3 Critical Nutritional Concepts
Our Family’s Type 1 Diabetes Revolution
Michelle MacPhee, D-Mom
I can count on one hand the concepts that, once adopted into practice, revolutionized blood glucose management in our family. I don’t even need the whole hand, just three fingers:
1. Carbohydrate Counting
When our son was first diagnosed, right out of the gate we learned about carb-counting. Given the tools available these days, I cannot comprehend how previous generations of Persons with Diabetes (PWD’s) managed diabetes without counting carbohydrates. When my mother-in-law was diagnosed with type 1 diabetes, the primary tool handed to her was the Glucose Exchange System. Though it is still the tool she is most comfortable with in terms of dosing insulin to cover food intake, there is a built-in imprecision to this approach. An apple, for example, is assessed at 1 exchange, which translates into roughly 15 grams of carbs – but when I use a nutritional scale to measure the carb content of the many apples that my son has eaten over the past 7 years since diagnosis, which vary wildly in size, I get carb values that range anywhere from 12 to 19g. The difference in corresponding insulin dose could mean the difference between an in-range, a high, or a low post-meal blood glucose (BG). So, though we didn’t realize its value initially, the precision of carb-counting was the first revolutionary concept our family adopted.
2. Glycemic Index
A few years later, after reacting often to both extremes of post-meal blood glucose readings, we learned about the second concept to revolutionize the way we managed our son’s diabetes: the Glycemic Index. We learned that some of those post-meal extremes could be attributed to the different rates at which different carbohydrates were digested, which impacted how well the meal insulin matched the rate at which those foods raised blood sugar. That is, some foods digest at a moderate rate, which matches the insulin action quite well; some foods digest very quickly, thus raising blood sugar very quickly, before the insulin has a chance to do its job, which results in large spikes in blood sugar after the meal; conversely, some foods digest more slowly, giving the insulin a chance to “get ahead” of the food, resulting in BG lows initially, followed by high BG later. Once we applied this concept to the foods that our family ate regularly (pasta, rice and chick peas, barley casserole) we saw a dramatic reduction in post-meal swings.
3. Fat-Protein Units
But there were still too many times when our son’s blood sugar was frustratingly high after certain meals: when we went to McDonald’s for lunch; when we had ice cream for dessert; on the rare occasion that we risked it all for Friday night pizza. At these times, his blood sugar would predictably rise into the high teens or mid-20’s (mmol/L), and would resist correction, though we would correct more often and use more insulin than what was usually effective. I tried using a temporary basal rate to increase the amount of insulin delivered, but I didn’t really know where to start, and the results were unpredictable. I would have had to do much more experimentation and analysis than I had the energy and motivation to do. It got to the point where I dreaded (and avoided) McDonald’s, pizza, or a frozen treat on a hot summer day, because of the price I would pay later in frustration and anxiety. Yet I struggled with the idea that my son was missing out on these typical kid treats, that our family’s activities were being controlled by diabetes. I hate it when we have to bend our lives to accommodate the Diabetes Dragon, especially when that bending is significant and ongoing. And then, thanks to Lorraine Anderson (RD, CDE) and Shannon Cassar (RN at the Alberta Children’s Hospital), I learned about the concept of Fat Protein Units, and the third revolution was launched.
Now I no longer dread ice cream treats; we have a strategy to deal with them that works amazingly well most of the time. When our son is invited to a pizza birthday party, I don’t have to groan anymore; I know we can cope with it. The occasional trip for chicken nuggets and fries isn’t a chore anymore, now that we know how to deal with the high fat content of this meal. While we wait for a cure for type 1 diabetes, life is much more manageable now that we count carbs, adjust for Glycemic Index, and calculate Fat-Protein Units. And I’ve still got two fingers left for another couple of future revolutions…. bring ’em on!
The above information was reviewed for content accuracy by Lorraine Anderson, RD, CDE.