moving to mdi quesiton about food and doses

[jacquiel]

Hi - first of all can i ask for no judgy comments just simple advice? About my son, terrible control, but going onto mdi to try and improve things.

Just come back from dietician appt re carbs etc but still have a couple of questions.

Son age 13 been on 2 injections a day since diagnosed 2 years ago. He is being switched over probaby at beginning of next half term (whitsun) to mdi. This is because his hba1c is horrendous (continually over 14 for the last 3 clinics).
It is because he basically eats whatever, whenever, sneaks food etc etc.

He is happy to be changing over, and fingers crossed for a lower hba1c in the next 3 months. He knows he has to do more tests and keep some records - this will be the battle I think.

Luckily for now the diabetic team just want to work round his current eating patterns, try and get him to be honest about what he eats, and fit round it - any more at this stage and it would be doomed to failure.

One issue we covered was that if he 'grazes' then it will be hard to give the right amount of insulin, and there will be highs.

She said if he had a small snack with up to 10 - 15g carbs not to inject for it, but then for example if he had another one of similar size an hour later, then to inject for both when he has the second snack.

Also she said if for example he snacks through a pack of biscuits, then may be to inject for a few - say 3 or 4 before he starts eating them, and then see how many he ends up eating and inject for the rest later.

Does this sound like a good plan you experienced folk?

Also - he will still end up buying and eating sweets - yes I know what he 'should' be eating and no amount of talking, discussing, moaning, etc will stop him - he has just become secretive about what he eats but eats it anyway.

So given that he will at some point buy sweets - how would you deal with these insulin wise? Inject, not inject? I know the sweets will cause his sugars to rise quickly and fall quickly so it could be dodgy injecting for the amount of carbs coz he might go hypo?

 

[stoney]

Hi jacquiel

My Son is now 14 and been diabetic since he was 3 and then only on the two injections per day, so has really grown up with it so it was easy to mould him. He also has the added problem of being coeliac so he definitely has to watch what he eats. I guess your Son being 11 diagnosed must be pretty scarey for him going (or in) Comprehensive at the time of diagnosis. He will not want to be different from any of his piers and I do get "why me" and "I hate being diabetic and coeliac" from my Son, and I do have to say THERE ARE FAR WORSE OFF THAN YOU in the world. My son has only just gone on the MDI's since February this year, and we are still learning. It was a bit scarey for him to inject in school and he used to ring me every lunch time with his BG and confirmation that he is giving himself the right amount of insulin. Now he is more confident and I don't get the calls anymore.

Your Quote

She said if he had a small snack with up to 10 - 15g carbs not to inject for it, but then for example if he had another one of similar size an hour later, then to inject for both when he has the second snack.

My Son's pattern for food is:

7.30 breakfast (70g) insulin
11.10 snack 10-15g
13.25 Lunch (50g) with insulin
15.55 (snack 10-15g if low BG)
17.00 tea (grams vary) with insulin
20.30 supper (approx. 70g) (DSN said not to inject for this at the moment)
22.00 Basal Lantus 15 units

As far as your Son's sweet and biscuit eating, maybe you can just run with it at the moment as he will not want to inject so many times in the day in case of overlapping of insulin and severe hypos

I do hope this has given you some help.

 

[ebony321]

Hi - first of all can i ask for no judgy comments just simple advice? About my son, terrible control, but going onto mdi to try and improve things.

Just come back from dietician appt re carbs etc but still have a couple of questions.

Son age 13 been on 2 injections a day since diagnosed 2 years ago. He is being switched over probaby at beginning of next half term (whitsun) to mdi. This is because his hba1c is horrendous (continually over 14 for the last 3 clinics).
It is because he basically eats whatever, whenever, sneaks food etc etc.

He is happy to be changing over, and fingers crossed for a lower hba1c in the next 3 months. He knows he has to do more tests and keep some records - this will be the battle I think.

Luckily for now the diabetic team just want to work round his current eating patterns, try and get him to be honest about what he eats, and fit round it - any more at this stage and it would be doomed to failure.

One issue we covered was that if he 'grazes' then it will be hard to give the right amount of insulin, and there will be highs.

She said if he had a small snack with up to 10 - 15g carbs not to inject for it, but then for example if he had another one of similar size an hour later, then to inject for both when he has the second snack.

Also she said if for example he snacks through a pack of biscuits, then may be to inject for a few - say 3 or 4 before he starts eating them, and then see how many he ends up eating and inject for the rest later.

Does this sound like a good plan you experienced folk?

Also - he will still end up buying and eating sweets - yes I know what he 'should' be eating and no amount of talking, discussing, moaning, etc will stop him - he has just become secretive about what he eats but eats it anyway.

