type 1 and snacks

[worried grandma]

I am seriously concerned about the amount of sweet snacks my grandchild is being allowed to consume. Blood glucose levels can fluctuate quite wildly and the parents seem more concerned about not making her feel "deprived" than about making her understand that sweet snacks/ treats and fruit drinks are not the norm any more. Insulin is given on a sliding scale as the parents think fit. Her main meals are generally quite healthy with low GI carbs - then it all goes 'wrong' when she is given Oreos as a desert instead of fruit. Breakfast is healthy oatmeal ... but with honey added as a 'little treat' and mini marshmallows are another 'little treat" to sweeten cereal. At a recent lunchtime outingshe was allowed to have a chocolatey sugary bar and this resulted in a blood glucose of 19.1 - this didn't come down until the following day!
Am I way off in my understanding that it's best to avoid regular use of sugarry additions? Her most recent HbA1C is 7.8 - up from 7.0 the time before.
Please can someone advise?

 

[totsy]

hi and a very warm welcome,
i do not have children with diabetes but have type 1 myself so can only give you my opinion, i personally wouldnt give a diabetic child that many treats, or an adult for that matter, obviously we need to be able to still have treats but if i do i inject for them, i myself would give a child a treat once a week,
i agree with you being worried as blood sugars of 19 isnt good at all and her hba1c is already rising, sadly there isnt a lot you can do , i hope a parent of a diabetic child comes along and is more helpful but i am in agreeance with you
aj

 

[AMBrennan]

Whilst I would agree that too many snacks and sugary drings aren't healthy for diabetics (or anyone, really), it should be possible for her to have these snacks without affecting her control with an adequate insulin regime.
Besides, the idea that diabetics mustn't ever touch sugar is not true, at least not any more - in reasonable quantities, of course. So porridge with honey (or dried fruit, or whatever) should be fine with an adequate insulin regime.
Also, I think that compliance will be a problem if the diet is to restrictive - if she can't have those treats as a part of her diet and insulin regime, she'll have eat them anyway.

But really the problem here is that insulin therapy is not adequate; and I concede that it may be easier to stick with fixed insulin doses and fixed meals (i.e. no snacks). Either way, banning treats would be an "easy fix" when, really, the parents should review the insulin regime with the help of their DSN.

 

[RussG]

@AMB
By 'easy fix' do you mean, literally, it would be something easy to do that would fix the situation or are you suggesting it might seem easy, but that the better thing to do is discuss the insulin regime? I take you to mean the latter, but it's not completely clear. Banning treats is not an easy thinig to do at all, in my book.

@worried grandma
There would seem to me to be multiple approaches needed. First, AMB is right that even if the parents continue to give large numbers of sugary treats, these should be accounted for in the insulin dose. In the short term this should be doable, although longer term it may well cause weight gain and concomitant issues. If some of the treats could be swapped for fruit, there would at least be some nutritional benefit and I would imagine a lower carb consumption.

However I tend to disagree with AMB on the main problem. The big issue for me, rather, is the parents' attitude - the excess treats / insufficient insulin is a symptom, not the root cause. I would suggest an open discussion sharing your concerns diplomatically is needed, perhaps discussing how you can help.

It may be that the child demands treats when she sees other children having them, but then again it may be that the parents are overcompensating for the burden of diabetes or any host of other reasons. We could speculate lots on this but only you and the parents (and child) will be able to get to the bottom of it. It is a very sensitive issue as I know nobody likes to feel their parenting is being criticised. AMB is spot on though, that treats can and should be a part of any regime for any child, but in moderation.

My non-diabetic son has a few dried blueberries or raisins (arranged in a smiley face) on his morning porridge and has never tasted sweetened porridge so hasn't ever developed the taste for it. He wouldn't see honey on his porridge necessarily as a treat.

I think you are right to feel concerned, but also that the situation does need careful handling. Good luck!

