I’m new to Type 1 Diabetes, as my son was diagnosed only a few months ago. He is 15, had Dexcom 6, and does daily injections.
The doctor said it’s normal for insulin to spike after a meal and that it’s more important for the blood sugar to come back down and be within range before his next meal. I thought that was fine, but I hear so many people trying to prevent spikes and saying they are so terrible.
Also, his doctor and nurses told us he can eat anything as long as he counts carbs correctly & doses insulin for it. (Obviously he needs balanced meals with veggies, protein etc. & not just junk food, like any healthy human.) Once again, I hear so many people saying to lower his carbs, even cut out fruits etc.
Luckily, my son is pretty active and loves all foods (including seafood & veggies.) I know not all carbs are created equal & that beans are not the same as scones lol. I’m hoping to get some feedback regarding these areas. Are these issues that develop the longer you have T1D?
Thanks so much
Hello @Neimeyer and Welcome to Type 1 Nation. You are in the right place for support we have many years of experience with having type 1. If I can give you a piece of advice, it is fantastic you are already asking these questions at only a few months in, but Type 1 is something you cannot learn all at once. This is something that requires trying, observing, modifying and then trying again - and it requires almost endless patience because blood sugar control has so many variables.
all doctors are conservative and don’t want the patient to “go low”. The reason, IMO, is because you can pass out, fall down or get very quickly hurt if you are low. So very few (in my experience, doctors who also have type 1) will even comprehend what you are saying.
ok so for someone like me, 40+ years experience with insulin and 40+ years of observations of how it works… in me… I can say it is my opinion that if I can keep my blood sugar between 70-100mg/dl all the time then I am in perfect control. I can also say it is nearly impossible to keep my blood sugar between 70 and 100 all of the time. The reality is: if my CGM shows mw go from 80 to 180 after a meal and then quickly come back down I wouldn’t change anything. If my blood sugar went to 240 and then came back down… for me… (since I am not growing, and lets just say I am not needing access to sugar for exercise) then for me, its a sign I had too many carbs in that meal. Even with my experience, I see after meal spikes of 240 sometimes, sometimes even higher, especially if I miscalculate or if I had a restaurant meal or just decided to eat that ice cream cake. It happens. I ( as well as your son) am not going to break.
I get it I have a son. I wouldn’t want anything to happen to him either. but insulin is slow and carbs are fast and it is very difficult to have “zero sugar spike” after a meal. SO it is my opinion that it is manageable if it comes back down. Telling a 15 year old kid to limit carbs to minimize sugar spikes when they are active and in sports and physically growing is (again in my opinion) not worth the calorie limit to his body.
If the CGM is showing reasonable “time in range” then you are doing a great job of control. It’s probably better than a “good hba1c” which is merely a time weighted average.
hope you continue to learn and to help him understand how to do it. It won’t be long before he is 100% in charge of these decisions and so understanding is key… I hope you both have the support you need.
I know we have so much to learn and will continue to learn. And he is definitely going to go through many changes before he reaches adulthood. I just wanted to make sure I’m seeing the overall big picture or at least headed in the right direction lol.
Thanks so much for the the insight! It is much appreciated.
It might be terminology: glucose is going to rise after eating, and a spike (of whatever) is typically defined as a sharp, fast rise. Sometimes people use the word “spike” for any type, which is naturally confusing.
When it comes to glucose I like to use the analogy of a bike ride. There are different types of rides: ones that take you through a park or perhaps your local neighborhood, where you cruise along on a fairly flat surface - there will be some dips and some inclines or small hills in various places, but overall it’s pretty flat. Then there are ones like the “Tour de France mountain stages," with insane inclines and steep descents. My goal is for my graph to resemble the ride through the park, with my numbers falling within or not far out of my high and low settings. And yes, there may be some steep hills - things happen with the numbers and you try to figure out why - but let the overall big picture drive you.you
Depending on how high (or low) the numbers go your doctor may adjust certain things such as carb ratio and/or basal insulin to help avoid extremes. You’ll be working closely with them to learn how and when to do it and eventually you may be making these decisions yourself!
Your doctor may want to keep your son’s range a little on the higher side for a while, as he may be in the “honeymoon phase” where his body continues producing some insulin. When it will do so is unpredictable so keeping the numbers a little higher allows for a cushion.
Your doctor can best advise where to try to keep the numbers.
