concerned sister

[kmt2007]

I am writing about my brother who is a type 1 diabetic.  My brother was diagnosed when he was 18 and begining his prime party years involving a large amount of alcohol consumption.  He is also very concerned with his weight and tries to avoid carbohydrates regardless of his diabetes.  I know this may be difficult to answer without knowing him but I just wanted to know it anyone (diabetic or professional) has any suggestions for how I can get through to him regarding his diet and overall blood sugar control.  He currently checks his blood sugars several time/day but they are rarely with the normal range.  I am worried that because of his poor care and higher interest in his appearance that his diabetes control his life will end at an early age.  Please realize, I am a dietitian and tried talking to him many times until he gets angry and refuses to listen so any creative or scare tatics will be appreciated.  Thanks.

[t]

Hello! I am a 24 year old diabetic. I have had diabetes for 16yrs. I have  children (4 and 10 months). I am now experiencing the many complications that come with this disease. It is due to my poor control of my sugars in the past. I have neuopathy in my feet and legs, I have retinopathy in my eyes, I have many GI problems, and my circulation is poor. My kidneys are ok, but I was having problems with protein in my urine at one time. The neuropathy makes me have pain and burning in my feet and legs. The retinopathy is bleeding behind the eye and my left eye is foggy at times more than my right eye. The GI problems I have are serious. Everything I eat runs right through me or I get very nauseous. I t is a very uncomfortale feeling. I can't interact with my children the way I want to because my energy level is extremely low. Every medicine I have tried isn't working. It makes it to where I can't go out and eat oranything because I always have to use the bathroom. Diabetes is a bad disease, but it can be controled. I really hope your brother understands that he can be in control, but he has to want to be. Otherwise diabete will control him, just like it is controling me. Good luck to your brother!!!

[JDRF-VOL-SG]

We are not doctors, but we who answer these questions are either type 1 diabetics ourselves or are parents of type 1 children. It seems that there are two issues here that concern you: 1) your brother's diet (omitting carbohydrates), and 2) his blood sugar control. Let's see if I can offer something to address both of them. Please realize that I am only offering my personal opinion, and an opinion based on one short paragraph of information that you have written for us.  

First, his wish to lose weight by going light on carbs or omitting carbohydrates entirely. The Atkins diet and the South Beach diet, both very popular right now, both advocate fewer or no carbohydrates in the daily diet. My husband has done the Atkins diet, and it does work. But there is a danger for type 1 diabetics, as you obviously realize, because we must always balance the carbs we eat with injected insulin. The reality is that he CAN omit carbs entirely and do just fine IF HE ADJUSTS HIS INSULIN DOSE accordingly. Type 1 diabetics these days tend to eat very flexible diets, counting the carbs they eat and using mathematical equations based on their own insulin needs to take the proper dose of insulin for those carbs. So some diabetics eat few carbs while others eat lots of carbs. The old diet charts that we used to base our insulin dosages on are not used when we do this. The point of this explanation is that there is no reason from the diabetes perspective why he cannot eat as few or as many carbs as he wishes. But this is ONLY true if he is adjusting his insulin dose properly for those dietary variations. Now, whether he is getting the proper nutrition from his low-carb diet is another issue entirely, and you may have better success talking to him from the nutrition aspect rather than from the diabetes aspect. It IS very important for any diabetic to keep his or her weight under control, so if he needs to lose weight, maybe you would do better to offer him some suggestions about the healthiest way to do that. His concern about his weight may be more of a health concern than an appearance concern, for being overweight is awful for a type 1 or a type 2 diabetic -- fat cells make it hard for the insulin to do its job, for fat cells are insulin resistant.

The other issue is diabetic control or lack thereof. Type 1 diabetics do often have blood sugar ups and downs more than type 2 diabetics or non-diabetic people. The key to good control is not entirely what the numbers are when we test, but more what we do in response to those numbers. If he is low, does he eat something quickly or drink some juice? If high, does he take some insulin to adjust that high number? How high and how low does he go (if his numbers are extreme, then yes, he does need to change his control habits, but if fairly close to the normal range, then he is probably doing OK)? I think the thing that would concern me most would be that it doesn't seem like he is testing very often. If he tests 5-6 times a day and adjusts to whatever the numbers are, his overall control is probably pretty good, but if he is only testing 2-3 times a day, he is allowing those 'off' glucose numbers to stay uncorrected too long and can suffer damages because of it. As to how to encourage him, I believe that the most important thing is to not turn him off by seeming to judge him on his control. One of the worst things that type 1 folks have to deal with is feeling guilty over numbers outside of the ideal range. We see these numbers as 'bad' and teens even often lie about the numbers so their parents won't chastise them or so they won't appear to their parents to be failing in their control efforts. So please don't judge! My recommendation would be to encourage him to test more often and adjust more often. This is really simple to do, and if he does this, his numbers will hit the ideal range more often because of it.

I tend to encourage people to just take each test as a separate instance -- adjust either insulin or food to normalize that number as soon as possible. Then test again in about 2-3 hours and do the same thing. By following this pattern, we don't have to worry about the numbers being 'off' because they won't be 'off' for very long -- a quick sip of juice can normalize a number within 15 minutes, while a few units of very quick-acting insulin can normalize a high number within about 2 hours. So the correction brings him into the normal range, and the more times he tests and corrects, the more often he will be in the normal range throughout the day. I personally use this system, and my a1c numbers stay right around the normal level with really very little effort. The key is testing often. That's all you need to ask of him -- test more often and adjust.

The reality, however, is that each of us has to take charge of our own health, and all you can do is try to understand him and encourage him. I believe the best advice you can offer is to encourage him to take one test at a time, for the overal picture can be overwhelming to us. He doesn't like having numbers that are out of the normal range any more than you do, for he feels bad when glucose is high or low. It is miserable to feel bad. So he has every incentive to take good control of the glucose levels, but may not know of a practical way to do it. I do wish you the best in trying to help your brother. You sound like you care very much, and I applaud you for that. One thing you might try doing rather than lecturing him is to ask him how he feels about it. You might be surprised... many diabetics feel very much all alone in this hourly battle and just a listening ear may be what he needs the most.