Yes that's what I'm thinking, it's going to be hard enough being diabetic never mind being the kid with the crazy mum who won't let them eat any sugar lolHi, I don't pretend to understand what you are going through as a parent but it seems to me if you are keeping her stable with diet on a day to day basis then a once in a while treat like a birthday party could be worked into the mix. I would imagine you would want to experiment a bit at home once things are stable so you know ahead of time how much extra insulin is needed. Kids do need to fit in with their friends, even at a very young age.
I already follow a LCHF diet, my elder daughter also does to some extent by choice although she has sweets occasionally too, she's well practiced in eating them out of sight of her little sisterI would assume that if your daughter is on a low carb diet then you and the rest of the family will also be on a low carb diet, otherwise family life is going to be pretty awkward and you will be making two meals all the time and your daughter will always be faced with stuff in the kitchen that she's not allowed.
Why don't you trial the low carb diet just on yourself for a bit and see how you cope in situations like birthday parties, Christmas etc. That might help inform how best to approach it for your daughter.
If you are doing low carb, the problem with occasional treats is that you don't know how to bolus for them - it takes practice to work out your I:C ratio and the timing of your bolus for certain foods, especially something that would be considered a treat! There's also a hypothesised issue that if you long term don't have carbs, your body become more sensitive to the occasional carbs and possibly insulin resistant when you take on the insulin required to manage the carbs, again because your body is out of practice at how to deal with the insulin and carbs combo.
Maybe have a look at type 1 grit and Bernstein for how low carb parents deal. But do make sure you have a chat with your health care team and go in to the disussion with an open mind.
Her doses are correct, I've spoke to the DSN who has told me obviously she needs to be eating less carbs and to make appointment with the dietitian to discuss changesAs well as speaking to a dietician and paediatrician, you should speak to a DSN. The foods you've reported your daughter eating are perfectly normal foods for Type 1s. I eat bread and cereal and my spike stays below 8. I believe your daughter's high sugars are to do with her insulin not being correctly dosed and/or used.
Be aware that many people on LCHF need to micro-dose and have a number of extra injectikns a day. That's why many have pumps - to avoid 10+ injections.
Her doses are correct, I've spoke to the DSN who has told me obviously she needs to be eating less carbs and to make appointment with the dietitian to discuss changes
Yes because the dose does cover the carbs in the end but before it does she spikes above 15mmolA DSN said that? The idea of basal/bolus is to adjust your insulin to match your food. Hooefully, the dietician will give you help to do that
Yes because the dose does cover the carbs in the end but before it does she spikes above 15mmol
Then pre-bolusing would be a possibility. I'm sure the Paed DSN will have experience of how to manage that with a young toddler
I pre bolus for her, she will still go from 3.5 to 14
I pre bolus for her, she will still go from 3.5 to 14
But in the instance of going from 3.5 to 14 there's only one thing that would help and it's eating something different, I can't give it any earlier if it's already sending her hypo from waiting?You may find you need to pre-bolus at different times in advance according to the meal. I used to spike to 11 after breakfast and thought it was just one of those things. But moving my bolus gradually means I now am usually around 6.5-7 after. Other meals aren't so bad so I can bolus closer to eating.
We want to avoid a pump until she's old enough to have a say in the matter unless there's no other choiceOther resources for any type 1 who is struggling with managing carbs and insulin:
- online carb counting course - http://www.bertieonline.org.uk - do they offer a carb counting/DAFNE course for parents in your area? If not the online course might be worth a look.
- Stephen ponder, sugar surfing - book on how to use continuous glucose monitoring and micro dosing, of carbs and insulin, to maintain tight blood sugar control
- juice box podcast - dad discusses his t1 daughter - lots of interesting guests and different approaches discussed
This is where an extended bolus on a pump might be helpful. Also the pre bolus might be a bit too early if she goes to 3.5 before eating? If you hypo before eating, it might be the hypo contributing to the spike as hormones will be released to make your liver give out glucose and to make you insulin resistant as a protection against the hypo. On a pump you could pre bolus 40-50% and get the rest of the bolus to run over an hour or two. If you were still spiking you could micro dose a correction or run an increased TBR to mop up unexpected highs.
We want to avoid a pump until she's old enough to have a say in the matter unless there's no other choice
Because making sure she eats a healthy diet isn't the same as putting her on a pump. If better diet choices help until she's old enough to give her input which will be around the time she may rebel the diet it makes more sense to do that imoBut she's not going to have a say in the diet either, is she? It's a pretty significant lifestyle decision, but of course it is your job to make those decisions for her and it really clear that you are thinking about it carefully and doing a really good job at making tough choices for your daughter. I'm just not sure why you prioritise her getting a day in the pump, but not in the diet? And you are already anticipating a rebellion against the diet...
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