So given that he will at some point buy sweets - how would you deal with these insulin wise? Inject, not inject? I know the sweets will cause his sugars to rise quickly and fall quickly so it could be dodgy injecting for the amount of carbs coz he might go hypo?

Hi,

What stands out to me is two things, his Hba1c is very high and that he likes to eat alot.

Eating so much, and sugary stuff is making him high alot, and because he tends to 'graze' your right in saying its hard to cover that way with insulin.

In your case i would rather him eat what he likes openly then at least you can try help him cover it with insulin, rather than him feeling punished and hiding sweets and things which i personally think will make him resent his diabetes and less willing to take good control.

Depending what his BG's are, a 10-15g snack is okay to have with no insulin, but as you said if he is to snack again later on then he should have some insulin. Same with if he snacks before a meal, add the insulin onto the meal as a correction.

Have you spoken to anyone about carb counting if your switching to MDI? this is an invaluable tool to learn with MDI and i think it would benefit you both.

One thing i do disagree with is having no insulin with sweets and chocolate. this still needs to be tackled with insulin, if you find he may hypo if his BG's tend to fall then maybe thin about reducing it for certain types of food, but it won't help his control or HBa1c if he's swinging high. It'll also make him feel a bit ****** too.

You may find as his control gets better with MDI that he will be happier, more awake and healthier Which might spur him to test his BG's more as he'll feel the benefits himself of getting better control.

I do definately think if you can't get him to cut down on sweets and carby foods then encourage him to control the diabetes first. Holding back things tends to make things worse in my opinion.

Good luck with it all, i hope MDI works well for you both

 

[jacquiel]

thank you both for your replies.

I really hope it works too!

This morning he woke up feeling ******, and said he didnt want anything to eat. When I asked him about doing his blood test he just said that there was no point because if he wasnt high then he still felt ******. :roll:

I left the house encouraging him to test - saying we need to know what it is anyway to get him sorted out.

I do feel like its an uphill battle though.

 

[ams162]

have u ever considered a pump i understand they r not for everyone but with the grazing its easier to manage levels, dylans hba1c have never been under 10 even with continued hard work and loads of testing but since being on the pump his last was 9.2 not fantastic but on the way to being better.

life on the pump has been so much easier for dylan and its not always a no to things either for example last night he had his first ever dip dab which he thouroughly enjoyed and his blood sugars were perfect again by the 2 hr mark.

MDI works for alot of people for us it made no affect to his over all hba1cs but he did get better control on them than the twice daily injections i hope they work for u and u get some control back i know how frustrating life can be when food is being hidden we went through a patch of that with dylan to the point he took some sweets from tescos when we went shopping as he knew it would be a no to having them, so he put them in his pocket and took them up to his bedroom however i caught him marched him back to the supermarket and got him to admit to the security guard what he had done, it was a hard time and i feel for u

keep smiling things can only get better

anna marie

 

[annettekp]

Hi my son is almost 3 and on the MDI regime. Being little I have slightly more control over what he eats although he does have a tendency to graze, luckily he doesn't have a sweet tooth so he's not eating lots of sweets but given the chance he would eat a ton of rich tea biscuits!

To avoid too many injections overlapping and causing hypos we follow the advice we were given. Insulin after meals (not before as there's no guarantee he'll eat what he's given). With snacks of 10-15g no insulin but he often eats a snack of 20g. I wouldn't give insulin for this unless his pre-snack reading was above 12. We correct any reading above 12 though.

We do split doses sometimes too especially at birthday parties and things like that or if pudding follows a long while after the main course.

I think its probably worth following the advice you were given to begin with and then tweak it as you see how things are going.

Good luck

Annette

 

[Pneu]

Right.. Having been diagnosed as a teenager and having had parents that weren't strict about my control and then having suffered later in life I am going to say this like I see it...

Your son is 13 it is your responsibility to ensure that he controls his blood glucose... he is slowly killing himself and therefore you MUST act to change this.. Ofc he is not going to want to take on that responsibility, he is not going to want to stop eating all the nice things, he doesn't want to face up to the fact.. BUT he must and he must do it sooner rather than later.

If his buying sweets don't give him the money.. if his eating rubbish don't buy it when you go shopping.. You have to be cruel to be kind or you son will suffer the consequences of poorly controlled diabetes, maybe not for 10 or 15 years but by then it will be to late.. I only wish my parents had taken a much more extreme line when I was younger.

 

[Snodger]

Others have mentioned carb counting and I wonder if you can ask to talk to someone DAFNE-trained in your area? DAFNE teaches carb counting and, importantly for your son, explains that you can eat what you like (including sugary stuff) as long as you cover it with insulin. It strikes me that if the 'forbidden' foods are no longer forbidden, it might help him? As Pneu says, it's about him taking responsibility - it might be easier for him to do that if he is helped to see that he CAN eat what he likes, when he likes, as long as he understands how to handle it.
I don't know if DAFNE courses are available for people as young as 13 - others on here may know. See http://www.dafne.uk.com/all-courses.html. I do know that you can self-refer to a course outside your area if they don't offer it there, because I did.

