how low is low carb?

Our ten year old son (non-diabetic) eats some carbs but no sugar. He is quite sturdy, never gets sick, is emotionally stable, does well at school, is a dynamite downhill skier, plays sports, etc etc. I am of the opinion that kids have a higher tolerance for carbs and, as long as he is not eating sugary things and keeps the highly refined stuff to a minimum, he will be ok. For diabetic kids, however, the situation is different. They have an intolerance to carbs. Ramping up the insulin to allow them to indulge in foods they cannot tolerate doesn't make a lot of sense to me, especially when they have zero requirement for those foods. Insulin is a strong medicine and the higher the dose, the greater the side effects and risk of hypos. Strategies to minimize insulin requirements make sense to me in both kids and adults.

My own fat intake is high. I eat a high fat breakfast of bacon and cheese frittata made with cream with tomato and mayo (est. 1-1/2 egg, 1 oz arlberg, 1 T cream, 2 rashers, 3 T mayo); a typical lunch will be a 14 oz container of beanless chili (pork, beef, italian sausage, tomato, onion, spices, chicken broth) and a typical dinner will be a 12 oz rib steak, salad with 1 T olive oil, 1 T mayo.

Your fat calculator may blow a fuse when you enter those data!

Lactation is not my area of expertise but, as near as I can tell, breast milk is about 51% fat, 42% CHO and 7% protein. The CHO is lactose which is a glucose molecule connected to a galactose molecule. This means that the infant is getting about 21% of its energy from glucose and 21% from galactose which gets metabolized mostly in the liver.

Jay

Sorry I disagree with your theory that T1 diabetics are intollerant to carbohydrates if you theory was correct then we would be intollerant to protein and even the glucose that comes from our own liver... As it's only our lack of ability of our pancreas to produce insulin that stop the body from dealing with carbohydrates and protien, it also prevents the body from using the glucose of our liver... Hence why it isn't intollerance without insulin we die even we ate nothing!

So it's totally wrong and very misleading to suggest it's an intollerance thing...

For the T1 diabetic the whole problem we face is all based around the abilites of an manufacured insulin.. We have to mentally calculate all the many different factors to provide a dose of insulin for the body to use effectively... Now get any one of these many factors wrong then the diabetic faces increased blood glucose levels due to insufficent insulin, or an hypo due to too much insulin being in the body and the body unable to turn it off..


But when it comes to children I think that parents should be working with their diabetic teams concerning many parts of their childs treatment. not taking advice from the internet where they can't validate the information being provided..

The internet information should provide support and for understanding the disease a lot better, information they gain should be discussed with their diabetic teams, who can then expand give futher advise etc..

Food intolerance: a reproducible adverse reaction to the ingestion of food or to any of its components, such as proteins, carbohydrates, fats and additives.

When one has diabetes, of any type, one has lost the ability to normally metabolize carbohydrates. Another way of saying this is that one has developed an intolerance to carbohydrates. In the case of type 1, they will always need to use insulin to manage their "intolerance". The question is how much. As you well know, the amount of insulin required is directly related to how much carbohydrate is consumed. My point is that insulin is not without its adverse effects and risks. A strategy that allows one to maintain optimum blood sugars with minimum insulin by reducing carbohydrates makes a lot of sense. Dr Richard K Bernstein, who is the leading expert in this area, has managed himself that way for decades and is world renown for treating his diabetic patients that way, too. He is on the internet but also has a clinic in New York to which people from all over the world go to learn how to manage their type 1 (and 2) by restricting carbohydrates.

By all means, follow the guidance of your health care providers but also know that alternatives exist that may actually serve you better. Ultimately, though, you choose what you want to do. It's your life, nobody else can tell you how to live it.

Hello Everyone,

thanks for all the posts relating to controlling carb and impact on children , i think this thread has taken on a very positive manner.

A type one child whether you call it an intolerance or lack of ability to process is going to have a harder time controlling there BG if large amounts of carb are consumed.

