ParentingDiabeticKids.com

Could you give some tips on how to dose for dinner rolls, french bread, etc. heavy breads? When my son eats these for dinner I can almost guarantee a spike about 3 to four hours later. Any help would be great.

White flour breads convert to sugar very quickly in the bloodstream. Dinners of grilled cheese or hamburgers can end up with prolonged highs and lots of nighttime checks. The highs last even longer when fat and protein are added to the mix.

Ultimately, we changed to whole wheat and sprouted wheat products, even
though our kids protested. It took some time, but the blood sugar control
was worth it, and now the kids choose wheat over white.

Also, giving insulin 20 minutes before the meal (unless your child's blood
sugar is low) definitely helps cut down on postprandial highs.

"How do we get over the high sugars our daughter constantly has?"

In the first year after diagnosis, parents of children with juvenile diabetes face a steep learning curve. Everything is new and each high blood sugar could be due to a variety of factors. Eventually, you will develop a clearer sense of what affects your individual child the most. When my son Danny was diagnosed at the age of seven, even though we carefully counted carbohydrates and double-checked insulin doses, he had many inexplicable high blood sugars. Sometimes we wondered if it was a surge of growth hormones, other times it seemed like it was too little exercise or too long a car ride. Ultimately, the changes that helped us the most were giving insulin at least ten minutes ahead of eating and a change in the quality of the food we ate. Each child is different, but Danny's body responded very differently to fruits, vegetables, meat, and whole grains than it did to pasta, fried food, white flour bread, desserts and white potatoes.

I notice that Italian food and pasta are listed as favorite foods on your family's profile. Danny's favorite food was macaroni and cheese or pasta with butter. Once I was sure that the pasta was raising his blood sugar levels despite the insulin, if we ate Italian food, I served larger portions of chicken with marinara sauce and vegetables and smaller helpings of pasta as a side dish. Even that didn't solve the problem completely, so we adjusted to whole-wheat pasta or no pasta at all. We made these kinds of changes at every meal, so that breakfasts were eggs or fruit shakes instead of pancakes or toast. Although it wasn't always easy to pass up the bread or the desserts, Danny's blood sugars levels improved dramatically along with his overall sense of well-being. In truth, we all felt better.

Another positive change was exercising after we ate or during long periods of inactivity. Sometimes a walk around the block after dinner or a game of basketball after lunch was all it took to counteract the effects of the food. We learned to break up long car rides with a Frisbee game or soccer halfway through the drive and to suggest a game of tag after a movie. Just remember that it is important to test your child's blood sugar before exercise to avoid lows.

Most importantly, be easy with yourselves. Taking care of a child with diabetes is not an exact science. Even if you have done everything you can think of, there will still be highs and lows. In the first year, diabetes creates a huge strain on a family. Make sure to celebrate when things go right, notice when your daughter is happy, and remind yourselves that things will get better over time.

"Does diabetes affect learning ability at least in the first year of diagnosis?"

Diabetes doesn't have to affect a child's ability to learn, but the first year after diagnosis does present unique challenges that can make learning harder.

My son Danny was diagnosed seven years ago at the age of seven. During that first year, his blood sugars were very unpredictable. We didn't know that simple carbohydrates like white bread would affect him differently than complex carbohydrates like sprouted grain bread. We didn't understand that a few animal crackers at bedtime would affect him differently than a handful of almonds. Therefore, at school, Danny was often either high or low, and he had frequent headaches and stomachaches from the ups and downs.

These factors definitely affected his ability to concentrate and learn at school. In addition, Danny wasn't used to testing his blood sugars in the classroom, having different snacks than the other children, having his teachers worry about him, and needing to test for ketones in the bathroom when he was high. Some nights, he had to wake up to eat a snack or get a shot as well, and he would be tired the next day. All of these issues got better over time as he adjusted to his new situation.

Now, at the age of 14, Danny knows how to manage his numbers in school so that he feels good. He doesn't consider diabetes to affect his learning in any way.

Helping your child and their teachers understand the school dynamics of diabetes will help the situation. Your 504 meeting will give you an opportunity to explain what specific accommodations your child needs at school such as access to their glucose meter, food and water. You can also set target numbers and teachers can postpone a test or quiz if your child is too high or too low. If your child's school has a school nurse, that person can be a tremendous resource for your child during the day.

In our family's experience, frequent testing, reducing simple carbohydrates such as white flour and white sugar, and increasing exercise are the best ways to make sure your child has a good day at school with diabetes.