 

[worried grandma]

Many thanks to all who responded.
I feel so sad for my grandaughter. Over the last days I have asked the parents what I consider to be reasonable questions about what foods are given and what effect it may have on her glucose levels but have been met with answers such as "milk is 100% sugar" and "honey is low glycaemic". My feeling is that milk does have some dietary substance while honey is usually seem as an alternative to pure sugar. The issue is also compounded by the fact that her father sits in front of her eating sweet things while I feel that a family oriented approach of less sweet treats would encourage her to take a balanced approach to her diet. In a few years her food intake will be outwith their control and that is dangerous territory for a child who has never had to consider the consequences of her sweet food intake. Another issue is that I am medically trained and though I have not practised in five years I am all too well aware of the risks because diabetes affects the entire body. Juggling insulin is a good way to deal with occasional spikes for special occasions but my perspective is that this is a car wreck in the making and I dread a phone call telling me she is seriously ill.
My original concerns remain - sugar need not be banned but unless ways of dealing with diabetes have changed in the last decade or so then it would seem to make sense not to pretend that diabetes does not have a huge impact on life.
I really do appreciate all input as it confirms that while sweet snacks need not be banned they should be on the occasional rather than the habitual end of the scale.

 

[phoenix]

. Insulin is given on a sliding scale as the parents think fit.

If she really is using a sliding scale insulin regime ie adjusting the insulin as a function of the glucose levels , rather what she's about to eat, then she would need to eat meals with relatively fixed amounts of carbs for it to work. I started using insulin this way, it worked and as a bonus I learnt to weigh/calculate carbs accurately.

A more flexible regime, is to count the carbs in each meal and then calculate the insulin required according to a personal carb/insulin ratio. (this is something to discuss with the DSN) This regime allows any foods, including sweet things to be eaten as part of a meal and occasionally (taking care not to 'stack' insulin for between meal snacks.
Pragmatically from a glucose control point of view there would be very little difference in dosing for biscuits compared with say an orange.... if you do it right, and there's the difficulty, this is not always possible, especially, from what I read, with children)
Nevertheless , I personally agree with you about eating healthily . My own non diabetic grandchildren are restricted on the amount of biscuits/sweets/crisps etc that they are allowed... as was their mother! I also think it's easier to live a normal life with diabetes if that normal life is an active lifestyle, fuelledby a healthy diet.


There are some books that might help you/them
1) Type 1 Diabetes in Children, Adolescents and Young Adults: How to Become an Expert on Your Own Diabetes Ragnar Hanas
2) Carbs & Cals: A Visual Guide to Carbohydrate & Calorie Counting for People with Diabetes
3) Possibly Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin (Marlowe Diabetes Library) by Barry J. Goldstein and Gary Scheiner (from US so BG units need converting to mmol/l) a very good book that explains the basis of dose adjustment according to carb intake.

It might also be worth having a look at the glycemic index site. The data base is useful .
Milk has about 12g carb in 250ml, milks have a GI in the 30s,
honey has about 20g carb in a 25g serving. As honeys vary a lot the GI varies; but mainly in the 60s and 70s ( sugar ie sucrose by comparison is 60-65)

The GI news on the same site has useful tips for adopting a healthy low GI diet,
http://www.glycemicindex.com/

 

[annettekp]

Hi

I'm the parent of a 3 year old diabetic on a pump. I'd like to comment on one or two things in your original post.

Her HbA1c is good for a child and well within the right range and her parents should be congratulated for having it at this level. Therefore her blood sugar can't be all that bad unless she is having regular hypos and highs.

You mention giving oreos instead of fruit as a pudding. Fruit has a high carb content and is every bit as likely to send blood sugar high as an oreo despite being the healthier option. Green grapes tend to send my sons blood sugar through the roof! We were told to give the treats and high carb foods as part of a meal so your grandchild is getting these at the 'right' time. It means her insulin can be adjusted to suit her blood sugar and her carb intake.

