Bolus Less

There are a few foods consumed around here for which the official carb count just doesn't work. Maybe the packaging is wrong? Maybe my daughter's metabolism is just way different for a few specific foods? We've decided it's more important to get the bolus right than to figure out why it happens.

Foods in our regular rotation for which we've learned to adjust from standard carb counts include blueberries, for which she needs barely a hint of insulin, and a specific brand of frozen tortellini, which is probably poorly labeled. 

Then there are other foods which we have to periodically relearn, like the Italian ice at our favorite ice cream store, which is significantly lower-carb than the Calorie King app's 'average Italian ice' measurement. This was the first spring we remembered a reasonable estimate and guessed well enough that we didn't have a long, low night.

Ever in search of non-dairy options, I recently picked up a boxed macaroni and cheese for my daughter to try.

The package said that the mac and cheese had 50-something carbs per prepared cup. Which seemed high to me, but I thought that whatever made up the 'cheddar flavor' part was, perhaps, super-carby. 

It was not. Or my daughter's system did not perceive it as such. Over the course of the following two hours, she consumed 30 carbs to bring up the ensuing low blood sugar. 

She liked it so it's a keeper. But it's not something that's going to be in the regular rotation. She'll have it after holidays, when there's leftover ham in the house (because mac and cheese with ham is a family favorite), or once in a blue moon as a quick fix meal out of the pantry for an unexpectedly hectic night.

The lingering question was, how are we going to remember to give less insulin for this next time, which could be months from now? By posting the product label on the inside of the pantry with "Bolus Less!" scrawled across it in sharpie. 

The Muffin Chronicles: Episode 1

My daughter has taken the same basic lunch to school since first grade:

A sandwich (usually sunflower seed butter and jelly)

Fruit (grapes, berries, a clementine, apple slices)

A salty snack (pretzels, goldfish crackers, sunchips)

This year, she needed a lunchbox addition.  With a 7 a.m. start to her school day because of a period 0 choir class, breakfast and lunch are a long time apart.  The previous lunch wasn't filling her up anymore, even with a larger serving of fruit and a heartier sandwich.

She needed something else nutritious which could be eaten quickly, wouldn't spike her blood sugar, and wouldn't rip out her braces.  The braces part eliminated the obvious granola bar choice, especially when paired with eating quickly.  We tried a couple of brands of soft cereal bars, but there was a definite blood sugar spike just in time for important classes like biology and geometry.  Her lactose issue eliminated cheese or yogurt options.  So we went with:

Corn muffins are her favorite but they're even better with blueberries.

Homemade mini muffins.  It sounds ambitious but hear me out.  If once every couple of weeks I make a batch of mini muffins and freeze them, I can take two out every morning, put them in a little container in her lunch box and she has a decent 20-ish gram snack.  Some recipes are good 'as is,' and for others I substitute whole wheat flour or decrease the sugar to make them a little easier on the blood sugar. 

Corn muffin recipes are plentiful so I won't bore you with that one, but I do plan to share a couple of (hopefully successful) muffin experiments in future editions of 'The Muffin Chronicles' this fall!

Food: It's What's for Eating

An 8 year old relative of a friend of mine was recently diagnosed with type 1 diabetes.  A couple of weeks post-diagnosis, my friend e-mailed saying that the family is really struggling with what to feed him.  He was previously very much a junk-food fan.  What ideas and advice did I have?

My initial e-mail response was lengthy and probably a little confusing.  It's such a complicated and loaded question.

My first response was to look for good articles and posts on my favorite blogs and websites.  After twenty minutes of that, I found twenty different ideas of how best to eat with diabetes.  No wonder they and so many other newly-diagnosed families are confused. 

I imagine the hospital team sent them home with a meal planning guide and some hand-outs about carbohydrate counting and the value of consuming protein and carbs together.  He's on injections for now, so limiting the injections is part of meal planning too.  But he's 8.  And everything's different.  And he'd probably really like a big stack of pringles and a snickers bar.

So here's what I said in a nutshell, hopefully more well-thought out this time (I'll be sure to get them the link to this post):

1. If nothing else, count the carbs.  Learn how to read the labels, learn the carb ratio, learn the math and give the insulin.  A snickers bar is not an apple.  French fries aren't steamed brown rice.  But if you give the right amount of insulin for them, his blood sugar won't spike astronomically and you'll be learning and practicing the carb counting skills which will be the basis of diabetes care for the foreseeable future.

2. Rome wasn't built in a day.  Protein plus carbs is great.  The combination streamlines the blood sugar levels.  Vegetables, fruits, whole grains and low-fat proteins are important too.  Foods with fiber affect the blood sugar less than straight white bread.  BUT eating is great too, and sometimes compromise is necessary.  I had a child who ate nothing but cold cereal, milk, chicken nuggets, goldfish crackers, baby carrots, sugar free jello jigglers and animal crackers for several months of her toddlerhood.  She lived to tell the tale.  Not only that, but this weekend she ate Moroccan spiced chicken stew with whole wheat couscous on Saturday night and roast salmon, salad with balsamic dressing and a brown rice medley on Sunday night.  We actively chose (after a few weeks of frustration) not to force the food issue when she was 2.  Now she's a good healthy eater, because that's the way her parents eat and she slowly learned that a variety of foods are delicious. 

