Advice requested from a certified nutritionist, dietician or diabetes specialist please

Food
1

My son is 2, has had diabetes since July '09, and his sugars are pretty well controlled.  However, recently I wanted to see if doing 25 carbs at each meal (breakfast, lunch, and dinner) would help control his sugars.

So far, and it's only been 9 days, is that I'm giving roughly the same amt of insulin each time, but he is still spiking way up for about an hour after each meal.  His patterns are different after each meal though.  Here's what they do:

Breakfast, he wakes up on or near target (150), he eats b/w 0630 and 0700

BG then spikes up into the high 300's for 1.5 - 2 hours

We check his BG at 0900 and then again at 0915.  If he is trending down, it usually happens very quickly, so a 10-15 carb snack is given to catch his low (10-15 b/c it depends on what the snack is).

Lunch BG is taken at 1015 and is usually b/w 100-170.

He naps from 1100-1315.  We check his BG around 1330 and it is usually around 170.  I give direction to my daycare staff that if his BG is >130, then recheck in 15 for a downward trend and if is coming down, then give his 5 carb snack. 

However, unlike the morning, where he shoots way up, then comes down nicely...when he wakes from his nap, his BG just keeps on steadily going up until 1800. 

At 1800, before dinner, his BG is always higher than 250, so I tend to give his Novolog about 15-20 minutes b/f he eats and that gets him through the night.

His regimine is: Lantus: 3 units (am), 2 units (pm). 

Target: 150                   Correction Factor: 200

Novolog: 1:5 breakfast   / 1:9  Lunch   /  1:11  Dinner

I normally will manipulate his ratios if I see a trend for more than 3 days. 

Question 1:  Why does his sugar spike way in the morning and come down nicely in time to give a snack, but doesn't do that b/w lunch and dinner?  Particularly if he's eating the same carb amount (25) at each meal and a majority of his food is on the Low Glycemic side. 

Question 2:  How can I get his sugar to not spike up so much after breakfast?  I've tried low carb (8 or less carbs for breakfast) and now I'm trying a consistant 25 carbs, but they both have the same affect.

I don't get it.  Thanks in advance for your help!

Ryan

~Blake's Mom!

 

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Hi Ryan -

Is there a reason you're posting this on an internet forum, instead of making an appointment with someone?  I may be wrong, but I'm doubtful you'll get a reply with the parameters you've set, for a couple of reasons:  1.  Probably no one here as ever actually treated your son, and therefore would be hesistant to give counsel, and 2.  This kind of advice is what they get paid for, so there's little incentive to do it free.  Also, there is potential for their advice given here to be wrong, and it's doubtful they'd want that liability.

If you'd like advice from someone who is not medically trained (but has years of personal experience with T1), or maybe is just a medical student at this point - that is most likely what you'll find here.  Again, I could be wrong, but I hope you're not frustrated if you don't get replies.

Best wishes.

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Well, I'm just looking for outside thoughts so that I can balance it out with someone else besides my Endo.  It's always good to get other opinions than relying solely on an Endo who has never actually raised a Diabetic child.  Thanks for your input.  If I don't get a response, that's ok, but I know there are specialists who read these posts and reply. 

have a great day

Ryan

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Question 1:  Why does his sugar spike way in the morning and come down nicely in time to give a snack, but doesn't do that b/w lunch and dinner?  Particularly if he's eating the same carb amount (25) at each meal and a majority of his food is on the Low Glycemic side. 

Don't cut his carbohydrates!! He needs a minimum of 130g of carbs/day for his brain to function at it's highest capacity (he's only getting around 90g if you include snacks, right now). Because he is young and growing, he will require more than that. The brain runs solely on carbohydrates (it will run on ketones if it can't get carbs, but we know ketones are bad). Don't limit his carbs so much.

In the morning, everyone experiences insulin resistance, whether diabetic or not. The body is "sleepy" and the liver is producing glucose on it's own, so the blood sugars naturally rise and have a tendency to stay up there.

It might not necessarily be the amount of carbohydrates, but the type, along with the other foods he is eating at his meals/snacks. There are simple carbs (like juice, candy, fruit, etc) that get into his system quickly and then leaves quickly. Then there are complex carbs that digest slower and stay in the system longer. If these foods are paired with proteins and fats and fiber, they will take longer to digest, therefore having a longer effect on the sugars (you may notice a slower rise over a longer period of time).

By lunch and dinner, his lantus may be becoming less effective, causing higher blood sugars that are harder to get down. This you would have to discuss further with his endo.

 

Question 2:  How can I get his sugar to not spike up so much after breakfast?  I've tried low carb (8 or less carbs for breakfast) and now I'm trying a consistant 25 carbs, but they both have the same affect.

I would change the types of food he is eating. Don't restrict his foods because he needs all the energy for growth and development. You can try increasing his proteins and fats at breakfast to slow down the digestion. For example if he usually has cereal and milk, try something like an egg and yogurt with a piece of toast and peanut butter. That is higher in fat and protein, but still has some carbs in it to get him going. Then, a couple hours later, you can follow it up with more carb-containing foods to provide him with the energy he will need (a piece of fruit, some crackers and cheese, whatever).

Like I said, it's probably not the amount of carbs, but the type along with the foods it is paired with.