 

[jacquiel]

We have seen the dietician and learnt about carb counting, which we understand the mechanics of - both him and us - although i am sure there will be things we are still to learn as we go on.

As far as being very strict - we have tried that and that i think is why we are where we are now.

He knows the ins and outs of why he should eat sensibly, complications, etc. We have and the consultant has given 'horror stories', she has told him about the kidney dialysis ward near us being mainly 'young adult' diabetics who didnt look after themselves, about a boy recently who she would not clear with dvla for being allowed a driving licence due to poor control etc etc. Impotence, delayed puberty and growth etc etc

But - he chooses to ignore it in the 'it wont happen to me' mindset.

He has money for the train - he sometimes uses it to buy rubbish.

He has pocket money - and yes he buys rubbish a lot of the time - i wouldnt not give ANY money to a 13 year old - its not fair and what i think is needed now is for him to be honest without fear of recrimination in order to get a handle on control now. We can improve his diet later in my opinion - the constant lying and hiding food needs to stop.

I dont buy loads of rubbish - in fact my kids say how there is nothing nice to eat in all the time, and its not fair - but if ever we do buy 'nice' stuff it disappears within a day and with 4 kids - its never them - always another suspect if you say it wasnt you.

We even had to resort to a lock on the food cupboard because in 1 day you would have no eggs, baked beans, hot dogs, crisps (when we bought them), jam, syrup etc etc

They either ask if they can have something out of the cupboard, or I keep standard stuff like the beans and noodles, and soup and bread and cereal in an accessible cupboard.

What we need to happen is for
a - him to be honest about what he eats
b - check his blood sugar more
c - keep some record of this
We obviously will help all we can by not freaking out if he says he had a milkshake, or whatever, reminding him to do a test (hopefully without being naggy) and write it up with him if needed.

I know how serious this is but honestly it is incredibly hard work with him.

 

[jacquiel]

by the way - thanks Annete and ams for you helpful replies - didnt spot them initially as i found the other two responses via the rss feed, and yours werent listed for some reason.

I will try what the nurse suggested and tweak it.

He is so rebellious though

 

[imalittlefishy]

I don't really have any advice, but a bit of reassurance - I was diagnosed at 11 (now 19) and I went through a rebellious phase at about 13 too, yes I was hiding sugary things, buying chocolate from the vending machine at school cos my parents weren't around...and I did grow out of it. By the time I was about 15 I was much more conscious of what I was doing to myself and made a real effort not to let my blood sugars get out of control, one thing I found after I went onto MDI from 2 injections was that I could get away with eating sugary stuff if I ate it close to meals (either shortly before or as pudding) and then I could cover for it. My parents were never very closely involved with my diabetes - I was very independent (stubborn!) even at 11, so they never really paid attention to what I was doing unless I was literally sat in front of them eating sweets(!) These days I'm much more careful with what I eat, minus the occasional lapse! I know it probably won't help much right now, but he as he grows up a bit it will probably sink in that this is something he will have to deal with for the rest of his life, so he may as well start now. Good luck to you both!
xx

 

[moonstone]

I think you also need to speak to the nurse about the fact that when you have such awful hba1cs you can get very, very hungry. Mine on diagnosis was 12.6% and I was like a heroin addict looking for my next fix on a constant basis. Getting up to eat in the night, even (and wee, and drink water etc etc). Directly after eating vast, vast quantities of food I'd be in the kitchen finding out what else I could have. Perhaps your nurse can give some advice on this symptom of hyperglycaemia to help convince your son to aim for better control because eventually the constant hunger wears off. I warn you though it took several months for me to gradually get past it but after about 2wks of injections and getting myself close to normal levels more often I did notice a massive difference. You have to be cruel to yourself in the short term to be kind to yourself in the long term. You could try perhaps to find some filling, no or low carb foods/snacks for him, to satisfy the hunger pangs without the hassle of injecting etc. Peanuts are meant to work quite well, I hear from others.

 

[jopar]

You are on a hard road here with plenty of bumps in it..

MDI will help with flexibility, but it will be difficult more so with his eating habits but it should give better results than 2 jabs a day..

At the moment your son with the 2 day jab, isn't seeing the relationship between the foods he eats and his insulin, once he's on MDI hopefully he be able to see the relationship between the two and naturally start heading toward better eating habits etc..

How open is your son to briabary

As if he was easily bribed I would use this to help with getting him to do his BG testing!

The reward could be a dayout or perhaps the computer game he's been hankering for!

