Low carb for kids

[shivles]

I get the same thing as @azure. The higher I am to start the less the insulin and corrections work and I'm not even talking high bs, just higher for me. It doesn't take much for IR to show up for me. I inadvertently fasted last week to see when my insulin started lowering me and I ended up injecting a whole days worth within 3 hours of waking. I don't understand it but I won't be fasting. With a 16 mo old it is hard to control activity and nap times etc which can also effect bs spikes and drops. I too would work on getting her starting point lower. I am worst at BF always so I have to split boluses so I don't hypo. I test again after I eat and then an hour or hour and have later and take a xorrection to stop me from continuing to rise. On occasion i need two corrections after BF so I'm in a good place before lunch and then the rest of the day runs smooth. You might try giving her the same BF everyday at around the same time and then you might be able to find a bolus routine.

Also agree getting basal right is huge. My basal doesn't last anywhere near 24 hours so I use bolus for food. I can't take more basal or I hypo during the night. Getting basal right allows to to figure boluses out better. Using different basal doses only complicates boluses.

She doss have the same breakfast daily but she wakes at various times so not much I can do about that lol

 

[Jaylee]

That's great you have found a system that suits you but as you know all people with type 1 are different and what suits one person would not suit another.
From what I can gather from Shivles is her family already follows a low carb diet so as long as she has read up and researched paediatric diabetes to have a full understanding of the issues that's great. We use pump therapy to manage our sons type 1 and he does eat most things. We are not wrong and neither are you just different approaches.
Just to note we ate out last night. My son had a lovely carb laden pizza at 6pm. I used the extended bolus function on his pump over 6 hrs. No spikes and at 5am and his bg is sitting nicely at 4.6mmol which it has been doing for hours. We have cgm at the mo so I can see exactly what his bg is doing. We know what we are doing through trial and error. Its difficult with very young children because they have lots of extra factors to contend with and the management shouldn't be compared to that of adults with type 1.

My humble apologies.. I was merely offering my empathy & non judgemental support for the OP's aproach to the daughters D managment.

wow, yeah. It's a long time since I was a youngster but I do remember the worry it caused my mum growing up, then ultimately "venturing" out on my own in my teens..
So I also agree that children & adults diabetes managment should not be compared... Far be it from me to "push" an insulin regime on a parent!

 

[Kristin251]

She doss have the same breakfast daily but she wakes at various times so not much I can do about that lol

Completely understandable. I woke about an hour and a half later than I usually do and my fasting was a bit higher than normal.

Can I ask what she has for BF?

 

[shivles]

Completely understandable. I woke about an hour and a half later than I usually do and my fasting was a bit higher than normal.

Can I ask what she has for BF?

2 slices of seeded toast with butter, crusts cut off

 

[Jaylee]

If you want to give her some carbs BF might not be the best time as we are most insulin resistant then. I always have a small spike even with just fat and protein at BF. Later in the day would probably be better.

It's kind of odd. I don't eat breakfast. But, I can wake around 5.30 on a work day, test at 4.8/5 get ready then walk the dog before work. (start work at 8. 1/4 hour drive to..)
So I grab something to put in my pocket just incase for the "walkies". (Habit.) & just before I get back then set off for work, (after all the scrabbling around.) do another test.. (Hey, I am about to operate a motor vehicle.) Around 6.1..
Delayed liver dump??

Edited to add. Just putting it out there.. I apreciate @shivles 's kid has a different sort of start to the day.

 

[mcpound]

The team have never give proper instructions for corrections and have told me only 'if she's over 7mmol and the dose works out at 1.6 units round it up to 2' ! So after lots of reserch out of desperation I'm working it out myself with the help of the mysugr app.

It's the food causing the high blood sugar surely? Her overnight didn't creep up last night it was fairly steady so I think basal is okay?