3. Dessert is okay.  We never stopped having treats.  One cookie instead of 3?  Yes.  Parsing out the Halloween candy over a couple of weeks.  Absolutely.  She had animal crackers and a glass of milk most nights until she was 5 or so.  Eventually, other cookies, frozen treats and brownies began to be included in the mix.  Holiday pies and birthday cakes have never been forbidden.  As a result, (I think) I have a kid who has rarely snuck extra treats or cried because she was left out of a celebration. 

Should this newly diagnosed kid be eating a scrambled egg wrap for breakfast, bean soup for lunch and a plate with 2 veggies, lean protein and whole grains for dinner?  Probably.  Should his primary treat be roasted almonds?  Yup.  But he's 8.  And his world just turned upside down.  And no kid or adult really eats like that anyway (well- very few, and they're probably not the happiest people). 

In the real world, balance is necessary. This newly diagnosed kid should be eating the healthiest combination of foods he's willing to eat on a daily basis.  He should be learning about good nutrition from his family, his healthcare team, and others who care about him.  He should be learning to read a nutrition label with help from adults, so that he can take the right amount of insulin for whatever he eats.  He should be learning about low carb and carb-free snacks he can eat when he's hungry but doesn't want to take an injection.  Meanwhile, his favorite foods should remain available and he and his family should learn how to cover the carbs in them. And he should have the occasional junk food if he wants it.  Having diabetes is hard enough as it is.

Birthday Day and Other Heavy Eating Occasions

My daughter's friend had a birthday last week.  It was on the same day as mine.  The kids have found a way to skirt the school nutrition policy of 'no outside food for celebrations' by bringing in treats to share at lunch. So lunch that day included oreos, hershey kisses, doritos and munchkins.  To her credit, she ate the sandwich and grapes I packed first, but she sampled the rest as well.

For dinner we went to a Thai restaurant and she had an uncountable portion of pineapple fried rice. We came home and had mini cupcakes and cannolis for dessert.

Our household diabetes philosophy (yours may vary) allows sweets, and even junk food.  Birthdays include cake.  S'mores over the fire pit or a trip for italian ice are part of summer fun.  A little bag of chips for the walk home is o.k.  Most days include cookies or a non-dairy frozen treat before bed. Taken one at a time, or even two in one day, we're o.k. with both the questionable nutrition of it and with the diabetes challenges.

'Everything in moderation' is the general idea. But on days when moderation goes out the window, I'm left feeling torn.  Should we ever let her eat this way?

"Yes!  You can eat anything except poison...or cookies made with poison..." is one side of the coin. But she really can't eat anything and maintain the same kind of blood sugar numbers she does when she eats healthy, countable things.  Twenty carbs of oreos and doritos is not the same as twenty grapes. Half a restaurant portion of pineapple fried rice and a bakery cupcake simply can't be counted and dosed for as accurately as portions prepared, weighed and measured at home. Add the 'one more dorito because everyone else is still eating,' or the picking all the pineapple out of the fried rice despite bringing home 'half,' and the challenge increases.

Still, I lean towards letting her learn from her mistakes over outright forbidding her from eating like this. She'll encounter days with heavy eating potential for the rest of her life, so perhaps helping her develop a healthy sense of how to handle them is the answer.  Last week's birthday day was an example of how not to handle it.  And she knew it.  She was upset that her blood sugar was high for hours.  Between that lengthy high and the general junk food overload, she had some lingering indigestion into the next day.

Sometimes she makes better choices.  Last weekend, she said no to lunch out with a friend before an evening birthday party because it would consist of too much uncountable food in one day.  She's come home from parties and told us she was the only one who ate the proffered grapes or salad to balance out the junk. She will report with alarm how many cookies or cupcakes some kids consume in one sitting.

I guess it's like all things diabetes, really.  We do our best.  We try to fit the diabetes stuff into what we consider a normal, healthy lifestyle.  We try not to let it ruin our fun.  We learn from our mistakes.  And we're never quite sure we're doing it right.

Today's Menu

Breakfast

              

This is one of our protein-containing, 5+ grams of fiber cereal choices which somewhat diminish the post-breakfast blood sugar spike.  

More excitingly, I bought a whole pint (well, several pints actually) of blueberries for less than one million dollars this week!!!

Lunch

Sunflower butter to protect her peanut-free friends at lunch, with great grandma's homemade spiced pear jam, which she makes special with less sugar just for my daughter.  With an occasional substitution of pretzels or sun chips, this is lunch every day.   

Snack

Snack varies every day.  Sometimes it's more substantial, like a smoothie or peanut butter crackers.  But today she's saving room for Grandpa's birthday dinner.

Dinner

I'll smash up half a sleeve of townhouse (ritz, etc. are all fine) and mix them with 3-4 tbs. of melted butter.  I might remember to squeeze in some lemon juice and add some pepper.  The fish goes in a greased (or better yet, buttered) glass baking dish.  The cracker mixture is spread on top.  Bake at 400 for 10-15 min. until it's flaky.  Yum!

We've nicknamed this rice blend 'crazy rice,' at our house.  It's got tons of flavor and a variety of textures.  Much more fun than regular brown rice.

Grandpa's Birthday Cake

I know- all kinds of problems with this.  Its's processed beyond belief.  It contains artificial everything.  The glycemic index is off the charts.

But it's Grandpa's favorite, and a family tradition.  So we'll indulge!

Food is one of my favorite topics to read, think and talk about.  So I, for one, am looking forward to reading the rest of today's Diabetes Blog Week posts which can be found HERE!