Carbs per meal?

My son was diagnosed last November at age 17. He’s been super compliant and responsible about it, but it has also been super hard. I read some of Dr Bernstein’s book and I really appreciated education I found on Diatribe. Really love Adam Brown’s book, Bright Spots and Landmines. I am also a hospital nurse. For years now, I have take care of diabetic patients and seen the worst of what can happen when blood sugars run consistently high. My son heard many horror stories before he was diagnosed, and this has been sadly ironically motivating for him. I am amazed at those of you who have lived with diabetes for decades with little to no complications. I find you all kind of miraculous! I realize diabetes effects everyone a little differently, and some people will be more prone to complications even if they work super hard to keep their A1C down. Frankly, I learned so much about Type 1 after my son was diagnosed. The huge majority of diabetics in the hospital are Type 2. I don’t think most nurses really get Type 1 unless they study it independently or have a family member with type 1. Just my experience, but also scary to me for Type 1 patients. I work primarily with adult populations.
All diabetic patients in the hospital are put on consistent carb diets limiting their carbs per meal to a certain amount, usually 60. When my son was diagnosed his Endo Dr recommend limiting to 60 carbs per meal. My son has done this faithfully, but he is also hungry sometimes and gets burned out on free proteins. I’m wondering how many of you limit your carbs? I realize limiting carbs/meal was not a recommended practice for Type 1’s until recent years, although many have experimented with it on their own. Have many carbs are you eating per meal? How many per day on average?
I have read that eating low carb can extend the honeymoon period. My son always has to take insulin with carb intake or he spikes. He is rarely low, but his last A1C was 5.0 (down from over 10 at diagnosis). The Dr says he’s still honeymooning, but I’m not sure if it’s totally that or consistently eating a low carb diet. Time will tell, I guess…

Hi Lora @lorarob, it is really wonderful hearing that there is a hospital nurse who has heard of autoimmune, TypeOne diabetes and knows that management for this 10% of “diabetics” differs significantly from the 90% diagnosed with the other many conditions.

You pose some interesting observations and ask many questions concerning your son and I’ll try to tell you what has worked for me during the past 63 years; I got my diagnosis on my 16th birthday. Being an observant nurse, you know well that all bodies are different and there isn’t any one method of treatment that works for the entire population.

I eat what I feel I must eat to maintain my body and allow me to be active and productive - including when I’ve been involved in sports, heavy construction, and also when I be just sitting at a desk pushing a pencil. For quite a few years my monthly daily carb count [as read from my pump reports] was 230 - 250 grams; slightly less now. I began what is now referred to as “carb-counting” in the 1970’s and learned to adjust insulin accordingly to somewhat manage my glucose levels. Insulin is a growth hormone and should not be used as a tool to eat significantly more than what a body needs to fully function - during my lifetime, I have maintained a BMI of less than 22. Setting a constant carb count for ALL meals would never work for me - currently over the period of a week I see that my meal carbs have ranged from 38 to 95 [my wife and I celebrated her birthday]. Observation, awareness thought, and ability to remember to “do what I know I should do” are keys to being able to do whatever and live a full active life while managing [T1 can NOT be controlled] our diabetes.

I can’t speak to honeymoon, if that exists, I may have experienced that for the six months before my diagnosis when I wouldn’t admit that I felt really lousy. Your son’s 5.0% HbA1c [meaning a 90 day average glucose of 90 mg/dl] looks really awesome, but that doesn’t tell the whole story - but the fact that he doesn’t experience “lows” indicates that he must spend a lot of time “in-range” without wild glucose swings. Wonderful. He could teach my something.

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Hi, Lora @lorarob ,

I’ll keep this as brief as I can. The 60-grams-of-carbs-per-meal thing is a simple way to turn a “variable” into a “constant.” It is very helpful for people who are new to T1D, and can even be helpful to more experienced people. But, with practice and experience, it is easy to let it return to the status of a “variable” and still manage diabetes well. And, it’s more like how many people would really choose to live if they were not affected by T1D.

Okay. What in the world am I writing about? Here’s the deal.

