Wednesday, September 24, 2014

The Elephant in the Room

 Basically insulin is a key for allowing the glucose (breakdown of food in our digestive system) to be utilized by our cells, all our cells.  Without insulin, glucose builds up in the blood stream causing high blood sugars and ketones and eventually death.  Before the discovery of insulin in the early 1920s by Banting and Best, children were put on a starvation diet to try and prolong their life.  Type 1 diagnosis was fatal.  The main difference between Type 1 and Type 2 (besides the autoimmune response in type 1s) is about the insulin.  Type 1s produce little to none and type 2s are resistant to the insulin their pancreas still produces.  When a child that is Type 1 reaches puberty they can become insulin resistant as well.  Some are put on drugs typically used for Type 2s as well as their insulin regimen.  So those are some basics.  Let's talk food.

When Sugar Bear was diagnosed we were given at the hospital a little booklet that travels in his kit.  We also were blessed with some iphones from my in-laws and between those two things we can figure out how many carbohydrates are in a meal for our little guy.  And then the learning took off.
 We were amazed at what all contained carbohydrates and how much from bananas, peas, carrots, some meats, some cheeses, peanut butter, breads, potatoes, milk, oj, etc...etc...etc...  We invested in a scale to make some of this math easier and more accurate.  Accuracy is so important in keeping Sugar Bear in range.  And even then sometimes it still doesn't work.  So we also have to take into consideration the  glycemic index of food.  Some foods will cause a spike in the blood sugar that will then bottom out like pizza, fast acting sugars (candies, fruits, juices), etc....   Other foods high in proteins and fats can help to stabilize blood sugar but they can also be high in sodium and unhealthy fats.  Peanut butter crackers after a juice for a low can allow the blood sugars not to spike or drop.  In a body with a normal functioning pancreas these processes happen without any thought.  Your body in preparation for a meal will release insulin.  When all the food is broken down and transported to cells it will stop producing insulin to prevent a low.  Your pancreas will also release glucagan to raise blood sugar if your body were to start going low.  The liver stores some of the glucose to release as well.  In a Type 1 this can be very important if one has a severe low.  It's not something one can rely on which is why we carry glucagon and a syringe with us every where.  And the glucose stores in the liver can be depleted. 
 Now let's talk food choices and the emotional toll diabetes takes.  Imagine you've had the worst day ever.  You can't wait to get home, unwind, grab your favorite comfort food, and relax.  What's your comfort food?  Is it "healthy"?  How would you feel if someone told you you shouldn't have that and then directed you to something they feel is better?  What if it was a holiday?  Do you indulge in foods you "shouldn't" at that time? 
Type 1 Diabetes is a never ending, constant source of emotional battering.  From highs and lows, to regular doctors appointments, to worries about long term complications, and social impacts and it all centers around food.  Go to the movies and there is popcorn.  Go on a date and you'll probably go out to dinner.  Friends have a party and there will inevitably be numerous foods (not necessarily "healthy") to choose from. Want to do something healthy like exercise?  Better test and adjust carb and insulin intake. Ever been on a diet or told you shouldn't eat a particular food?  It becomes the elephant in the room.  It's all you can think about.  It's all you want even if you KNOW it's BAD for you.  Can you go one time winning that craving?  How about 100 times?  A thousand?  With Sugar Bear we have taken the very sound advice from another parent of a child with type 1:  Child first, diabetes second.  It doesn't mean that diabetes isn't part of the equation.  It most certainly is.  But when we weigh how to operate or treat him, we err on would we act a different way if he didn't have diabetes?  If the answer is yes, then we have to figure it out. We have to do it. So we SWAG (scientific wild a## guess) that popcorn he had watching a movie with his friends because they wanted popcorn and so did he.   We indulge in ice cream to celebrate moving up a grade.  And he gets chocolates and candies at Easter, Halloween,and Christmas.  He'll get to eat all his carby starchy favorites at Thanksgiving.  And he can most definitely have cake on his birthday.  It becomes about covering with insulin not making him feel different.  Diabetes already makes him feel different enough with testing 6-10 times a day and having to take a shot 4-6 times a day. Feeling awful with highs and lows.  Oh, yea, and doing math just to eat.  This doesn't mean he doesn't have limits.  We all do.  Everything in moderation and sometimes even moderation.  Will we let him sit down and eat the entire Trick or Treat bag in one sitting?  Um, definitely not.  But we wouldn't want him to do that even if he didn't have diabetes.  Will we make him feel guilty for wanting to?  Nope.  But he will get to have it.  We will plan accordingly. 

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