June 10, 1999
Meal Planning, Food and Diet
Question from Iowa, USA:
My 10 1/2 year old daughter was diagnosed with Type 1 diabetes last year. Humalog and Ultralente (2.5 Humalog 5 Ultralente breakfast and supper and 2 Humalog lunch) but her blood sugars are so wild, anywhere from 45 to 300 in any given day. Our pediatric endocrinologist just keeps telling us to adjust insulin doses but it doesn’t seem to work.
They have her on a constant carb diet. We count carbs at each meal and snack. She gets 65 to 70 grams of carbohydrates at each meal and 25 to 30 grams at each snack. Her snacks are at 3 and 8 p.m. We were also supposed to give 15 to 20 grams before P.E. or basketball but numbers have been too high to continue that.
The diet you are describing seems to be quite inflexible. I think you might want to investigate having a referral to a dietitian who can help you individualize the diet. A nutrition assessment/history is the first step (find out what your daughter is eating or wants to eat at breakfast — count how many carbohydrates in that meal (i.e., a breakfast of 2 pieces of toast and an 8 oz glass of juice and 8 oz of milk would be about 72 grams of carbohydrate, so if she has an insulin to carbohydrate ratio of 1 unit regular per 15 grams of carbohydrate, she would give about 4-5 units of Regular or Humalog). But, if she was going swimming after breakfast she should decrease the amount of insulin. If she wanted an omelet and no toast, just a glass of juice for breakfast, she certainly needs less insulin, as 2 units or so. Anyway, flexibility is the key and I hope you can seek some help in having the diet tailored to her wants and needs. Keep in mind this needs to be in the context of good nutrition (not 5 candy bars per day).