I've ordered the bernstein book but will have a look at the others thanks

The thing is that although the basal is correct at night people have different insulin needs at different times of the day. It is very common for children to need much more background in the morning due to hormones which make people more insulin resistant at that time. I know my son is much older and on a pump but to illustrate his basal is 0.15 for most of the daytime however its increased 0.45 for breakfast then 0.20 for an hour after breakfast to avoid the dramatic spikes. When he was around your daughters age we sometimes went up to 0.50 basal breakfast time when he was having a growth spurt so he actually needed more at times when younger. Even when he has nothing for breakfast he still needs that increased background and doesn't have a hypo so it really isn't related to food. Not sure how you manage the different insulin requirements on Levemir. Maybe extra corrections or prop bg up at certain times? You can test how much correction doses you need by next time your daughter is high and at least 4 hrs after eating give a small dose maybe 0.5u of novorapid and test every hour to see how much its brings the bg down and adjust the dose accordingly but bare in mind that result will only apply to that time if day. Night timescmay require a different dose. Anyway as already said the book called Children and Adolescents with type 1 diabetes is brilliant. It covers all this stuff in a very accessible way. X

 

[azure]

The team have never give proper instructions for corrections and have told me only 'if she's over 7mmol and the dose works out at 1.6 units round it up to 2' ! So after lots of reserch out of desperation I'm working it out myself with the help of the mysugr app.

It's the food causing the high blood sugar surely? Her overnight didn't creep up last night it was fairly steady so I think basal is okay?

I've ordered the bernstein book but will have a look at the others thanks

I understand corrections will be harder with small doses and a toddler, so all I can do is explain what I personally do. I have a correction ratio. Please note this is mine and other people's will vary. Mine is 1 unit of insulin brings me down 4mmol. So I use that to calculate how much insulin to have if I go too high.

To answer your question - no, it's not necessarily the food. If your daughter starts from a high blood sugar, injects and eats, then she'll be more resistant to the insulin (because she's high). It makes it harder to,control the blood sugar. Starting at a good place - ie an in range sugar - is much easier. Earlier, I think you described her jumping to approx 15 after a slice of toast. That's higher than you'd expect the toast to make her. So it's possible her body is short of basal insulin. For adults and older children, you can do a basal test - to check the basal dose is right - but it involves not eating for segments of the day, so not something you could do with a little child.

Do check out all the books. Dr Bernstein is famed for his low carb approach but, in my honest opinion, his excellent blood sugars are due to his incredible knowledge about insulins and how to use them. I can't stress enough how learning to use insulin appropriately will solve 90% of high sugars. You really do have to be your daughter's pancreas, as much as you can.

 

[himtoo]

@shivles
as you are the mother of a toddler that depends on you for her livelihood -- i have a lot of respect for you making the decisions that affect her development.
i have stayed out of this topic for those reasons until now

you posted a CGM type graph that showed a high pre meal starting point with a spike but not a significant spike to warrant a dramatic change in diet to LCHF
change in BG needs to be measured as a change from the start point to the peak
so a start of 10 to a peak of 15 is actually ok in terms of peak versus start point

it is getting the start point to be in range that is as much or more critical
so a start of 5 and a spike to 10 is ok ( many non D's experience this sort of spike when eating )

I think perhaps reading some of the books that have been suggested might help provide a balanced view.

 

[azure]

I agree with @himtoo , @shivles On both things - the high starting point being the issue, and his praise for you fighting to do the best thing for your daughter.

You sound like you're frustrated with the help your getting from your daughter's team. Do persist. Sometimes we have to keep pushing to get the help we need sadly.

How have things been today? I honestly feel it's the insulin not the food that's the problem. If you can get that right, then I think you'll find things a lot easier. You'll then be starting from a more level, better blood sugar, and, with the right meal time doses. A big weight will be lifted from your shoulders.

Don't despair. It wasn't until I got Type 1 that I realised it wasn't simple to control. I'd assumed you just took your insulin and that was that. The reality is that it takes knowledge and work to get things right, and that work has to be done by the patient (or their parents) as much as by the doctors.

