Dietitian advice unhelpful

[bizzilizzi]

Ok so this is about my daughter, who is type 1 and coeliac (coming up for one year since diagnosis) aged 9.

I tried to talk to the dietitian about her eating a lower-carb diet. This was after six months of blood sugars all over the place (I'm not new to carb-counting, I've been doing it for my husband for 10 years). She said my daughter's target should be 230g/day! But that it should be relatively safe to drop to 150g/day... (I don't think I've ever given her more than 150g/day, except on special occasions, maybe). I experimented with a lower carb diet, i.e. around 90-100g/day, thinking that was really quite moderate, not really low at all. And the dietitian analysed what she had eaten and said she was actually getting enough for her nutritional needs, without giving any more specifics about how low they would be happy for her to go. I kind of didn't want to push it so have left things a bit open, and we're now generally giving her 20-30g for breakfast, 30-40g for lunch and 40-50g for dinner, plus the 5-10g snacks that we're not supposed to need to bolus for but actually we do.

So I have a few questions (and I'm aware of the limitations of a forum like this for giving dietary advice about children):
1. It being quite easy for us to do breakfasts that are around 10g carb, would that be considered 'low carb'?
2. Is it worth doing only the one meal a day as low carb? I can't at the moment cope with organising low carb dinners, and her school lunches are compulsory cooked meals (that is a whole other nightmare).
3. At what point does a diet become 'low carb'?

I have no problems with going up against established medical whatnot, what I have a problem with is seeing my daughter struggle with the effects of rapidly changing blood glucose.

Btw, at her last clinic appointment I tentatively suggested that Levemir might be better for her, and lo and behold, within five days of switching her levels were significantly more stable. It's not good enough but it just serves as a reminder how crazy they were on Lantus. I'm not looking forward to telling them that we refused to follow the consultant's instruction to give it as a once-daily injection though...

Thanks for any feedback!

 

[MeiChanski]

Ok so this is about my daughter, who is type 1 and coeliac (coming up for one year since diagnosis) aged 9.

I tried to talk to the dietitian about her eating a lower-carb diet. This was after six months of blood sugars all over the place (I'm not new to carb-counting, I've been doing it for my husband for 10 years). She said my daughter's target should be 230g/day! But that it should be relatively safe to drop to 150g/day... (I don't think I've ever given her more than 150g/day, except on special occasions, maybe). I experimented with a lower carb diet, i.e. around 90-100g/day, thinking that was really quite moderate, not really low at all. And the dietitian analysed what she had eaten and said she was actually getting enough for her nutritional needs, without giving any more specifics about how low they would be happy for her to go. I kind of didn't want to push it so have left things a bit open, and we're now generally giving her 20-30g for breakfast, 30-40g for lunch and 40-50g for dinner, plus the 5-10g snacks that we're not supposed to need to bolus for but actually we do.

So I have a few questions (and I'm aware of the limitations of a forum like this for giving dietary advice about children):
1. It being quite easy for us to do breakfasts that are around 10g carb, would that be considered 'low carb'?
2. Is it worth doing only the one meal a day as low carb? I can't at the moment cope with organising low carb dinners, and her school lunches are compulsory cooked meals (that is a whole other nightmare).
3. At what point does a diet become 'low carb'?

I have no problems with going up against established medical whatnot, what I have a problem with is seeing my daughter struggle with the effects of rapidly changing blood glucose.

Btw, at her last clinic appointment I tentatively suggested that Levemir might be better for her, and lo and behold, within five days of switching her levels were significantly more stable. It's not good enough but it just serves as a reminder how crazy they were on Lantus. I'm not looking forward to telling them that we refused to follow the consultant's instruction to give it as a once-daily injection though...

Thanks for any feedback!

Hello, welcome! I think with children, we have to be a bit mindful. I know from a few on this forum have said anything under 120-130g carbs per day is considered low carb. Anything under 20g is keto but I think these guides are for adults. I assume children need more. I also think it is a bit of a grey area, while low carb works for adults with type 1, some have experienced they need more insulin for certain things like protein. You also have to bear in mind your daughter is growing up, growth spurs and soon hormonal changes and it'll play with her blood glucose as well, so she may or may not need more insulin in those circumstances. It is also a bit of a grey area with low carb for us, while studies have shown it works, ketones might be a bit dangerous for us. Like when the body starts using ketones for energy instead of carbs, I think someone said they still need as much insulin with normal glucose on keto with high ketones.
For me, and this is only about me, I do low carb for breakfast because of insulin resistance and dawn phenomenon in the mornings. It makes my mornings a bit easier to manage until lunch and as the day goes by, the insulin works better. For the rest of the day carb counting for carbs for lunch and dinner have been okay. You don't have to do it strictly, you have to see the patterns in her blood glucose to decide a possible well suited low carb meal for her.

 

[MeiChanski]

Could I ask has your daughter been considered for an insulin pump? With carb counting knowledge, it should help her with erratic blood glucose levels.

 

[bizzilizzi]

Hi, thanks for your reply. They have said she might consider looking at a pump but she is quite resistant. She hates having a new sensor put on and I’m not sure how a pump compares but I know it has to be changed far more frequently!

 

[MeiChanski]

Hi, thanks for your reply. They have said she might consider looking at a pump but she is quite resistant. She hates having a new sensor put on and I’m not sure how a pump compares but I know it has to be changed far more frequently!

Oh it breaks my heart when I see toddlers ripping their infusion sites and sensors out because they hate it. Yes with a pump, the sites and infusion sites have to be changed more regularly, do you think she can put up with it for 2-3 days?

 

[bizzilizzi]

Well I guess we’ll see, if/when she agrees to give it a go. Not that I buy into the idea of the pump as solving all her problems tho!