You know, I wouldn’t sweat the low-/no carb issue. For a few months after diagnosis, I would see all these posts of flatlines from people who were going low-/no carb for their kids. I seriously debated whether that made sense, and, like you realized that it wouldn’t make sense for our growing kid and his older brother.
But I felt really torn, like maybe I was worsening his life and increasing his risk of complications. I imagined him being 17 and dealing with kidney disease, and knew I would feel incredibly guilty if I hadn’t done everything in my power to prevent that.
Then I started actually doing a few low/no carb meals and noticed that they actually spiked my kid higher than the equivalent high-carb meal I just bolused for… I started crunching numbers and found no correlation between his daily carb intake and his time in range, TDD, avg bg, or glucose variability. (Granted, there is a confounder in that, when someone is running high you tend to avoid giving them carbs, while when they’re running low they need lots of carb corrections, which could wash out the effect of carbs on his numbers.)
As for low-carb, it takes a whole different approach to bolusing and my guess is there’s some threshold. If you go below it, maybe you can achieve that flat line, but if you’re above it, you achieve the same level of swings without getting to eat very enjoyable foods. There’s also a rough transition period where BGs may actually be worse as the body interprets the lack of carbs as starvation and amps up insulin resistance.
And when I meet adults who have these crazy low A1Cs, they’ll say they become so sensitive to carbs that they may take 1/4 of a glucose tab to treat lows!!
I don’t want my son on a diet where a wayward gram of carb here or there would be the difference between a 150 and a 60! It just seemed too restrictive for him, not to mention his non-D brother.
I also started asking people in real life I met who had achieved good A1Cs for their kids, and none of them actually did low/no carb. Instead, they were super meticulous about tracking/logging everything and knew their kids responses very well. Their kids also stuck to routines, eating similar foods every day at the same time, and practiced good BG hygiene. For instance, not eating while high, waiting to come into range, not snacking at night, etc.
I am realizing it IS possible to get a great A1C without restricting my son’s diet beyond the reasonable limitation on junk food. In the past two weeks Clarity has changed its A1C estimate for my son from 6.9 to 6.4 – all we did is up his basals and strengthen his carb ratios, and we actually let him eat MORE carbs. He’s in range pretty much all day, and between 70 and 160 about 75 percent of the time, with 2% of the time spent low. So that has made me realize it’s possible to actually get a decent A1C relatively easily. Of course, we are using openAPS which helps, but I think it is still possible using CGM to achieve similar feats.
All that is to say: Take heart and don’t feel you’re short-changing your son for not doing a low-carb diet! I am positive it’s possible with all the technology at our disposal for your son to achieve great blood sugar control. Maybe not an A1C of 4.9 to 5.4, but a 6.0 or 6.2 for sure. Also remember that no studies have demonstrated a reduction in complications for type 1 diabetics who are running this low compared to those with, say a 6.0 A1C – because so few people with type 1 diabetes have historically been able to achieve these levels.