Hello! I’m new here and looking for advice on transitioning a child to a healthier diet and lowering her A1C.
We are long-time foster parents but are new to parenting a child with diabetes. Our 9 year old foster daughter was placed with us about 6 weeks ago, and she has Type 1 Diabetes (diagnosed 8/16). Before being removed from her home, her diabetes management was very poor. She apparently ate a lot of fast food and high carb/sugary snacks, her mom counted carbs inconsistently, and they apparently missed doses of insulin frequently. She was hospitalized twice in the last six months for DKA, and her A1C at her latest hospitalization (just before she was placed with us) was 12.1%.
We are working very hard to feed her a healthy diet, count carbs, test her BG frequently, and help her to dose her insulin properly. She’s very compliant and responsible about much of the process. At her last endo appointment (when she had been with us for 3 weeks), her endo was thrilled to see that her average BG over those three weeks was 127, with only one spike over 200 and only a couple of lows under 70.
Our big struggle now that the honeymoon period of a new placement is over is that she’s starting to become more resistant to choosing snacks that are low carb or to taking insulin to cover higher carb snacks. For example, she constantly wants apples for snacks, but doesn’t want me to cut the apple and give her an amount that is under her threshold (her ratio is 1:12), nor does she want to take insulin to cover that 20 carb apple. We give her the choice between the two, and encourage her to eat her apple with PB (as an example) so that she’s fuller and doesn’t want another apple an hour later and we go through the same struggle again. We don’t budge on this, and are kind about it and give her choices of things she likes, but her response is usually, “Well, Mommy let me have an apple without insulin, and I was fine.” Except, she obviously wasn’t fine…
She does pretty well at meals, especially because there are 4 other kids in the house (including her bio sister) who are all eating the same healthy meal. And she’s fine with dosing appropriately for meals, most of the time.
Additionally, we are struggling because she has twice weekly supervised visits with her mom, and they just got approval to leave the visitation facility (with a supervisor) during visits. After her visit on Thursday, she came home with a 32 oz soda in hand, and had eaten Panda Express (chow mein, teriyaki chicken, and orange chicken with white rice), as well as frozen yogurt. Her BG was over 250 when she got home, and then we struggled with lows all through the night (my husband and I took turns checking her BG in her sleep and giving her juice and glucose tabs throughout the night). Her BG has been like a roller coaster since that evening, and she still seems to be dealing with the effects of that visit. Luckily, her social worker agreed to tell mom no more eating out in future visits, once I told him what was going on.
Any ideas from those of you who have been managing your or your child’s diabetes for longer and have more experience here? Also, any advice on lowering her A1C? We go back to the endo next week, and I am hoping to spend more time with the diabetes educator and dietician at that appointment as well. If you’ve read this far and have any advice for me, I greatly appreciate it!