To carb, or not to carb: that is the question:
Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous lows
Or to take carbs against a sea of troubles
A little twist on Shakespeare's soliloquy, probably the most famous speech in the English language, is the first thing that came to mind when I started to think about today's topic. I have no doubt about it, carbs can mean life; to be. Aside from treating lows, as we wrote about on Thursday, carbs are essential fuel; especially for growing concerns (aka our children). Although most of my recent encounters have been with families of diabetic children, I have met a few adults who have managed this for years. For the adults there seems to be, not so much a divide, but rather two schools of thought on the subject with some common ground. As far as the kids go though, every doctor, nurse, nutritionist I've spoken with seem to agree: as long as he's growing, he needs carbs.
It makes sense to me. Every science and biology class that I took at least touched upon the subject and identified carbohydrates as a key source of energy. From everything I've read about healthy, balanced diets, carbs are an important component in varying proportions depending on stage of life. Specially focused diets and personal choices not withstanding, it is our opinion, and in agreement with the clinic team, that Jonathan needs carbs to develop and grow.
So to answer the question: Carb.
That being said, to carb is to count. For meal time there is no leniency, every carb is counted and factored in. One of the drawbacks of injection vs. pump, is that the finest tuning is to 1/2ū, but there is a bit of a way around that - adding or subtracting a few carbs to get the denominator to the right number - not perfect, but it helps for consistency. We have not picked any specific diet or meal plan but rather opted for basic healthy choices. For breakfast, he most often prefers oatmeal and a glass of milk (ok chocolate milk), occasionally Cheerios or toast with some fruit and milk. Lunch is typically a sandwich, yogurt, fruit (strawberries), some sort of treat and depending on the total (we have to target 45g because of the fixed dose that the nurse gives) and either a Kool-Aid Jammer 10 (which is 2g), or some milk. Dinner is any number of things, typical family fare - usually a meat, a vegetable, a starch, milk, and a dessert; occasionally hot dogs or chicken nuggets with fries. Of course from time to time these meals deviate due to travel, special occasions and such, but at home/school it's fairly routine.
In addition to meals, Jonathan gets two snacks. Mid-morning snack typically consists of a cookie (animal crackers or arrowroots) and cheese for 10-15g depending on breakfast BG and planned activity, and afternoon snack is a 14-18g variable - there's a snack box he gets to choose from. Snack time is a little more liberal and is always open to changes while keeping a 15g target in mind and we tend to change things up on the weekend so that he doesn't get bored. From time to time we face situations where something becomes available to him that is out of the norm; this ends up as a judgment call and is sometimes difficult. When things pop up out of the blue we usually try to negotiate with him, but if all else fails one cheesy or one Skittle isn't going to do a whole lot of damage, but just one.
The big "To carb, or not to carb" questions in our lives center around what I call "heading down". Heading down is an observed trend that if it continues could result in something bad before a scheduled meal or snack time. This usually happens in the evening when I look at his Dinner#, Bed#, and Dinner+4hr#. Those three pieces of data allow me to draw a line/curve that is weighed against the type of food he had and the evening's activity. If I see that he's heading down steeply, I might give a small snack (5-6g) to help level him out. If I see that he's a little tight but not necessarily something I'd typically correct I usually just end up checking him every 2-4 hours through the night and deal with a true low if it comes. Sometimes this happens during the day when his activity level is higher, but we usually have a better handle on it as the ins and outs are more observable, night time is a more frightening because a) he's relatively still and it's not obvious why he's heading down and b) he not being observed like he is during the day and has no conscious knowledge of how he's feeling.
This is all part of our "new normal". It's integrated into our lives and is done most often with minimal disruption. It is the way it is, at least until after Sunday's topic isn't just a dream.