To live successfully with T1D (i.e., to manage blood glucose levels well) one must “balance” three variables - insulin, diet, and exercise. That’s what was taught at Camp Sweeney when I first went there in 1958, and it is still true today. So, the task for a person managing T1D is to attempt to ensure that the “balance” between available insulin, available carbohydrates, and their level of activity “for the next two-to-three hours” is a good “fit.” When the “formula” works well, blood glucose is well managed. But when there is a “miscalculation,” the person’s blood glucose level can either rise to an undesirable level, or it can drop and cause a significant hypoglycemic episode. This blood-glucose-level thing is a “moving target,” and it’s difficult to get the three variables to match up well all of the time. Too much insulin causes hypoglycemia, too many carbs raises blood glucose, and a lack of exercise causes blood glucose to rise, too. (But, to tell you the truth, the exercise thing is so very complicated - for now let’s “pretend” it’s simple.)

One way to make things easier is to turn one of the “variables” into a "constant. That way it’s effect is much more predictable, and then you just have to consider two variables, not three. The 60-grams-of-carbs-per-meal recommendation turns “diet” into a constant, so the only “variables” that have to be considered are insulin and exercise. That’s a whole lot easier. And if a person turns exercise into a “constant” too (same amount at the same time every day) then the only thing that has to be considered is insulin. And I’ll let you in on a BIG secret, when diet and exercise are held constant, insulin turns into a “constant,” too.

Well, that’s the idea. And, it works, kinda’. But our bodies are dynamic and are constantly changing in response to environmental and internal stressors, so expecting things to “stay the same from one day to the next” is unrealistic. We still have to “prick our fingers” so we can see how well the “big 3” are in balance. Heavy sigh!

So, all of the above is a long answer to what is a very simple issue - 60-grams-of-carbs-per-meal turns diet into a “constant” in the formula for managing blood glucose levels.

Do I use the 60-grams-of-carbs-per-meal thing? No. After 60+ years of living with diabetes, and with this “spur of the moment lifestyle” that I lead, I use a formula of “1 Unit of Humalog per 30 grams of carbohydrates” to manage meals and snacks. And I follow a five-different-basals-per-day routine for “normal” days; for unusually active days I manage my basals manually. And for sedentary days (on the computer all day) I do the same. But I am very comfortable with the “Big 3” variables, so I don’t mind changing them to match my day - such would be very difficult (and dangerous) for someone new to diabetes management. With experience it gets easier.

Well. I went on with this for much too long. I hope it makes sense. Best of luck to you and your son!



Great input so far! I have had diabetes for 35 years, with decent A1Cs, 7.5 or less, the entire time. Staying active, good weight, etc., still, I have been experiencing complications for the past 5 years, primarily a number of vision problems and CKD. So, yes, it affects individuals differently. You mentioned Adam’s book, which I find helpful, but I can’t go as low-carb as he does :slightly_smiling_face:. I run Loop, a DIY solution. As Adam has mentioned, it will handle up to 10-15 carbs per meal without blousing. Seeing the affects of eating carbs in real time with Loop has convinced me that lowering carbs is the only way to stay feeling good and increase time in range. I make my own protein snacks - mainly various cuts of chicken grilled with a butter and Franks Hot Sauce recipe from the Internet. Your son’s A1C is amazing, given that he’s not going low. And you’re right, time will tell, re honeymooning. Good luck! With persistence and technology your son should live a long and relatively healthy life!

Hi @lorarob Lora, you’ve got a lot to think about with the great advice from @Dennis @BillHavins and @mikefarley, but with respect to your original question yes I do “limit” carbs because on a typical day it makes insulin management easier, and I have a pound or 2 to lose.

Recently I’ve been hitting the gym and riding my bicycle. As a result I’ve had to “up” my carbs on workout days while reducing both meal and background (basal) Insulin.

If your son doesn’t need to lose weight or needs to gain a little weight the way you do that is increasing carbs and insulin because besides glucose control, insulin is a growth hormone.

So if your son is active and skinny, his limiting carbs/meal may be waaaay higher than it would be for someone needing to lose weight or someone, for example, not very active. Now if he is on a cross country track team right before a run his meal carbs could be in the 90-100 grams range . A nutritionist with both diabetes and athletic experience may be helpful.

