The other night, the four of us went to Fenway Park to enjoy a Red Sox game. For anyone who is trying to limit their children's consumption of junk food and/or sugar, a game at Fenway is kind of a nightmare. Men in yellow shirts come by about every 2 minutes selling soda, cracker jacks, lemonade, italian ice, frozen lemonade, "sports bahs" (my personal favorite), or cotton candy. Plus, there's soft serve ice cream at the concession stands inside. Each time one of the vendors walks by with the goods, it becomes harder to resist the kids' pleas. Finally, we gave in, and we bought Bisi a bag of cotton candy. Before you say, "WHAT? I can't believe you let your diabetic daughter have COTTON CANDY. That's the worst!!," let me explain. On the cotton candy man's first pass, we pretended we didn't hear Bisi's request. On the second, out of curiosity, I asked the vendor to show me the "nutrition" information (though it seems beyond ridiculous to use that word when talking about a food that consists only of sugar and food coloring). He showed us the label, and it said that 1/2 a bag of cotton candy, one serving, is just 15 carbs. That seemed unbelievably low to me, so I looked up cotton candy on an app we have where you can find the nutrition information of basically any food (My Net Diary), and it said essentially the same thing. By comparison, I struggle to find a yogurt that is below 20 carbs. A cup of chocolate soft serve ice cream is 56 carbs; a cup of Minute Maid lemonade is 28; a Sports Bar is 26 (My Net Diary is so all-inclusive that I was able to find "Boston Red Sox Sports Bar" on it). So, the next time the cotton candy man came around, we took a deep breath and bought a bag. Then we tested Bisi's blood sugar, and gave her the 1/2 unit of Humalog that the calculations called for. And we hoped her blood sugar wouldn't spike so high that we'd have to correct her later, and then get up three hours after that to test her.
In fact, we did have to get up at 3 am to test her--because she was too low when we tested her before she went to bed. She came in at 92, so needed a little boost of milk to bring her blood sugar up above 100, where it's supposed to be at night. I guess we should have let her eat a little more cotton candy.
Our experience that night highlighted something that every person who's been dealing with diabetes for a long time knows, but that we are just figuring out. Straight sugar is actually relatively simple to deal with, because Bisi's reaction to it is so predictable. Sugar is fast-acting, and so is insulin, so if she's eating something with just sugar, her blood glucose level tends to be pretty easy to control--as long as we calculate correctly. Where things get more complicated is when you add fat into the mix. We've been enjoying going to the new Shake Shack down the road from us, where the burgers and custard are unbelievably delicious. But the three times Bisi has been there and had a juicy cheeseburger along with a small custard, her blood sugar has been above 250 at night, meaning we need to give her a shot of insulin at 11 or so, and then check her again three hours later. By now I'm familiar with the pattern, so the last time we went, I gave her more insulin than the calculations called for--but still she was too high that night. The problem is that the insulin takes care of the sugar in the custard, but the fats in the burger and in the custard cause a second spike in her blood sugar, and by the time that spike hits, her insulin has waned. Bisi is thinking of going on an insulin pump, and one of the advantages of that technology is that you can tell it to give the insulin in waves--one wave for the sugar; a later wave for the fat. Still, I'm sure it's harder than it sounds to get it right. (Jessica Apple of A Sweet Life wrote about how difficult it is for diabetics to handle the combination of sugar and fat in a dispatch from a diabetes fundraiser where people were treated to a donut buffet, with add-your-own sprinkles and chocolate syrup--probably the worst combination for a group of people with diabetes. Here's her account.) For now we're living with the irony that something that I've always viewed as the junkiest of the junky--cotton candy--is actually, in terms of managing Bisi's diabetes, not so bad. So a year from now, when we're next sitting in the stands at Fenway and Bisi asks for her favorite treat, I won't hesitate to let her get it.
So true. There are a bunch of foods I think of as juice: cotton candy, fat-free frozen yogurt - big instant spike. Dramatic, but so much easier to predict and manage than the fat-carb combo.
ReplyDeleteThe pump's dual wave feature really does make it easier. The first time I used the dual wave was years ago on Thanksgiving (a notoriously high-carb, high-fat fest). I was nervous to try it but it worked amazingly well - I still remember that my pre- and post meal numbers were both in the high 80s, just a few points apart.
Shake Shack! The best diabetes part of Shake Shack (based on one trip) was the pretty fonts used on the Nutrition Information packet. (And the availability of that packet.)
ReplyDelete