Type 1 Diabetes...need more snack ideas

Choosing snacks for Alyssa is an ever evolving task. Being a child with type 1 diabetes, high energy, high metabolism, and one who could previously eat anything she wanted....means mom had to become very creative. Her snacks need to be around 15g of carbohydrates to keep her blood sugars level.  I always keep sugar free jello, sugar free popsicles and cheese sticks on hand, as they are low carb alternatives when Alyssa’s hungry between snacks or meals. She loves vanilla flavored yogurt and a serving of the light is 14g of carbs. All the little 100 calorie snack packs have somewhere between 14-17g of carbohydrates and there are tons of varieties and great when you're on the go. It also gives her a chance to have chocolate chip cookies in mini size :). Sugar free jello pudding, ritz bits peanut butter snack packs, gold fish snack packs and 4 to a pack of peanut butter or cheese crackers are all 15g of carbs or less too. If she experiences a low blood sugar, I usually give her a 4oz. juice box followed by a protein/carb snack of cheese and crackers or cheese and a few grapes or apple slices. She has 3 snacks a day and who would want the same thing over and over? Therefore, I am always on the lookout for new snack ideas.




(An updated version of a early post).

What is A1C??

I have had several readers ask, "What is A1C?"

Of course, prior to Alyssa's diagnosis, I didn't know either.

Basically, A1C is a blood test that reflects patients blood glucose levels for the past 2-3 months.  Specifically, the A1C test measures the percentage of hemoglobin (the protein in red blood cells that carries oxygen) that is covered with sugar.  The higher the level, the higher average of blood sugars and the higher the risk of complications.

A normal A1C is between 4.5-6%, which means an average of 80-135 mg/dl (blood sugar levels).  An A1C 6.5 or higher indicates diabetes.  There is also pre-diabetes which is an A1C of 5.7-6.4%.  For most adults with diabetes, the ideal target is an A1C of 7% or lower (average bg's 170 or lower).  With children, the target is 8 % or lower (average bg's 205 or lower).

Counting Carbs

Counting carbohydrates can be quite difficult when your type 1 child eats something that doesn't have a label.  This week, Alyssa has been going to vacation bible school and the first thing they do is eat dinner.  The first day was pizza, applesauce, Oreos, and a Capri Sun (I brought a Capri Sun Roarin' Water because it only has 8g of carbs compared to the 22 in regular Capri Sun).  I knew a regular applesauce cup has about 22g of carbs, at least the brand I buy does.  I knew a regular slice of pizza has about 45g of carbs.  The Oreos were 25 g of carbs for a 3 cookie serving, but she only ate 1 of them.  Adding it all up in my head....this was a total of about 83 grams of carbs which would normally mean a basal rate of 4.15 units of insulin.  However, I knew she was going to be running around like crazy for the next few hours and burn up a lot of those carbs, so I decided to give her 3 units of Novolog.

At the end of VBS, blood glucose check read 212 (honestly, I thought it would be lower, but not too bad).

Changes

The endocrinologist made a few changes to Lu's regimen because her hemoglobin A1C had gone up .2 since our last quarter visit.  Yesterday was the first day of the dose change and also her 3 hour cheer practice.  I was a little nervous to give her the higher doses with breakfast, but didn't want her to spike before the 10:30 practice time.  Her Lantus was increased from 9 units, to 10 units and her Novolog rate was increased from 1 unit for every 20 grams of carbohydrates, to 1 unit for every 15 grams of carbohydrates.  I gave her the updated dose with breakfast at 7:30 and on the way to practice, checked her blood glucose levels.  258 at 10:15.....we are back to those post breakfast spikes where the insulin is taking a little longer to kick in.  Practice immediately started with warm-up and practicing jumps.  After about 20 minutes of that, they started tumbling and that lasted about 30 minutes.  At 11:30, we did a recheck of her bg's and she was at 115.  She had a snack, apple slices, peanut butter crackers and low-calorie Gatorade.  They practiced their competition routine and around 1:00, she gave me 'the look', which I knew meant that she didn't feel good.  Re-check, bg's 62.  Quick juice and a snack and the timing was good because the team decided to take a break.  10 minutes later,she perked right back up and finished practice with energy left over.

Dum Dum

On my last visit to the pharmacy to pick up Alyssa's diabetes supplies, I decided to go through the drive thru. I told the lady behind the glass that I need to pick up my daughters prescriptions, gave her date of birth and confirmed our address. Alyssa was in the seat next to me and the pharmacy tech waved at her. We chatted for a few minutes about the heat (over 100 degrees that day) while she rang everything up. It takes a few trips through the pass through because of the boxes of syringes. On the last pass, I opened the door to the pass through and beside Alyssa's bag of insulin was a Dum Dum lolly pop. I just smiled. And yes, Alyssa ate the sucker later!

I thought I had it together.....ugh

So, today was our quarterly visit with the pediatric endocrinologist.  Interesting morning, to say the least.  To start things off, I didn't sleep well last night, so when the alarm rang this morning, I didn't want to get up.  Thinking maybe I shouldn't have....  We did Alyssa's normal morning regimen and she asked if she could have a little coffee this morning. So, since she was up earlier than she had been in a few weeks I thought a little 'children's coffee' might help her get going.  I measured the milk, sugar free creamer and mixed them with a little coffee.  I accounted for that with her Novolog dose and we hit the road to drop her brother off at his first day of driver's ed and then on the see the doctor.

When the nurse called us back, she wanted to check Alyssa's blood glucose levels and I thought for sure it was going to be within range.  At this time it had been 2 hours since she had eaten....but a reading of 405.  I was floored!  She hasn't had a reading like that is such a long time.  Re-check...305...better, but what the heck??  I felt terrible.... I mean, I carefully measured her food, counted the carbohydrates, and calculated the insulin dose.... all of a sudden I felt like the worst mom in the world.  I mean, I know realistically that things like this happen and diabetes is a very tricky disease.  Sometimes bg's fluctuate for reasons out of our control like stress or excitement.  I know Alyssa and I both were excited to discuss the insulin pump with the endo.  Another blow, her A1C was 8.2, up from the last visit.  Ideally, they would like to see it 8 or less.  Ugh!

Well, on a happier note we did discuss the pump.  We are scheduled for an insulin pump class on Tuesday evening.  After we pick out the pump we want, the next step will be to contact the insulin pump company to start the purchasing process and see what pump and how much our insurance company will pay for.  I'll go into more detail in another post about the process of getting Alyssa started on the pump and the steps we'll take in the near future.

Pump talk

As I've mentioned before, I've been hoping to talk Alyssa into getting the pump. I know it seems to be an easy decision because she would go from 4 injections of insulin a day to changing the pump site every couple of days. However, I also know the idea can be quite scary and she already has to deal with so much. That is why I've never really pushed it, I just hoped she would show me when she was ready. This morning we went out for breakfast and the topic of getting a pump came up again. She showed a little more interest in the pump this time and said she would try it :). Fortunately, tomorrow is our appointment with the endocrinologist; so, we'll see how it goes!! There are several steps before we can start using the pump, but I'm excited we are on the way!!