I like to recommend the book Think Like a Pancreas by Gary Scheiner. He has Type1 and is a diabetes educator so he has a unique first hand perspective. I think you’ll find it a helpful complement to your training.
Thanks so much! Truly appreciated
@Neimeyer Hi Nicole, and welcome to the JDRF TypeOneNation Forum! Thinking constructively and asking questions the way you are is the thing to do. Keep in mind that not all people with diabetes manage the same way primarily because with R1D there isn’t a “one size fits all”. I’ll offer suggestions based on what I’ve learned through living with TypeOne for many years. Oh, I’m still learning more effective diabetes management.
You should almost always expect your son’s body glucose level [BGL] to rise after eating a meal, some food combinations can cause the rise to be faster and and go higher [100++ mg/dl] than other meals, and you are correct in thinking that his BGL returns to his pre-meal level within 4 hours of eating. This “return” indicates that he is using an effective I:Cr - insulin to carbohydrate ratio for calculating his meal bolus. His Dexcon G6 is a wonderful tool, it is a perfect way for him to see & learn. What you want to avoid, not always possible, is for him to go way high and then drop very low; the tighter his range the better off he will be over time.
Your thoughts about eating very much align with mine. Your son and I were “gifted” with diabetes at the same age, I’m now in my 80s and living a full active life, and I’ve always eaten most foods exactly what the other 8 family members gathered around the dining table were eating, except I usually skipped my mother’s awesome pies and cakes. To this day, my daily food intake includes at least 3 vegetables and three fruits. Healthy, balanced meals. Sure, I “splurge”, but try to estimate the additional insulin required to keep my BGL reasonable a few hours later.
Best wishes for his success. I hope that he is taking the lead in his diabetes management and care, never too young to learn to be “Dr. Me”.
Thanks so much for the kind words Dennis!
I appreciate your breakdown, it really helps. And I am so glad to hear you’re living a full life
So grateful for the support. This is such a wonderful community!
To add a bit to Dennis’s wise advice - when you - we😊 - see numbers rising it’s tempting to add more insulin: is called stacking. Insulin takes time to start working, and I know from first hand experience that adding more simply will not rush the process. Instead, when the numbers do start to return they will go too low. So hard as it is, you simply have to wait.
I love “beans are not the same as scones”! Gonna steal that one.
I can’t advise, technically I’m old enough to be your son’s great-grandmother and my life is very changed from when I used to exercise a ton. But I can tell you this: even small changes in lifestyle make big differences in blood sugars. I went, stupidly, extremely sedentary during the first year of COVID, and boy did I pay for it. More erratic, unpredictable blood sugars were only part of that.
Keep up the exercising as much as possible. For me, even moving around a few times an hour on an otherwise slow day can make a big difference in my metabolism for the next 24 to 48 hours. Metabolism, as measured not only in how much insulin I need, but how quickly the insulin metabolizes the meal, how spiky or flat my blood sugars are after taking eating, and what my basal needs to be overnight.
Thank you for the insight! Great advice!
P.S. The moving around goes for travel, too, for me anyway.
More so car travel than air, because when you fly only maybe 3-4 hours you at least get to usually walk fairly much in the airports. Sometimes very vigorously to catch that next flight! I visited my sister when she lived in Australia, though, and I broke my kneecap 2 days before the return flight. The Quantas flight attendants were very unforgiving about me wanting to keep my clearly-well-bandaged leg straight out into the aisle or even just stand in my seat in order to keep it straight, no matter how much I explained. So I stood in line for the bathroom - repeatedly. The attendants glared daggers at me, but who were they to say that I did not also have diarrhea?
When your knees bend, even in a plane seat there are stretching exercises you can do without getting out of your seat, including marching in place. Doing that very slowly (lift leg 5 seconds) also provides a stretch for your lumbar area. Sitting “Cat-Cow” helps a lot. Also helps to be well beyond being embarrassed by stares. But I haven’t flown in this post-COVID age, so my advice, I don’t know how inappropriate it is.
Long car trips are my real problem. I inherited some long-distance-trucker gene from my mother, we both could drive until the full tank was emptied if allowed. I have to remind myself to get out of the car and at least walk around it a few times before getting back in, no matter how much it delays me more. But, the more distance walked and more often, the better. Mom lived a 10-hour drive from me, and I resented every stop along the way, but if I didn’t get out of the car my BG and metabolism spelled t-r-o-u-b-l-e when I arrived and well into the next day.
