Low Carb diet for children

[DCUKMod]

What I’m trying to say is that they can take advantage of the honeymoon and live insulin-free if they go low carb. That way they would have a much more comfortable honeymoon, that’s the only reason why I think they could try low carb for now.

But obviously moving forward as honeymoon ends insulin is a necessity regardless of whether you eat 30g of carbs a day or 300

I think you missed a critical word in your response. That word being potentially (as in potentially insulin-free period).

Whilst I have no skin in the game in this, my concern for stopping insulin for a T1 would be having to restart it again, when the child is already verbalising she hates her injections. Disrupting that routine, only to be forced back to it (which is pretty much, if not absolutely inevitable) could suggest to the child that she has failed (in her desire to stop injecting forever).

I think it's a really, really tricky situation.

 

[DCUKMod]

Not just that - post honeymoon with more carbs = more insulin = more chances of getting the dosage wrong = more hypo, hyper.

during honeymoon = less carbs + little bit of insulin = less strain on the remaining islets = longer life for the islets.

Basically, will 90g carbs (or slightly less than that) result in any long term growth inhibition? There is a lot of research that leads me to believe this is not a problem for adults - just the lack of research on what this will do to a 6 year old child is what concerns me.

Eshobabu - What is the family's usual diet like? Is it low carb, or if it is now, how long have you all been eating that way?

If your family's eating style is changing, do you have other children who may resent it? That could be unhelpful to everyone, and the family dynamic.

Nobody here can tell you whether your child with thrive on your described diet, or any other for that matter.

Where are you based? I'm wondering if you would be able to source a qualified dietitian familiar with low carb eating for suitable, professional advice.

 

[KK123]

All of you have made excellent points - I am very glad you pointed me those two artciles the part that scares me is this.
: "There is currently a lack of clinical studies into low-carbohydrate diets for children with diabetes. Low-carb and ketogenic diets appear to show no significant issues in terms of safety for children in general though.". From the link to the published research - "Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD". What I am unable to find, is long-term effects of VLCD on kids. Does it at all harm them? Why is my medical team saying she needs 150-180 g of carbs a day and things like her brain needs carbs to function?

So back to what a lot of you are saying - restricting her further. You are right - I hate doing it. And I dont intend to completely go <30g. I am more concerned about what I am doing now - around 90g and not 150g that the doctors say. We dont have any sugary things in the house at all, so all her carbs are from brown rice, whole wheat bread, veggies and milk. Since there is no cake, chocolate, and juice at all in the house (except strategically placed hypo supplies) - the thing about children, out of sight out of mind. Once a week or so we will go out and she will binge - like yesterday we had pancakes and she shot up to 360 :-( so we had to give insulin. If she were to go to a birthday party or something, it would be similar. Exceptions like that are fine - we are not going to put her in a bubble. I am more talking about normal day to day routine outside of events like these. And it would be the entire family not just her - I myself eat only once a day and exactly what she is eating - so its not like its just her being left out. Since her diagnosis, we have all eaten healthier and exercised more!

The part that I am deeply confused about is where an entire community of people is attesting that they raised their kids with excellent glucose control on LC diets (I saw TypeOnegrit ) just fine and medical professionals telling me her brian needs 180 carbs a day to function - something just does not add up there.

You sound very balanced. Don't forget also that when these articles refer to children they seem to be on about teenagers not 6 year olds. x

 

[hyponilla]

Did you come across LetMeBe83 on your travels?
https://letmebe83.org/
They were basically faced with the same questions as you are having and it's worked out well for them. It might offer some comfort.

The problem with nutrition is that nobody really knows much and it's a lot of guesswork. Also the debate of high and low carb is polarized and there's a lot of extreme points of view that tend to take up space. I think many diabetics eat moderate carb and do quite well. I used to eat ketogenic but now I have about 60 grams of carbs a day which is fine. You get better at dosing insulin and things do get easier.

How about reducing carbs and see how you go, without committing to one or the other? There's a lot of fun low carb foods to make with kids like cauliflower crust pizza and zoodles.

