rest.
When I was his age (long, long ago, and way pre diabetes) I did a similar fast for Oxfam. We were in the centre of London and supposed to spend the night 'safely' in a church hall. (thats what my parents believed, and probably today teachers would be far more vigilent). We actually spent most of the night in Piccadilly Circus, collecting money for our charity in various 'silly' ways. At the time I don't remember actually being hungry but we used a lot of energy up. When I got home I was absolutely exhausted .(Hence my caution).
After all those years I have great memories of that weekend. I'm glad I did it and think that your son should go but with clear safeguards in place.

[ant hill]

My son wants to participate in a high school fundraiser for World Vision called "The 30-hour Famine."
I would see that he takes with him his BG meter and Jelly Beans or similar and test often!! What would make me worry is that he may fall into a low so see that he well quipped and tell him if you are low, For god's sake EAT!!! ;)
It's all very well that fasting is a practice in a cholesterol test but something like this is a Grey area. See that his friends know what to do if he fall low. :)

[Alice]

This is making me remember one of my "lost memories" of childhood! I had signed up sponsors for a "Walk for Mankind" which I believe was 21 miles around my home town. I remember water stops and maybe a few KoolAid/Punch stops.

My friends dropped out very early. I walked the entire 21 miles without a meter...I don't think I had much in the way of glucose with me...I had confidently told my mother there would be juice along the way.

I was very happy...and I'm sure my mom was very relieved when I called from the City Center for a ride home. This was back in the early 70's...no cell phones, meters, etc.

Now, it's one of my proudest moments. (Ignorance is bliss)...for all I know, my glucose could have been in the 200's the whole way...or just on the edge of happiness...I'll never know. As Richard says in his epic journal...we just didn't know. But it didn't stop us very often.

[ant hill]

This is making me remember one of my "lost memories" of childhood! I had signed up sponsors for a "Walk for Mankind" which I believe was 21 miles around my home town. I remember water stops and maybe a few KoolAid/Punch stops.
Hello Alice :), I can soo remember those days of guess how you feel and indeed ignorance is bliss as back then I was at the Barre in ballet class and then I wish I had a meter then as I throw my body around and create some sweat and drank water like a fish and I had a jar full of jelly baby's or beans.

My friends dropped out very early. I walked the entire 21 miles without a meter...I don't think I had much in the way of glucose with me...I had confidently told my mother there would be juice along the way.
Yeah, I just made sure that I ate well and have something with me and no meters. :confused:

I was very happy...and I'm sure my mom was very relieved when I called from the City Center for a ride home. This was back in the early 70's...no cell phones, meters, etc.
Now, it's one of my proudest moments. (Ignorance is bliss)...for all I know, my glucose could have been in the 200's the whole way...or just on the edge of happiness...I'll never know. As Richard says in his epic journal...we just didn't know. But it didn't stop us very often.

Yes, I miss ballet as I had Meany friends at that time, I certainly don't miss those En Pointe shoes so as you see a ballerina on her toes and smiling then the pain that she is hiding is there. :( Many blisters. :mad: Today they have toe socks so not so painful? MMMmmm...... Ahh Those were the days. :)
Alice, When you were diagnosed? as I was in '71. :)

[Alice]

Peter, I was diagnosed in 1965 or so...yes, things were more by instinct then...I think that's still a good talent to keep on hand!

Really, now that I've slept on this...he'll probably be fine. After all, he does have the benefit of a meter...and a pump...so he basically will have everything he needs. As long as he is responsible at checking, I wouldn't worry too much.

But, being "old school"...I still recommend that you discuss with a doctor. Many doctors of young adults love a "challenge" and love to encourage young ones to live a normal life.

If anything, it will be a learning experience! I hope he reports back!

[HollyB]

Our CDA has confidence in him and thinks he should go for it but her concern is starvation ketones in the event the juice isn't enough to meet his energy needs. She's advising him to check ketones as well as BG every 4 hours or as needed.

We'll check in with the supervising teacher to make sure the juice is available freely and that they understand he will be bringing glucose tabs and some "real" food just in case he needs it. He'll also have a cell phone so if he gets into trouble and needs to bail we'll come get him.

I'm not too worried about the exhaustion from the all-nighter -- he's done that before! -- and at least he's not likely to sleep long enough to have a low in his sleep.

[Funnygrl]

I wouldn't do it. I remember this fundraiser from high school, and I thought it was dumb then too. Good cause, bad idea. Going 30 hours without food isn't really a good idea for any growing teenager, much less one with diabetes. I know even though my basals are fine, I trend low and feel like junk if I go too long without a real meal. Plus, it will deplete glycogen supplies and put him at risk for more severe lows the next few days as well. Starvation ketones aren't really a concern if they'll be drinking juice though.

I'd rather see teenagers raking yards or doing some kind of walk to raise money, but that's just me.

[Subby]

You sure got a range of opinions here, I can see the point in all of them. I suppose I hope this is one decision he might make for himself, and if he wants to do it it's not simply because of the pressure to "be normal" or possibly put himself at health risk to keep up with the peers (who risk very little, what with working pancreases and all). If there is any doubt, I definitely agree there are many (possibly better) ways to fundraise without fasting and non-compliance for good reasons should be encouraged.

I'm not sure that "starvation ketones" of the likely magnitude involved are something to be worried about, in my understanding they are distinct from the dangers of DKA. Did the educator say why they were such a concern? I see it as an unecessary burden to be testing ketones like that if BG levels are in the green and he feels ok and keeps hydrated. But, that's just my opinion and I am very happy to be corrected.

[HollyB]

Hi Subby,

yes, this has been very interesting!

There are plenty of kids in his school who DON'T do the fast, so I don't think he's being pressured. I think he sees it as an interesting challenge, to see if he can manage it OK.

Unlike some kids I've heard of, Aaron doesn't tend to get ketones easily (in fact hasn't had them that we know of since dx) so I tend to agree that if he's feeling well, he doesn't need to go crazy with the ketone testing. On the other hand, it's easy enough to do and be reassured that he's OK.

Thanks to all of you for your input -- it's helped me think this one through.

[Alice]

I guess this fundraiser is polar opposite to what we used to do in high school and college...that was to sell Krispy Kremes for $1 a box. We would go to the factory and fill our cars with do-nuts...then hit the college dorms and neighborhoods on Sat/Sun mornings. Not quite the same...is it?

[RobiJo]

Go for it. I did these in college. He just needs to test frequently. Drink the juice when needed to prevent hypos. I didn't need any fast acting insulin the entire time during the fast. The hardest part was after the fast was over... I overdid it afterwards and ran high then. My carb ratio didn't seem to work right the day after.
Tell him to have fun!