T1D child and no weight gain

[justadad]

Hi,
Eight months ago, my son was diagnosed with T1D. A month or so before diagnosis he weighed 35 kgs (77 lbs). When diagnosed he weighed 30 kg (66 lbs). Some two-three months after diagnosis he regained 2-3 kg.
He has grown taller since then, probably some 4-5 cm (2 in.), but he has not gained any weight, in fact he even lost whatever he regained. He weighed himself this morning, 30 kg.
Might this be due to the lower carb intake? If I am calculating correctly, his daily carb consumption is somewhere between 80gr and 120gr a day.
Any thoughts on this, anyone?
Thanks

 

[slip]

TBH his weight is secondary, how's his blood sugars been?

 

[azure]

Does he see a dietician @justadad ? When I was diagnosed, I was given an eating plan. I know things aren't as regimented now, but have you been given advice about diet at all?

It does sound worrying that he's not put on weight, so if it was me, I'd get some reassurance about that. Perhaps he simply needs more food? What's his diet like in comparison with pre-diagnosis?

 

[justadad]

Thanks for the reply @azure!
No, he doesn't see a dietitian. His diet is based on what we "think" is common sense, which might be wrong...
What has changed in comparison with pre-diagnosis is the amount of simple carbs. The amount of food is pretty much the same. We have substituted white bread with graham, bavarian, pumpernickel, rye bread. Same one or two cups of milk per day. Same snacks before lunch and dinner - apple, peer, berries, sometimes a rice cake or a fruit yougurt, and some ice cream when he is physically active. Lunch is often meet in combination with potatoes, kidney beans, green peas or rice and fresh salads (replaced white rice with parboiled). We have fully eliminated juice and fizzy drinks, with the exception of coke zero. So there is a change in his diet, but we mostly tried to reduce the simple carbs.
I guess the fact that the simple carbs are out and protein and fats are the same as ever, (he has never been an eater really) maybe this could be the reason for the lack of weight gain?

Thanks

 

[CathP]

My daughter seems to grow taller for one clinic but not gain weight, and then gain weight for next clinic, but not grow much in height. I'd have thought if he's shot up in height he'll fill out at some point.

Feed lots of protein for growth.

 

[justadad]

TBH his weight is secondary, how's his blood sugars been?

Thank you for the reply @slip!
His BS have been pretty good. Tested HbA1c two months ago and it was 5.8
The past two months the libre has been showing good ranges, with the odd peaks of 10 or 11 mmol. But they would drop quickly. Normally before meal he would be between 5 and 7 and after meal he might have a peek of 10-11, and two hours later he would be in the range 5-7 again.
Morning BS is almost always between 5 and 6.

Thanks again

 

[justadad]

My daughter seems to grow taller for one clinic but not gain weight, and then gain weight for next clinic, but not grow much in height. I'd have thought if he's shot up in height he'll fill out at some point.

Feed lots of protein for growth.

Thanks @CathP !

 

[tim2000s]

the simple carbs are out and protein and fats are the same as ever

This is something you need to be careful with. In removing the simple carbs, you may have also removed more than just doing substitution. One of the risks with low carb for kids is underfeeding. It's really important to look at their entire calorie intake, and in quite a few cases, the reduction in carbs can result in an inadvertent reduction in calories. The best thing to do is to go away and have a look at a day's meals, and work out the calorie content of them.

I've no idea how old your son is but moderately active 5 year olds are usually reckoned to need around 1500 calories a day (as an average), whilst very active ones are around 1800 to 2000.

 

[justadad]

I've no idea how old your son is but moderately active 5 year olds are usually reckoned to need around 1500 calories a day (as an average), whilst very active ones are around 1800 to 2000.

Thanks @tim2000s !
You are correct there, I have minimised the importance of calories and focused on limiting the bad carbs. By the way, he is 11 and not very active... I will do more calorie counting. Thanks again!

 

[noblehead]

No, he doesn't see a dietitian. His diet is based on what we "think" is common sense, which might be wrong...

Just the same it's worth having a chat with a dietitian just to make sure his diet is nutritionally balanced and he is consuming the right amount of calories for his age @justadad , that's what I would do were it my boy.

 

[justadad]

Thanks @noblehead!

 

[azure]

Thanks for the reply @azure!
No, he doesn't see a dietitian. His diet is based on what we "think" is common sense, which might be wrong...
What has changed in comparison with pre-diagnosis is the amount of simple carbs. The amount of food is pretty much the same. We have substituted white bread with graham, bavarian, pumpernickel, rye bread. Same one or two cups of milk per day. Same snacks before lunch and dinner - apple, peer, berries, sometimes a rice cake or a fruit yougurt, and some ice cream when he is physically active. Lunch is often meet in combination with potatoes, kidney beans, green peas or rice and fresh salads (replaced white rice with parboiled). We have fully eliminated juice and fizzy drinks, with the exception of coke zero. So there is a change in his diet, but we mostly tried to reduce the simple carbs.
I guess the fact that the simple carbs are out and protein and fats are the same as ever, (he has never been an eater really) maybe this could be the reason for the lack of weight gain?

Thanks

I was going to mention calories, but Tim has already done so : ) You could use something like MyFitnessPal to add up a few days food calories to get an average daily amount. I'd also ask to see a dietician to get their input.