Cheers good luck :four_leaf_clover:

Thanks for all of your thoughts! I appreciate different perspectives and understanding that comes from experience. I think it’s all a little like the lottery. It’s a luck of the draw that anyone gets Type 1, and the severity of complications also seems to be somewhat luck of the draw. Some people can get away with smoking cigarettes for 50 years without much consequence, while others get lung cancer, or compromise their lung function to the point that their quality of life is drastically altered in bad ways or they die. We all just have to do the best we can.

In a way you are correct Lora @lorarob working with the human body and trying to get similar results every day is a “lottery” - your son’s body and your body which is not affected by T1D. I’ll also note the four members who have responded have slightly different perspectives to which I’ll add, combined these four have more than 225 years combined observing each his own diabetes.

Personal observation of how activities, foods and emotions USUALLY affect my body glucose level is important. “Usually” is the operative word here - your son can be doing everything the “right” way and suddenly he has a day when he can’t get his BG above 70 and another day when no matter how much insulin he takes he hangs above 250. Take a breath and say tomorrow will be another day and know that “Murphy’s Law” is never inactive.

I’ve only been diagnosed Type1 for five yrs. But at diagnosis I was at 13.7. Since then, I havent thrownan A1C greater than 6.0. But only over the last 6 months, have I had 6.0’s, but on purpose! To stop me from crashing during the nite, I really wanted to sleep more than two hrs a nite in a row, I started eating late night to last till 6:30 or7.
I usually go to bed with big reading on cgm of 95 to 115. I wake up around 108. But I do not count carbs at all. Nor do I limit sugars either. I’m cautious about sugars, but I do not limit my intake. Well I don’t drink sodas, tea or water are standard fair.
I also don’t bolus for highs. I drop within an hour or so back to the 100’s to 120ish range on most meals. I have a large sliding scale too. About 50 per one unit of insulin with a base of 5 units. I usually range in the low hundreds to 95 before I eat each meal.
It works for me, may not work for anyone else, but it works well enough that Drs say I don’t care what you eat, drink etc as long as I keep #’s good.

Everyone is different! That’s my main point! Just have to find what works for him and roll with it. If he’s not crashing at this level or blowing the roof off the scale, he’s golden.

I still get asked why I get some #’s over 200, but sometimes they just happen. Why I don’t know for sure, but they rarely go there for more than an hour or so, so I just don’t worry about it or I try to do something physical to bring it down. By physical, it could be riding the lawnmower if it needs done. Nothing major, just not sitting watching tv.
Awesome numbers, I just think that sometimes you can go too far in limiting carbs etc and that’s not good too!

God luck

Well, I’m going to rain on the carb parade, as I have an entirely different perspective.

I’ve had T1D for 27 years and have zero complications. I pump (the gold standard of diabetes care) with the Tandem X2 which suspends my insulin if I begin to trend low, and wear a Dexcom G6 glucose monitor. By year end, Tandem’s pump will have a software update to increase insulin to combat high BG. My A1c remains right around 5.2.

The new measure of control, instead of A1c, is ‘time in range’. Staying within a determined target range is healthier than numerous highs and lows, otherwise known as the diabetes roller coaster. My range is set from 80-130.

Insulin is a fat storing hormone, and using excess amounts of it to control BG has its own complications, beyond weight gain.

Diabetes, at its core, is a carbohydrate intolerance disease. I urge you to read that sentence again and think about it. If your son was allergic to peanuts would you suggest he eat them at every meal and just medicate himself to handle the symptoms?

I’m a strong believer in Dr Bernstein’s approach. Contrary to people saying it’s a recent development, I first read his book in 1999. I actually read it in tears, as it simply made perfect sense. With my first day of low carb food, my insulin use decreased by a third, and my BG became a nice, smooth line, instead of the ups and downs that had become my norm.

I eat well—real food that’s easy to obtain and order in restaurants. As for hunger, it’s excess insulin and carb intake that create that viscous cycle. Reduce carbs to a bare minimum (I eat 30 max per day), eat primary enough protein and fat to satisfy, as well as whatever non-starchy veggies desired, and hunger is a non issue. In the absence of the majority of carbs, the addiction is broken and the cravings disappear.

Your son can enjoy things kids eat, but he’s got to be more mindful. Pizza? Sure! Either homemade with the ‘Fathead’ recipe online or just eat all the yummy toppings from a restaurant pizza, leaving behind the only thing that requires insulin: the crust. There are more low carb options and recipes online now than ever before.