Work out a pointing system that if he doesn his basic blood testing he would earn enough points say within a month to earn his reward.. If he hasn't done his basic bg's testing he it will take longer to recieve his reward.. You could do a small weekly reward along side the bigger reward

A lot of problems around blood testing for any diabetic young or older, is getting it to the stage it becomes a natural part of the daily routine, so hopefully with something like the above you can establish the routine..

But if you decide that to try bribary, do remember that target needs to reasonably achievable, you do need to do it in such a way that if he fails he doesn't see it has a punishment..

Good luck with the change over, and if it doesn't seem that it's panning out well, not bash yourself up about it, as you do need to remind yourself, he's 13 years old his hormones are starting to change and rage, bad enough time with a non-diabetc lad but one with diabetes the hormones will also effect his blood glucose levels and his control..

Reality of living with diabetes, we live 24/7 with a spanner dangling over us, waiting to drop into the works!

 

[leggott]

The bolus/ basal regime will work much better for your son. I wouldn't worry too much about diet right now, just tackle on thing at a time. The important thing at the moment is to get blood sugars under control.

Perhaps try and reward him for testing and for counting his carbs (once of course you have learnt this). Let him buy sweets with his money, but at home make sure that there are not too many treats so if he is hungry he has to eat whats in the cupboard.

As with all teenagers they don't want to listen and think that they won't suffer the consequences of their actions. By going on at him all the time it will probably just make him rebel even more. At least if he injects every time he eats his blood won't consistantly be high, he will then start to feel better and once his bloods are more stable you might have a better chance at tackling his diet.

Good luck

 

[jacquiel]

Thanks for your replies (dont get on the computer at the weekend, so just seen them)

Over the weekend things went pretty well !

He was I think open about what he had, and tested and i wrote down the time, the bm, the food, the carbs we thought it was (to be checked by nurse in 2 weeks), and any insulin or correction dose.

We talked about if his bm was a bit high it would be better to have a low or no carb snack.

He asked me to buy stuff, and we went to B and M and bought nuts, and various other snacks both carby and not carby, and when we went to the pub during a dog walk he had pork scratchings rather than crisps. He seems more aware and open to the change than i thought he would - hopefully it wont wear off too quickly. Following some lower carb recipes on here we had marscapone with lemon flavouring and lemon zest for pudding, and when we had sausages we had black farmer which have low carb.

His BM over the weekend was great compared to normal - highest was 15.9 , and most readings were between 5 and 8 - unbelievable!

I have bribed him with a book (he loves reading) for 2 weeks of keeping the diary before we see the nurse (starting on basal bolus in half term coming up), and then the next book in the series for keeping the diary for 2 weeks once he goes on the new regime. Seems up for it, but I am writing it in, with him there, but he is up for working out the carbs and checking his blood as long as i write it down. - so MUCH MORE POSITIVE than I expected - [fingers crossed smily]

 

[ams162]

so pleased things have been more positive for u both over the weekend, kids with diabetes seem so resilient dont they

anna marie

 

[stoney]

Brilliant News, onwards and upwards

 

[moonstone]

That's really brilliant

 

[annettekp]

That's good to hear!

 

[ebony321]

Thanks for your replies (dont get on the computer at the weekend, so just seen them)

Over the weekend things went pretty well !

He was I think open about what he had, and tested and i wrote down the time, the bm, the food, the carbs we thought it was (to be checked by nurse in 2 weeks), and any insulin or correction dose.

We talked about if his bm was a bit high it would be better to have a low or no carb snack.

He asked me to buy stuff, and we went to B and M and bought nuts, and various other snacks both carby and not carby, and when we went to the pub during a dog walk he had pork scratchings rather than crisps. He seems more aware and open to the change than i thought he would - hopefully it wont wear off too quickly. Following some lower carb recipes on here we had marscapone with lemon flavouring and lemon zest for pudding, and when we had sausages we had black farmer which have low carb.

His BM over the weekend was great compared to normal - highest was 15.9 , and most readings were between 5 and 8 - unbelievable!

I have bribed him with a book (he loves reading) for 2 weeks of keeping the diary before we see the nurse (starting on basal bolus in half term coming up), and then the next book in the series for keeping the diary for 2 weeks once he goes on the new regime. Seems up for it, but I am writing it in, with him there, but he is up for working out the carbs and checking his blood as long as i write it down. - so MUCH MORE POSITIVE than I expected - [fingers crossed smily]

Excellent!

So it sounds like you've gotten stuck in and your comprimising with each other!

and because he's not being kept away from things he likes and is also getting a little prize (a book) its seems to be helping him be more involved in his own care!

It'll be also good for him to see good results so he may be more inclined to reach for a low carb snack rather than sweets!

you must be really chuffed, i think i certainly would be too!

i hope the basal/bolus regime works well for you!

good luck with everything