You say he's not much of an eater, so you might need to consider the concentration of calories in the food he eats and their fillingness if you can see he's not getting enough calories. Eg one of my children (not diabetic) isn't a good eater, so I concentrate on packing nutrient and calories into a small amount of food.

You don't mention snacks and maybe they'd be a bad idea if he doesn't eat much, but it's something to bear in mind as an option. I'm presuming he has full fat milk and the like? I also find peanut butter is a good way to add concentrated calories.

 

[justadad]

You don't mention snacks and maybe they'd be a bad idea if he doesn't eat much, but it's something to bear in mind as an option. I'm presuming he has full fat milk and the like? I also find peanut butter is a good way to add concentrated calories.

Thanks @azure! Yes, full fat milk every day, and peanut butter at least 3 times a week, usually for breakfast, spread on 2 slices of bread, with 200 ml milk. When he is in mood for something salty, then it is a chicken sandwich, or some salami and yellow cheese sandwich. Or a bowl of mixed cereals (40 grams or 20 grams of carbs) and I add a handful of walnuts and again 200 ml of milk.
And the snacks, there is always a snack some 2 hours before lunch and 2 hours before dinner, and if he is under 6 mmol before bedtime, another one then. Being this a very hot summer, the snacks are more fruit and less industrial, but he used to have some biscuits or granola bars for snacks.

Thanks for all your advice!

 

[Natt]

Thanks for the reply @azure!
No, he doesn't see a dietitian. His diet is based on what we "think" is common sense, which might be wrong...
What has changed in comparison with pre-diagnosis is the amount of simple carbs. The amount of food is pretty much the same. We have substituted white bread with graham, bavarian, pumpernickel, rye bread. Same one or two cups of milk per day. Same snacks before lunch and dinner - apple, peer, berries, sometimes a rice cake or a fruit yougurt, and some ice cream when he is physically active. Lunch is often meet in combination with potatoes, kidney beans, green peas or rice and fresh salads (replaced white rice with parboiled). We have fully eliminated juice and fizzy drinks, with the exception of coke zero. So there is a change in his diet, but we mostly tried to reduce the simple carbs.
I guess the fact that the simple carbs are out and protein and fats are the same as ever, (he has never been an eater really) maybe this could be the reason for the lack of weight gain?

Thanks

Hello justadad
When I read your posts its like I wrote them myself, situation with my son is very similar to yours...He is almost 5 months in now.He was chubby before diagnosis 46kg and didn't lose any weight prior to dxd.Now he has lost a few kilos and has also grown.I agree with you that this is probably due to significant cut in carbs especially simple ones. We saw a nutricionist and she told as that he needs to be on 2000 kcal diet, measured by his age (11) and a need to lose some weight. Recommended carb intake was 250 g per day divided in 3 meals and 2 snacks.We were having a hard time chasing the amount of carbs (75 for lunch) and he couldn't eat that much so we stopped.As you say we have to apply some common sense into this and 250 g of carbs even if recomended by doctor is too much.We are now around 150, slowburning carbs only.Bgs stable and in range, knock on wood.
I guess if you are concerned with him not gaining weight, it would be good to consult a nutrucionist and maybe increase his carb intake a bit...

 

[justadad]

Hello justadad
When I read your posts its like I wrote them myself, situation with my son is very similar to yours...He is almost 5 months in now.He was chubby before diagnosis 46kg and didn't lose any weight prior to dxd.Now he has lost a few kilos and has also grown.I agree with you that this is probably due to significant cut in carbs especially simple ones. We saw a nutricionist and she told as that he needs to be on 2000 kcal diet, measured by his age (11) and a need to lose some weight. Recommended carb intake was 250 g per day divided in 3 meals and 2 snacks.We were having a hard time chasing the amount of carbs (75 for lunch) and he couldn't eat that much so we stopped.As you say we have to apply some common sense into this and 250 g of carbs even if recomended by doctor is too much.We are now around 150, slowburning carbs only.Bgs stable and in range, knock on wood.
I guess if you are concerned with him not gaining weight, it would be good to consult a nutrucionist and maybe increase his carb intake a bit...

Thanks @Natt!
Increasing the carbs would mean increasing the dose of insulin. Being on two insulin shots a day, I would hate to have to introduce a third one, or go back to the previous 4 insulin injections a day.
I will have to speak to a professional, but comparing from everyone's input today, I guess a bit more carbs and calories would do the trick.
The joys of diabetes
Cheers

 

[azure]

@justadad If he's on mixed insulin that makes it trickier, but hopefully you shouldn't need to introduce another injection.

If there's no mix that suits your son's needs, you can draw up your own mix of insulin from vials. This is what I did at one stage after they couldn't get the percentages of my mixed insulin right. It meant I could adjust each of the two component insulins myself eg keeping the slow acting basal one the same, but increasing the fast acting meal one as necessary.

 

[justadad]

@azure, thanks again, unfortunately, there is only insulin pens in my country, so not too many options really. We have, however, extra novorapid, to inject in case of high bg before lunch, which we have done on a few occasions.

 

[DaveA4282]

My 3yo was diagnosed last month and had lost a lot of weight. He is fairly picky with his eating, so we just filled him up with lots of sandwiches made from whole grain bread, and wholewheat pasta. Ensured some pretty quick weight gain without sending his BS overboard.