My goal is to live a long, healthy life without complications. Minimal carbs for my carbohydrate intolerance disease make it nearly effortless.

I’m happy to correspond via email if you need more info.

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When I read Dr. Bernstein book, I felt it was truly enlightening! My sister and a friend both had children with Type one diagnosed a few years ago. The endo at the time (same one my son see’s now) told them they could eat whatever they wanted as long as they covered the carbs with insulin. They even encouraged them to eat chocolate bars and ice cream, etc. I didn’t know this until after my son was diagnosed last November, and we got the education to limit carbs to 60 per meal. From my nursing perspective it made perfect sense. But I was shocked to know that my friend and my sister’s kids’ had both been eating just whatever they wanted and covering with insulin. But, I found out that that was what was the recommended practice from the ADA. I was still, and probably will for awhile, be learning. My friend was told if her daughter’s A1C was around 8.5, that was good. Although she has started to have some neuropathy already 7 years later. My niece struggles all the time was super high blood sugars. My son has been super compliant with low carbs and is not as hungry as in the beginning, the first two months were the hardest! He’s okay most of the time. He eats 4 meals a day spaced about 4 hrs apart, up to 60 carbs per meal but most often 40 or less. It’s working, but as a Mom/nurse I just wonder about everything! I don’t think he could do 30 carbs per day or even 60 for the whole day. He stays in range most of the time doing MDI and using Dexcom 6. It’s just so interesting to me how everyone treats so differently.

Just curious…you don’t count carbs at all? So do you give your meal insulin after you eat based on your blood sugar? You’re A1C is great for what you are doing. I had a T1 patient that ate whatever he wanted at every meal. He gave himself 30 units before every meal, and then he did a post meal dose an hour after eating if his blood sugar was high. He was a huge dude, but he said his A1C was around 6.5. His way of managing scared me, but it seemed to work for him.

Lora @lorarob, I probably shouldn’t jump in again, and I do NOT want to diminish what others have suggested for your sense - but I do want to support what your instinct and professional training is saying to you.

Yes, a person with TypeOne can eat just about anything and everything as long as s/he is knowledgable and capable of maintaining that critical and often delicate balance between food, activity and insulin. And that being said, a person with diabetes, like all human beings should eat a well-balanced diet, eat sensibly and eat and pump full of insulin just for the sake of eating.

Your son is young, growing and his body is still developing; IMHO, he should consult with a registered dietitian/nutritionist familiar with diabetes management. He may learn that he should be eating four [or more] times per day and that all four meals need not each be 60 grams of carbohydrate.

As Valerie @valerieadams pointed out, the very low carb Dr. Bernstein approach has been proven very effective management for many people. It is one of the first effective diabetes management tools “discovered” in the 1790’s [225 years ago] during the French Revolution when grains, hence breads, were very scarce; those people with diabetes appeared to survive a little longer. Insulin wasn’t isolated until 1921 and not available for use until 1922.

I totally agree with Dennis. I have spent the last 5 yrs trying to do what my Endo tells me to do. Everything I do is with Dr approval and advise! That part is most important. I can’t stress it enough.

But yes it is true I, I do not count carbs at all. Actually I take my two basal shots per day and then before I eat I take my fast acting insulin shot. But it is no where near that amount you stated. I do not take any other insulin for high readings.
In fact I never dose for any reading after I eat. I would be in a coma if I did. I drop very very quickly at any time. Due to this reason, I only dose before I eat. The dose is minimal as well. My sliding scale is 1 unit for every 50 points. But that also depends on what I eat and how I feel. Honestly I have never given myself more than 7 units of fast acting insulin ever.

My body chemistry and my reactions to foods is anomolous. I have had to endo’s ask me you eat what? And what is your reaction? I have the ability to print my daily CGM readings and I will show them what my reactions are and I log all of my injections. I’ve spent years logging each food I eat, it’s reaction and the amount of insulin I take and my glucose readings before I eat and for every hour after I eat till the next meal. I don’t arbitrarially just does and guess. I test each food I eat for weeks before I accept what it’s ( my) reaction to it is. I can eat the same thing 3 days in a row and have a totally different reaction to that food each time.