Any advice on school field trips? My 11 yr old son is going to the museum without me for the first time since being dx a year ago August. He is pumping and the school nurse is going. I would really rather go- it's about an hour away and it is fo...r the whole day. But he doesn't want me to - he said he could handle it! I guess it's good for him to feel empowered to manage his diabetes at a young age but it is scary for me. Do you guys pack a seperate backpack with all supplies and how much should I "train" the nurse on pump stuff?

I remember my son’s all-day field trips very well! My anxiety was also high and I compensated by preparing well in advance. I’m glad that your son feels ready to care for himself and that the school nurse will be available. I typically prepared a schedule for the day that I gave to my son, his teacher, and his school nurse. It had all my contact information and his medical insurance information at the top. Then, for example, it might say:
 
8:00am test blood sugar
If over 120 my son should bolus. If under 90, my son should have a snack.
10:00am test blood sugar, bolus for number and snack, have snack 10 minutes later
And so on...
 
You will want to create it with your son, so that you can plan together and decide how much the nurse will help.
 
In addition, I sent my son with all his supplies in his backpack: new pump sites, granola bars, glucose tabs, glucose gel, glucagon, back up batteries for meter and pump, extra test strips, and a charged cell phone. His school nurse always had so many other children to take care of, I wanted him to have access to his own supplies.
 
In hindsight, I see how these steps towards independence really helped both my son and me prepare for his adolescence. You will see that each of these successful experiences gives your son more confidence in himself and gives you more peace of mind.

I'm taking my 9 year Type 1 Diabetic son snow skiing next month and just really need any helpful tips. He'll be in ski school for the 1st day and I'm petrified!

First, I would call in advance and request some private time with the ski school manager and your son’s instructor. If you have prepared a handout with your contact information, his medical insurance numbers, his testing and snack schedule, and the warning signs of low blood sugar, your meeting doesn’t have to take very long. Make sure you review all the safety information and what to do in the event of a low blood sugar. Even if your son is carrying his own test kit and supplies, provide his instructor with some glucose tabs, a glucose gel tube, and a granola bar (or some other snack with carbs and protein) in case your son leaves everything on the chair lift. Oftentimes, ski schools have scheduled breaks, and you can coordinate with your son’s instructor to meet for blood sugar testing, snacks and insulin doses at designated times. You want to be confident and organized, so that the ski school staff feels prepared rather than alarmed.

Before the trip, you will also want to talk to your son’s endocrinologist about lowering his insulin doses. Skiing is strenuous, so that also means being careful overnight because of the delayed effects of exercise.

My daughter has recently started a new bad habit. She has been eating the school breakfast along with the breakfast she gets at home. Nobody has been watching her and I'm not sure if its their responsibility. She is 8 years old and has had diabetes since she was 18 months so she knows she's not allowed to eat without permission. But I'm feeling that she wants to be "normal" and eat breakfast with her friends at school. I have not confronted her about it yet because I'm not sure which way to go. I asked her why her sugars where in the 500's in school and perfect on days off. I specifically asked if she ate on the bus or before lunch and she gets really upset saying she doesn't, and how i should believe her. I don't know what to do!!

My son Danny got Type 1 at age 7 and is now 15. I get many emails from families dealing with this issue, and I have to say that the majority are from mothers of girls age 8 or 9 up to 17 or 18. This time in a girl’s life is a very difficult gauntlet to pass through in our current school culture. There is enormous pressure to conform and “be normal” at a time when girls are trying to figure out who they are as individuals and find their inner compass. My daughter Jess is now in college, but I clearly remember her fear of being marked as different and her stories about the girls who were targeted.
 
There are probably many reasons that your daughter wants to eat breakfast with her friends while not admitting it to her mother. At junctures such as this, I always try to approach it from a team point of view. This is an excellent opportunity to show that honesty is safe and met with support. Most important is her faith that her parents are on her side and trying to both keep her safe and healthy while helping her meet her goals. Even at the age of 8, she can brainstorm with her parents about how to incorporate sitting down with her friends for breakfast. She could bring a healthy snack to school and eat that with her friends. She could skip home breakfast and just eat with her friends by getting insulin from the school nurse, if there is a full time school nurse.
 