If you want more information, let me know. Or try contacting a local diabetes educator or dietitian. They can provide help too. I am a nutritionist, and will be a dietitian at the end of June. I am working towards becoming a CDE, but I am not a professional yet.  I have never raised a diabetic child, but I lived with it for awhile. LIke Kim mentioned, professional help will be the best route for you to go.

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I dont seen a long acting insulin, does he take one?

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[quote user="Greg Borkman"]

I dont seen a long acting insulin, does he take one?

[/quote]

Lantus is a 24hour insulin. what i didnt see is a quick acting insulin like NovoRapid to take at meal times.

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[quote user="Daniella"]

Lantus is a 24hour insulin. what i didnt see is a quick acting insulin like NovoRapid to take at meal times.

[/quote]

 

that's what Novolog is. It's exactly like Humalog.

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im clearly blind...

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clearly

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Dont worry im also blind it seems.

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C,

Thanks for responding.  YOU were actually the one I wanted to hear from (couldn't remember your name, sorry), but I've only been on the site a few times and I remember you becoming a CDE very soon!  Thanks

I confirmed what I was thinking.  I don't want to cut down his carbs at all, those times were more for a trial and error period.  When he was first diagnosed, his CDE recommended 30 carbs, so I'll actually give the 25 carbs a few more days for trend analysis and then move up to 30 carbs.  He gets about 15 carbs b/w breakfast and dinner and then another about 5 carbs before bed.  

He usually eats cereal (cherrios or oatmeal) in the morning with egg and yogurt, but I like the PB and toast idea.  I had tried 1/2 of a mini bagel, which he loved so that may work.  I may throw in either PB or avocado, which he loves.

The great thing is, he's a great eater, even with veggies!

When talking this out with my husband yesterday, I had actually come to the conclusion that his Lantus was wearing off after 2 pm, so that would make sense.  I talk to my Endo about once or twice a week, and he's great.  I just like to get a different perspective.  (he's not diabetic and hasn't raised a kid with diabetes).

My next question is:  what is the suggested amount of carbs per weight for children?  Is it different for adults?

Thanks so much, C!  

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lantus:  3 units am and 2 units pm

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carbohydrates aren't based on weight, they are based on calories. carbohydrates should total 50-60% of your calories every day.

If you want to give me his height and weight, I can give you approximates for how many carbs a day he needs. Adults need a minimum of 130g per day, but most need more than 200g (athletes typically need more than 300g). It's very individualized based on height, weight, frame size, and activity level for every person. Because the brain only functions on carbs, it's important to make sure you are getting enough during the day.

I'm afraid I can't help much with changing his insulin, but if you are keeping in touch with his endo, they will help you figure that out.

 

Good luck!

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He's about 2 feet tall and 30 lbs.  He's only 2! ")  

I'm not looking of changes in his insulin, more looking for the science/physiology of why BG's increase or decrease the way they do.   You're teaching me exactly what I'm looking for, so thanks!  

I'm forever on the phone with his endo and NP's, but I like to get lots of perspectives.  

C...on a separate note...I've always been into fitness and nutrition and had intended to become a nutritionist once I retire from the Navy, but now more than ever since my son was diagnosed, I'm about 99% sure I want to work in the field.

1.  How did you become a nutritionist?

2.  What's the difference b/w a nutritionist and dietician?  Do Dieticians have to stick to FDA/gov't guidelines?  

3.  I'm a science type and will probably get a second degree and masters in Physiology.  Do you know what jobs are out there for Physiologists/nutritionists?

I've looked all over the JDRF and ADA websites for job postings, and various other places like the Cooper Institute, etc, but I'm assuming that you've sort of been around the block in terms of what's out there for Diabetes help and training.   Just a thought!

Thanks for your help!  

Ryan

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1.  How did you become a nutritionist?

A nutritionist is someone who has completed the dietetics schooling, but has not completed the internship. A nutritionist doesn't have a legal definition, which is why a lot of people with no schooling are able to call themselves 'nutritionists.'

2.  What's the difference b/w a nutritionist and dietician?  Do Dieticians have to stick to FDA/gov't guidelines?  

A dietitian is someone who has completed the dietetics schooling and has also completed the dietetic internship. To be a registered dietitian, you sit for the registration exam after completing the internship. Dietitians have a scope of practice they must follow. Because we aren't doctors, we can't give medical advice - we must stick to food and nutrition (you can find more about dietetics scope of practice at eatright.org).

3.  I'm a science type and will probably get a second degree and masters in Physiology.  Do you know what jobs are out there for Physiologists/nutritionists?

At Iowa State University (I'm sure other schools have something similar) there is a cominbed bachelors/masters degree in nutrition called "diet and exercise." It's basically both dietetics and kinesiology. There are jobs out there for Sports Nutritionists, Wellness Coaches, corporate wellness... lots of things. To become a certified diabetes educator, you must be either a RN or a RD. It requires about 2,000 contact hours with diabetic patients and you have to pass the certification exam.

If you are really interested in becoming a dietitian or a nutritionist (nutritionists are more limited in available job positions), go to www.eatright.org. This is the American Dietetic Association. You can find information there about schooling, jobs, guidelines, available programs, etc. I am currently looking for dietitian positions - they pay decently and I can go almost anywhere with a profession in dietetics.

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He needs about 1400 kcal per day (more if he's an active child). This works about to be 175-210g of carbohydrate every day (50-60% of total calories).

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Awesome!  thanks!

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C, you're like a little gold mine of information!  Thanks so much!