I know I’m different from everyone else! Even tho I’m in the everyone is different percentage group, the 10% of diabetics withT1. I’m in an even smaller group. This I know is tough to understand. But what I am saying is that with rigorous testing and patient monitoring, you may find that your son may need to eat differently for his body chemistry.

I also make sure I’m eating as healthily as I can. I’m really trying to find a way to get around having to eat candy, drink sodas to stop my lows. I may never get there, but I’m gonna try. I only change one meal a day. Even then I may only change one food item on one day to find my reaction to that food item. It’s time consuming, slow, careful study of each food. But with this process, I have learned that I can eat pretty much what I want and not have issues with long lasting high glucose readings. Why? In many cases I have no clue.

All I am suggesting is that with careful testing with Dr consent, you may find a diet for your son that doesn’t leave him hungry or malnourished.


I did forget one thing that I should make very clear. I followed Dr instructions for 6 months counting carbs dosing based off of that figure as instructed to do so. I was crashing like a mad man. I plotted my reactions on an X- Y grid and showed him my responses to following the “ normal “ instructions. I also used a log of my reactions to insulin intake. I also logged my glucose levels after eating at 1 hour intervals and my treatment responses. I was testing close to 20 times per day. I bought extra test strips to do this with.

I followed scientific procedures like I had been trained to do in college. I was a premed student with a biology major. I did get accepted to med school, however I could not pay for it. Money was not available in 1980 like it is today.

Just thought I should add this to what I’ve told you to make it clear that what I am doing is based on scientific testing and with complete Dr approval! I do not and will not make major changes like this without Dr approval.

Due to this, he has told me I can do what I am doing so long as I do this as safely as possible. What I was doing prior was not working at all. I clearly was failing to improve as he had anticipated and agreed to allow me flexibility only if I could prove what I was doing or intended to do had scientific backing. Therefore, I have been working this out over the last 4 1/2 yrs to be able to achieve the results I have.

Hope my explanation has been clear enough to alleviate any reasons for concern or worry. It is most important that I say again. I know that my reactions to insulin and foods are very different than anyone else’s reactions.
My body chemistry is very different and my reactions can sometimes be unique.
Like being in the hospital for prep for colonoscopy and endoscopy and being on glucose drip and crashing 5 times during the night. When I told Endo about it he said and your surprised why? Another example when crashing give or drink orange juice right! Nope 6 oz of o j will bring me up on average 10 points. Heck a small Pepsi, the little cans, only brings me up (on average) about 50 points.
I hope I answered your questions and your concerns about How, what and why I do what I do.
If you have questions etc I’ll answer them best that I can.

@Charlie4801 Wow. It’s impressive how much thought, research, and effort you have put into learning about how your body reacts and what you need to do to take care of you. You would make a good health care provider. :slight_smile: I have done personal research with other chronic health issues my family has in similar depth. You never know what will work best for any given person.
As a side, we have talked to the diabetic nutritionist several times. They recommended 3 meals a day at 60 carbs each. I am a researcher by nature, and tried to find and make as many low carb options as possible, so my son could eat more. Then I told him to try 4 meals a day because he was hungry more often than either of us liked. The 4 meal plan works much better. We told the dietician what we were doing and she gave a hesitant okay. But, his A1C has continually improved since diagnosis, so we’re good.
My son is not overweight at all, and he’s also pretty sedentary. We went hiking on vacation for several days, and he did really well with extra snacks.
I am truly grateful for everyone’s thoughts and shared experience. It helps. Thanks!

The best medical advice I ever got, from 2 of the very best doctors I ever was related to is this: if what you are doing is working, then keep doing it.

The off-hand advice for any t1’s is to not be sedentary. even if it’s a little pinchey move more than not, try to do something that counts for cardio every day.

Sitting and reading, you will do much better with low carb and high protein (on the average) but if he can eat 90 grams carbs and his bs is satisfactory and he feels better… then who cares?

while polling the audience may give you more depth of what others find that works, it too can be confusing and contradictory. Your own observations are what matters most.

