Carb "Sensitivity" in my 10 year-old with T1D

History: My 10 year-old has had good BG control in the past, with A1c's in the upper 6s, and a few low 6s. We moved and got three mid-7s in a row, so we tightened things up. (1) For the first 3 months we cut back carbs to 30 per meal and one 30 carb snack after school. (2) We had some problems with lows almost daily, and because adjustments to meal bolusing and basal rates were not solving the lows entirely, we cut more carbs to use less insulin at meals. (3) For the last 3 months weeks he has been eating two 11 carb meals and two 15 carb meals. We try to maintain precision in carb control through weighing and repeat the same 10 meals. (4) His I/C ratio was 1:10 for breakfast in the past and 1:13 for the rest of the day--these numbers didn't change in 4 years. When eating these lower carb meals, his ratio is 1:4 for breakfast, 1:3 for lunch, 1:10 for after school snack, and 1:6 for dinner.

Have others had this same response to lower carb meals?! What is interesting is the he has had the exact same breakfast and snack for the last 30 days, but one meal is 1:4 and the other is 1:10--this seams to be a huge variability. Is it possible that his body is getting "better" at turning more of the protein in these low carb meals to glucose. We do 15g of protein for all 4 meals for a total of 60g a day.

Although he has been on this diet for 30 days, I'm going to try adding more carbs back in, maybe around 30g-40g/meal like we did earlier and see if his insulin needs go back to normal. I just hope he has the same good control that he has right now. There are days when he is within 15 points of a 105 (his ideal setting) all day long.

Update: so for dinner last night and today we have gone back to the approximately 30-40g carb meals, eating 4 meals a day. What is fascinating is that I used the 1:10 setting. At all three meals so far he spiked (200 or so), then went low within 2 hours. He is has the Dexcom G4, so we are monitoring closely. I think that over the next couple he will go back to "normal."

my guess is if he is eating very little carbs he needs some insulin to cover the protein and fat, hence the different ratios. i hesitated to respond because obviously we are at two opposite spectrums in diabetes management. i just had to check my sons meter, he is 14 and maintains a1c's in the low 7's which i think is commendable for a growing teen. he averages 250-300 plus carbs a day! we pre bolus, and always incorporate fats and proteins into his meals and snacks. but he is growing and he is a teen and likes certain foods. it is hard enough growing up with diabetes i have never felt the need to change his diet significantly, we always ate healthy before and are just more mindful about balance now. i wonder how your son feels about his diet and also what his endo or pediatrician feels. we all have to do what is right for us and our children. i hope when jacob is a bit older he will consider going lower carb but for now i think letting him feel like he has control in his decisions is important at this age. best of luck with your son, just felt like i had to put in my two cents, i am wondering now what the average carb consumption is for teens and or tweens.

I find this very interesting. I too have a 10 year old boy (skinny, 36kg)on the pump for past 3+ years, Dx 2006. He too has Hba1c between 6.4 and 6.9.

He eats on average 200 gr carbs a day, not limited, as part of a varied and healthy diet

His ratios are set the the moment to : 1:C at bfst 1:13; 1:16 for the day and 1:14 for evening. I have also noticed that at school where he runs and plays straight after a snack 1:20 fits better and if he eats close to bed time (half an hour or so) 1:10 works well. So it changes, as it does for your son. What I am trying to say, the bodies metabolism rate is different throut the day so it does not surprise me to have such different ratios.

I also found I have to swing between 1:14 for bfst to 1:12, fine tune the basal at that time and then get back up to 1:13 etc, all test test and experiment just as you do. POINT here - tweek to basal does a LOT for my son and subsequently to I:C ratios.

Now I am not sure that limiting carbs or any food as a part of a balanced diet in a developing child is a good thing. Would love to hear how it affects its energy / mood / growth etc levels. I do know that we generally eat TOO much carbs nowadays.

As for lows during the day and drastically changed I:C ratios (lower ratios higher insulin doses, right?) i trust you have considered following:

- LOWS before: GI of carbs he eats (thinking insulin was faster then his food)
- increased demand for insulin: hormones? growing etc...

Hope some of this musing helps. I love your train of thoughts.

I guess I'm with Jacob's mom. My 12 yo son probably averages 250 carbs a day. His doctor said that he is a kid first. He just happens to have diabetes. If he goes to a party with pizza and ice cream he eats it. W just count his carbs and give the bolus. His A1c has not been above 7.1. His last was 6.3. I try not to be to strict because I don't want him to sneak food without telling me. This has worked for us so far. He is a growing boy he is going to need the carbs for energy. His body just may not be getting enough. My sons carb ratio varies too though. He is 1:8 at breakfast, 1:10 at lunch and 1:6 for dinner and he takes his lantus at bedtime. We do try to have carb free meals like cauliflower crust pizza every so often so he doesn't have to inject. I would talk with his endo and get their opinion. All endos will be different, you just have to have one you trust.