You also mention that her blood sugar went up to 19 as a result of a treat and didn't come down till the following day. Its unlikely that the food was to blame for such a continued high as long as she was given the right amount of insulin to cover her carb intake. Children unfortunately go high for other reasons besides food - excitement, illness, stress, growing, too hot, too cold - its often very difficult to know what the reason is.

A DAFNE course would be very useful for your son/daughter. I have the first book that Phoenix mentions and it is really good.

Your son/daughter is very lucky to have a parent as interested in treating diabetes as you are and as supportive. My own mother-in-law still thinks its cruel to stick needles in him to check his blood sugar and feeds him excessive amounts of rich tea biscuits to make sure he doesn't go low!

Annette

 

[SophiaW]

I am seriously concerned about the amount of sweet snacks my grandchild is being allowed to consume. Blood glucose levels can fluctuate quite wildly and the parents seem more concerned about not making her feel "deprived" than about making her understand that sweet snacks/ treats and fruit drinks are not the norm any more. Insulin is given on a sliding scale as the parents think fit. Her main meals are generally quite healthy with low GI carbs - then it all goes 'wrong' when she is given Oreos as a desert instead of fruit. Breakfast is healthy oatmeal ... but with honey added as a 'little treat' and mini marshmallows are another 'little treat" to sweeten cereal. At a recent lunchtime outingshe was allowed to have a chocolatey sugary bar and this resulted in a blood glucose of 19.1 - this didn't come down until the following day!
Am I way off in my understanding that it's best to avoid regular use of sugarry additions? Her most recent HbA1C is 7.8 - up from 7.0 the time before.
Please can someone advise?

I'm a parent of a child with Type 1, my daughter has had D since she was 4 years old. If your grandaughter is on an insulin regime where she injects insulin to cover the amount of carbs she's eating then I see no reason why she shouldn't follow a healthy balanced diet like any other child without diabetes. Having an Oreo as a pudding following a healthy meal, or having some honey on her breakfast as a substitute to sugar is not unhealthy. A healthy diet can include a small sweet treat after a meal, there's nothing wrong with that provided her insulin is adjusted to cover the carbs being eaten and she's not eating large portions. I agree with the child's parents that diabetes shouldn't make a child feel deprived. If your grandaughter is snacking on oreos between meals, or having several at a time or skipping a healthy meal and only indulging in sweet treats then I would be concerned. The reading of 19.1 could have been a result of miscalculating the carbs from a meal, or as already pointed out it could be due to illness, excitement or any number of other reasons. Sometimes a wildly swinging BG can happen which is not easily explained, I believe it can be a result of growth hormones in a growing child. It's the nature of dealing with diabetes in children and often not the result of something sugary that they've eaten. Our daughter eats a healthy balanced meal followed by a sweet treat which can be anything from a small bowl of ice-cream, a yoghurt, biscuit, mini chocolate bar, fruit, apple crumble etc. We keep the treat portions small and always as a part of a meal rather than inbetween meals. Occasionally treats are eaten inbetween meals but we try to avoid that unless it's out of our control. A HbA1c of 7 or even 7.8 is good for a child, I think the child's parents are doing well and should be congratulated for it.

 

[worried grandma]

Once again - thanks to all who have responded.

On the subject of sliding scale insulin - this is NOT being done with the knowledge and approval of her DNS. Am I concerned? You bet!!

re HbA1c - At her last visit her parents were told that the preferred level for her should be somewhere around the 7.00 it had been previously and they should work towards bringing it down to that level again. Her next appointment is in two weeks and going by what I have seen I have little reason to believe that the situation will have changed. I am trying very hard to be supportive and encouraging while balancing a non interfering stance but it's so hard.
Also re the high of 19.1 - my fear is that she sneaked an extra sweet treat while us adults were busy - and yesterday I found her chewing on sweets right after her mid afternoon (healthy) snack. There is no point n getting cofrontational with her about this as that could make her blank advice and as I said before I feel that a family centred approach with everyone pulling at the same time would be the best way forward. Christmas is coming and my heart is in my mouth already!

