It sounds like you are on the right track with the diet for your child. As some members have already pointed out, humans do very well on a variety of different dietary regimens eating what is available in their environment. The key being that they lived well by eating fresh , unprocessed food.
It seems strange to me that doctors routinely recommend extreme ketogenic diets for children with epilepsy and get excellent results, yet medical professionals in the diabetes field stubbornly stick to the belief that their patients need a high amount of carbs in their diet, especially children. I don't want to be too paranoid, but I think it would be wise that you don't talk about your daughter's diet with her medical team unless you know they can be trusted. All too often parents are threatened by child protective services if a doctor thinks the parents are not following the correct medical protocol. Keep the diet to yourself. Being none the wiser, they will be pleased with the results
Thanks for outlining this DAPHNE and it's pluses and minuses, Sally; I've wondered about it when I heard it mentioned. All the self-management emphasis is great, but the 1CP is just a return to the old exchange system, the lack of pp goals is strange and bottom line it's the same ole "you can eat whatever you want and bolus for it" that is popular in the U.S. and which is, imho, a catering to the culture of indulgence and an abdication of responsibility to look at things like the ultimate weight gain and IR that can result. And hey, if you never check your blood sugar PP you won't know if that plate of rice sent your blood sugar through the roof. My friend's husband used to do that. He would never test after a meal, but would test before the next meal and he and his wife would exclaim at his good blood sugars! I don't think they liked it when I said, "sure, you totally ignored the spike!"
I know I rant a bit on this topic, but why do people look on it like there are two alternatives, 1. Eat whatever your little heart desires, no matter how crappy or 2. Restrict your diet to boring things and feel like a deprived martyr. Some of us feel good eating healthy! Not to mention enjoy those good pp numbers!
Even though the paleo is far from my own choice, I think Fiona is on a great track with supporting her daughter in healthy eating.
I concur 100% with Brian's analysis, and here's another problem with basing insulin doses solely on estimates: foods vary! Two tomatoes of the same size and weight can vary significantly in their carb content. So if you rely on the Mark I eyeball to determine carb counts, you have the same variability issue that Brian describes with regard to labels. Eat to your meter. It's the only empirical number you have, and empirical data trumps the best estimating rule in the universe.
I would have agreed with this until I read Nora Gedgaudas' Primal Body, Primal Mind. Most medical opinion about carbs seems to not be based on fact, unfortunately.
Has anyone ever known a child in the U.S. that suffers from stunted growth? It seems like our kids are more prone to excessive growth.
But as we know, meters are only within 20% of what they need to be calibrated off. Meters aren't accurate (and cgms is only within 10% of the meters so that's no better), but they are just something we have to go with as we can't get better. There is no such thing as precise anything. We've all done it, taking a test from different fingers or different hands. Or switching to our backup meters and finding different results.
But that is the thing with DAFNE, it trains people to eyeball things. I remember my training with it, different plates of pasta, different fruits, and things. From that you run the numbers off your doses and meter. The old UK system from the 70's and used right up to DAFNE wasn't bad, it just wasn't as in depth as DAFNE. Based on the, here's a biscuit, it's 10g type approach. Heck, I still have in a draw my original 70's bright orange ring bound monster guide to food. It's quiet amusing these days, but I think it was the reason I was pretty good in school at maths having to do it from such a young age. And while DAFNE is time consuming, the 5 days of all day training it gives us is brilliant, and great it's being rolled out to all diabetics over the older systems.
My issue with eating to a meter is eating less because it's high, or more as it's low takes away choice. These things shouldn't be a concern, we correct and we go on as we feel. We shouldn't be limited by meter, by carb value, or anything else. We should have the freedom to be able to adapt to enjoy all foods and not be a slave to sticking to one thing to play the numbers. We aren't slaves to these numbers to make decisions over what we eat, we choose. Healthy or otherwise, it's our choice, but the numbers shouldn't ever play a part of interfering with our freedom to do anything.
Parents bother me with this. While they do try to help they tend to do nothing but regulate the poor kid even while not knowing it. Come later years all that occurs is the kid snaps and rebels from the parent who's enslaved them to a regime which limits their freedom of choice over food and activity. And either ends up loathing them for it, or worst that I've seen repeatedly hospitalising themselves with DKA through rebelling from their parents and along with it everything else.
Well, this is an area where individual conscience has to rule.
But I have to correct one misstatement in your post. It's not true that meters are only accurate to within 20%. That's the most they are allowed to be off by, not necessarily what they are. In other words, 20% is the maximum range within which they must fall. That doesn't mean that each meter is that far off, and most aren't.
The way to gauge your meter's precision is to compare its readouts with the ones you get from a full on laboratory test. My meter, for instance, is always within 4% or better. Every time.
And no one (most certainly not me) is claiming that absolute precision is possible or achievable -- just that empirical measurement is the best you can do. Certainly better than guessing, and that's what an estimate is: a carefully calculated guess.
Just to be clear, I am not arguing for one technique at the exclusion of others. Apply your own judgment to your own individual circumstances, but in so doing, use ALL the data you can get. Every last bit.