I remember the year that Danny hid some of his Halloween candy and secretly ate some each night before bed. We couldn’t figure out where the highs were coming from and kept increasing the insulin dose. Finally, I found him with a fist full of chocolate that was melting between his fingers. As a parent, sometimes humor is the best answer, and we ended up having a good laugh at the absurdity of the dripping chocolate. After he cleaned up, I sat with him and explained my role as his helper and advocate. I explained that I couldn’t keep him safe if he didn’t tell me the truth. In this case, he could have had dangerous lows if he had skipped a night of sneaking! We agreed that if he was having a sugar craving and just needed something sweet I would be sure to keep chocolate on hand, but that we would bolus for it.
 
This is all good stuff to insure a foundation of trust and communication before hitting the teen years. The reward is that my six-foot tall son comes home after being with his friends and admits he had “way too many carbs and not enough will power” and asks me to check him during the night so he won’t go too low from all the bolusing.

Also, he cares enough about his health and his body not to drink alcohol or take risks that his peers are taking, and he isn’t shy in telling his friends about the risks of drinking alcohol with diabetes. If your daughter can see that you are there to help her take care of her diabetes while she is trying to fit in by helping her work out her issues, it may also open up conversations about the quality of school food and the reasons for making good choices.
 
As you know, the stakes get higher as they get older and this is the time to give your kids lots of alternatives to hiding the truth.
 
I hope this is helpful,

What's the deal with Diabetes and feet, my 5 year old was diagnosed 3 months ago, the Dr's didn't mention anything about shoes or feet, but on internet sites about diabetes it seems to be an issue, she hates wearing shoes, does she really need to wear them all the time, or can she go barefoot when at home?

I can only answer this from our family's experience. Dan was diagnosed eight
years ago and his medical team suggested he never go barefoot again. They
warned that cuts and scrape might not heal and there was an increased risk
of infection. As parents, Brian and I didn't want to change Dan's life that
dramatically, especially because we spent our vacations camping and at the
beach, both traditionally barefoot times.

Over the years, Dan did get scrapes and cuts, including an accident in which
he needed stitches, but his feet always healed normally and he has never had
any difficulties. At each endocrinology appointment, Dan's doctor checks his
feet and they are in great shape.

I think the warnings are important for children who are experiencing
circulation problems.

My daughter, 13 years old, started to go crazy with a nearly carb-free diet. She refuses to eat properly and lost a lot of weight . She is terrified of going hyper and I think she just doesn't wanna eat to avoid high blood sugar. She is on the pump and her basal rates are already very low and she still goes low a lot especially at night. She also started exaggerate exercising . Thank you for any suggestions, we are really worried about her.

I agree with everyone's answers, and I would add that teens with diabetes benefit from the support of their peers. Some school nurses in the US are creating "lunch bunch" opportunities for kids with Type 1 to talk with each other while eating together. This might be worth pursuing at Gabby's daughter's school if the nurse can identify some teens with diabetes that are eating normally.
 
Also, there are other chances to find teen role models. dLife TV has done some teen round tables that are available online. Children with Diabetes  has both opportunities to find pen pals and teen chat rooms.

Our 5 year old daughter Ava does not have a lot of fat. She is currently on shots. Would a pump be hard for her because she has less fat.

My son started the pump when he was ten years old. He had very little body
fat, and he had to pinch up skin from his belly to insert the site for the
pump. Our endocrinology nurse helped Dan with his technique, and he didn't
have any issues with it. One thing to keep in mind is that there are several
different infusion sets, and your endocrinologist can help determine which
would be best

When carb counting, do I subtract the fiber for total carbs OR include the fiber??? I'm coming across more and more food items that have more fiber and if the fiber doesn't change bg why count it!?

Our endocrinologist at Boston Children's Hospital has had diabetes herself
since she was a young child. Some of the best advice she gave my son was to subtract the fiber grams from the total carbohydrates and then add half the protein grams. She also advised Dan to take insulin twenty minutes before eating (unless his blood sugar level was already low). She explained that protein actually raises blood sugars, but more slowly than simple or complex carbohydrates. This formula allows her to keep excellent blood sugar control, and it has worked wonderfully for my son.

Can the heat make a child go high? When it's hot, my son tends to go very high and stay high!!

Extreme weather can definitely affect blood sugar numbers. The issue is that each child reacts differently. My son experiences low blood sugars more frequently with very cold or very hot conditions. His body burns carbs trying to keep itself warm or cool. Meanwhile, your son and many other children go higher in the heat. Now that you have noticed your son's pattern, you can talk with your endocrinologist about how to adjust insulin levels to compensate.

