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Probably the biggest confusion people not familiar with diabetes have, regardless of Type 1 or Type 2, is about the difference between sugar and carbohydrates. Everyone automatically equates carbs with sugar. We used to think the same way and were thoroughly uninformed prior to V’s diagnosis. The reality is that carbs come from many different sources. Let’s break it down. There are three types of carbohydrates: starches, sugar and fiber. This means that there are carbohydrates in many different foods: grains, fruit, nuts and seeds, milk, and starchy vegetables, just to name a few. Even non-starchy vegetables have carbohydrates, but usually not enough to be concerned about. It is also possible for a food to have a substantial amount of carbohydrates and not a single gram of sugar. In fact, there is a quinoa blend we purchased at Costco recently, which contains 30g. of carbs to a 1/4 cup of dry mix and zero g. of sugar.
So the photo above that spells out the word carbs with various bread and pasta products is totally misleading. They could spell carbs with kale and it would still be accurate.
When we eat carbohydrates they are converted to glucose, which fuels our body with energy. Therefore, consuming any foods containing carbohydrates raises blood glucose. As a rule of thumb, anything more than 5g. of carbohydrates needs to be covered by insulin. This is where carb counting comes in. We need to know exactly or as exactly as possible how many carbohydrates V will eat in order to accurately calculate the right insulin dosage. We read labels very closely because the carb content varies greatly from product to product. Processed foods are especially tricky and can be “carby” even when low in sugar.
OK, so sugar is not the only thing to look out for, carbs come from many sources, even veggies have carbs, count the carbs and give insulin. Got it.
But wait, there is more! Not all carbs are created equal. Let’s start with simple carbs. Simple carbs are your good old sugar, aka fast acting sugar – cane sugar, honey, juice, etc. They are a quick source of energy, digested very rapidly, and can send your BG soaring in no time or put you on a roller-coaster of highs and lows. So sugars are the enemy? Not so fast. They are essential for treating lows, when you need that quick boost in BG immediately. V always has to keep a supply of fast-acting sugars on hand. We favor glucose tabs, jiuces and energy gells for durability, ease of use and effctiveness.
So, carbs are everywhere, simple carbs are good for treating lows, but otherwise not great for BG. Check lables, count the carbs and give insulin. Got it.
But wait, there is more! Let’s look at complex carbs that are, well, complex…
Starches are complex carbs. Also, fiber is a complex carbohydrate. And you thought it was only good for keeping regular! Fiber is the type of carbohydrate the body cannot digest, so generally it does not affect BG and does not need to be covered by insulin. That’s the reason non-starchy veggies are “free”: even though they are carbs, they contain so much fiber that unless you eat a metric ton of them, they will not raise BG. Starchy veggies have more carbs that have to be accounted for, so don’t load up on that loaded baked potato before calculating its carbs. Also, as a rule of thumb, if a food has 5 or more grams of fiber per serving, we need to subtract that from the total carbs.
By the way, a glycemic index will give you a good ballpark idea of how quickly different carbohydrates are digested and converted to glucose.
OK, so we have to look out for carbs everywhere, stick to simple carbs for treating lows, aim for complex carbs for slower release of energy, check on fiber amount and subtract it form total carbs, eat veggies with abandon but be mindful of starches. Got it.
But wait, there is more! Let’s talk about foods high in both carbs and protein. What’s protein got to do with it? Protein slows down the absorption of carbohydrates. It does so in a rather elegant way, too. Instead of delivering all of the energy at once it provides a slow release instead. Less crash and burn, more sustained energy, less chance of blood sugar spiking up. Yogurt, for example, may be a better snack than crackers when we want BG to maintain, because of the higher protein content. However, it’s not as good a choice for treating a low because it does not kick in right away.
Alright, carbs are practically in everything so pay attention, aim for complex carbs, account for fiber and subtract it from total carbs as needed, veggies are free except when they are the starchy kind, add protein to help keep BG leveled, but stick to simple carbs for treating lows. Got it!