 

[KK123]

What I’m trying to say is that they can take advantage of the honeymoon and live insulin-free if they go low carb. That way they would have a much more comfortable honeymoon, that’s the only reason why I think they could try low carb for now.

But obviously moving forward as honeymoon ends insulin is a necessity regardless of whether you eat 30g of carbs a day or 300

What's the advantage of living 'insulin free' in these circumstances, ie a 6 yr old? Insulin is a hormone, a missing one in type 1s so needs replacing. In my view it is NOT a medication best avoided. I was told that small amounts of insulin during the honeymoon period may be beneficial in that it's assists your beta cells and gives them a rest. I'm assuming that this little girl became extremely ill prior to diagnosis (whilst not on insulin) so personally I would not be happy to battle on by diet only as there is a risk she could become ill again even on a low carb diet. There's the basal response to consider, not just what you eat.

 

[tim2000s]

What I’m trying to say is that they can take advantage of the honeymoon and live insulin-free if they go low carb. That way they would have a much more comfortable honeymoon, that’s the only reason why I think they could try low carb for now.

But obviously moving forward as honeymoon ends insulin is a necessity regardless of whether you eat 30g of carbs a day or 300

I think you need to be wary of this statement for children in the honeymoon period.

Child onset Type 1 (diagnosis under-6) is generally regarded as being significantly more aggressive than adult onset, so there is a high likelihood that a child going low carb will still require background insulin in order to maintain glucose levels and regulate excess FFAs in circulation.

 

[MarkMunday]

... What I am unable to find, is long-term effects of VLCD on kids. Does it at all harm them? Why is my medical team saying she needs 150-180 g of carbs a day and things like her brain needs carbs to function?...

If the metabolism has been conditioned to rely on glucose for energy, yes, 150-180 grams of carb a day may be required to feel good and perform well. But if the metabolism is retrained to use mostly fat for energy, this is no longer the case. Living without carbohydrate becomes the norm. It doesn't harm children. Consider communities like the Inuit that survived generation after generation in austere conditions on food that included no carbohydrate. Things only fell apart for these people when carbohydrate was introduced into their food supply.

 

[eshobabu]

Did you come across LetMeBe83 on your travels?
https://letmebe83.org/
They were basically faced with the same questions as you are having and it's worked out well for them. It might offer some comfort.

The problem with nutrition is that nobody really knows much and it's a lot of guesswork. Also the debate of high and low carb is polarized and there's a lot of extreme points of view that tend to take up space. I think many diabetics eat moderate carb and do quite well. I used to eat ketogenic but now I have about 60 grams of carbs a day which is fine. You get better at dosing insulin and things do get easier.

How about reducing carbs and see how you go, without committing to one or the other? There's a lot of fun low carb foods to make with kids like cauliflower crust pizza and zoodles.

I had not, thank you for sharing - I did read a lot about type1grid and Dr Bernstien, so this is right up that alley and pretty much similar to what I read elsewhere.

It is still fascinating to me that we are not able to conclusively, decisively, and authoritatively answer this simple question:

"How many carbs a day does a 6-year-old child MUST have for normal growth and development"

 

[TypeZero.]

I think you missed a critical word in your response. That word being potentially (as in potentially insulin-free period).

Whilst I have no skin in the game in this, my concern for stopping insulin for a T1 would be having to restart it again, when the child is already verbalising she hates her injections. Disrupting that routine, only to be forced back to it (which is pretty much, if not absolutely inevitable) could suggest to the child that she has failed (in her desire to stop injecting forever).

I think it's a really, really tricky situation.

I just thought that the child’s pancreas seems to be coping fine at the moment albeit with a few peaks here and there. Not many people get that good of a honeymoon, if it was me I’d personally go low carb and just let my pancreas deal with it and not have to worry about diabetes. You know, it’s basically a full time job and there’s never a moment where you don’t worry about your blood sugar. It would certainly allow the parents and the child to get in terms with the disease. With the injections, there’s no way around it, reality is the child will sooner or later get used to it and as the honeymoon fades away there will be more frequent injections and that’s what makes us T1Ds hard.