My son was dx May 25this year and he is 14 ...the months prior to dx he was getting worse and worse in the morning and not wanting to eat. Now he is positively nauseous in the morning until 10:30 or so , so I have to pack him his breakfast too. Is this normal and should he have an empty stomach for the first 2 hours of his morning...he does not feel like eating at all and I have tried him with everything, normally he is a good eater being 5 foot 10 and 180 already at 14 but not in the am anymore!!!

Karen does your son  wake up at a physically comfortable number? My 16-year-old son Danny has trouble with nausea and a lack of appetite in the morning if he wakes up with either very high or very low blood sugars. Therefore, we test him at 2:00 am and he tests himself as soon as he wakes up to insure glucose control overnight.  

Meanwhile, Dan says many of his teenage friends without diabetes don't eat
breakfast. If blood sugar levels aren't the cause, he suggests it could be
regular teenage behavior.

No specific question other than tips for handling the transition to middle school, high school, and then college life.

My son Dan was diagnosed at age seven and is now a junior in high school. All along the way, we felt it was important to help him move toward independence without getting burned out or overwhelmed by too much responsibility. Our endocrinologist, nurse diabetes educator and various school nurses have been invaluable because they all have similar goals for him.

 In seventh grade as Dan started middle school, we met with our school nurse. Dan wanted to be on his own and told her so. The nurse wanted him to come to her office at 10, 12 and 2:30. They compromised with the decision that they would start the school year with three check-ins per day, with the goal of cutting this down. Also, the nurse volunteered to find him in the cafeteria at lunch, so that Dan didn't have to go to her office three times. After a month or two, at 10am, Dan used a phone in the classroom and called in his number. Halfway through the year, the nurse saw that Dan was making good insulin decisions and started calling the teacher at 10 and just making sure he tested without having to talk with him. By 8th grade, unless he was high or low, Dan was just checking in with the nurse before lunch in the cafeteria. When Dan was sick, injured, or having blood sugar issues, they kept in closer touch.

 Now in high school, Dan made the same transition. As a freshman, he and I met with his school nurse and they developed a plan. She didn't know him and wanted three checks per day. He agreed to call/visit the office until she thought he was ready to handle his own care. The first year, he forgot to check in regularly, had several lows he didn't report, forgot his pump at  home, and was generally disorganized. His school nurse found him and also called me. We did what we could to support her. When Dan complained about  the routine, we just remarked that he obviously loved all the attention; otherwise, he would get his act together and give her confidence in him, the way he had in middle school.

By sophomore year, Dan had adjusted to high school and was much more reliable. He saw the nurse at lunch and called her at 2:30 before sports. Junior year, he just visits her at lunch. Their goal is that he will be independent as a senior, unless he is low or needs supplies from her office.

Meanwhile, at home, Brian and I have had the same philosophy. As long as he is taking good care of himself - testing every few hours, bolusing ahead of eating, changing his test site regularly and eating fairly well - he can have as much independence as he wants. If he starts having more highs and lows, we step in with support and supervision temporarily.

Certain jobs he wants us to do: we test him every night while he sleeps because he doesn't wake when he is low and plays sports year round. I
continue to change his lancet once per day, draw up reservoirs, and handle all the insurance and pharmacy issues. I also check his meter once per day to look for patterns. During the end of his senior year in high school, he will take over most things in preparation for college.

I hope this is helpful,

Laura

My son was diagnosed at 5 1/2 and is now 8 1/2. I can see him struggling with having diabetes lately, like sneaking food. In the beginning of diagnosis, I use to feel bad for him and always sorry for him. Just lots of hugs and tears. I still feel the same way but I feel I am a bit confused on how to discipline him. Do I do the tough love and tell him.... "this is how it is and always will be so lets move on and deal with it" You always hear the stories of " My mom was tough ... never let me give up . Made me keep going forward" I feel I should be that way. Maybe it will make him strong and gain control more when he is older, BUT he is only 8. I know he wants to be independent. I know he is struggling not being "normal" like his friends. I feel that approach my be too tough at this age. On the other hand I do not want to coddle him. So confused and was wondering how everyone else treats their children with the disease.

 This is what I would add to what has already been said:

My son Dan was diagnosed right before he turned eight and he is now
seventeen. As I look back, one of the defining conversations we had at least once a year went like this:

Dan: I just wish I could eat tons of pizza and not even think about it.
Laura: I know. Food is your thing. Some kids have parents that fight all the time. Some kids have learning issues and don't get good grades. Some kids try out for sports and can't make the teams. Everyone has something and you have diabetes.
Dan: Yeah, that's true. Sam's mother has cancer...