I realise that there have been many changes with the management of diabetes (not my specialty) which is why I appreciate any and all input. Grandmas like me have no one to call when a situation like this arises.

 

[ams162]

i understand ur concerns and its hard being a grandparent looking on the situation as im sure u can prob not do anything right and feel powerless to the situation. i wish dylan had a hba1c as good as ur granddaughters his has never been that low in 5 years altho i can understand u worrying that its on the increase. i do limit things to a point with dylan but if i said no to most things i have found from experience he will sneak food up to his room and i know nothing about it so i guess its getting that happy medium with it all. like a previous poster has said the best time to have these sweet things are when u are eating a meal so as long as its accounted for it shouldnt be a huge problem, as for the parents working things out on their own well i do that to i adjust things when its needed and dont phone the nurses for advice every time something is tweaked but then i go to appointments and tell them what i have changed and they are generally happy with my decisions they say to me that i know dylan best so im the expert in his care they r there to help and guide us with the knowledge they have.

perhaps ur best bet is to sit down with ur son or daughter and air ur concerns just tell them u have been worrying about her levels increasing and see if u can offer some help in any way. hope u manage to sort something perhaps direct them in the direction of this site
anna marie

 

[SophiaW]

On the subject of sliding scale insulin - this is NOT being done with the knowledge and approval of her DNS. Am I concerned? You bet!!

Are you absolutely certain of this? For your grandaughter to have the basal/bolus insulins (which are the type used in sliding scale control) a doctor must be prescribing them so someone must know that she's on this regime. A pre-mixed insulin does not work on a sliding scale and is a different type of insulin.

When working on a basal/bolus insulin regime (sliding scale) generally there is no strict set dose of bolus insulin to take at specific times of day. You simply work out how many carbs are being taken and inject the required amount of insulin to cover as and when you eat. This can vary from day to day depending on what is being eaten and at what times. The basal insulin is injected at the same set time each day and generally stays the same from day to day but occasionally needs adjusting as the child grows. Guidance will have been given by the diabetic team but really it's up to the parents to work out from day to day how much bolus insulin is needed.

The pre-mixed insulins were more popular a number of years ago and these were injected at set amounts each day and at specific times, much stricter control was needed to ensure meals were eaten at the same time each day and the same number of carbs in each meal from day to day so it was more difficult to have a pudding one day and not one the next. The basal/bolus regime does away with these restricting requirements and gives the person with diabetes the opportunity for much more variety from day to day both in terms of timing of meals and size of meals.

You're right that the lower the HbA1c the better so the 7 is better than the 7.8. Your grandaughter's diet does need to be watched, it's so easy to slip because D is a full time responsibility that never sleeps or goes on holiday. I'm sure we've all had times when the HbA1c has moved in the wrong direction. The clinic appointments are a good way of reminding us that we're slipping and need to put full effort back into it (it does require full effort every single hour of every single day ). I would hope that the child's parents are trying to get things back on track for her. But remember this doesn't mean excluding all treats, just means making sure the insulin is adjusted correctly to cover them and they are eaten as part of a main meal and they're not in large quantities. Because insulin can be injected to cover sweet foods doesn't mean she should eat too many, but at the same time doesn't mean they're totally off the menu either. The same advice for a healthy diet for any child, all children should not eat large quantities of sweet foods but in the right quantity they are okay to eat.