A diet approved by a diabetic team that has enough carb to ensure they thrive but not so much that they are on a rollcoaster of hypers/hypo's would seem the way forward. Whilst allowing for a near normal a consumption of treat (likely to be high carb/high sugar) foods at the right times.

(is the level of treats the average normal child gets currently correct ? probably not or we would have an obesity issue , so mayne a bit less than the average child)

Finding that controlled level of carb is an exercise that as a parent I need to achieve whilst keeping other factors in balance.

At this point I would estimate 100-120g carb a day might be about right.

thanks
Matt

As a parent of a T1 child I don't think I'd ever have a problem with him sticking to a normal diet that includes approx 40% carbs. Sure, I watch his weight, height, hunger or refusal of food. Even if he ate a meal with a lot of carbs I could calculate the correct amount of insulin. The only time I would have certain difficulties is if he wanted to eat again before the first meal was digested and the insulin had started to wear off. If he had a carby meal then a carby snack within a couple of hours he would end up out of range and if I gave him more insulin for the carby snack he would most probably hypo from stacking insulin. There are ways around most situations to still end up with good levels.

I'm not sure about this but I think it would be safe to say that if I removed CHO from my son's diet I could end up in the loony bin and my child in foster care.

Can I add in my $0.02 on 'carb intolerance'. I have a friend who is has coeliac disease. He is severely intolerant of gluten. He avoids being ill by completely avoiding gluten. If I am intolerant of carbohydrates and have to take insulin to treat my 'intolerance', why can't I eat no carb and stop taking my insulin?

The answer is because it's not carbohydrate (as most people here would understand it) my body can't metabolise, it's glucose as in the end result of the mechanism, which includes whether it comes from carbohydrate, protein or gluconeogenesis. Even when taking a pretty low carb intake (approx 50g a day) I still needed a basal insulin load. In another thread, someone asks 'if it's not an intolerance, why do we all get made to take glucose tolerance tests?'. Well I think the most important word in that sentence is 'glucose' and not 'tolerance''.

Nobody here is advocating ramming themselves (or anyone else) full of carbs. We all practise some form of carb restraint, but I find the attitude being put out there that eating any carb is consuming poison to be both incorrect and extremely unhelpful. Everyone here (and I mean EVERYONE) needs to be respectful of other people's choices.

Now this is a low carb thread, so a debate on what counts as low carb is an appropriate topic. However, nowhere on this site should people's choices be ridiculed or sneered at. I've said this before and I'll say it again: we all have to find our best route for managing this, be that low carb, no carb, more carb or a potion made from the rear quarters of South American fruitbats. As moderators we will not tolerate personal attacks, nor will we accept people insensitively throwing around epithets that people will find insulting. As moderators we are watching these threads and are trying hard to keep the dialogue and flow going. Don't give us reasons to stop it.

Very well said Russ

Excellent post RussG!

Nigel

Hello Russ,

I am confused by your post , does it relate to this thread ?
Also if you are going to moderate threads including my posts could you use langauge I can undestand please - epithets ????? no idea what you are referring too

By the way anyone had any BG issues with muscles (from the sea) my daughter ate them tonight and BG was higher than I would have expected (although it could have been the potatoe crochets ...)

thanks
Matt

RussG said:

If I am intolerant of carbohydrates and have to take insulin to treat my 'intolerance', why can't I eat no carb and stop taking my insulin?

Click to expand...

It's a matter of degree and it depends mainly on how severe is your insulin resistance and how much beta cell capacity you have. For type 1 diabetics, there is no capacity to produce insulin so their tolerance is quite low and they will always have to use exogenous insulin. For type 2 diabetics, even if they are currently using insulin, yes, it is possible for some of them to get off insulin by getting their carbs below their personal threshold depending on how much beta cell capacity they have preserved. For others, however, the loss of beta cells is past that point and they, too, will still require insulin. In either case, the amount of insulin required goes up in proportion to the amount of carbohydrate consumed. Less exogenous insulin is better than more so efforts to reduce the carbohydrates will still be a good idea in order to minimize the requirement for insulin.

canuck1950 said:

For type 2 diabetics, even if they are currently using insulin, yes, it is possible for some of them to get off insulin by getting their carbs below their personal threshold depending on how much beta cell capacity they have preserved.