Although insulin helps relieve stress on the pancreas, the pancreas produces however much insulin it wants regardless. I mean I still produce some insulin but if I increased my basal then my pancreas doesn’t “rest” or anything and doesn’t reduce it’s own insulin production so I’d end up going hypo and if this particular patient doesn’t need insulin then I don’t see a problem in that but I do realise that sooner or later the child would need some exogenous insulin so I would definitely check BG at least 4 times a day

 

[TypeZero.]

What's the advantage of living 'insulin free' in these circumstances, ie a 6 yr old? Insulin is a hormone, a missing one in type 1s so needs replacing. In my view it is NOT a medication best avoided. I was told that small amounts of insulin during the honeymoon period may be beneficial in that it's assists your beta cells and gives them a rest. I'm assuming that this little girl became extremely ill prior to diagnosis (whilst not on insulin) so personally I would not be happy to battle on by diet only as there is a risk she could become ill again even on a low carb diet. There's the basal response to consider, not just what you eat.

Well at the moment the child is off basal and bolus with only a few peaks here and there. Low carb could help pancreas as insulin needs would be lower.

Not many people have as good honeymoon as this patient, the child has gone nearly into full remission which is amazing obviously with a few peaks. I know that if I had the luxury of a honeymoon that good I’d deffo go low carb just to live a bit longer without constant bolus calculations, weighing food, guessing carb contents and pricking your abdomen 9 times a day for injections

 

[TypeZero.]

I think you need to be wary of this statement for children in the honeymoon period.

Child onset Type 1 (diagnosis under-6) is generally regarded as being significantly more aggressive than adult onset, so there is a high likelihood that a child going low carb will still require background insulin in order to maintain glucose levels and regulate excess FFAs in circulation.

Well I’m only going off what the original poster has said and it seems the pancreas is coping fairly well. Going low carb would just help the pancreas deal with glucose more easily but obviously during this time they would still be checking the blood sugar to make sure the child doesn’t go high or go into DKA.

 

[eshobabu]

Thank you all for your replies. Yes she is pretty much off insulin for the past week or so. We didnt do it by choice, she was going hypo every night when she was on insulin.

When she eats around 30g of good carbs per meal she needs no insulin. She spikes to around 200 and then back down to 100 within 4 hours all by herself no basal no bolus in time for the next meal. There have been no nightly hypos since she went off insulin either.

If she eats more than that or eats bad carbs like juice or pancakes or similar she spikes higher stays there longer. It only happened once. We gave her insulin and she came back down albeit she was already on her way down.

So she eats 90g of good carbs a day and needs no insulin. This is less than what we were advised around 150 which led to me posing this thread. Thinking back, if i remove all the junk she used to eat prior to diagnosis she was still eating similar to what she eats now. All we have essentially done is replace white rice with brown and bread with whole wheat and taken out juices and replaced chocolate milk with goats milk.

We also have a cgm so we watch her glucose like a hawk.


Hope this helps clarify

 

[ert]

Thank you all for your replies. Yes she is pretty much off insulin for the past week or so. We didnt do it by choice, she was going hypo every night when she was on insulin.
Hope this helps clarify

I recommend you ask your diabetes team about a Novo Pen Echo, which gives half units of insulin. I'm not sure how much basal insulin your daughter was started on, but I started on 1 unit in the morning and 1/2 a unit at night. Sometimes I miss the night injection if I've done a lot of exercise. The consultant at the hospital said to start with 7 units morning and night, which is a general starting point, but my specialist disagreed as my tests supported I was insulin sensitive. It's something to discuss with your diabetes team.