I was diagnosed with a blood sugar of 25, in the early days my average blood sugar was 10 or 12, but I gradually got a handle on the diabetes and improved that enormously. My highest sugar yesterday was 6.7 and most of my sugars were in the 5s. I ate normally, including snacks (with a bolus), but what allowed me to get that control was knowing insulin inside and out.

So - you can do it. Look at control as steps to climb one by one, not a massive leap in one go

 

[shivles]

Graph from teatime yesterday to now, both meals so far been a nightmare! Breakfast I think her own body must have contributed insulin so not lots I can do there, lunch I'm stumped on again.

She had a slice of eggy bread made with seeded bread and fried in butter plus 100g plain Greek yogurt, 17g carbs which was 1.1 units, give her 1 unit. Not all the bread got eaten so I'm predicting that eventually she will come down too low

 

[azure]

She went high overnight, seeming to shoot up quite suddenly during the evening. Was this because she ate a snack? I'm wondering again whether it was a lack of basal making her high.

 

[shivles]

She went high overnight, seeming to shoot up quite suddenly during the evening. Was this because she ate a snack? I'm wondering again whether it was a lack of basal making her high.

She was low at bedtime and I was struggling to get her back up, she had 15g sugar before she came up to 6.6 then she continues to rise

 

[azure]

Ok - I can understand you dont want to risk her goung low overnight. Gradually you'll learn how much glucose works and how much long-acting carbs your daughter needs afterwards. Don't panic about that - think of it as more info that helps you learn.

Starting the day high makes things harder because we normally have a tendency for BS to rise in the morning. So your struggles aren't unusual if she started high. It is harder.

I think your lunch sounds promising - a good mix of carbs, fat and protein, and good nutrition for your little girl. Pity she didn't eat it all, but that's toddlers for you! Maybe try a similar thing with scrambled eggs? Its hard to get a conclusion on lunch as she didn't finish it. I think if it was me, I'd have a few lunches - maybe 3 or 4 - and rotate them, trying to learn what they do to her sugar. You can then look at varying them somewhat, along with the insulin with your team's help, to get the best results. Id stick to similar levels of carbs each time just to make things easier.

You will work this out - it just takes time and persistence and some careful experimentation.

 

[shivles]

Ok - I can understand you dont want to risk her goung low overnight. Gradually you'll learn how much glucose works and how much long-acting carbs your daughter needs afterwards. Don't panic about that - think of it as more info that helps you learn.

Starting the day high makes things harder because we normally have a tendency for BS to rise in the morning. So your struggles aren't unusual if she started high. It is harder.

I think your lunch sounds promising - a good mix of carbs, fat and protein, and good nutrition for your little girl. Pity she didn't eat it all, but that's toddlers for you! Maybe try a similar thing with scrambled eggs? Its hard to get a conclusion on lunch as she didn't finish it. I think if it was me, I'd have a few lunches - maybe 3 or 4 - and rotate them, trying to learn what they do to her sugar. You can then look at varying them somewhat, along with the insulin with your team's help, to get the best results. Id stick to similar levels of carbs each time just to make things easier.

You will work this out - it just takes time and persistence and some careful experimentation.

She still went to 13.5 without eating it all

 

[Kristin251]

I am not on a pump so I have little knowledge how it works but I do know that though you will still need to prick her fingers you wouldn't need to prick her stomach. Might be worth considering. I know how you feel about it and I would too but there seems to be no consistency so it might be a better option?

I would try to find a different breakfast too or skip the toast and see if that helps. Nothing wrong with eggs, bacon or sausage and some yogurt. Carbs in the morning can be very hard to control. She could maybe have the toast later in the day?

 

[shivles]

I am not on a pump so I have little knowledge how it works but I do know that though you will still need to prick her fingers you wouldn't need to prick her stomach. Might be worth considering. I know how you feel about it and I would too but there seems to be no consistency so it might be a better option?

