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Need help and advice

K

Karen Kinnaird

Newbie
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4
I am anew member and joined on behalf of my friend (Janine) and her 14-year-old son (Alex) her was diagnosed as a Type 1 Diabetic about a month ago. His glucose level was 37 when he was admitted to hospital. Although I am not diabetic my partner who is 78 is a Type 2 and has been for about 15 years. He switched to insulin about a year ago due to the effect sustained use of Metformin on his kidneys. So I am no stranger to the condition or its awful side effects.

I am afraid this posting is going to be somewhat length, but I want to get help, advice and support for Janine as soon as possible. I have bougt her a carb counting book and encouraged her to join a Forum like this so she can 'talk' with other people about it and also to find one for Alex so he do the same with other kids his age.

For the past 10 years Alex's diet has consisted of almost all carbohydrates: cheese pizza, chips, baked potatoes, pasta, cheese sandwiches on white bread, sausages rolls (with awful sausages), fish (breaded or battered, baked or fried), chicken (the same as the fish), yoghurt, cocoa puffs, pancakes, waffles, and sweets. He eats (still) no fruits, vegetables, salads, herbs, spices - absolutely none. Since being diagnosed he has added bananas, gone from 8 to 2 slices of pizza, from white white to wheat pasta, from white to wheat bread, and cut out sweets. His glucose levels are generally in the double figures with the occasional day where they are sustained at around 5. He takes about 40 units of insulin in two shots each in the AM and PM. He has had the odd Hypo, but I suspect that is due to the exercise, diet and instability of the glucose levels. He is quite active and, thankfully, is not overweight (rather more underweight).

I have tried to tell Janine that a diet such as his is dangerous for him and it needs to change radically and now not later. She has tried to introduce scrambled eggs, green beans and sweet potatoes into his diet, but he says he doesn't like the taste or texture. So that puts them back to square one.

Can you help me and tell me whether I am on the right track on my advice and if so, how I can convince her she has to change his diet radically, whether he likes it or not?

Thank you in advance for reading this long posting, but I care about both of them and am at a loss of how to help them, so I have come to you - the diabetic community - for help.
Karen
 
Kids are always difficult as it's a fine balance between allowing them to be children and taking care of the diabetic side without standing them out from their peers...

There is nothing wrong with chips, pizza's etc as long as it's in moderation, and that is the keyword Moderation..

It sounds as though with 2 injection's a day he's on a mixed insulin, which combines the long acting (background insulin) with a quick acting insulin, to get this to work well you do need a strict regime of carbs through out the day matched to the insulin, not idea for the dymanic world of a 10 year old.. As it offers very limited flexibility..

She be far better of asking to go onto MDI (multiply daily injections) the downside does mean that it involves more injections, but because you injecting the background seperately and quick acting insulin for foods being eaten, it is a lot easier to adjust the quick to suit the amount being eaten at any one time, and make correction in the dose that reflect his activity levels i.e he's been to footie practice it may be that when he has his tea, on this night he needs a lower carb-insulin ratio to prevent an hypo... or at dinner time he needs a lower ratio due to having P.E in the afternoon etc...

As to eating habit, well I'm afriad it is likely to be a slow and frustrating process for his mum, to encourage healthier eating practices, a fussy eating kid are a nightmare at the best of times..

But if she looks around at website such as the splender one, there are a lot of recipe's about that can make foods such as cakes and biscutes etc more diabetic friendly..

And for things such as chocloate bars, well there is a place for these either as a occasional treat, or offered when he's doing some exercise again before or after footie etc where he's going to be burning of the sugar from them..
 
I developed T1 as an adult and for me It was very scary suddenly thinking that my your whole lifestyle had to change (actually for me the changes were less than I thought they would be but I was already eating my veg and fruit :wink: )
A healthy diet for someone with T1 is exactly the same as a healthy diet for anyone else. but telling a teenager what is good for them is as I'm sure you realise, often counterproductive.
His diet can be built upon. He can continue to eat carbs and I'm sure he will have been told that no food except perhaps full sugar coke is forbidden. Some foods however, are far more difficult to dose for correctly and his present insulin regime is inflexible. (see below)
It sounds as if his mother doesn't do much cooking herself. There are many healthy foods that appeal to most teenagers. Grasping at straws a bit, but there are several cook books aimed at teenagers. I'm not suggesting that you give it him, though you never know he might like to cook himself but maybe one might help Mum. (one that comes to mind is Real Food, Real Fast by Sam Stern) Obviously books like this won't be aimed at people with diabetes and a few of the recipes might be too high in fast sugars/fats for his insulin regime to deal with but most seem to have half an eye on a healthy eating.
He needs to accept his diabetes and learn to manage it for himself. There is a book that many parents and young people (and older ones) find very useful
Type 1 Diabetes in Children, Adolescents and Young Adults: How to Become an Expert on Your Own Diabetes Ragnar Hanas. It will certainly help the parents and it maybe that he will be able to get something from it himself.
Unfortunately, the twice daily insulin works best with a fairly regular lifestyle with consistent meals . Many doctors (in the UK) seem to put people onto this at first Often people find they do better on a regime that involves 3-5 injections a day. This allows them to dose for meals separately and to vary when and how much they eat. This fits better into most peoples lifestyle (as do pumps which more young people are getting) but I would think he will now need time to come to terms with things before making what might seem to be a drastic change
 
I appreciate your response. First of all he is 14 not 10. Surely he has to have some fruits, veggies, etc in his diet, doesn't he? I see what you are saying about the multiple injections and I think they are working towards that as it makes a lot of sense. It's the balance that's going to be a bit tricky.