But wait, there is more! Let’s add fat to the mix, specifically the greasy “bad” kind of fat. Think cake, ice cream and pizza, not eggs and avocados. Fat also delays the absorption of carbohydrates. But wait, isn’t is a good thing? Protein delays the absorption too and it makes for more leveled BG levels. Alas, no. Put simply, fat postpones the inevitable spike in BG until a few hours later. If V has pizza, she will be OK for a couple of hours, and then BAM her BG is sky high. We try to offset the effects of fat by programming the pump to deliver only a portion of her insulin right before meal, saving a good chunk of it to be delivered over the next 3 hrs as we anticipate a post-meal spike in BG at a later time than normal.
OK, let’s see here. Carbs are everywhere but sugar is not the enemy. Simple carbs are essential for treating lows but stay away from them unless you want to send BG to outer space. Complex carbs help BG to stay more leveled. Fiber matters, don’t forget to subtract it from total carbs. Eat your veggies. Don’t forget that fruits have carbs too! Protein will slow down absorption of carbs and provide for slower release of energy, so make sure your meals have some protein. Fat also delays the absorption of carbs but then the BG spike will ultimately catch up with a vengneance, so adjust insulin delivery accordingly and be mindful of how much fat your are consuming. Especially when it’s fat combined with simple carbs, like cake. Got it! Or not. Because wait… Is fat the enemy, or maybe cake, or pizza? But fat does not even have carbs or sugar, so what gives? Do we continue to fraternize with the enemy and find ways to adapt? And what do complex carbs really ponder about?
I don’t know how about you but my head hurts by now. If you got through this post and are not thoroughly confused, I will give you a cookie, but only if you are able to correctly explain to me the complexity of how it will affect BG based on its unique carbohydrate, fiber, protein and fat content.
With V’s diagnosis of Celiac came a massive purge of many pre-made foods that we had in the house. On one hand it’s good for everyone: the less processed food we eat, the better. On the other hand, with both parents working outside the home, we rely on pre-made food for some of our meals because we simply do not have time and energy to make every meal from scratch. We said good-bye to chicken nuggets and breaded chicken for while. Not that we’d eat it often, but from time to time it came in really handy when we were in a pinch. Then a friend of mine clued me in that Target had gluten-free chicken nuggets and breaded chicken made by Tyson. It was really yummy and you could not tell it was gluten-free! And, compared to other brands we found in specialty stores, it was affordable! (Please don’t get me started about the exorbitant price tags of some GF foods.) And then, on a recent trip to Target, I noticed that they added Perdue brand of GF breaded chicken. Naturally, I had to put both brands to a very rigorous and scientific test. It just to happened that V’s best friend and her Mom were visiting so I recruited them to be my expert testers. I prepared both samples by first heating them up in a microwave and then toasting them in a toaster oven. My testers did a blind test: they did not watch the preparation and did not know which sample was which brand. Here are the exciting results of the test:
Smell: Sample A won a unanimous preference. Sample B did not smell badly but everyone said that sample A smelled more like real chicken.
Visual Appearance: Sample B won hands-down. It looked more flakey, more fresh, and it looked more like a breaded chicken breast. Sample A looked more like a long chicken nugget.
Taste and Texture: I participated in this portion of the test and we had mixed results. I had a preference for Sample B because it was softer and I liked the flavor of the breading. Kids and friend’s Mom preferred sample A. Kids said that sample A tasted more like chicken nuggets and they liked it. Friend’s Mom was not a fan of the breading flavor.
Nutrition and carbohydrate content: Both brands use boneless chicken breast with rib meat as the primary ingredient. The list of ingredients for Sample A is shorter. Sample B contains soy oil as one of the ingredients, which is not something I am crazy about. Both samples have equal carbohydrate content: 14g.carbs in 87g. of Sample A and 13g. carbs in 84g. of Sample B, which amounts to about three pieces for each brand.
