<<Disclaimer: Verify this information before applying it to your situation.>>
Greg:
I have an 8 yr. old daughter Brittany, who has been a celiac for 7 years
and was diag. with juvenile diabetes in Jan. of '98. The first and
foremost thing is that this mom needs to work very closely with a
"informed" dietitian who has a real understanding of celiac disease.
Many do not. The diabetes complicates the issue because now carbohydrate
is an issue. It is important to try to stay within the carb guidelines
the dietitian gives. Of course, kids are usually not going to eat every
calorie indicated on the suggested menu. Many times this demands a call
to the pediatrician for adjustments in insulin. Brit was given a 2000
calorie diet when she was in the hospital - I have a child that is a
very good, healthy eater but there is no way she is ever going to eat
2000 calories at this age (maybe 1200-1500). So I called the dr's.
office and we made adjustments in her insulin for less food. I have a
degree in nutrition (worked in product development for General Mills) so
I am able to make the dietary adjustments. Until the mom is familiar
with what she needs to do, she really needs to heavily rely on the
dietitian for info.
The book for diabetic kids that I have found most helpful for myself is:
"Sweet Kids," by Betty Page Brackenridge and Dr. Richard Rubin. Dr.
Rubin's son was diag. with dm at age 7. The book is very supportive and
reinforces the fact to not battle over food. I have always felt this is
important in diabetes control (and parenting in general). If food
becomes a major issue on how much, when, etc. as a parent you are in for
a nightmare. Granted you do have to follow the rules (schedules) pretty
close, but there is room for flexibility, it is that no one tells you
this when you are in the hospital with a new diagnosis.
The main trouble with celiac/dm is that the rice, corn and potatoes you
are allowed to have on the celiac diet create a nightmare for those
blood sugar readings. Now, this does not mean this child should never
eat these foods, it just means some adjustments must be made. With dr.
approval (actually nurse approval) I asked if it would be o.k. to
increase Brit's Humalog 1 unit at suppertime if we have potatoes, rice
or corn. We do not do these foods often because Brit has seen the
skyrocketing bg's even when we have towed the line perfectly, exercised
more, increased the insulin a little. She does not like it when her
sugar is high because it affects her stamina. There is no way that we
would ever have potatoes and rice or potatoes and corn at the same meal
or even on the same day. Unfortunately - it just doesn't work for us.
The gluten-free breads are pretty high in carbs and the Energy Rice
Bread that has 16 carbs per slice sends the sugar up because it is so
dense. This does not mean the daughter can't have bread just prepare
and plan carefully for it.
Tell this mom to learn everything she can about carb counting. This is
much easier when you have a celiac/diabetic (in my opinion) because then
you will eventually learn when and how much insulin to adjust things
for.
A tip for breakfasts - especially if her child tends to not be a morning
eater or prefers cereal. Cereals can be tough on the bg's too (lots of
carbs then add milk carbs on top of it. We use Van's Gluten-Free Waffles
and each waffle is 16 carbs. Brit (not a morning eater which is scary
after she injects her insulin) will eat one of these and does fine - no
low bg's in the morning. I know this sounds like I don't feed my child
breakfast in the morning. Some mornings she will drink some juice or
fruit with it and some mornings not. We just don't do battle. Brittany
is real good about eating her snacks and other meals throughout the day
and her sugars are just fine. She recently has had bg's running higher
than normal and I finally figured out that her allergy medicine
(Claritin) appears to have done it. After going off the claritin her
sugars are better - but of course it could be the stress of starting the
new school year and an adjustment of a new schedule. We will be seeing a
ped. endo. next week and will ask questions.
Counting carbs is the key and give the child many healthy food choices
then this isn't such a big deal. A word if warning - if this child is
in elementary school - the birthday parties may make her child unhappy
even if she has supplied alternatives. Brittany has always been a
trouper about the celiac disease but last year (in 2nd grade) it really
got to her that she shouldn't eat the tons of candy and cookies these
other children were eating. My personal opinion is that the teachers let
the parents get out of control on this issue. These kids didn't need all
that stuff anyway. This year her teachers have a much more simplistic
approach to birthdays. Brittany wouldn't eat the stuff but she would be
very unhappy (if I happened to be there - which I tried to do) or when
she came home from school there were tears about it. This does get
better and I tell Brittany and eating healthy like we do (which is what
we did even before the celiac/dm diag.) and exercising regularly we will
be ahead of the game compared to these other people down the road. They
are going to create other health problems because of their bad habits
and they will eventually have to change how they eat whether it is heart
disease, diabetes, etc. Brittany is very accepting of this fact and it
is a reasonable answer for her.
Hope I helped.
Pam
I would like to know how old this child is? As far as snacks Brit eats
Hain's Ranch Mini Rice cakes a lot, with peanut butter, cheese or some
other form of protein. Brittany also eats a wide variety of fruits, so
have plenty on hand so the daughter will reach for the right thing.
For example, if the daughter would like to have some "Fritos" as part of
her snack. Let her have the "Fritos" (count the carbs - 32 Fritos equals
15 carbs). I don't usually hand out 32 because I don't want Brit to get
into a habit of eating tons of junk food. Brittany knows if she eats
something like that she has to eat something healthy with it. She is
very accepting of this and we don't do battles.
Trust me - there will be a time that her daughter has been injected with
insulin and refuses to eat. A PARENT'S WORST NIGHTMARE! This has
happened to us a couple of times and I just stayed very calm and tried
to talk her into eating dinner. She flatly refused! The next best option
was to offer Regular Pepsi or something with sugar in it she liked. I
don't like doing this because I don't want to set an example for her if
she won't eat she will get a "treat." So far this hasn't been the case
and later in the evening she does decide to eat dinner - this of course
makes her bedtime bg higher because of eating so late and then the
morning bg may be a little higher because you have changed the eating
schedule some. But if this is only done once in a while it is no big
deal. As adults there are times we don't have an appetite and
force-feeding someone isn't going to get you anywhere.
As far as more snack info. just stay with very healthy snacks,
gluten-free crackers (Brittany likes the WASA CORN - 2 crackers = 15
carbs, Holgrain Rice Cracker - 8 crackers = 15 carbs, etc). Now we have
not had any problem with rice or corn based crackers raising the bg.
It just tends to be potatoes (baked, mashed, fries and if a product
contains a lot of potato starch), corn (on the cob or off), and rice
(brown, long grain, etc). If you go out to eat once in a while let her
have fries if you can find out if they are gluten free. Some places make
fresh fries and don't fry anything else in that fryer. But try not to
let her "pig out" on them, because there will be a price to pay. If she
does she will learn that it is not worth it. Brit has "pigged out" a
couple of times and I am talking about "pigging out" on carbs as a
diabetic not as a regular person. Brit is much more conservative in that
area compared to most people. She prefers to not go overboard - it has
kind of become a 6th sense in her - she knows how her body feels. Brit
is very in tune with her body - many diabetic kids aren't - but I
suspect the diabetic/celiacs are more in tune because usually they have
had to deal with one disease before the other occurred. Experience
helps.
|