I think it is important to be loving, sympathetic and flexible when kids are
burned out or feeling sad about their diabetes. That said, over time, seeing the diabetes challenge as one part of a life with many blessings helps the family keep the priorities on making good food and exercise decisions in a matter of fact way.

My 3 1/2 was recently diagnosed with T1 and we are struggling with a possible growth spurt causing him to constantly be hungry. We are still on35g/25g/25g meals and 15/15/15g snacks. After a meal he's full (sometimes a struggle to get him to finish) but then within 1/2 hour -he wants more food. We have maxed his carb allowance for that meal/snack so we turn to 'free foods' that don't have carbs. Cheese sticks, turkey roll ups, chicken strips, salami - he's tired of it all. Any other options you can give me?

Some other low carb healthy options: scrambled eggs, no-nitrate turkey
jerky, celery with cream cheese or peanut butter, plain yogurt with small
amount of honey, a handful of almonds...

We have a 15 y/o son that is having a lot of highs (300-500)and a few lows. He is on the pump and was diagnosed 2 years ago. He started out really good and responsible but is now not checking himself on a regular basis and has to be told repeatedly to check himself, dose, change his pod, etc. He also has open lunch at school and eats a lot of snacks after school. He refuses to eat most healthy food. We are stumped on how to handle this especially since he will only get more independent from here on out and we will have less monitoring. Any suggestions would be appreciated.

I have a few different strategies to recommend:

 

1. The carrot - Remind your son he will feel much better if he tests and boluses regularly. In order to motivate him to develop better habits, you can agree on something he really wants - new clothes, a videogame - and then decide what schedule of testing and taking insulin he needs to earn it. My son is seventeen and we did this with him successfully when he was younger. Once the new behavior becomes habit (and your son remembers what it feels like to have good blood sugar control) then you no longer need the system.

2. The stick - Your son is nearing driving age and most boys will do anything to drive. You might want to remind him that it isn't safe to drive or pursue getting a license until his blood sugars are within a good range. You could offer a meeting with a good nutritionist as a way to start moving toward the driving goal.

3. Teenagers often listen to other adults more clearly than their parents. Your son's coach, school nurse and endocrinologist might be willing to speak to him and encourage him to take good care of himself. My son checks in with his school nurse every day at lunch, which gives her a chance to monitor his self-care.

4. Avoid buying any snacks for the house that you don't consider healthy.That way, he can eat whatever is available without restriction before and after school. I have a lot of tips for helping kids eat healthier foods on my web site, www.challengeofdiabetes.com.

All my best,

Laura

My son is 8, he was diagnosed with type 1 on Feb.10th, 2011. He went to diabetes camp a couple weeks ago and had a great time. Although, I was told when we picked him up that he asked to have his sugar checked 20 - 25 times a day, he became very paranoid about going low. Since he has beenn home, he's been acting the same way, telling me he feels "weak," and thinks he's low. He wasn't like this before camp AT ALL, he played soccer and finished his basketball season no problem...after he was diagnosed. He had fun and never went low. Now, he's saying he doesn't want to play football ( his favorite sport ) or any sport, for that matter. Is this a normal phase for a child his age ? Do I make him play a sport for exercise ? I honestly think the only reason he doesn't want to do anything is for fear of going too low... I don't know what to do.

My daughter was a diabetes camp counselor and she witnessed campers having some very scary lows. I wonder whether Erica's son experienced or saw someone having a low blood sugar reaction and got scared. Another possibility is that someone described what extreme lows are like and it was too scary for him. Most endocrinology teams can recommend a skilled diabetes psychotherapist that might help in this type of situation.

My 9 year old got up the other day and gave herself 10 units of insulin via her pump. When I asked her why she said she didnt know why she just did I dont know if she is just acting out or if this is something more?

At nine years of age, kids are starting to want independence and to make their own decisions, but they don't have the cognitive ability to understand the full impact of their choices. I suggest bringing your daughter back to her endocrinologist. Her doctor could talk with her about the seriousness and importance of the actions she takes with her pump. Perhaps you could work as a team to give her more independence (pushing the buttons, helping with the math, counting the carbohydrates) with the understanding that you or the school nurse are always there while she does it.