A1Cs and Random Highs

[crohrer]

Hi everyone,

I'm the father of a 9 y.o. girl with T1D. She was diagnosed at age 5. She's been on a pump for about 2 years.

My daughter's specialist encourages us to let our daughter eat like a kid. That is, sweets in moderation are ok. I'm very curious to hear from other parents who have dealt with T1D in children. Do you let your child eat sweets after dinner? How about a cookie in the middle of the day? If you do, how are their A1Cs?

I have such mixed emotions about this. First and foremost, I want my child to continue to be healthy. If I can achieve that while still letting her enjoy some refined sugar, even better. My concern is that she'll occasionally go high, 400+ maybe once or twice a week. Her last A1C check was mid-7s.

So, let's hear it. What level of restriction works best for you?

[Subby]

Hi, can't really help with your main question as I have no experience with making such decisions with kids with diabetes. I was curious though: when you say "my concern is that she'll occasionally go high, 400+"... do you mean this is a concern or fear that it might happen, or do you mean that this is actually happening? And if they are actually occurring, is there a specific relationship between the highs and the times of snacking?

[crohrer]

Thanks for responding. I see that I wasn't so clear there. She does occasionally go high, sometimes as high as the 400s. We test her 5 times a day: before every meal, at bedtime, and late at night. So, when we test, she hasn't had any food for at least a couple of hours.

It's those times (having fully digested her food and still being high 3 hours later) that really scare me. I'm trying to make a correlation. I'd be happy to hear that we just need to adjust her numbers. Or, maybe we're not counting carbs correctly. But it's not a consistent problem.

I'm hoping there are people out there who have come to the same crossroads and made sense of it. No more dessert? Stick to meals of 50g carbs or less? I know this question is open-ended. At this moment, any tips are appreciated. We've been dealing with T1D for 4 years and there are times when I still feel so helpless!

[Subby]

Well I'm sure people will have general opinions about levels of sugary carbs, but the only way to really answer your question as far as what is the cause of the spikes and therefore what to do about it, is to track and log the meals more closely at least for a while, and see if you can find a correlation with such things as:

- time of day (may suggest both a change of I:C is needed, and/or a change of basal rates)
- amount of carbs/foods
- type of carbs/foods
- combos of foods such as carbs plus fats - fat tends to prolong spikes (and indeed can worsen them overall) so this is a common culprit for long spikes

It might be you find little correlation, in which case you might then consider more systematic changes such as basal testing (however that might be done if it can with a child), changing up the diet dramatically, troubleshooting pump issues or if indeed the pump is causing variability full stop, etc etc.

If you don't already have it, I suggest you get Pumping Insulin by John Walsh. It is a thorough and very useful reference for all things pumping. I do think he's a bit default high carb though: some (not all) T1s can really benefit from cutting their carbs from at least a bit to a lot. I leave the ramifications of that in terms of what is fair on the child in this kind of case, to others...

You might also like to search for a forum called children with diabetes. There are a lot more parents there than here, last time I looked.

[Gladtobehere]

The book recommended by Subby is a "must have". I found it a revalation when I started pumping a couple of years back.

I think there are 2 key points regarding the main question.

The first is that if you deny a child the treats, or some level of normality regarding their eating habits you run the risk of that child simply not taking your advice any more. And that result would be devastating.

What you really want diabetic children to learn is how to manage their diabetes. That should include taking bolus insulin for a treat. What all children should be taught is how to eat healthy and keep the junk to a minimum.

The food analysis also recommended by Subby is critical. But I must admit having next to no experience with diabetic children.

Personally, what I find for high numbers , 2 or more hours after a meal are either;
1) WAY TOO MUCH (quick)carb in the meal. Things like bread, rice or deserts. (I simply try to keep these carbs to a minimum)
or
2) TOO MUCH FAT in the meal. Things like Pizza, which delays the digestions until the bolus insulin is used up. Perhaps a COMBO or delayed Bolus is in order?

Ohh, and a couple of beers also can cause a high number even with a good meal. but I doubt that is your daughters concern.

So, don't deny the treats, but be sure to teach moderation and treatment. Keep your daughters love and respect and as much as possible let the doctors worry about the other stuff.

