do kids develop some kind of defense system in their body if they get diabetes from young age? if it is the case, maybe it is good to let them stay on MDI, and switch after the puberty
I don't know for certain, Weide, but our diabetes team has told me that it seems that for some unknown reason, children dx before puberty seem to be protected from the effects of highs until after puberty. That is why they apparently allow the "normal" range for young kids (ie my 3yr old) to fall b/w 6-12mmol. Once they hit puberty, I was told that tighter control is much more critical. Not sure if that answers your question.
To all the parents on this thread, I have a general observation to mention. Everyone seems to be talking about out of control numbers, with very few answers as to why they are occurring. Ever since my daughter was dxd over five years ago (now age 14), I have made it my 100% priority to understand cause-and-effect, and to take precise measures each time there is a high or a low. The one key factor no one seems to be mentioning, is the types of food your children are eating. Without question, the single most important factor for us has been to understand the glycemic index of every food which she eats. This has enabled us to understand, with some trial-and-error, precisely how her numbers will be influenced by the types of foods she eats (e.g. apples vs. strawberries, pasta vs. rice, bread vs. pizza, etc.) We've got it figured out for every meal she eats, when to pre-bolus, when to use the extended bolus feature of the Medtronic pump and for which foods, and also what to do if she gets our of her range. Her basal/bolus ratio is always at 50/50%.
This did not happen overnight, but when you understand the glycemic indexes of foods, you might kick yourselves (as I did to myself) when you realize that what they are eating, is often the main cause of the problems. The second part is what you are doing when trying to make corrections to get the numbers into range. Also, how to check the insertion/injection site, amount of exercise, even the temperature of your refrigerator where your insulin is stored. If anyone wants more input from me, I am happy to share my thoughts. We are now almost 20 consecutive days in a row without a high or a low of any significance. That's a record for us, and her A1C's have never been higher than 6.7%. For the last few years, she has had no problems in school, and overall lives a pretty normal life with low stress in the household. It wasn't always that way, so I am happy to help others if I can.
This may be a bit off topic, but I'm going to say it anyway.
Generally speaking, kids are resilient. Their bodies are programmed to repair damage on a daily (or nightly) basis, mostly while they sleep. They bounce back, and their bodies seem to pretty quickly fix stuff that would knock "mature adults” on their keesters.
I once read a pretty graphic description of what a high BG does to the tiny little vessels throughout the body. It was really disturbing to think of that happening to my son every time he had a high, and I got myself into a tizzzy just thinking about what was happening every time *I* did not keep my son's BG in range.
But then I thought about how INCREDIBLE a child's body is at fixing all those little booboo's that occur throughout the day. My (non-D) 7-year old can rip his foot open on a garden implement today ('cause that's how he rocks), and a few days from now it's barely visible, because he heals *that quickly*. All night long, his little body is on overdrive spewing out new cells in every corner of his little body, and in the morning he's all beefed up and ready to tackle a new day. That's what kids' bodies do.
My D-Kid is no different. I know that he can have a couple of days (or nights) of highs, but as long as we work on keeping his BG as stable as possible, make sure he gets as much sleep as he needs, and good nutrition during the day, his body will be able to deal with those occasional spats of highs. Overall, he's the healthiest of our three kids...always the last to get the flu and the first to recover.
It's really easy to get caught up in EVERY high or low and feel like you're not doing your job. But the fact is, we're attempting to perform an impossible job. We cannot "be" a pancreas. We can only do our best to mimic the incredibly phenomenal, mind-blowinging complex thing that a pancreas is. Every hour of every day.
Try to keep in mind the "milestones". Quarterly A1c numbers are a good start. We have annual bloodwork that gives us a bigger picture on all of the body functions that *may* be affected by D. Annual eye exams that let us know IF there have been any changes to the vascular system. On a more intimate, weekly-ish basis, I check his feet to be sure that all those little bumps, bruises and boo-boos are healing normally. "Big Picture" is what I, personally, aim for with our son's health. I just can’t do any better than that.
I am not a pancreas. I am not an endocrinologist. I am not a doctor. I am not a nurse. I am "just" a mom who loves her D-kid, who was unexpectedly shoved into all of those roles in an Earth-shattering one-hour period of time about 2.5 years ago. I'm doing my best, just as you are. Just as we all are.
Take a deep breath. Look to the horizon. Stay in touch with the D-community (here at Juvenation, in the blog world, by e-mail, and in person through local groups).
Take another deep breath. Don't get yourself overly wound up in the details. You're going great.
Blessings,
Mo
Well said Mo. Thanks for that, I know I needed to hear it.