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That rings true Doc, I was put straight on insulin, well 3 days after diagnosis and almost immediately started to reduce my carbs to around 60g to 90g a day, I was quite anal about my portion control as well and after a little under 12 months and after loosing 4 stone (56lb) I managed to stop insulin, I am T2 obviously. I now eat slightly more carbs a day probably between 70g and 120g maybe as much as 130g a day and have managed to keep the weight off and keep my HbA1c firmly in the 5% range.

I am still diabetic of course, just a well controlled diabetic who doesnt need to go ultra low on the carbs, Atkins or Bernstein style, just eat a good balanced diet in the correct portions to enable me to maintain my control and weight.

How low is low, 70g to 130g is low for me considering the amounts I used to consume, dont we all set our own levels?

Matt1212 said:

Hello Russ,

I am confused by your post , does it relate to this thread ?
Also if you are going to moderate threads including my posts could you use langauge I can undestand please - epithets ????? no idea what you are referring too

By the way anyone had any BG issues with muscles (from the sea) my daughter ate them tonight and BG was higher than I would have expected (although it could have been the potatoe crochets ...)

thanks
Matt

Click to expand...

Matt here is a dictionary definition of epithets for you.

http://dictionary.reference.com/browse/epithet

I have not had a problem with mussles, but do have problems with potatoes.

Hi Matt

Sorry can’t abide muscles so can’t answer that one, but I would look at the crochet potatoes more so if these were homemade, as it could have been a miscalculation of total carb content, due to breadcrumbs always hard to estimate carb content on a breadcrumb coating..

As to Russ’s epithets basically what Russ is saying using intolerance to carbs to describe the problem faced by the T1 diabetic’s is bolder dash!

I’m a T1 diabetic, I’m not insulin resident, nor am I’m allergic to carbs, my body will appropriately handle any amount of carbohydrate thrown at it as long as I’ve got my calculations right of the insulin dose… And this is where control problems arise purely on this calculation, it’s a good idea to read up Bernstein’s small number theory/principle explains this matching of insulin problem well, even though I do agree with the principle I don’t agree with his prescribed carbohydrate amounts…
The bases of the principle is that the larger the number the more likely unpredictability will set in surrounding either insulin adsorption, food adsorption and control being effected by unpredicted changes not calculated for.. So small numbers limited the impact of miscalculation..

Even though I agree with the principle I don’t agree that any individual doctor such as Bernstein or Dr Jay Wortman can prescribe an amount that fits all.. When I study what they have to say, it’s very much like revisiting my first consultant many years ago.. And the carbohydrate exchange mantra..

My then consultant/diabetic team prescribe not only insulin but also the amount of carbs per meal and snack, which reasonable worked well, but nowhere as near as effective as me being taking the reins to determine management/calculations involved…

If you are having a lot of variable unpredictable outcomes with control, it may be that insulin pens as a delivery system isn’t helping, and you might get a better control with the improved control of delivering insulin via an insulin pump!

So I am clear I think this thread has agreed that :

1. Lower carb intake = less BG issues , due to lower insulin requirement
2. Everyone has a different level of carb intake they can attain good BG control on
3. It is up to the individual to find this level
4. For some people protein based foods may also require some insulin
5. In regard to children the above would apply but any decisions need to be discussed with the diabetic team

I think I might start a new thread in youth section to see if anyone is using a carb controlled diet with their T1. child

Many thanks to all
Matt

Hi Matt,

Yes I think that's a decent summary of what people have said. I think getting the views of other parents is a great idea as it is more complicated with children. You also have to factor in that children are, well, children and don't always respond well to a rational scientific explanation, particularly if their friends may be doing something different.

Good luck and I hope other parents have useful advice for you.

