I have a teenage son diagnosed three months ago. My interests as he moves out of honeymoon is to keep an eye on the amount of carbohydrates he receives to help with stability of blood sugars and to reduce the amount of insulin he needs.
How low is too low? I hear about the connection of dka and hypoglycemia.
Mainstream calls it carb restricting. I am calling it carb reducing.
Anyone work this way? Anyone work this way during honeymoon to prolong honeymoon?
Thank you.
I'm a fairly active person and I keep myself to under 30g of carbs per meal for most meals - enough for a sandwich or burger, as long as I don't slather it in jam and choose a side salad rather than fries!
Diabetic Ketoacidosis comes from the body not having enough carbs & insulin to handle its energy needs. It starts breaking down fats to produce energy and this results in ketoacidosis. This can happen to anybody on a low-carb diet and is fairly easily preventable. You can actually feel it as it starts to set in so if you dial the carbs down until he starts to notice it between meals, then bring them back up to where he feels fine, you'll be able to work something out in a week or two.
Hypoglycemia comes from the blood sugar dropping below safe levels due to too much insulin/activity. Keep some Dextabs or juice on-hand at all times to correct this. I keep my Dextabs in my pocket but a fanny pack is VERY handy. You can also get little 4-pack containers that clip onto a keyring or a glucometer.
A lot will depend on your son's activity levels and, for the first while, you'll be learning and adjusting.
The good news is that you can adjust things down the road to improve his sensitivity if it starts getting out of control.
Also, some general advice is to grab the following:
- Calorie King app/site (carb values for food, including fast food)
- Diabesties (BG tracking app that will share readings to an attached account. This way you'll be able to see his readings, and text with him, as he logs them. Full disclosure: I work for the company that made this app. But, it is completely free)
Best of luck!
Cheers,
Adrian
Our endo did not recommend restricting carbs during teen years. My son is 20 now and voluntarily watches his carb intake now averaging 100 to 200 carbs per day, but did not during his teen years. Between playing competitive sports and growth, at times he averaged 300 to 500 carbs per day.
My son did not have the benefit MDI or pumping until age 13 for MDI and 14 for his insulin pump. Up to that point, he was on a fixed meal / snack schedule of about 2,500 calories. He was always hungry. On moving to MDI and then the pump he grew so quickly that he has stretch marks up both sides. It is obvious to me that his body was greatly in need of the extra carbs that he was able to access on moving from the outdated food exchange system to carb counting.
I am not sure that restricting carbs will prolong the honeymoon. Once the immune system decides to kill off the beta cells, there isn't much that you can do to slow it down or stop it.
As for how low is too low. most agree the proper range for a teen is 80 to 150. But something in the 70's still isn't considered a true low, you just dont want to leave them there because bg can fluctuate so fast. I know my oldest, before she was dx'd typically ran around 75. But now that she is on artificial insulin she cant stand it as soon as she hits the 70's, she begins to feel low at about 78.
I know the amount of carbs is a hot topic here on tu, so i will only relay what we do. Your diabetes may vary. My girls are 10 and 12. One is 4'11 78lbs, the other is 5'1 90lbs. They both fall on the average to slightly under on BMI. They both engage in 25 hours or more intense physical activity (they dance and swim competitively), that DOES NOT count running around with their little brother or jumping on the trampoline ;). The nutritionist that we meet with every year says that for my girls to continue to be competitive, and grow properly (puberty is around the corner) they need between 200 and 300 carbs per day. or 65 to 100 carbs per meal based on a 3 meal day (they typically eat 4 meals a day). My girls have decent A1C's (except when my almost teen decided she wasn't going to test anymore, thank God we are past that!) They tend to be in the 7's. My younger daughter had no honeymoon, she was making no insulin when she was dx'd, super scary!. My oldest had a honeymoon that lasted about a year and a half. Little change in insulin needs, could sneak food, forget to dose, and she still had an A1C of 6.0. When the end happened over a course of 6 weeks. We went from never changing levels to upping her insulin every 2 days. that was also very scary! But it didn't matter if she didn't eat carbs during that time. Her body was destroying her last remaining islet/beta cells. She simply wasn't making anymore insulin. Now my girls are both pumping and the amount of insulin doesnt seem to bother them. It is just a number. They are more concerned that i keep our fridge stocked!
Hope this helps. Remember that everyones journey with diabetes is different.
One more tool that might be useful: The EatSmart scale, which a number of us here use, has a builtin database of 999 common foods. You place the food on the scale, dial in the code for that food, and it tells you exactly how many carbs are in that portion. I find it to be an enormous help, both for accuracy in carb counting and for saving time and effort.
I have a Salter scale that my youngest and I use for the exact same purpose. Very handy.
I'm going to come in on the side of Cheryl and say it may not be such a good idea to carb-reduce in a teenager. Keep in mind, they are growing and experiencing brain development. For that, they need glucose. LOTS of glucose. And to process the glucose, they need insulin.
Understand that ketones, per se, are not evil. They are the product of fat burning and are a good and needful thing when someone exercises or is ill. Insulin is the natural limiter of ketone production, because in someone with a functioning pancreas, the presence of insulin signals that there's glucose in the system to be processed, and so fat burning stops. Ketoacidosis comes about in diabetics when there is insufficient insulin to limit ketogenesis to what the body needs — that is to say, in a person whose pancreas has shut down but hasn't started insulin therapy (many T1s get diagnosed because of DKA) OR in a T1 when there isn't enough insulin going in to trip the "don't burn fat" switch.
Now, my endo has said that if an ADULT diabetic were to never eat carbs, then all they'd need is a very small amount of basal insulin to prevent ketogenesis, and that would be it. BG would stay stable and they'd never need to inject boluses. But in a kid, that's not realistic, because growth hormones and other factors screw up insulin transport — makes teens insulin resistant, in short. So teens actually tend to need more insulin than adults overall, as well as more food. I have never known any teenage boy who didn't want to constantly stuff his face, and I think if you attempt to limit what he eats to certain foods or certain types of food, you're going to wind up with a sneak-eater, which will make his BG less stable. Counterproductive.
Then there's the whole issue of the fact that teens are developmentally attempting to establish a separate identity from parents. Think for a minute how that works with you attempting to reduce his carb intake in the interests of stable blood sugar. It may start out well... but having raised two teens already, I can promise it won't end well. He'll rebel. NOBODY likes to be told what to eat, and that goes triple for teens, probably quadruple for diabetic teens. And, in reality, he does not need a special diet — that came directly from my endo, when I asked the same thing. He can eat anything he wants (within reason — junk food isn't good for anyone) and stay relatively healthy, as long as he boluses for the carbs.
Bottom line, I think you should let your son eat whatever he wants and dose for the carb count he eats. You will have enough difficulty instilling the testing & bolusing habits without going into "eat this, not that" with him. Pick your battles, and make them few in number.
Regarding extending the honeymoon: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462593/
Not available at this point, but research is hopeful.
I took a look on Amazon. There are different Salter scales and Eat Smart Scales.
Can anyone point me in the right direction?
Which one? I am looking on Amazon?
Can you give me more support on DKA and carb reduction. The endo's get quite nervous when you tell them that I have looked at the amount of carbs per meal that make him stable at this stage. 30 to 40 to 50. I do not think that this is carb restricting. But if I am looking at a low glycemic or paleo type approach or even those that go raw. How low is too low? He is only on 1 unit of lantus in honeymoon so his insulin is already low. How low can I go on carbs? I rather increase his protein/fat content and look at low glycemic carbs and give him paleo bread to eat. But I don't want him to get into trouble. I have not found one person that can answer that yet!