I have been diabetic for 30+ years, but I can not imagine the difficulty of trying to treat a diabetic child.

I wish you and your daughter all the best. And good luck with these difficult questions.

[Kathryn10]

Hi Crohrer,

My sister and I have had t1 since we were toddlers. I remember our parents only letting us eat sweets when our blood sugars were low. They sometimes let us eat them at other times and would give us extra insulin, but I have vivid memories of doing somersaults and made-up obstacle courses over and over again in order to get my bgs down so that I could eat ice cream

[mom24grlz]

Hi everyone,

I'm the father of a 9 y.o. girl with T1D. She was diagnosed at age 5. She's been on a pump for about 2 years.

My daughter's specialist encourages us to let our daughter eat like a kid. That is, sweets in moderation are ok. I'm very curious to hear from other parents who have dealt with T1D in children. Do you let your child eat sweets after dinner? How about a cookie in the middle of the day? If you do, how are their A1Cs?

I have such mixed emotions about this. First and foremost, I want my child to continue to be healthy. If I can achieve that while still letting her enjoy some refined sugar, even better. My concern is that she'll occasionally go high, 400+ maybe once or twice a week. Her last A1C check was mid-7s.

So, let's hear it. What level of restriction works best for you?

Hi my daughter is 13. She was diagnosed with type 1 at the age of 11. yes we do let her eat like a kid. She does not eat a low carb diet. If she wants cookies and milk or ice cream for a snack i'll let her eat it. As long as we won't be eating dinner within the next 30-60 minutes. As for sweets with dinner. If she wanted a sweet i'd make sure she ate everything else on her plate first. But i also do this with my non-d kids.

Ashleigh's A1C's have been in the 6% range since diagnosis. Her highest A1C was 6.6% last summer. She goes in July for her next endo appointment but based on her BS i expect her A1C this time to be between 6.0%-6.2%. It was 6.2% in February.

Christina mom to 4 girls. Ashleigh-13 Type 1 diabetes. Pumping animas ping

ETA: Please come check out Welcome to Type1Parents!!. It's a forum for parents of type 1 children that i post on. Great bunch of mom's and dad's.

[crohrer]

All these comments are great and very helpful. It's good to see the variety of approaches to diet and lifestyle. One thing I'm picking up from you all is that you don't see a blood-glucose reading of 400 two hours after eating. Ever.

[bdelatte]

Honestly I wouldnt let her eat like a kid. The one thing i wish my parents would have done when i was a child was really watch me. They were good about not giving me sweets but i still ate high carb meals with them. (Granted a lot of the reason they fed this stuff to me is b/c they werent educated that carbs are bad, not just sugar) so i cant blame them. If i ever get in your situation, i would get my child on low carb and get them in that habit so that when they do reach adulthood its not has hard to adjust. and honestly, there are TONS of low carb cookbooks out there with yummy desserts. That is just my opinion though and i am sorry to hear about your situation . good luck

[mom24grlz]

All these comments are great and very helpful. It's good to see the variety of approaches to diet and lifestyle. One thing I'm picking up from you all is that you don't see a blood-glucose reading of 400 two hours after eating. Ever.

400 no. Occasionally we see 300s. And we know what foods cause them. Poptarts make Ashleigh spike to about 375 2 hours after eating them. So we avoid those like the black plague LOL! And cream stick donuts spike her to about 300 range. She can eat regular donuts with very little spiking, but those cream sticks we just can't get the handle on. Fortunately donuts are a special treat and not something we regularly have around the house.

[crohrer]

Thanks for all the great comments and feedback. I feel relieved to know that other parents are making it work with differing levels of diet restrictions. I think I need to start documenting what it is that's causing her to have the highs and start either restricting them or changing our bolus strategy.

We had pizza tonight and I reflected back on what some of you said about pizza. So, I was fully prepared to see a high a few hours later. Well, she ended up going low instead. Go figure. We'll see if those pizza carbs actually hit even later than I'm expecting when I test her later on.

[Gladtobehere]

Thanks for all the great comments and feedback. I feel relieved to know that other parents are making it work with differing levels of diet restrictions. I think I need to start documenting what it is that's causing her to have the highs and start either restricting them or changing our bolus strategy.