Matt1212 said:

So I am clear I think this thread has agreed that :

1. Lower carb intake = less BG issues , due to lower insulin requirement
2. Everyone has a different level of carb intake they can attain good BG control on
3. It is up to the individual to find this level
4. For some people protein based foods may also require some insulin
5. In regard to children the above would apply but any decisions need to be discussed with the diabetic team

I think I might start a new thread in youth section to see if anyone is using a carb controlled diet with their T1. child

Many thanks to all
Matt

Click to expand...

1, Not always I would check out Bernstiens forum to get a clearer picture.
2, Yep
3, Yes it is this enables individuals to have a more like/dislike based diet rather than struggling with prescribed deit that may not be needed or suited to the indivivual
4, yes the protein/insulin need is a hard one to work out
5, Even adults need to be discussing treatments etc with their team as it's only your team that have your medical history etc... And sometimes something that sounds like a good idea for other medical reasons aren't..

Matt1212 said:

I think I might start a new thread in youth section to see if anyone is using a carb controlled diet with their T1. child

Many thanks to all
Matt

Click to expand...

I think as parents we control our kids diets, diabetic or not. Yes, I control how much carbohydrate Khaleb has at meals and snack times but I can't say I limit his food consumption solely on the basis of how much carbohydrate he consumes. He has a balanced diet with a wide variety of foods. New foods are only introduced one at a time and I get a good idea of their blood sugar impact for future reference. He is having a growth spurt at the moment and averaging 165gm carbs per day with good levels overall.

I think the deal with less carb = less insulin = better control just comes down to the fact that there is much less room for error if you have a very small portions. If I was 2.5gm out on a 30 gm serve it would be no big deal but if that serve was 90 gm I'd then be out 7.5gm - this would be noticeable if I over or under estimated/counted. It can be hard with some fresh foods to accurately count carbs and I can't say I've always found the nutritional information on packs to always be reliable (especially on what I would call convenience food).

How does your child feel about food being restricted? Have you got a picky eater that doesn't like many things anyway? Do you need to consider a child who is either under/over weight? What about a child that does a huge amount of sport? Lots of things will impact on a suitable amount of food/calories/carbs.

For kids, I'd be a little more concerned about the social and pyschological impact of a restricted diet. I really feel for those facing the cost and inconvenience of a gluten free diet. You might find better answers to good blood sugar control than just controlling the amount of carbs being consumed.

Hello Jen,

You are correct a lot of the improvement in BG will be due to less error in the amount of insulin needed.
However I know certain foods are always going to cause BG peaks at 2-3 hours.
I hope to replace the issue foods (tend to be high GI carb) with lower carb alternatives.

For example my daughter loves making and eating pancakes at the weekend.
However she will always have high BG for a couple of hours afterwards.

If however we make the pancakes with ground almonds the carb contents falls from around 40g for her breakfast to 10g (some chocolate/nut spread also included)

So I hope subtle changes in diet will allow a more controlled use of carb and not be restrictive in choice.

thanks
Matt

Just a thought on pancakes. We sometimes go to maccas on a sunday morning and I give Khaleb extra insulin with breakfast so he can eat them for morning tea (he only gets the butter and not the syrup). I know he isn't going to hypo in the time it takes because I have repeated this test a few times and give the morning breakfast insulin to suit. The insulin is peaking at the same time he has the high gi food so we tend not to get any spike and the day goes on as usual. Home made pancakes are probably not as high gi as maccas.

I too, would limit or omit foods that caused very unreasonable control. It used to be banana when Khaleb was little but I've since reintroduced them and things are okay. Pizza can sometimes be a problem but if he has the pizza and some other food together it works out a lot better. Low gi foods can sometimes be as troublesome as high gi in my experience. I give Khaleb rolled oats for breakfast as being low gi it suits that time of day when he seems a bit insulin resistant (growth hormones in the night maybe or just the Levemir wearing out?). Lunch time Khaleb needs some fairly high gi food and dinner is somewhere between the 2.

They must work out quite expensive pancakes using ground almonds. I looked at making a few improvements to food using alternatives but the cost turned me off. Australia is really expensive for food compared to other countries and I think the ground almond meal was about $7 for a little bag. I have a blender with a grinder attachment so might have to look at making my own if I can buy almonds cheaper.