@Charlie4801 - I wonder if you’ve had a c-peptide test, and if so, what were the results? just wondering out loud. you certainly don’t have to reply =) . Yes our metabolisms are different and sometimes the average reaction and average treatment will not work, and that’s why this disease makes YOU the primary doctor…


I have, but don’t remember the results of the c peptide test. I assume that it was normal, I only tend to remember negative results.
It’s funny that you should say that about us becoming our own primaries, because just yesterday had to do dr visit with nurse practioner and she remarked the same. We were talking and she asked about insulin, if it had changed or if Dr had told me to change it. I explained that they ask me if I have changed any levels etc. she was surprised that they allowed me to do that. Even tho I’ve seen her for the last 2-3 yrs, she still doesn’t understand that type 1’s are different from type2’s.

It amazes me how learned people can’t, don’t or won’t take time to understand the differences.
My wife had to be hospitalized for an e-coli issue for 5 days. Somehow she got one of the rarest forms of it and it’s very infectious. Since I have serious eye issues, I can’t drive. Several people offered to take me to see her. I had to refuse, because of the infectious part. Everyone didn’t understand there is no way I could be there because the treatment was no food and ride it out. Pain meds only. I could never survive that. Eating for me is chore, not pleasure. That and 4 days without food, impossible. Even the nurse practitioner didn’t understand that the no food thing can’t work. I’ve crashed on I V. 5 times in one night. If I didn’t have my emergency supplies, it could have gotten very serious real fast. Till I explained it to her, softer she asked if I fasted before appointment. I told her you never want to see me without eating. She asked why. I explained it this way. Simple just add water, instant asshole! Without food that’s what I become. It gets real negative from there.

But Lora, you may even think about 5 meals a day for him. I did that for while, till I started gaining weight. It took close to 6 months for me to gain up to my goal weight. Along with having to change insulin amounts. I had to add nearly 4 units a day. I’m not overweight either, but I do try to stay 10% over what the Dr says my ideal weight is of 165. If I get sick, I’ll drop those 10 lbs in days. If figure that I need the reserves for emergencies. After I explain it, all but one of my Drs agree I’m right.
Interestingly, I’ve found that I need both artificial and natural sugars in my diet. I stay healthier and my glucose levels remain more consistent. As someone said, I don’t know why, but it works! And I always said if it ain’t broken, don’t fix it.

IMHO tho if you take the time to work on it, you can find a diet for your son that works for him. If you get it right, he’ll have more energy, look better, feel better and have a much better attitude. Getting there is very, very hard work tho. Yeah you’ll. Make mistakes and sugar levels will go wild for a few days, but you have to look at the long run. 2 or3 months from now, not just the day to day levels.
Even with my careful research, I have unusual days where stuff goes wonky, I’m either higher than a kite for 2 or 3 days, but then it smooths out and I’m back to my normal level of around 115 to 125 on average per day. At the end of the day, it’s the three month level that counts. Not that I had a high one day of 275. It’s the mediation of all those days that counts, not worrying about one meal or one day.
It’s seems simple to say, but a pain to achieve. I had to raise my level so I could sleep thru the night. I went from 5.6 to 6.0 to do that. But now most days I get 6 hrs a day of uninterrupted sleep instead of 3 hrs at a time.
My goal is to get back to what is considered normal. I may never achieve that, but it’s the goal. Gotta look at the long term, while focusing on the day to day. Lots and lots of work to get there, but I think the end result of being able to live longer and to avoid as many of the complications as I can during that time is worth all the work to get there. I have things I want to do in life and I’m not afraid of the work it will take for me to get there… lots of people say that I can’t eat this or do that. My answer is simple. Watch me, I’ll do it. It might take a while, but I’ll do it.


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Really interesting Charlie @Charlie4801 that you may have a "normal [range 1.1 to 4.4 ng/mL] c-Peptide; each time my Serum has been checked for c-Peptide the results have been <0.1 ng/mL meaning none could be found.

It is critical that each of us becomes Our Own Primary Doctor. I have been my doctor for the last 60 years, setting my insulin dose[s], observing results and reporting what I find to the professional doctors - several of whom happened to be at the top of the diabetes field. Of course, at each visit I would discuss evolving diabetes theory and then figure out how to implement care in a practical way. One of the most notable experiments was in the mid-1970’s when a Joslin research doctor asked me to attempt what we called “Intensive Management”. This was before the advent of digital BG Meters and became what is now referred to as MDI which in the 1980’s with new BGM was proven effective through the international DCCT Study and subsequently became the standard method for treatment of what was to be called TypeOne Diabetes.
We each must be observant and do what works for us.

