What are some of the best type of foods for a 4 year old diabetic?

[Kats Mother]

My daughter, Kathryn, was diagnosed with diabetes in Dec. 2004. We have been struggling to get her sugars under control since then. I believe it partially has to do with her diet. We've spoken to 2 dieticians already and while they helped some, I would like to know where to go to get more information on the best types of meals to prepare not just for her but for the entire family. We like chili; yet I hear that that's not really the best food for her. Any ideas how to help ease the cooking anxiety in my home? I'm worried that I'll give her too much or too little.  And when she asks for more, I always feel bad. We are giving her Novalog (1 unit) before each meal (not snacks--just meals) and while it helps some, her sugars still seem to hit high peaks and end up dropping low in the morning. Lantus is given at bed time but that doesn't seem to help much either so that is why I believe it has to do with the foods that we eat/cook around my home.  Thanks.

Krista

[JDRF-Team-sgg]

I am not the parent of a type 1 diabetic, but am a type 1 diabetic myself. I was a child when diagnosed, and know the worry you are feeling, for I saw it in my own mother. I AM a mother, though, and know that getting a 4-year-old to eat an exact amount of food borders on impossible.

I personally find that simple foods are the easiest to deal with when trying to balance food with insulin. By this, I mean things that are separated out so that their carbohydrates can be measured or counted exactly. In my experience, foods like chili are hard to perfectly match with insulin — they are a mixture of foods containing varying amounts of carbohydrate, which makes exact carbohydrate counting difficult (you have to add the carbs in all of the ingredients together and then divide by the number of servings in a pot of exactly the same-sized servings in order to be exact). Most of us don't go through all of this math and measuring before spooning up bowls of soup. Furthermore, foods like this with ingredients that contain carbohydrates in small amounts, like tomatoes, mix with the fats in the meat, and the resulting mixture sometimes digests slowly because of the fat in the food. When this happens, I usually find that my glucose will drop before bedtime because the insuiin is peaking before the food is fully digested, and then I will find it rising high the next morning.

While I love foods like this and certainly would not tell you that you cannot eat it, I would encourage you to make the bulk of your meals out of foods that are simple to count. If a food has a carbohydrate count on the package, you are pretty safe. If the food is a simple piece of fruit, you can know that it will digest fairly quickly and you can figure the carb content fairly easily. I personally try t make meals mainly out of simple meats (watch out for barbecue sauces containing carbohydrates), vegetables, fruit and whole grain bread. Casseroles are difficult to figure out carbohydrate contents for, so I tend to avoid them.

I also think that it is better to test often and perhaps to eat multiple small meals during the day as needed than to eat 3 large ones. This keeps some carbohydrates going into her system all day long rather than just at mealtimes. It causes less after-meal spikes and eases this up-and-down swing a lot. I tend to nibble small snacks every 2-3 hours and then can keep my meals down to small ones.

The classic solution to night lows is to add some carbohydrates to an evening snack, and make sure you mix them with protein to slow the digestion down so the snack will last during the night. However, read on for another suggestion about the night low problem:

As for the Lantus dropping her low in the mornings, many of us who take Lantus prefer to take it in the morning in order to avoid this problem. You see, even though it is advertised as a peakless 24-hour insulin, there is indeed a slight peak action about 4-5 hours after injection. And it doesnt of course just quit working exactly 24 hours after injection, but starts to peter out somewhere between 20-24 hours after injection, depending on the patient. So when you inject it at bedtime, you are setting your daughter up for a slight peak in insulin in the middle of the night or in early morning, and since she has not eaten all night, this can cause lows. My own endocrinologist tells me that all of his patients who have dealt with night lows are put on a morning injection of Lantus instead of night injection. This makes the Lantus peak just before lunch when the diabetic person is alert and awake. Some of us find that our Lantus peters out while we sleep and since we are not taking Novalog during the night, there may be high glucose readings in the morning. For some of us, it works best to take a large dose of Lantus in the morning, followed by just a unit or two at night so that something is working during the night. I believe that in my case it is pretty much impossible to have a severe low at night this way. Even if the glucose levels drop low, the insulin is waning and so if I do not wake up, my glucose levels gradually rise in the wee hours of the morning. You may want to talk with your daughter's endocrinologist about this as a possiblity. Obviously you have to slowly work into this schedule, for you cannot take a full dose in the morning after taking a full dose before bed. The change is done over a period of time, one unit at a time, until the right balance is acheived. I wish you the best. Hopefully your daughter will stay as healthy as long as I have -- I wish her a long a and healthy life.

[JDRF-Team-LRS]

SGG has covered such important topics, and I agree with the approach.  

You mention that your daughter gets 1 unit of insulin before meals.  This is interesting to me because now that you're getting a handle on testing & food choices, it seems to me you can work with your endo to learn about carbo counting & matching her meal shot dosages to the carb content in those meals AND her activity levels and BG around the time of the meal.  Some endos work with Certified DIabetes Educators or nutritionists/dieticians who specialize in DM.

Two numbers they can help you discover & learn to work with (and they WILL change as your little one stops producing any insulin at all, as her hormones change thru growing, and then adolescence ... etc.): (1) Insulin:Carbohydrate ratio and (2) insulin sensitivity factor.  THese numbers often vary by time of day, too.

(1) insulin: carbo ratio -- This is the number of grams of carbos that one unit of insulin will "cover" -- just enough that her BG before and her BG 4-5 hours later is about the same.  This number is important to determine how many units of insulin to take for a give meal or large snack.  It is used in conjunction with current blood sugar & activity level.
(2) insulin sensitivity -- This is the number of "points" our BG will drop if we take 1 unit of insulin.  THis number is important to know when we try correct a high number.

Finally, for folks who take tiny amounts of insulin, there are low-dose syringes (that make it much easier to see and deliver, for example, 1/2 unit increments.)  For folks who take really tiny amounts, they also make a diluent to dilute a normal vial of insulin.  The reason to dilute U-100 insulin, where 1cc=100 units is to create a U50 or U20 insulin where 1cc has 50 or 20 diluted units.  Again, having a diluted insulin can make it easier to measure out 1/4 or 1/2 units at a time.  There is considerable training to safely diluting and safely using diluted insulin, but it can be a great tool if your endo wants you work with fractional units.

It may be too soon to consider it, but age 4-5 is not too young for pump therapy, which makes it MUCH easier to dose in tenths of a unit as needed.

Good luck.  There's a lot to learn and yet it's clear you've learned a tremendous amount already.