I notice you didn't respond about my idea of a 'radical' change of diet. Any reason why?
Karen
 
Thank you for your response. I agree with you about the multiple injections. My own feeling is that he has not really come to terms with his condition. He doesn't feel any different, except for occasional hypos, and he is basically still on the same diet, with not much significant change. I'm not trying to justify what I think is right in terms of diet, I'm just trying to get some support for the fact that he needs to realise that he HAS to add things that are not carbs. Am I wrong in that?
Karen
 
HI Karen
You are not wrong, a carb-only diet is no good for type-1s, and as you know not for type-2s either.
Many patients are given what I consider bad dietry advice about carbs from dieticians in diabetes clinics- my brother in law is such a person, and unfortunately/naievely believes everything he is told., but it's human nature to trust the "experts" even if they appear to be anything but :?

It must be really stressful for your friend, but her son is 14 and not 4 and he will have to take responsibility for his own diabetes /diet and realise that he's endangering himself by eating the wrong things. I don't envy your friend's situation, it's hard with teenagers at the best of times, everything you say can sound like your nagging :(
I'm in a situation at the moment with my 18 yr old - trying to peruade him how bad spending too much time on the computer is for him. When he's been on it for long periods, playing games, etc; I notice a change in his character, he gets angry, depressed and it's starting to affect him in a big way. He's become very insular and reluctant to go out on his own, he is also disfigured. I've made a decision this week to seriously restrict his internet access for his own good and I hope it works and he realises I'm not out to spoil his fun, but to improve his quality of life. Also encouraging him to come out running with me, which he does enjoy thank goodness, and realises that physical activity DOES make him feel better. I feel guilty because we indulged him when he was going through cancer treatment but for his sake I've got to rectify it now, so he can lead a more normal life now his health is better, although I know as the bad guy I will bear the brunt of it :(
He's got worries that most kids don't have, and undoubtedly your friend's son does too, even if he doesn't express it. The psychological issues of childhood illness are a minefield. When your child's ill you want to do everything for them and it's hard to be hard on them, but sometimes it's necessary.
Your friend is very lucky to have you caring so much. Less knowledgable people can misunderstand and even trivialise diabetes. All my mother ever said to me following my diagnosis at 19 (even though I felt like a big kid!) was "oh well, millions of people have got it".
As Jopar said, I MD/basal bolus regime would be good as it will give him more flexibility and probably better control. It's hard if you're an active teenager to be restricted to fixed meal-times, a basal/bolus regime means you can choose when you eat. I was on a mixed regime to start with, but for that reason switched. It made me feel in control of my diabetes rather than it controlling me.
Jus :) x
 
Hi Karen,
It will be hard - yes, obviously he 'needs' a radical diet change, but he is a teenager who has been eating in a certain way for a long time, and he has a big shock of having diabetes.

From my experience of 2 teenagers with diabetes - age 13 and 16 I can say that i would concentrate on the checking blood sugars regularly as my priority for him. A lot of teenagers rebel against having the diabetes by not looking after themselves properly, not caring, and not being able to think about how that behaviour affects them in the long term.

They hate the fact they have diabetes, and want to stick their head in the sand and ignore it.

Going on at him about the diabetes and also the diet in my opinion will help to alienate him.

I think that the diabetic nurse should be a big help in sorting out his insulin requirement initially, and the most important thing would be to make sure he checks his blood sugars and does his injections.

Hopefully the rest will follow. At the end of the day if he can move onto multiple injections then at his age i would personally be okay with what he is eating as long as he injected the right amount of insulin to cover the amount of food.

There are too many battles with teenagers, and i wouldnt push this one. (just my opinion!)
 
Thanks to all of you

I would like to thank all of you who responded to my posting. I basically joined the forum to see what it was like, what types and numbers of responses I would get. If I were my friend I would definitely join and encourage my son to do the same in the teen group. Janine is new to this, but seems to feel she knows pretty much what she needs to know about it. I disagree, but as with the whole situation I have no control what they do or don't do and to be honest i really don't want control.

I have children and grandchildren (thankfully none of them are diabetic) and although none of them like every food, they like and eat enough things to have a somewhat well-rounded and healthy diet. This is not the case with Alex. With his diet I feel he has been and is missing the vitamins and nutrition that is found in the other food groups. You don't have to be a dietician or medical doctor to know that a 90% carb diet is not healthy in any way, shape or form and with a diabetic it is a recipe for disaster. I live with a diabetic and I see what the horrendous side effects are - and this is with a good diabetic diet.

I agree with all of you that multiple injections would help, but what about the long-term? As long as Alex keeps being very active and pumps in the insulin he believes (and I am not certain that his mother does not agree) that he can keep his diet as it has been for a very long time. Yes there have been a few changes, but very few and the changes that have been made pretty much involve changing the makeup of the carbs, i.e. wheat instead of white. So there are very few rows over food.

I am concerned and fearful for what the future holds for Alex if he doesn't change his eating habits or his mother doesn't force him to add some of the other food groups, and lower the carb levels. Yes there will be fights, but I believe eventually Alex will come to accept, even like, some other foods. Right now his taste buds are atrophied because everything he eats is bland and when something with tast is introduced he and they automatically reject it. If he doesn't like it, his mother scratches it off the list - the list of what is left is shrinking somewhat. But as i said before there is nothing I can do - it's up to them and I just hope she will take some of my advice and suggestions - one of which is to join this forum.

Again many thanks for all your input
Karen
 
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