Thanks for the reply! Our family has never been much over the 150 carbs per day level for any of us, but I understand how a teen could eat 300 easy! We had actually never intended to stay on this low of a carb count diet (I do it with him); however, from the beginning he really liked the diet. Calorie-wise he gets 2000 calories a day, which seems to be adequate. He reports that his energy levels are no different between the two diets, but he is hungrier less often on this diet. He has been on the diet for 30 days now and did not lose any weight, though did grow about a 1/4 inch (little bit less than 1 centimeter). As for his pediatrician and endo, I've never found any research that says eating 50 carbs, but getting almost all of them from vegetables is bad. Because he likes the diet so much and because his numbers are so steady, I've been hesitant to add more carbs. If we were having problems getting enough calories or vegetables, I would of course change it. The only thing I don't like is that he is using just as much insulin!

Thanks for the input. I know that malnutrition and low calorie diets are correlated with diminished growth, but his diet is 2000 calories a day with 2/3 of the carbs coming from veggies. The other third comes from nuts and peanut butter. He drinks fortified almond milk instead of cow's milk also. I absolutely know that we are well under the daily recommended allotment for how many carbs he is eating. As for energy, he hasn't reported a change. He requires the same amount of sleep and if anything is more active. I'm a runner a few weeks ago he asked if he could start running with me. He runs for 2 miles three days a week. Now that I think of it, maybe he had a gluten intolerance? Maybe that is why he is feeling a little more energy? As for mood, he says that he is less hungry on this diet. I've been doing it with him becuase I, like others, very it as a bit extreme for a 10 year-old and if he didn't like it, I would have already moved him up in carbs. Originally, I was lowering carbs and then go to raise it up until the point where his BGs lost their "steadiness." But the difficulty is that he likes it and his BGs are great. According to his Dexcom G4 software, his BG has averaged 112 over the past 30 days with a standard deviation of 33. He deals with very few lows under 75 and very few highs over 170. He only goes over 150 maybe 5 times a week. I think we will bump him up to 30 carbs a meal and keep the 11 carb snack and see if his insulin needs remain about the same. If we can keep his BGs levels around where they are now, I will be very happy.

Thanks Linda! I appreciate the input. Our endo was the one who suggested some diet change to get better control over lows. Though, I don't think she was thinking a Bernstein diet, that was the first book we read! Also, though his A1c was coming back good, his standard deviation was higher than she liked. As for sneaking food, we have never worried about this. Like you, we let our son eat whatever he wants to within reason. I suspect the only difference, is we do all our meal planning in advance and we only have dessert once a week. Like my wife, our children are just naturally extremely controlled when it comes to food.

congrats! as long as your son is liking it and feeling good kudos to you and him, maybe i'm a bit jealous because my son isnt willing to change! but at 14 things are a bit different, this morning he was 53 and he has gym and wants to work out after school, he is good he gets up tests got his apple juice for his low....i wanted to give him some extra milk with his breakfast and he is like mom i never have that i dont need it.. i say well i am pretty smart and a little bit more respect would be great... he says you should get the most annoying award! lol...tread lightly with grouchy teen! a day in the life of a parent with a diabetic child that no one else would relate to but all of you! as long as your son is liking it, getting in enough calories and feeling great god bless you for doing the unamerican thing and starting your son off with a healthy start. we generally eat way healthier than most kind of in between you and the rest of america! best of luck! amy

Me again.....was just reading "think like a pancreas" and found this on page 51 (new edition) Under Factor 3: Food he heading:
"Protein's effect on blood sugar is minimal. One exception is when very little carbs is consumed. Without dietary carbs to provide glucose for meeting the body's energy needs, the liver begins to convert some dietary protein to glucose.......However, when carbohydrate is present in a meal or snack, protein has little to no effect on the blood sugar."
To me, that means you still need what your body needs whether you get it from protein or carbs, therefore insulin requirement is more or less the same on both diet plans (is that the case with your son?)

I think that is what was happening with him as well. We moved back to he higher carb meals and he quickly adjusted back to his old settings. For the first two normal carb meals I went with a 1:10 ratio, and he spiked on both a bit and then went low on the second meal. So, for snack (a 30 carb snack) and supper last light I went back to the 1:13 ratio he has had for years and he stayed level. So, my thinking is that his body was able to adjust pretty quickly adding carbs back in, though it took a lot longer for him to need more insulin for less carbs. I originally made a typo and said he had been on the diet for 3 months. I actually meant weeks. For the first few days we only had to bolus for the carbs themselves, but then slowly he required more and more insulin. At first he didn't want to change his diet back to adding more carbs (I'm not making that up, I swear), but I explained to him that he was using just as much insulin on the low carb diet as his was on his old diet. He's done one other YouTube video. I'll see if he will be willing to do one on this diet experiment.

Thanks for sharing all this with us. Just as a mater of interest on low carbs mostly veg + protein diet did you have to use extended or combo boluses to avoid lows at less then hour marks?

Nope, not on the lower carb diet. Even though he required the same amount of insulin for a meal with 3 times as many carbs, his BGs mostly stayed steady without doing extended boluses.

Check out this group on Tu - TAGgers UNITED. Check it out. You may want to try it. I use it with my dtr at times and I usually have good results.

Awesome! I just joined and will read up!