Price and accessibility: Both brands are available at Target in the freezer section but I have not been able to locate them in any other stores. Perdue’s price tag is $5.79 for 22 oz. net weight. Tyson costs $6.29 for 14 oz. net weight – significantly more expensive.
Overall impression: If you did not know these samples were gluten-free you would not be able to tell. Perdue brand is slightly less processed but in taste and appearance strongly resembles chicken nuggets. It is also less expensive. Tyson brand looks and tastes more like breaded chicken breasts but it is a little more processed, more expensive, and breading flavor may not appeal to everyone. Ultimately, it is a personal preference. We have a few bags of Tyson brand left in the freezer and once we are through with them we may switch to Perdue, or may continue to purchase both.
I took my kids on a first real trip since T1D diagnosis. We went to Disneyland last year but we drove there, only stayed for a couple of days, my husband came with us, and we were fairly close to home. This time I flew solo with kids to visit friends who live in a small town in a different state. This presented a first-time challenge of packing all of the diabetes supplies. Now, packing for T1D is like Noah’s Arc on steroids. You have to pack two of everything, and then some more, to be prepared for every contingency. And there’s lots of “everything”: meter, strips, lancets, pods, sensors, tape, various wipes, fast acting sugars. And there is a bunch of paperwork, just in case: a letter from the Endocrinologist, a list of all medications, notes from the pump and CGM regarding TSA screening and safety for X-rays. I made my list, I checked it twice, I packed. I felt very prepared.
Going through TSA was fairly simple. Since the CGM could not go through the X-ray machine, we requested a visual inspection. I was a little concerned about how long the process would take, since we were also carrying enough sharps to poke every passenger on the plane 50 times, plus insulin and other liquids that would be too much of a pain to put in a zip lock baggie separately. I also prepped my daughter that she may need to go through a pat down. Imagine my surprise when it was I who got frisked by TSA. “We do not pat down children”, they said. Interestingly, I have heard of some other T1D kids getting pat-downs, so I do not know if there are different rules for international flights, or if TSA agents don’t always know what they are doing. Nonetheless, it only took a few extra minutes for us to get through security, they looked through our belongings but thankfully were not perplexed by anything. We were at the gate with plenty of time to spare and found a spot to finally eat our breakfast.
V opens her diabetes kit and asks: “Where is the poker [lancing device]?” Umm, what? We look, it’s not there. We go through her bag, it’s not there. We must have left it in her room in the morning. But hey, we packed double of everything, so I go to our back up supplies and pull out another lancing device. Whew. Crisis averted and I am feeling pretty smug about being so prepared. So smug that I snap a picture of the back-up supplies bag at the airport while we are waiting to board.
About a day into our travels I realize I should have packed a plastic container for sharps. Normally she disposes lancets in a small container that she carried in her bag, and we dump it out into a large container at home. And it just so happens that my friends do not happen to have a plastic container that would work. Besides, I would not want to leave it there, and would need to bring it back with us to dispose of all the sharps. I got lucky there. I happened to put some of our airplane snacks into a tupperware container, which I was able to re-purpose for a sharps container for the trip. Of course I could have made a trip to the store and purchased a suitable container, but still… OK, lesson learned and I am feeling less smug.
Moving along, things are going pretty well for a few days, and then it’s the night before going home. It is 10:15 PM and I see that V is down to 2 test strips in her kit. But hey, I brought more, so no worries. I reach into back-up supplies bag. I do not see the strips. How can it be? I packed them for sure! I was absolutely certain. I crossed it off the list. Maybe the box of strips fell out when I was getting something else out? I tear the room apart but alas, the strips are nowhere to be found. And we are in a small town. Almost everything is closed down. ALL the pharmacies are closed. The next 24-hr pharmacy is at least a 45-minute drive. O.M.G. Breathe. Do not panic. There must be a solution.