Christmas is a difficult time of year especially for children with D and their parents. There are so many Christmas parties at schools and clubs, everywhere you go or people you visit seem to have cakes and mince pies and all sorts of treats on offer and it is so difficult to balance your child staying healthy but at the same time not feeling excluded because of D and then you run the risk of the child resenting their D, something we want to avoid otherwise it can become a losing battle. It's all about balancing it all out and not an easy task. Something I often suggest to my daughter when she's been offered a treat and it's not a good time is that she takes it but keeps it for later after her evening meal as a pudding. That way she doesn't feel like she's being left out or excluded from treats but she gets to eat it at a time that would be healthier for her BG control i.e. mixed in with a meal to dilute the sugar spike. Halloween is another time of year that can be tricky, our neighbourhood is quite "into" halloween and all the kids (and some of the parents) make a big effort. We still take part but the treats collected are put into a jar and are used as hypo treatments or my daughter gets to have one mini-treat each evening as a pudding after her main meal. So these are some ways that perhaps your grandaughter can work with her treats, keep them for later and if there's lots of them like at Christmas then have her put them in a jar and just one a day as a pudding. Christmas and birthday parties my daughter will always have a sweet treat but on her plate she will also put a good mix of healthier foods like sandwiches and fruit.

 

[phoenix]

Just in case there's any confusion in terms (and hope not to confuse more) The parents have far better advice than I on the pratical day to day use of insulin in children

In my earlier post I picked up on your sliding scale phase.
My understanding of this phrase actually differed from Sophies. I ttook it to mean that bolus(fast acting) insulin is dosed in response to the glucose reading , and not the amount of carbs to be eaten. It's a method often used in hospitals using a drip. (and often keeps glucose unnecessarily high)
There are some people who are start insulin using an adaptation of this method. It uses rapid insulins for meals and a basal for background. You test, and inject ,the amount dosed may be altered by a unit or 2 if the level is above or below target. It is reactive and it can only be effective with a fairly rigid diet and exercise plan. (and children don't live rigid lives)


The more recent , more flexible method used by many of us today, is to use a basal insulin for the background and inject a bolus that takes into account things like the present glucose level , prior or subsequent planned exercise and crucially the number of carbs to be eaten.

A third method is a mixed insulin regime where both basal and bolus are alreasy combined (premix insilun) within one injection,( given 2 or 3 times a day) This is as Sophie describes, less flexible as if the dose is increased to cover more carbs, the basal (background) element is also increased

 

[SophiaW]

Thanks for clarifying that Phoenix, didn't know about the sliding scale you mention so assumed the term sliding scale referred to the basal/bolus as the bolus amount varies dependent on the factors you mention.

 

[Beav]

7.8 is a good HBA1c. That is the same reading as mine last time I went to the hospital. They said it can be worked on but its not dangerous but after all im a 20 year old male so hourmones etc make it hard for me to control it at times. I know at the hospital I was 15 when I was diagnosed and they said a lot of young children whos parents have to keep a tight control on what they eat just don't pay attention to it. For example they will eat sweets etc like other children do and the parents get so relaxed about it. Like I say though 7.8 isn't dangerous but I wouldn't want a reading of 19 for long. :crazy:

 

[dot]

My son is type 1 and luckily, as we already had good eating habits we haven't had to make too many changes in order to accomodate his needs.

I would take up your point about the father sitting in front of the child eating sweet things - this really isn't setting a very good example, and is not really very fair is she isn't allowed any. We don't really do snacks between meals, and sweets or chocolate tend to be something we share as a family at the of a meal - a "finisher offer" as we call them. That way, it can be allowed for in the insulin injection. Just as important, all the family are behaving in the same way, all eating responsibly and not making my son feel left out.

There was something else i wanted to say, but I have clean forgotten what it was

 

[worried grandma]

OMG what to do??

Biscuits and fruit juice are the snack of choice right now!

Sliding scale insulins are still being given and highs and lows abound.

I despair.

 

[noblehead]

Hi WG,

I can't offer anymore advice than whats already been said, just a shame you can't convince the parents that sweets/biscuits should be a occasional treat rather than something to consume once or twice a day.

Reading back in the thread your granddaughter was due a diabetes check round about now, how did she get on?

 

[Jen&Khaleb]

I think if the child is happy, not having many hypos, not over weight or frequently ill you should leave the parents to decide what to feed their child. This child has a good hba1c and it is fairly normal to see some fluctuations in blood sugar with young children. There is nothing worse for someone with diabetes than the 'Food Police'.