how low is low carb?

Matt1212 said:

Out of interest Nigel which is the issue the insulin or the food ?

You stated my daughters insulin routine is amiss , but then stated an adult should not eat the high GI foods.

this seems to be contradictory.

Weighing up the postivies/negativies of every food is a decision parents of type 1 children do many times a day - if controlling carb leads to better BG control then it a discussion worth having

Anyone know any studies on minimum carb requirements for children ?

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Hi Matt!

I never mentioned that ''an adult should not eat the high GI foods'' :?.... what I did I did say was 'the alternative in a adult would be then be to go for lower gi carbs' it was you that said your child's breakfast was ''high GI carb foods'' (please reread your posts), as for insulin issues well they are always best discussed between you the parent and the child's HCP.

Unsure why you keep coming back and trying to pick fault at the advice I have given, however I'll suggest a couple of routes for you as you have some doubting issues regarding diet, either:

Speak with your child's HCP as anyone else would suggest

Post in the youth section of the forum as there is some fantastic knowledgeable parents of type 1 children who may offer some suggestions or advice

Or alternatively if you have any issues regarding what I have wrote in this thread then please do take this up with a forum moderator or someone at admin.

Best wishes and take care!

Nigel

Thanks Nigel - now feeling suitably admonished I exit the building
however no nearer solving the conundrum of rice krispies and BG 15 vs a fry and BG 6.
Oh well .....

hi Matt, Kids can be so erratic at times. May be worth doing some fasting tests for a few hours when she wakes up. Novorapid normally peaks around 2 hours and has finished working after 4, so to come down so much after 3 hours would suggest basal to high and bolus too little. Having said that it is very difficult to get background insulin accurate all day and for us we used to make sure it was at it's best coverage at night and then work with snacks and higher boluses during the day to counteract the highs and lows.

we did a fasting test (4g carb and .2unit insulin) for breakfast and BG was flat all day so I think the basals are correct , I am coming to the conclusion that even with the best effort possible higher GI foods need to be a rare treat - convincing a child is tricky though

Matt

Things to look for in what could be wrong with insulin and why it could be blamed..

Basal insulin

Now it could be that your daughters basal insulin is incorrect, either in dose or not able to provide the correct level of coverage..

It could be that at breakfast and the hour or so after, it's isn't enough to cover what's coming of the liver probably..

The return to normal levels 3 hours or so later, could be that in reality there is too much insulin in the system, so it starts combing with the quick acting insulin dropping the bg's lower.

Quick Acting Insulin

Could be that the raito's are out..

The spike etc could be based on incorrect insulin, not hitting quick enough, and taking too long to burn out.. This would cause a spike then still be impacting on the blood glucose later on..

Now any one or more of the above problems could be invovled hence the need to seek/work with the diabetic team/consultant to see if, what and how could be resovled!

Children live a very much more dymaci lifestyles than adults do, their daily activity levels change a lot faster and are a lot more unpredictables than an adult, their emotions also will change in a flash all impacting on control, along side the ever changing and shoveling around of hormone levels, as their bodies grow and mature... The more extreme retrictions there are in the carbohydrate side of the diet, does make control even harder..

But the very biggy and most important one, it the psychological impact6 on the child...

Children have enough of a hard time coping/dealing just with being diabetic amongst their peers, and add into this equation a exteme low carb restrictions further impacts psychological on the child as they can't join in with their mates outings to such places as MccyD's Pizza hut, the invites to paties stop, can't even have an humble ice-cream with their mates...

Children generally go through a phase of rebelling against the disease at the best of times, due to the restrictions they face with standard diabetic diet, increase the restrictions the more likely, the quicker and with more impact they are likely to rebel..

Yes a parent of a diabetic child will go through many dilema's with there child trying to maintain a level of control that prevents complications further down the line is extremely difficult.

But to do it in such a manner that prevents the child from normal interaction or set the further apart from their peers than needs be is in my opinion abbrusive...

Control wise, for any T1 to follow an extreme low carb diet sucessfully actaully requires 3 types of insulin, the background, and indemediate one to inject 30 mintues at least before an high fat/protien meal, to match the profile of protien etc. Then a fast acting insulin for corrections..

Whatever any of us say can only be suggestions.
I think most of us adults with T1 are very wary of giving suggestions about children.
Rice krispies are actually very high GI (82) so one would expect the rise to occur quickly and then fall.. too much, have you checked at 1 hour? like Leggott , I suspect the basal is a bit out but also appreciate that it's difficult to check, ie fasting, with a child.
Why not try a lower Gi breakfast? An egg with some granary bread and a small piece of fruit, proper porridge (not the instant packets) with some berries. Plain yoghurt (with sweetner?) and some berries with a piece of lower GI toast, bacon , tomatoes and again a slice of low G1 bread. Nutella might be useful as a spread as it is fairly low gi and you don't need much. Perhaps , try to find a lower gi cereal she likes (list here but unfortunately most of the popular ones are very high ) http://www.gilisting.com/2004/05/glycem ... reals.html
I agree with Jopurs comments about rebellion against an overstrict diet, I've read many accounts of young people who have done this and think this is one of the biggest problems for parents.You're somewhat between the devil and the deep blue sea

. And just to show we are all different for me bacon, an egg and sausage would need about 4u of insulin. My normal breakfast of 40g of oats made to 255g of porridge with semiskimmed milk with a handful of berries and a few slivered almonds normally requires 3.4u.! (as long as I don't sit down all morning !)