I say all this, yet I am not a mover-arounder by nature. Far from it. Maybe that’s why I’m more conscious of the need, I’m just also more conscious of the pain in the behind it feels like if your focus is on other things.
I didn’t even think about traveling! I am the same, I could totally power through the drive to get where I’m going. We do have some road trips coming up during the summer. Thank you so much for the advice. I will definitely implement more movement when making travel plans.
“all doctors are conservative and don’t want the patient to “go low”. The reason, IMO, is because you can pass out, fall down or get very quickly hurt if you are low.”
I had to see a brain surgeon about a year ago. He said the problem with blood sugars went beyond that, actually.
In his arena, highs don’t do you any favors but don’t damage your brain in a permanent way (unless you are really too high all of the time).
Every low blood sugar, though, damages brain cells - permanently.
He emphasized that twice for good measure. My lifetime of dramatic lows (58 yrs T1) flashed before my eyes when he said it!! I had gone to see him with a list of my 7+ lifetime concussions thinking that was my problem, but the brain surgeon was more focused on my history with low blood sugars.
Now. That said. I had a good job as a Principal Engineer in a software company. My brain wasn’t what you would call ruined, despite the most spectacular low of my life, in high school, when I was unconscious for 13+ hours after being found and admitted to the hospital.
But my memory ain’t perfect any more, and my last MRI shows areas of shrinkage that compare to that of a person 15-20 years older than I am. Was it the all the low blood sugars? Dunno, I should get another opinion, but I don’t want to have another low if I can help it.
Thanks for that info! I always hear people saying to be careful of the highs, because of eye, kidney, and nerve damage (let’s not forget all the people that always talk about losing toes & feet.). And I got the vibe that the scary/important concern of lows was more about not getting hurt from falling, concussions etc., but not actual long term or brain damage.
I would be dead by now if lows caused any practical damage. Just putting it out there, doctors are afraid of lows: that’s why their opinions are biased.
My body can tolerate lows - which while helpful is kind of scary. I’ve been walking around in the 40s or 30s, and I once got home from driving and found I was on the 30s! I felt fine - the only sign something was wrong was when someone blew their car horn and I nearly jumped out of my seat. Thankfully I was pulling up to my house - the fingerstick was done a very few minutes later.
Many years ago I was having small memory issues which I blamed on “one insulin reaction too many” - I said it jokingly but really was not saying it in jest. And let’s not forget - the heart is a muscle and needs energy, so it may be worth a talk with your doctor on the topic of lows and the heart.
The main concern with lows is how they affect us in the moment, although they do have a cumulative effect; highs in the other hand do their damage over time. So as with anything, it’s best to avoid extremes.
I’m very grateful for CIQ and my CGM!
My son is 15 and was diagnosed almost two years ago to the day. We have followed the path suggested by your doctors and nurses and had relatively good success far with a1cs in the mid to low 6s and time in range oscillating between 70-80% in each of our visits despite lots of In and Out Burger and Pizza in the dietary mix. Our initial ER stay upon diagnosis head cheeseburgers and chicken strips on the menu and those nurses were pretty soothing to the young guy who thought he was going to eat rice cakes for the rest of his existence. He is definitely still in his honeymoon period per our pediatric endo and that is a bit of a crutch for us.
Our biggest struggle is working with him on the inevitable trips out with his friends. We have really worked on building a rapport where he feels comfortable sneaking away and calling us to make sure his dose guesstimate is in the correct range. We have met a decent number of new friends with children his age in the T1D community and the biggest issue for the teenage stretch is the refusal of the kids to own their condition . They will not think through their proper bolus, not wait the required time after injection, or even skip injections as they don’t want to be the “Diabetes Kid” in front of their friend group.
I will say that in all of my conversations, we definitely live in a new age of monitoring and rapid reaction and that ha made things infinitely easier. There is no easy path for this but I am quickly appreciative of how much new pump and CGM technology has unburdened patients as compared to even 10 years ago.
There are summer camps for diabetic kids, I think of all ages. A 15 year old might consider himself “too old for camp” but you never know. There may be done links under the forum Resources tab, or you could the ADA.
A moderator in another post suggested but to include links, so I removed the one to the American Diabetes Association, but it’s way enough to find.
Thanks for sharing! My son is in that same boat, definitely doesn’t want to be the “Diabetes Kid” in front of his group. And he doesn’t like to eat in class (to prevent upcoming low, like after PE) when others aren’t allowed to eat in class. I try to tell him that his a medical necessity, but he is a teenager and hears what he wants.