 

[eshobabu]

I recommend you ask your diabetes team about a Novo Pen Echo, which gives half units of insulin. I'm not sure how much basal insulin your daughter was started on, but I started on 1 unit in the morning and 1/2 a unit at night. Sometimes I miss the night injection if I've done a lot of exercise. The consultant at the hospital said to start with 7 units morning and night, which is a general starting point, but my specialist disagreed as my tests supported I was insulin sensitive. It's something to discuss with your diabetes team.

Do you bolus at meals? Are you in a honeymoon phase? My daughter started with 6 units of basal. Kept going hypo everynight until we eliminated basal altogether. Humalog is on an as needed basis.

 

[nickm]

I know a lot of T1s maintain excellent sugar control by simply eating less carbs <30g a day.

Hi eshobabu. Blood sugar control is not the only consideration for some T1s. I suggest you look at how poorly those on <30g/d perform in sport compared to others, especially in the long term. Look at the carb intake of those T1s of retirement age who are right up there with the best their age in athletics or other demanding sports. While you personally may not value success in competitive sport, one of the dilemmas of parenthood is how much we limit our kids to persuade them to conform to our own agendas.

 

[Goonergal]

Hi eshobabu. Blood sugar control is not the only consideration for some T1s. I suggest you look at how poorly those on <30g/d perform in sport compared to others, especially in the long term. Look at the carb intake of those T1s of retirement age who are right up there with the best their age in athletics or other demanding sports. While you personally may not value success in competitive sport, one of the dilemmas of parenthood is how much we limit our kids to persuade them to conform to our own agendas.

Could you provide some links to the evidence for those claims, please?

 

[nickm]

Could you provide some links to the evidence for those claims, please?

Hi Goonegal. I would be more than happy to present that information in an appropriate forum, but both doctors and low carbers are never going to let that happen in their worlds, are they. Common sense says do what successful people do and there are no more long term successes than those capable of competing at national masters level, especially if they were not so athletic when younger. The question is why you have not already looked at data on that issue. Another question might be why was I refused membership of type1grit. Was it because my documented athletic performances have improved from non-athlete to national standard using methods they do not approve of? My results have been on the public record for years. Do you know of any T1 my age who matches them in all round terms? Have you asked the Bernstein people to provide evidence? I have many times and they are consistently unable to name even a single follower who is even close to equaling even one of my M55 PBs. Perhaps you should join one of the many FB groups for T1 athletes, although you would have to search many years of posts from a dozen FB groups and online forums to collate just some of the data I have.

 

[Goonergal]

Hi Goonegal. I would be more than happy to present that information in an appropriate forum, but both doctors and low carbers are never going to let that happen in their worlds, are they. Common sense says do what successful people do and there are no more long term successes than those capable of competing at national masters level, especially if they were not so athletic when younger. The question is why you have not already looked at data on that issue. Another question might be why was I refused membership of type1grit. Was it because my documented athletic performances have improved from non-athlete to national standard using methods they do not approve of? My results have been on the public record for years. Do you know of any T1 my age who matches them in all round terms? Have you asked the Bernstein people to provide evidence? I have many times and they are consistently unable to name even a single follower who is even close to equaling even one of my M55 PBs. Perhaps you should join one of the many FB groups for T1 athletes, although you would have to search many years of posts from a dozen FB groups and online forums to collate just some of the data I have.

I have no idea who you are (anonymous usernames and all that), but forum rules require posting of links when making claims along the lines of those in your previous posts.

We are now in danger of derailing this thread, so please post links, or should you wish to continue the discussion, start a new thread. Thanks.

 

[nickm]

Hi Eshobabu. You can join the T1 athlete FB groups and internet forums and find out who I am, what results I and others get and what results low carbers in my age group, M60, get. I hope that will help with the choices you face.

 

[DCUKMod]

Hi Eshobabu. You can join the T1 athlete FB groups and internet forums and find out who I am, what results I and others get and what results low carbers in my age group, M60, get. I hope that will help with the choices you face.

Nick - @eshobabu is enquiring about diet, so I'm not quite clear how exercise for adults ten times the age of her daughter fits with that, and focusing on it is in danger of derailing this thread.