My understanding of "eat to your meter" - at least the way we use it here, is it doesn't imply "eating more because you're low or less because you're high". What it implies is looking at the results of your 2 hr pp tests to see what works and what doesn't. If no matter what kind of cereal you try, 2 hours pp you are always 200 than that is telling you that cereal doesn't work for you. (Some people would say just take more insulin, but there are flaws in that way of thinking such as developing IR and/or gaining weight).
The level range is what you set yourself. They have a guide, but on day one you set a range you want to get your numbers into and each morning you compare notes and tweak to achieve it. It's quiet interesting to share all your blood readings each day through the week with everyone else.
What you missed out above is the training on the different types of insulin and absorption curves and also activity times and drop off periods for them, to also bring into your range your food v insulin. Sometime having the insulin after a meal, sometimes later if on MDI, or on a pump tweaking different curves.
The CP system though get's canned by the students usually first day since we have all been using standard carb counting, and well all CP is just dividing it by 10...so a waste of time. But it's all the same thing give or take a decimal point.
On our course we were all taught to test at wake, test before a meal, test two hours after a meal, test before bed, test any other time you feel like which was part of the test grid. The two hour after a meal though is part of the course. Anyone complained about using too many strips, tell them where to go...but that last bit was very much a British thing about dealing with our GP's :P
The course actually does mention healthy eating briefly, but it's more just mentioned along the way as it being a personal choice and being diabetic shouldn't ever limit any of your freedoms to choose be they good or bad. And that good/bad food was another discussion since this was to just deal with allowing people to use those freedoms.
The big thing though is flexibility. One girl in our group only ever ate one meal a day. Others had the old style of 3 meals and 3 snacks. But again that was the thing, choice for us to do whatever and be able to adapt to whatever that may pop up through the day. Yes doing it, it does feel very intensive training which it is. But being able to have that pizza, or just a soup instead or nothing at all are great freedoms to do what we want, and not be controlled by what my meter says or be limited by being diabetic at all.
Problem David (dns)- you don't think your lab blood sugar has some bit of variability associated with it's test too?
One of my local hospital's lab sheets on equipment said a glucose analysis needs to be within +/- 10% of actual. Doesn't sound a whole lot better than these meters......
Not sure if this was sarcasm?
Most people would view stunted growth more on the height side and perhaps organ development etc and not so much their increasing or decreasing weight.
would a good multivitamin and /or supplements help if there were in fact a danger of stunted growth in Young children who eat a low carb diet? i mean, i think a healthy low carb diet is good for adults, have no idea for young children...
Well, the charts that I have always seen look at height and weight and not height and organ development. So, in the US I guess kids do suffer from excessive growth in that the can be short, yet overweight.
Hi,
I really feel like I need to chime in here. I am a mother of a Type 1 child --we are 1.5 years into this. She is 10 years old and we do the Bernstein Diet as a family. I have type 2, and my other children are borderline type 2.
We all have A1C's in the 5% range, even my type 1 daughter. Ok, we don't always stick to the "6-6-12", especially since my kids are very active. However, we are TOTALLY grain free, gluten free, and dairy free.
Let me just say that my daughter's health is outstanding. We just got her most recent blood work back from our family physician, and he scribbled all over it with "Awesome!" "Amazing!" and "Perfect!". He said he can't wait to see us for our next follow up. She is growing, she is happy, and she actually loves eating this way. We do not feel deprived at all.....we just put our heads together and rock out in the kitchen as a family. My son came up wit a grain free recipe for a pound cake....and he named it "Poundless Pound Cake!" It was totally yummy. We do not miss bread and junky carbs at all.
As far as I know there is no evidence that carbohydrate, or higher levels of them are essential for growth. However there is evidence that high bg do stunt growth in children I believe. Diabetes is so different for everyone, if she is happy eating what she was normally eating, and she is ok, I would just stick with that, provided she doesn't have too many lows. Lower carb will prolly allow her to use less insulin over all anyway. You can adjust Dr. Bernstein's diet, you don't have to stay as low as 30g or even eat the foods he does/recommends, she can still get the benefit of a low/moderate carb diet hopefully that way. I would just go ahead and try whatever her normal diet was, monitor things closely and then show them the results. No one will argue with good results. And remember, you and she are the ones who are really going to be managing this in the long run, it is all trial and error for each person.
That recipe sounds great! can you share it here?
I absolutely agree the "Type 1 Diabetes" by Hanas is the most complete book I have ever read. I highly recommend it.
I'd be hesitant to go all out with small kids. Frankly we don't know enough about their nutritional needs to know for sure, but you can certainly get rid of all sugar/sweet straight off the top. Then cut back on simple starches and high carb foods like bread, potatoes, pasta, etc. Get rid of fruit juice (generally not healthy for anyone)and go with water. Then cut back on milk (go with cheese). Then eat plenty of vegetables. Fruits nuts, and beans should probably be eaten in moderation (a normal serving, but no pigging out). PS No popcorn...it's worse than bread.
My understanding is that kids can have fairly chaotic BG levels with all their hormones kicking in all the time, so taking a DAFNE approach with a child is probably a bad idea. The DAFNE UK website states ( http://www.dafne.uk.com/342.html )...
"DAFNE was developed for adults with Type 1 diabetes and as such is not suitable for children with Type 1 diabetes."