It's not a just a simple numbers game
Not all carbs are created equal. Not only are there simple carbs and complex carbs, but each of these sugars might react differently in each body. There are some foods that hit Walker hard, but have little impact on Ollie. Or vice versa. And it might shift depending on the activity of the day, or the phases of the moon, or the color of their shirt. Diabetes likes to keep us on our toes.
But in general, we know how certain foods are going to affect the blood sugar. When a blood sugar is dangerously low we reach for juice, and when they’re heading out for a long bike ride we hand them a peanut butter and honey sandwich. A hearty granola bar with nuts and seeds and dried fruit is drastically different from a small handful of skittles, although both have the same carbohydrate value. We have to constantly be making calculations and predictions in our head any time we have a snack or a meal, not only in how much insulin to dose but also how the combination of fats and proteins and sugars are going to play into the equation.
Our family tends to stick to a whole food diet, with the exception of emergency glucose. On the counter I may have a vat of kombucha brewing, and nearby will be the cookie jar stocked with Smarties and Rolos. The kids will have a school lunch packed with kale salad and chia seed crackers, but in their camelbacks are skittles and atomic fireballs. We are an exercise in contradictions. Before the kids were diagnosed I made every meal from scratch and had only healthy snacks at the ready. Although I still make healthy meals and snacks I also know there is a quick and consistent effect from a pre-measured juice box or a roll of smarties. I tried making homemade quick acting carbs for the kids but I found they spoil quicker and the waste was overwhelming. At 3 am when the glucose meter flashes 58 at me, I can quickly grab a juice and trust their blood sugar will rise.
When the kids or Marshall are low, meaning a blood glucose reading below 70, we always reach for fast acting carbs. Fast acting carbs are things like: juice, gummy candies, Smarties, Skittles, or soda (for Marshall). These sugars hit the system quick, and will give an immediate boost to blood sugar. We typically expect to see a rise within 15 minutes after eating 15 grams of carbohydrate, sometimes sooner. If the blood sugar doesn’t come up after 15 minutes, we follow with another hit of 15 grams. The general rule we are all taught in Diabetes 101 is: 15/15 (15 grams, 15 minutes). Once the blood sugar has risen above 70 or 80 mg/dL we typically will follow up with another snack, only this time something with some protein and fat in addition to carb. The fat slows down the absorption of the sugar and the protein is sustaining. In theory, this will help the quick bump of sugar to keep them level and minimize the chance of crashing again. Sometimes we give insulin for this additional snack, but at a lower dose. It really all depends on how low they were, how their blood sugars have been throughout the day, and what they’ll be doing for activity in the coming hours.
There are also times when their blood sugars are just drifting low, or as we like to call it “the floating leaf”. They’re not crashing, but they certainly need a little something to pick them up. For times like these we reach for a complex carbohydrate, like a nut and seed granola bar, apple and peanut butter, or some carrots and hummus. These snacks are less frantic and can be a bit more thoughtful and tailored to the taste of the kids (or Marshall). They are intended to give the blood sugar a little bump, but more useful in sustaining a nice level number. Again, depending on their blood sugar and activity level determines how much and if any insulin is dosed along with the snack.
At night time it’s a whole different ball game. Marshall is able to get himself up for a 2 am snack if need-be, but we try to maintain an “as normal as possible” sleep schedule for the kids. This means chocolate milk and juice are our go-to nighttime carbs. If blood sugars are below 70 mg/dL we have them drink juice, and if they’re only drifting low then we might have them take a few sips of chocolate milk. Remember, the protein and fat of the chocolate milk has a more mellow blood sugar hit, while on the other hand the juice is going to hit fast and hard. The kids rarely even wake for these treatments and can sip on a straw without opening their eyes. These low episodes often get incorporated into their dreams, as Walker has told me, and it rarely disturbs their sleep cycles. Marshall will typically wake himself from a low by dreaming about food.
I can still make a mean protein/date bar and my tofu fudge pops are pretty kick ass, but I have also come to appreciate the convenient single serve store bought snacks. Without thinking twice I can rattle off the carb counts of most store bought granola bars, and get more excited than any normal person should get over 15gram serving sizes. I have little use for a 25 gram NutriGrain granola bar (it only crumbles and falls apart in our bag, not to mention too many carbs for not a lot of sustainability), and adore the mini Apple&Eve Sesame Street juice boxes. T1D parents covet our 15g carbohydrate packs, and can often be seen scanning nutrition labels for the highest carb count per ounce of juices on the shelf (at 2 am you only want your kid taking in a few ounces of liquid instead of a full glass of watered down apple juice!).
And now you know, when a parent of a kid with type 1 hands them a graham cracker with peanut butter it’s usually much more than just a snack.
