Carbs and restrictions and dilemmas, oh my…

Newsflash: the more carbs in a meal, the higher the post-meal BG. Also, the lower the carb intake, the easier it is to control BG.

Duh, right?

OK, it’s nothing new or shocking. And moral of the story is simple: cut down the carbs. Now, go implement it with an 8-year-old. I think that even our Paleo friends will agree that cutting carbs is not an easy task with kids. So what on Earth do we do to manage carb intake and reduce it? I don’t have any answers, just some musings.

What got me thinking about it in the first place is the recent phenomenon we’ve noticed about post-breakfast BG spikes. When V eats waffles, she can easily go from normal range up into 300s within 1-2 hrs of the meal. Even though she usually gets back into a better range a few hours later, this swing is rather outrageous.

Actually, let me stop here for a moment and process this. A person without Diabetes will eat whatever they want, and their BG will stay roughly in the 100-140 range post meal. But for a kid with Diabetes, going into 200s and even 300s after a meal is “normal”. This is crazy.  And this is not something we would have known had it not been for the CGM that shows us all the “in-betweens”. So my daughter could have a fasting BG of, say, 130, eat her breakfast, and be near 300 an hour later, then go down to 150 3 hours after her breakfast. Think about it. Think about how it can affect her body, her energy level, her mood. Just let it sink in…

Now, let’s take a look at our “problematic” waffles b-fast: Two GF waffles are 41 g of carbs, only 6 g of it from sugar. One table spoon of either syrup or jelly, ranging from 9 g. to 13 g., all of it sugar. 2/3 cups of low fat milk are 10 g. of carbs, with a considerable amount of protein that is supposed to slow the absorption of sugar. The total ranges from 60 to 64 g. of carbs per meal. And it sends her BG through the roof. There is something evil about those waffles. If V eats cereal with milk, which also amounts to about 60 g. of carbs, she spikes a lot less, even though more carbs in cereal come from sugar. Go figure. We started doing this trick with the pump where we reduce her basal for a couple of hrs and make up the difference in the bolus. This seems to help keep the spike from going into 300s. Of course, ideally we’d change V’s breakfast. Get rid of waffles. Introduce greek yogurt with fruit and GF granola, maybe with a small piece of toast. In reality, it’s not going to happen now so it’s not a battle I’m going to fight.

Lunches and dinners are easier to control, especially when we have time to cook from scratch, and we try to build them around protein and vegetables. In the meantime I bought a small Greek Yogurt and will offer it to V with a bit of jam. Maybe she’ll like it this way?

I am hesitant to be aggressive with carb reduction for two reasons. One is that I genuinely feel bad. It is unfair. She does not eat sugary cereals or pop-tarts  or other desserts masquerading as breakfasts. And while waffle b-fast is not an ideal healthy meal, it’s not half bad. And not an every-day thing. Sometimes she’ll have cereal or oatmeal. Or eggs and bacon, when I have time to cook it. And she really likes waffles. How much do we want to take away foods that she loves and most other kids get for granted? It makes me sad.

Another reason is that I do not want her to grow up feeling restricted and resentful about restrictions. I do not want her to feel afraid,guilty or shameful about eating “bad things”. I do not want her to grow up and start making poor choices about her food because parents are no longer in control of it. I want her to develop a healthy relationship with food and enable her to make healthy choices not because she “should” but because it comes from a place of listening to her body and taking care of herself. How do we accomplish it when some restrictions are indeed necessary? How do we strike the right balance? What is moderation? When do I tell V that no, having 100 g. of carbs for dinner is not going to happen, unless it is a special occasion, and when do I let it slide?

A person with Diabetes can eat “whatever they want”, since they can manage it with additional insulin. A person with Diabetes cannot eat whatever they want if all they want is high-carb food. What we put in our bodies matters to everyone. What a Diabetic puts into their body matters x 1000. Even for an adult, the journey and the lesson of honoring one’s health and choosing health from within, while enjoying and savoring food, is a huge task. A kid with Diabetes must start learning this lesson very, very soon. The innocence of cookies and ice-cream and not worrying much about their diet is ripped away from them at the time of a diagnosis, and to a large extent it is also ripped away from their parents as well.