Hi Michael
could you elaborate? It certainly sounds hopeful, but how exactly do you
calculate the glycemic index? Let's say you're having spaghetti with meat
sauce. How do you know how much protein is in the sauce? And what if you put
parmesian on it. Does that change it? And even if you knew it, how does that
translate into timing? Does a food with the same glycemic index get
metabolized faster if you excercise? Or slower at night (which we have found
with our son)? It seems dauntingly complex, but maybe you have found some
simplification that captures the important time constants?
thanks
Bruce
It's even more complex than that - but don't get frustrated. For my daughter, the important thing that we learned is that pasta releases carbs for six hours. It might release faster if it is cooked more, but most of the time, she will eat two servings, and we will do a dual wave bolus for 6-hours at about 100-120 carbs. That includes our assessment of the sauce and any vegetables in the sauce like carrots or peas perhaps. For us, it works like a charm, every time. But, it took us a while to figure it out, and tweaking her pump to get it right. We don't factor carbs for parmesan or any proteins in the sauce.
Another example for us is fresh pizza (we never, ever eat frozen pizza or chain restaurant pizza). Pizza for us requires a 1 1/2 hour bolus for two slices. Two servings of vegetable or chicken fried rice is usually three hours.
And yes, the exercise will cause the insulin to work faster, but we found the carbs then will release faster as well, so we still do the same bolus but keep an eye on her numbers later on to see if there is a drop. If there is a low, we treat it with 15 carbs, set the timer, and test again in 15 minutes to see if she has stabilized. We test again in an hour.
If there is a high, we discuss the possible causes of the high (forgot to bolus, didn't count the right carbs, possible site congestion, etc., then we do a correction, and test again in an hour. Absolutely no carbs when she is high! If she is still high again, we automatically give her a shot, check her site again, or change it, go for a walk, then test again in an hour.
We have lots of basic rules which we always follow and which keeps us out of trouble. We always pre-bolus for meals, at least 15 minutes (unless she is low). If you don't know the exact carb intake before the meal, then we pre-bolus for 1/2 the meal at least 15-30 minutes, then do the rest after she finishes.
We avoid all cereals, pretzels, some fast-acting fruits like watermelon and pineapple, and stick with slower acting foods like, flour wraps with eggs for breakfast, pancakes, strawberries, apples and bananas, popcorn, rice, pasta, pizza, etc. Do a Google search on Glycemic Index and look for a pyramid illustration, then test for yourself what works best on each of your favorite foods.
Everyone should do what's right for them, but my best advice is educate yourselves as much as possible over the Internet. Don't depend 100% on your doctor. The more time you put into this, the better your results will be.
Hope that helps!
Michael
hi Michael
thank you for your great insight!
I could understand we can intense manage while we are with our kids, but how are we going to manage them while they are in school?
My daughter is 14, so we do everything diabetes-related together. She understands as much as I do, so really my job now is to help remind her of things. We collaborate every time she eats something to make sure we have the right bolus. When she is at school now, we know what she eats for lunch - again no fast acting carbs, which helps her get through her day without any spikes. She also tests, then pre-boluses about 20 minutes before lunch. She is getting better every day, and taking on more responsibility. It's actually quite bonding for us. We make mistakes, but we try never to make the same mistakes twice. Very rarely does she experience a high or a low without a reason. We always try to understand what caused it, so we don't repeat it again.
By the way, I highly recommend that everyone attend this annual conference at least one time - there is so much information there, it will change your lives - www.childrenwithdiabetes.com/.../orlando2012.
Hope that helps - please keep the questions coming!
I am glad you have such tight control over your daugther's sugars. I think everyone needs to do what works best for them. I agree that it helps to know the GI of foods. Here is where I take issue. I made a promise to myself and my 3yr old that diabetes would not single her out. I would never send her to a birthday party and tell her she couldn't have cake because the icing had too much fast acting carbs. If she asked for cereal for breakfast, I won't tell her it is taboo. There is nothing better on a hot summer day than a slice of juicy watermelon, diabetes or not. If that means having a high or breaking a streak, so be it. She is a child, and a young one, with a life full of diabetic challenges ahead. I am determined to make diabetes fit into her life, not the other way around. I am committed to teaching her adaptability, flexiblity, and diligence where diabetes management is concerned. I will learn how the insulin works so that she can enjoy what she wants (at least once in a while). As an adult, I want her to be able to handle the curve balls, and to do that I need to teach her how, not to avoid certain things because its too hard to figure out. I don't want her to grow up thinking that this thing that has made her different means she can't have or do what all of her friends do. It may just take a bit extra planning/figuring. If as an adult she chooses to avoid certain foods, then great, whatever works, but my goal is for her to learn that she can do this, and anything else she desires. I don't mean that I will let her eat a pile of sugar loaded garbage, just as I wouldn't have pre-diagnosis. I mean absolutely no offence, Micheal, and I commend you on the tremedous job you are doing with your daughter... 20 days is truely amazing. I strive for such a great run. I just do it different, a different school of thought is all. Finding balance is not easy, but I will.... for her. Everyday I do it for her.
hi Michael
could you elaborate more about what is means:
a dual wave bolus for 6-hours at about 100-120 carbs?