I would try to find a different breakfast too or skip the toast and see if that helps. Nothing wrong with eggs, bacon or sausage and some yogurt. Carbs in the morning can be very hard to control. She could maybe have the toast later in the day?

We've been told not to give injections in her stomach and only her thighs :/ but yeah as I say I won't consider a pump until I've explored the other options

 

[mcpound]

Graph from teatime yesterday to now, both meals so far been a nightmare! Breakfast I think her own body must have contributed insulin so not lots I can do there, lunch I'm stumped on again.

She had a slice of eggy bread made with seeded bread and fried in butter plus 100g plain Greek yogurt, 17g carbs which was 1.1 units, give her 1 unit. Not all the bread got eaten so I'm predicting that eventually she will come down too low

Just a thought. Food with a more fat tends to raise bgs over a slower time frame because the fat in the food slows down the absorbtion so if you give a full bolus with that type of food you may have a hypo followed by a steady rise in bg hours late. Just thinking about the eggy bread fried in butter? With injections I think you do this by splitting the bolus so you give some ar the beginning and some a while later. I've never done this so maybe others can offer advice on it. With a pump its called a square bolus. If my son has pizza I have to give his insulin bolus over 6 hours.

 

[shivles]

Just a thought. Food with a more fat tends to raise bgs over a slower time frame because the fat in the food slows down the absorbtion so if you give a full bolus with that type of food you may have a hypo followed by a steady rise in bg hours late. Just thinking about the eggy bread fried in butter? With injections I think you do this by splitting the bolus so you give some ar the beginning and some a while later. I've never done this so maybe others can offer advice on it. With a pump its called a square bolus. If my son has pizza I have to give his insulin bolus over 6 hours.

We have the opposite problem, she spikes like crazy soon after a meal and sometimes will drop to hypo later but not always

 

[azure]

We have the opposite problem, she spikes like crazy soon after a meal and sometimes will drop to hypo later but not always

We can only guess and make suggestions, but if I had that result, I'd look at my pre-meal BS; my mealtime insulin dose (timing and amount); and my basal. My hunch is one or more of those is causing the problem or certainly making it a lot worse.

You're reporting high sugars, and there are a lot of them (the odd one isn't abnormal). I know you said your daughter's basal had been reduced because of hypos, but perhaps - and this is just something to,explore with her team - you could increase the basal fractionally when you get the CGM so you can monitor her closely. I'd also ask about splitting the basal dose - to two injections a day. Many people on Levemir find that helps control a lot.

Prebolusing is hard with a child, but it can make a big difference to any spikes - an almost unbelievably difference. I'd also suggest asking to,try Humalog instead of Novorapid, as many people find it acts slightly faster.

Once you get the basal dose fairly sorted, you can then assess, with your daughter's team, whether her mealtime insulin to carbs ratios need to be changed.

If you approach this systematically, you can make improvements, I'm positive.

Note - when you say she went up to 13.5, how long after the meal was that?

 

[shivles]

We can only guess and make suggestions, but if I had that result, I'd look at my pre-meal BS; my mealtime insulin dose (timing and amount); and my basal. My hunch is one or more of those is causing the problem or certainly making it a lot worse.

You're reporting high sugars, and there are a lot of them (the odd one isn't abnormal). I know you said your daughter's basal had been reduced because of hypos, but perhaps - and this is just something to,explore with her team - you could increase the basal fractionally when you get the CGM so you can monitor her closely. I'd also ask about splitting the basal dose - to two injections a day. Many people on Levemir find that helps control a lot.

Prebolusing is hard with a child, but it can make a big difference to any spikes - an almost unbelievably difference. I'd also suggest asking to,try Humalog instead of Novorapid, as many people find it acts slightly faster.

Once you get the basal dose fairly sorted, you can then assess, with your daughter's team, whether her mealtime insulin to carbs ratios need to be changed.

If you approach this systematically, you can make improvements, I'm positive.

Note - when you say she went up to 13.5, how long after the meal was that?

Thanks I will bring those points up with the team.

It was 2hrs later