Somehow my reptilian brain kicks in with a memory that I saw diabetic supplies on the shelves of a CVS store, not exclusively behind the pharmacy counter. Hang on… You don’t need Rx for most diabetic supplies. It’s just ridiculously expensive without insurance coverage. So maybe, just maybe, if we find a store that is open, we can find something there. To my relief, the Walmart is open until midnight. I have never been happier about going to Walmart, which I generally prefer to avoid. But on that night, Walmart = love. My friend takes me there, and on the way mentions that she has a diabetic friend and, if nothing else works, she will call and wake her up and see if we can get strips from her. I’m deeply grateful but crossing fingers that we won’t have to use that option. I also ask my friend about where they would get their medication filled if they needed it in the middle of the night. Is there a pharmacy at the ER? And perhaps if I cannot find anything at Walmart I can go to the ER to have a heart attack and ask for some test strips on a side.
We get to Walmart, where indeed there is a diabetes supplies section. There is hope. I scan the shelves like a hungry vulture. I find several brands of test strips. The cheapest box is over $50. Who cares, I’m willing to pay whatever it costs. Except none of the brands are compatible with the two meters that we have. I scan the shelves again and spot a kit that includes a meter and 20 test strips. It’s not a brand we use or will use in the future, but it will do! And it’s under $20 to boot. I walk out with much needed supplies and without a heart attack. I get back to the house, test out the meter and the strips and everything works well. Breathe and eat chocolate ice cream. Crisis resolved.
Next time diabetes packing will be a two-person job. One of us will pack and the other one will check everything against the list. And maybe we will pack triple of everything, just in case.
First week after school got out was a camp week for the kids. V went to Camp Wana Kura – a day camp for kids with Type 1 Diabetes. This was her opportunity to feel completely normal and to be fully supported by a team of nurses and volunteers, the majority of whom also had T1D. She did arts and crafts, played games, swam in the pool, and made new friends. And for us it was like a breath of fresh air.
Ever since the diagnosis we are on call 24/7. When V is not with one of us, we are always checking our phones, waiting for another phone call, text or email with a question or concern. We’ve gotten called because her pod failed, or she had a low or a high, or there was confusion or question about carbs, or there was something else related to T1D and gluten-free diet. A few months prior to diagnosis my husband and I were starting to feel that taste of fleeting freedom, where both kids were old enough that they would happily spend a few days with my parents and we would get a little break, go on a date, and even go on a short trip together a couple of times a year. It all ended abruptly with T1D. Caring for V is complicated and we can’t just send her to a sleepover or even a playdate without doing some serious preparation. When she goes somewhere, we are always ready to take that phone call, or to drive to wherever she is. We are never free. And we have been very reluctant to try to do something fun while someone else watches the kids. I could not understand why for the longest time. After all, my parents often watch the kids when they are out of school, kids stayed in their house overnight, V has gone on a couple of sleepovers at friends’ houses, and we have great friends who are always willing to help out. But then it hit me – it’s that constant on-call feeling. When it’s a regular day and V is with someone because we are at work or otherwise doing something we need to do, we are not only prepared to be interrupted at any moment, but are used to it and not bothered by it. And there aren’t many times when both me and my husband are tied up at the same time. Usually if one of us is busy the other one handles the phone calls and trouble shoots. But something like a date is a different animal altogether. The point would be to get away, focus just on us, reconnect, not talk about kids, recharge our batteries. But it’s so hard to do because mentally and realistically we are still on call. The calls don’t always come but they surely do come often enough. And if we are going to be interrupted multiple times, why even bother? Our last attempt to go on a date was an epic fail, as documented in this post. We haven’t tried to go on another date since.
The first day V was at camp, I kept glancing at my phone all day. And then I’d remind myself – no, no one is going to call. She is not at school. If her pod fails, or she has a low, or there is anything else short of a real emergency, the camp staff will handle it without needing to get us involved. It was a really strange feeling. For a few hours every day we could let go of our on-call hyper-vigilance. I cannot say that I was able to fully let go of it, but there were moments when I could breathe with relief. There are no breaks from T1D for us, except for these rare moments, and it is more exhausting than I care to admit.