July 31, 2000
Meal Planning, Food and Diet
Question from South Dakota, USA:
My 11 year old daughter has had type 1 diabetes for a little over a year. She followed the ADA diet and consistently gained four to six pounds every three months. From before onset to present, she has gained 23 pounds. Her insulin demands also steadily increased. At her last visit, her insulin needs were a little high. For the last three weeks, we have followed a diet laid out in Barry Sears book about The Zone. We have switched to all fruits and vegetables for carbs, two-and-one-half to three ounces of protein (usually lean), and a very small serving of monounsaturated fat are served at each meal. If any other carbs are to be consumed, it is in a seven to nine gram serving instead of the usual 15 gram serving size. My daughter has lost four pounds and lowered her daily insulin needs from 63 to 50 units. Her energy level has increased also. Is this a recognized diabetic diet? Most references to complications and the protein diets refer to stats from 15 years ago. Isn’t it necessary to take into consideration that blood sugars need to remain consistently in the normal range (I also mean after meals too — my daughter’s blood sugars are usually between 120-140 mg/ dl [6.7-7.8 mmol/L] one hour after meals) and whther or not insulin needs are higher than absolutely necessary? I found that following the ADA diet of carb counting was deceptive since glycemic index was not also taken into account.
My goal is to feed my daughter a healthy diet, but to keep post meal blood sugars within a normal range also. In doing so, I believe she can avoid the long term complications associated with diabetes, since I feel the complications are from the high blood sugars and the insulin used to treat them. What is your response to my questions and observations?
Answer:
I do agree that high blood sugars and high insulin levels are causes of complications over time. I also believe in a growing child that leaving out the starch/grain group of foods can lead to nutritional deficits and also a lifestyle that is difficult in this society (i.e., pizza parties, eating out with friends, etc.).
I feel there is more to diabetes control than just the sugar control, that is a feeling of well being and belonging in the peer group. I agree that sometimes carb counting education which focuses only on total carbohydrate, and not the sources, can be deceptive. One still must use good judgement and be aware of how the body/mind is responding to a meal plan. I have no problem factoring in the glycemic index into food choices, but I believe all foods have their place in a well balanced meal plan. It is often the case that after the initial weight loss experienced prior to diagnosis is regained that the meal plan is not altered downward and the insulin becomes what we feed. I call it “feeding the insulin instead of the child.” Periodic assessment by a dietitian will help determine the appropriate number of calories needed to promote optimum growth and development.
JM
