Wil Dubois

Got questions about life with diabetes? So do we! That's why we offer our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week, Wil is taking on the topic of Food and Diabetes, in response to a new D-Mom whose small daughter was just diagnosed with type 1. There's a lot of confusing talk out there about low-carb diets, and even a debate among the medical pros themselves about whether carb counting is actually the best method.

So, here's Wil's take on managing carbs -- and don't worry, per his signature style, it ain't no copy and paste of what your local dietician advises.

Ask-DMine_button

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Sumi, D-mom from New York, writes: Hi, Wil! I’m a newly “diagnosed” diabetes type 1 parent: My little girl (2 years, 4 months) was diagnosed two months ago. We have been feeding her a low-carb diet and have cut out, let’s see... dairy, wheat, and sugar due to some feedback from sensitivity tests and the scare of killing off her remaining beta cells even quicker (though I think she is already coming out of her honeymoon). She has somewhere from 20-30 grams of carbs per meal and I still haven’t found a way to feed her any carbs for snacks without high blood sugar readings that send me panicking. 

The dietician at the hospital doesn’t think it wise to give a two-year-old, or anyone for that matter, less than 100g of carbs a day, and she also recommends me to give her up to 10g of carbs for snacks without any insulin between meals. She thinks my daughter may have starvation ketones in her blood at this rate and that it may affect her growth and development. I’ve been doing research and talking to people, but everything seems to be for grown bodies, not growing toddler bodies. So my question is this: How many carbs should a two-year-old be getting, and is it safe to go low-carb for them? Also, how the heck do I feed her carbs between meals when her insulin is not working anymore? (She would eat snacks every hour if it were up to her, but we try to keep it to two-three hours, and then only nuts or protein.) I hope this finds you well, and that you may have some insight.

Wil@Ask D’Mine answers: It’s not too often that a reader question scares the hell out of me. But this one does for two reasons. First, I’m not sure that I (or anyone else on the planet) know the right answer; and second, if I (or anyone else on the planet) are wrong, the results could be devastating. You are correct that the lack of info we have on toddler bodies is appalling. We know bupkis.

But here’s what I think. Cutting wheat seems to be the current “best practice” in the treatment of little T1s. There’s a pretty good link between T1 and Celiac, not that we understand it. But where you see type 1 in very little people, you also often find problems with gluten. As you can live just fine without gluten, why not do it?

(As a side note: it does not bother me that we don’t understand the relationship between the two diseases; after all, we are still in the dark about the cause of type 1 diabetes!)

But dairy? That worries me a bit. Sure, if she has a diagnosed lactose intolerance, and some little T1s do, then it has to go, but she really needs calcium for her bones to grow right. And as to sugar, carbs are the real enemy, not sugars per se. So be sure you look at that through the right lens. Sometimes foods with sugar actually have a lower blood sugar impact than a high-carb “sugar free” food. As an example, I’ll direct you to the baked potato.How Many Carbs

I also have issues with your goal here. Cutting out foods to help control blood sugar, I’m fine with. But cutting out foods to try to lengthen her honeymoon, I find, frankly, crazy. Why on earth would you want to do that? Look, we know where this will end. At this point in time, we do not have the medical technology to stop type 1 in its tracks. The autoimmune process will slaughter the beta cells and we are powerless to stop it. The sooner it happens, the easier it will be to control your daughter’s blood sugar. In honeymoon, some days she has endogenous insulin, and some days she does not. That makes control impossible, if not dangerous. I’m sure I’ll piss off all the other D-moms (again) for saying this, but I think a drug that actually accelerates the process would be a blessing.

Once the only insulin in play comes from outside, control will be easier. The fewer variables the better, plus when the body is still spurting out some insulin there’s no way to measure it in real time, and bad low blood sugars are more likely, and completely unpredictable.

OK, on to carbs. I have no qualms about the hospital dietician’s advice for 100 carbs per day. I realize this is the first time I’ve agreed with any dietician on anything, but that said, I’m not convinced that it would be bad for a growing child to be low carb. I bet if we could carb count through history, we’d find that for most of the time our species has been on Earth, children ate much lower carb than we do now. So I’m open-minded on that. Just keep an eye on her growth curves.

But the dietician’s advice of giving a T1 a snack with no insulin coverage is asking for trouble, trouble that you yourself have seen. All food needs to be covered. I actually think you should increase the carbs in the snack to whatever her IC ratio is for the smallest dose you can give. For instance, if you are using 1 unit pens and she is at 1:20, make her snacks 20 carbs. I’d only do a 10 carb snack if her IC ratio where 1:20 and you had an accurate half-unit pen.

As to “starvation” ketones, don’t let the dietician “think” they could exist. Test them. Get an Abbott Precision Extra meter and blood ketone strips, even if you have to pay for them out of pocket, and test for them. If she’s clocking ketones, she’s insulin deficient, and needs either more basal, or more fast-acting with meals and snacks.

Back to carbs for a minute. I actually trust the wisdom of two-year-olds. Two-year-old children haven’t been Love Carbs Bibcontaminated by the world yet. They are selfish, self-contained ecosystems. If your daughter would be happy eating snacks every hour, this is probably what her body needs. I’d let her. I’d abandon the low-carb nut and protein snack approach and let her eat a snack big enough that you can cover it. You don’t need to hold her snacks to two-to-three hour intervals. Stack the insulin. If you bolus right for what she eats it will be fine. You can safely stack insulin so long as you are also stacking carbs.

I hope all of that helps somewhat. I understand that this is all new, and that no one agrees on anything, and that we in medicine don’t know jack about small, growing children’s nutritional needs. My advice is to listen to everyone who will talk to you, but trust only yourself. And your two-year-old.

And welcome to the family. Both of you.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

 
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.