Hi Loraob Lora
I am another long term survivor (43+ years) with few complications as of yet. I got my first pump about 9 months ago but up till then I was taking multiple injections daily. As others have said the 60 carbs/meal are a means of simplifying the system. Keeping physically active is about the best way to keep healthy for for all of us. I don’t recall seeing anything about medications your son is taking but if he is taking injections keeping a regular carb schedule for meals is very helpful to minimize amount of time tweaking. Whether it is 60 60 60 breakfast lunch and dinner or 20 80 80 or something else, keeping a somewhat regular schedule will make dosing easier at least until he is more experienced. Starting with the 60 carbs per meal is just giving you very basic system which you will have to tweak until he gets something that works for him. Again exercise, testing and regularity are keys to using insulin (particularly with injections) Also don’t make any permanent changes based on one bad test result but do so if yo see patterns. When I was taking injections as a bolus before each meal I specific amounts for each meal which I would tweak each day depending on what the test was at that time. For example I would take 5 units of humulog for my lunch bolus and that would stay relatively fixed unless I noticed that before dinner I was either consistently high or low for more than a couple days and then slowly adjust it until it ran more normal. Even if you know what you are doing take baby steps and change things slowly because the body is incredibly complex. Everyone you speak to will have a different system. Ultimately he with your help will have to figure out one that will work for him. (With our help and advice as well.)
Good Luck!!

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Something I thought about that might help to help your son. One of the things that happens due to being diabetic is that so many things/issues/problems, is this. One small thing can be out of whack and so many systems are affected. The result is that you feel like crap, but that’s not unusual, but you don’t know why. It becomes very hard if not impossible to identify what’s bothering you.

Your angry, mad, depressed, happy, sad, this hurts, you can’t feel your( name the body part), etc. all this is happening at once. This can be overwhelming and disconcerting. Which adds to the problem. Your son may have all of this going on at the present time and add in he’s hungry too, because the “magic” combination has not been found for him, yet!

With all of these influences affecting him, it’s very hard to figure out what. Is the root cause… By going slowly, methodically and as organized as you can, you can start to fix problems. Use the highest priority first. In this case, hunger.
Yes the doctors, nutritionists have set a limit. But, that limit may not be correct for him. Play with it, figure out what works. Then present it to Dr, get the advise, if we do this, what are side effects, harmful or not. With advise try for 3 months see what happens. Is this better or worse. Better? If yes, next problem. Worse? Get advise to fix problem. Each problem work on slowly, carefully till he’s feeling as good as he possibly can. All the time working with his Drs to make sure he’s as healthy as possible. Yes sometimes this or that level will be out of whack when the quarterly testing is done. Then find out the most likely reason why. Correct, test again in 3 months, better or worse. Over time, I do mean years, things will improve.
You will make mistakes, do the wrong things, eat/drink the wrong things. But by making records of what your doing, it will be easier to identify what you goofed on and fix problems. This is what I do in general and it has worked so far…

Hopefully describing what I do and how I’ve done it will help you help your son to get a handle on this wretched disease and make life as bearable as possible, as soon as it can be. With so manny influences from so many areas of his body all happening at once, it can be very difficult to find out what is the most important area to work on.
All you can doo is start somewhere and work thru it. Fix and go on. It’s a process that has to be addressed one way or another. Ignore or treat. Pick the priority, obviously dangerous or life threatening issues go to the front of the line. Sometimes the choices come down to the lessor of two evils. Eat this and tend to gain weight or not sleep thru the night? Which is more harmful? Pick the lesser, go on to the next problem. Get feeling better, then work on what can I eat differently to sleep thru the night. Never ending process of give and go.

Hope that describing it this way allows you to figure a way to help your son help himself. Or at least give a method to try to get to the ultimate goal of feeling and reacting as normal as possible that a diabetic can.

Sometimes, one must think outside the box that the drs try to put diabetes in to find solutions. I can personally say that for me only, this is what I have to do to survive. Think outside of the box, because I react so differently.