We had pizza tonight and I reflected back on what some of you said about pizza. So, I was fully prepared to see a high a few hours later. Well, she ended up going low instead. Go figure. We'll see if those pizza carbs actually hit even later than I'm expecting when I test her later on.

Sounds like you have a plan.

I would like to add that everyone seems to have different responses to food. For examples there are meals that will put me very low. For those meals I have learned to do 1/2 the normal bolus to start and then do correction bolus at 2 and 4 hours to avoid the low.

I also find that the serving size makes a huge difference for me. For example 1 small peice of Pizza, I bolus normal, BUT if I were to have 2-3 slices, I would need to do the 1/2 bolus trick or risk going low at 2 hours.

Experience is the only way to figure out what works. And it is best if the diabetic learns these things and can apply the different coping techniques as the situation arises.

Good luck.

[Rachele88]

ok Im new to this forum, so I want to just say that I was a little girl when I got Diabetes (6) Im 31 now. No complications, just random high bg. My doctor, when I was a child told my parents to do the same. It didnt hurt, but instead made me feel "normal." I do have to warn u however, when she starts going through puberty, her sugars are going to get crazy, and so are her sweet cravings. My advice to you is if you know that its gonna be a 'sweet' night, try no carb dinner or very low carb dinner...make up for the sweets by cutting carbs. That was the easiest for my parents, it will prob cut out those huge spikes as well. Good luck!! I give you alot of respect being on here for her...Your a great Dad!!

[Lizzie G]

theres no reason to not have sweet treats, or to reduce your daughters carbs at other meals as a result. if you use the correct amount of insulin for the number of grams of carbohydrate you eat, you can eat what you like (within the bounds of normal sensible eating). this is the approach i have always had to type 1, and despite plenty of ignorant comments from people about what i am 'allowed' to eat, i have always had far better control than any of the other RL type 1s I know and kept my A1C in the fives. yes you may spike marginally higher if you eat a whole bunch of sweets, but if the correct amount of insulin is used then this should be back to normal within 3 or 4 hours. if the reading is still high, you havent matched the amount of insulin you have taken and would have had the same issue whether it had been sweets or bread. as your daughter gets older she will learn more and more about how different types of food affect her and will find a way to eat or drink exactly what she likes and it not to cause an issue. in the meantime, are you aware for example, that the glycaemic index of chocolate is similar to wholewheat bread and causes a similar spike? do you stop her eating toast? chocolate is actually very easy and predictable to cope with, and hopefully your daughter, like many young girls, prefers chocolate to plain sugary sweets. ditto icecream: the fat content slows the release of glucose into the bloodstream considerably and better matches it to the action of your insulin.

it's also pretty easy to avoid spikes simply by timings, if she really likes those sugary sweets, then get them as a treat on a family walk. just a gentle walk can eliminate spikes.

as your kids get older they will learn to take over control of their own diet and diabetes, which is very important. they are much more likely to be motivated to look after themselves if their experience of someone else being in control involved a 'special' diet, and hopefully she simply wont want to fill her body with garbage as she gets older!

[Antionette]

All children should eat healthy, limit sweets, salt, soda pop, etc. There is no reason for a T1D child on a pump to limit sweets any more than a non-T1D child. The key is moderation for sweets and to make sure they are eating healthy foods as well. My daughter had sweets when she wasn't on a pump, but only at snack time and sometimes for desert. At snack time she still had to stick to her preset carb amount, but most of the time she also had to have a healthy snack, eg vegies & dip, or do a split like half a piece of fruit and 1/4-1/2 of the sweet that she wanted. No child should be continually replacing 'junk food' for healthy food. In my opinion, the worst thing you can do to a T1D child is make them feel different and if they can't have cake OR ice cream at a birthday party they will be labelled as 'different'. Remember, there are also many problems caused by low self esteem. My problem with the low carb diet is 1) they are being treated like Type 2 Diabetics and 2) replacing the carbs with protein and/or fat. A high protein diet can lead to kidney failure & they don't need to be put at a higher risk for that. A higher fat diet causes cardiovascular problems. A high carbohydrate diet causes weight gain. It's all about moderation!