All different foods have there place in a varied diet
So McDonalds etc should be allowed as a treat

If i know I am using insulin as effectivley as possible is there an issue with my daughter consuming 100g carb per day and achieving good BG control vs consuming 160g and having erratic BG control

If a dieticain reviewed the food consumed at both 100g or 160g carb a day I am sure they would approve of the content

Is 100g carb a day for a child low-carbing ?? or just eating a diet suitable for someone who has zero insulin production

Hi Matt

Do you have a dietitian - for kids it is not just a question of carbs it is calories as well.

I am not sure how old you child is but I really think you should see the Diabetes Dietitian.

we have and any food diaries have been deemed fine
What good are calories anyway if your BG is 15 ? the food you have consumed is surely causing you damage and not giving you energy ?

Matt the choice of food is important of course but it may also be that the insulin needs some adjustment - kids requirements change very quickly as they have periods of rapid growth. If you do not have enough calories then kids can fail to thrive, so you have to balance both. I really think you should go to see your team for advice - low carbing is more difficult for kids.

I will and do consultant the diabetes care team
Question remains though is a child between age of 4-8 weighting say 18-25kg and eating a balanced diet with 100g carb actually LOW-CARBING ?

Matt - with respect that was not your original question. You asked whether you should give your child a carbier breakfast and suffer a BG high after three hours or a lower carb breakfast and have steadier levels. This is what is called a false dichotomy. Those are not the only two options as several have pointed out.

This is a judgement for you and anyone else involved in caring for your child. As everyone here has made plain, they will not advise you on what your child should or should not eat and you should seek professional advice, which you say you will do.

You are now asking whether your child is low-carbing or not. Frankly the label as to whether or not your child is low carbing is irrelevant. You are clearly concerned about your child's diet and wellbeing and that is a very positive position. However, you have been given the views of a number of people with long term experience of diabetes about the factors that may be influence your child's control. You are free to listen to or ignore these, but I don't think this thread is developing in a positive manner.

I hope you and your child are able to find some good breakfast options that work for both of you.

Hi Matt

Not sure if your child is a boy or girl but the average for a 4-6 yr old is around 1500 - 1700 calories/day ( F/M). That is an average of course.

So yes, 100g is low carbing even if you base it on 40% calories from carbs which equals 150gCHO. Children have very different requirements to adults but do not need excessive amounts of protein - hence the reason I suggest you see the dietitian and talk it over with them. Also the bacon etc also provides a lot of salt!

They would be able to analyse the food diaries as well.

Hope that helps - I am guessing that you have a daughter!
Ally

Anyone know any studies on minimum carb requirements for children ?

The actual requirement for carbohydrates for anyone, child or adult, is zero. On the other hand, the RDI for adults is 130 gm/day, an amount designed to prevent physiological ketosis (a natural harmless condition). For children, the RDI varies depending on their age. In either case, it is an arbitrary designation since, as I said, the actual requirement is zero.

The questions you are asking suggest to me you are on the right track in trying to figure out what will best control your child's BS. If you have not already done so, I recommend you visit the website of Dr. Richard K. Bernstein who has great expertise in this very issue: http://diabetes-solution.net/

Jay - I am not aware of any and if you get the right diabetes education and insulin ratio to carbs then children can get good control.

It is hard enough for parents with diabetic kids without making their diet more abnormal.

As you know children have very different requirements and do not tolerate fat as well as adults. So I think a moderate approach will be the best option - worked when I was in Paediatric diabetic clinics.
Interesting theory though - I wonder why breast milk contains CHO?

I am not aware that Bernstein is a paediatric diabetologist but correct me if I am wrong! Do you work with Type 1 kids?

I will mail you about those papers - been a little busy in work!

sorry Jay misread that - been a long week , read it as carbs and diabetic kids?

There are references to CHO in the UK govt Dietary reference Values . Do not have a copy to hand!

So what happens if children have too much fat, considering your statement that they can't tolerate it?

wiflib

I am not sure where the idea that kids don't tolerate a high fat diet comes from. My own (non-diabetic) 23 month old daughter is thriving on a low-carb/high-fat diet. She has access to carbs (except sugary things) but chooses not to eat them. She is also the product of a LCHF gestation, BTW.

Yes, I have had experience with Type 1 kids. Earlier in my career I ran the diabetic kids camp over a four year period. Granted, that was before I clued into carb restriction, but I don't see why we should feed carbs to kids who are intolerant of them, just as it makes no sense with adults.

Well small kids often get a type of toddler diarrhoea and that has been linked to a high fat intake - seems to increase transit time in the gut. That can also continue in older children - has been linked to a type of IBS tummy ache.

Plus there is also the actual amount of fat that you can get kids to take - this is a question I have often asked low carbers but in practice they do not have huge amounts because where are you going to put other than drowning food in butter or oil . I find that many kids do not like that.

Kids with diabetes have enough to deal with without having to be very different. I am not advocating a high carb diet with a lot of sugar but dose adjustment gives them some normality.

Some of the studies on the use of ketogenic diets have shown that some kids have had increases in blood lipids but the diets do need the use of specialist fat supplements that in the UK are available on prescription.

My kids are equally as healthy as yours Jay and they have eaten carbs( not sugar) - in fact my youngest has never been to the doctor ( except for jabs).

Jay out of interest how much fat do you actually consume a day. I can calculate it for you - have an analysis package on my laptop so it is quick.
Ally

I'm not an expert on infant nutrition but I wonder about the macronutrient content of mother's milk? Surely it is rich in fats? I had heard that despite the carbohydrate content, exclusively breast-fed infants spend much of the time in ketosis.