1 1/2 hour bolus for two slices?
I am just not sure how it gets done.
thanks!
Hi Jen - I appreciate your thoughts, and felt the same way. When my daughter was first dxd at age 8, I didn't know anything about diabetes. But, after she got on the pump and I started to tweak her settings, we found that we were able to have a lot of control over diabetes. With regards to foods, we just found that eating known foods which will spike her, can cause such problems in the house, that it just wasn't worth it. As a teenager, she has so much homework, that we can't afford for her to be high during the day or after school. I've spent too many nights waiting for her numbers to come down, and then starting her homework at 9:00pm, staying up until midnight. When she's high, she can't concentrate, she is irritable, arguments break out, you know the rest. Plus, she's a teenage girl, which is hard enough! Lol.
So, we just make smarter choices, that's all. Watermelon is okay if she's low, otherwise we choose apples, strawberries and bananas; all of which we found have slower acting carbs. We choose egg wraps, french toast, bagels, oatmeal and pancakes over frosted cereal in the morning. Not so difficult actually. Birthday cake, ice cream and snacks are all okay, as long as we pre-bolus in advance, accordingly, and as long as she is not already high before she eats them. We also like low-carb yogurt too. To us, it's just not worth the aggravation in the household anymore. We've been through it already. She's happy and the household is much happier.
Hi Jen,
I just wanted to say that I agree that I think it is great that Michael takes such great care and interest in his daughters diabetes but agree with you that we also need to let kids be kids. I have said it before that my father has had diabetes since 1941 (DX at age 1) and is doing well considering. My brother was diagnosed 33 years agon and is now 45 and also doing well.
Back in the day we did not have insulin pumps, NO GLUCOMETERS, the insulin of choice was NPH and (I forget the other name). THe only way to check my brothers sugar was with a urine strip and there was no way to know PRECISELY what his sugar was.
All that being said b/c while I appreciate the impact glycemic index has on blood sugars (as a diabetic myself I know all too well that baked potato is better than mash/fries, whole wheat is better than white bread, etc...).
However, like Jen (the dietician) and myself felt that if I made major changes to my son's diet he would rebel and resent being diabetic and then we would run into problems with his treatment.
I try my best to offer him "healthier" choices as a diabetic (high glycemic vs. low glycemic) but since he was a very picky eater to begin with, the dietician said it would be hard to change his habits and that what was most important was the carb counting and taking the insulin and keeping sugars within target range 2 hours post meals.
Sure, he feels better when he has toast versus a poptart for breakfast since his sugars shoot up and he came to the realization HIMSELF that poptarts were a bad idea and we no longer (at his request) give a poptart for breakfast. Instead, if his blood sugars are lower at bedtime I will give a poptart sometimes as a treat for his bedtime snack.
So I do believe we should all strive for a balance so that our kids can live as "normal" a life as possible without putting them in harms way.
Sure, my son's sugars are not perfect and as he hits purberty I hear they will be all over the place (he is 10).
So good luck to all the parents out there and try not to worry too much...we already have enough (stress) on our plates without having to beat ourselves up for something we really can't control (most of the time).
As I have said before (a quote from my dad), "Of course your sugars are high, that is why you are considered diabetic...just take the necessary steps to bring it down by taking a dose of insulin and checking your sugar".
PS...Just a note that with my father and brother (my son and myself) being diabetics for so long it is ironic (and sad) to say that my dear sweet mother is the one that past away last month due to heart disease and she was not diabetic (at the age of 69) while my father who is diabetic for 70 years is still living and on vacation as we speak.
Think it's best not to compare your parenting or your child's diabetes management to anyone else. Some people thrive on rules and structure but most of us don't. And the Joslin 50-year diabetes study showed that some long time type 1s still produce some insulin... so it's easier for some diabetics to have more normalized blood sugars. It also showed that there are unknown factors related to complications developing.
www.businessweek.com/.../651365.html
I think you're smart to let your child live and eat normally and manage diabetes around that. I grew up in the age of really restricted diabetic meal plans and have struggled with eating disorders for much of my life. Diabetics are twice as likely to have eating disorders as the general population.
With diabetes we all just need to do the best we can and find what works for us. Then go on a live good lives.