Saturday, March 23, 2013

The Three-legged Stool

In the fall of 2009, as we were leaving the hospital after Ben's initial diagnosis we were given a list of follow up appointments we need to make over the next couple of weeks including a visit to a dietician, a social worker, a nurse educator and our new endocrinologist. The day of our appointment with our new endocrinologist the office called and explained they needed to cancel our appointment because our new doctor was out of the office sick. We rescheduled for a few days later. Within a few hours we received a second call from the doctor's office and they asked if we would like to see Dr. Wolfsdorf today instead. They explained that Dr. Wolfsdorf was able to cover some of our sick doctor's appointments. I agreed that would be fine, but what I did not realize at the time was how much of a privilege that was. I thought Dr. Wolfsdorf was just a doctor with extra time on his hands. Instead, Dr. Wolfsdorf is the Chief of Endocrinology and the Director of the Diabetes Program at Boston Children's Hospital! And Jeff and I had no idea.

When we arrived at the appointment I was pretty much a wreck. It had only been a couple weeks since Ben was diagnosed and my head was still spinning. When we entered his office he asked us to sit down and he started reviewing all our logs (which at the time were excellent).

Then I remember the doctor telling us, "Managing diabetes is all about the diet."

Hmmm, I was confused. For those first weeks we were continuously told Ben could eat whatever he wanted. We just needed to count carbs and give him insulin.

So I asked Dr. Wolfsdorf, "But Ben has Type 1 diabetes. Is that true about Type 1 too?"

The doctor replied with a stern, "Yes."

The conversation was that quick. Soon we were talking about the mechanics of managing T1, types of insulin (long lasting vs short lasting) and insulin to carb ratios.

Over the past three years, since Ben’s diagnosis, we have been focused on the mechanics of diabetes. And because Ben is a very active boy we have also spent a lot time learning about exercise. It's been a challenge. And we have learned a ton! But I have not forgotten what Dr. Wolfsdorf told us, "It's all about the diet." And I have slowly started thinking about managing T1 as a
three-legged stool with each leg being equally important. The three legs, in my mind, would be the mechanics/insulin, exercise, and diet.

When Ben was first diagnosed we met with a dietician. The dietician suggested should Ben eat more vegetables and protein. She also suggested that we could arrange some peppers and carrots on his plate and make a smiley face.  Apparently, kids love that? Seriously? (Ben is too smart for that.) She also suggested we should put rolled up cold cuts in his lunchbox as his snack.  Again, seriously? (There is zero chance Ben would touch any cold cuts.) Since that appointment with the dietician we have made very few real changes to Ben's diet. We have learned to avoid a handful of foods (bagels, soft pretzels and slushies). But so far all we have really done is learn to count the carbs in Ben's meals.

To be clear, we have tried to reduce the amount of refined and sugary carbs Ben eats and replace them with veggies and protein. But almost every attempt has been a failure. And the blame falls squarely on me. It has always felt like Ben has had to deal with enough and taking away his favorite foods seemed like I was pushing him too far. (At least that it how this guilty T1 mom felt.) But it is now time for me to put on my big girl panties and deal, deal with what likely is our biggest T1 challenge yet, diet.

Now that I have my big girl panties on I need to be honest with myself, I don't eat any better than Ben! How can I expect a 10-year-old to do something I myself am reluctant to do?  Maybe this might just be the time to lead Ben instead of push.  The time has come to stop snacking all day and then ending it with a bottle of red wine and a box Cheez-Its.  So my plan is to change my diet (and Jeff's) first.

At the suggestion of a friend, Jeff and I decided to follow the Whole30 program. Over the past few weeks we have made some extreme adjustments to our daily diet. And as a result we both feel great. All three of our boys have watched us work through this diet and some of our healthy changes have already started to rub off on them. We can no longer keep blueberries and blackberries in our house for more than a few hours!

Now that I have seen some small success with my plan, I feel empowered to focus in on what the boys eat. The first meal I want to fix is breakfast. My goal is to never buy a box of cereal again!

Hopefully, if we keep doing the hard work adjusting our family diet (and I don't let my T1 mom guilt overwhelm me) we will be able to right Ben's three-legged stool. In the end all of us might just be happier and healthier. And I might just need to raise a glass (of red wine of course) and cheers to Dr. Wolfsdorf.


  1. Good job and keep up the great work!! About 6 months ago I made some drastic changes to my diet as well. I attribute it to wearing the DexCom and finally seeing what foods were actually doing to my blood sugars. Cereal, for example, was the reason I was staying high for the entire morning.

    Since then, I have never purchased a box of cereal again. For breakfast I eat eggs, bacon, sausage (turkey) or low carb wraps w/peanut butter, etc. The minute I cut out the "sugar, simple carbs" is the minute I finally saw serious improvements in my BGs.

    1. Cereal is the worst ... At the CWD conference I learned that you can treat a low blood sugar with glucose, skittles and Cheerios! Spiking your blood sugar with Cheerios can not be a great way to start your day whether you have diabetes or not.

      Katie it's great to hear you have found success! Thanks for the encouraging words.

  2. Wow! This is exactly what I needed to read. This stuff has been so much on my mind. In the hospital/at diagnosis, most everyone gets the same pep talk, "Your child can still eat whatever he used to eat," as if it is more important to reassure the family that things won't really be so different than it is to help them have good health care. I like that Dr. W very much!

    The thing about the super-carby eating is that it is sort of...normalized? Many kids can eat over 100g CHO per meal. I imagine it's not good/optimal for any of them, but T1 kids/families are hyper-aware of it not being good for them. My non-D son will eat THREE BANANAS with peanut butter as an after school snack. And I let him. And I don't feel bad about it. Because it seems so wholesome. But that is one ton of carbs. 3 bananas would wreck the D-child's BG, mood, and outlook on life for hours.

    And Whole30! One of my best friend is on about day 27 of the program, and posts a photo or drawing about it each day on Facebook. I have been thinking I need to do it too. What is scaring me away is the no nuts/no beans part. Also it seems like you need to eat meat, and I don't like meat. I do like sweet potatoes/cucumbers, and according to her drawings those are on the menu. Anyway, I hope you write about your Whole30 experience and encourage me to sign up!

    Can we brainstorm a list of good meals for T1 kids? (I.e. you tell me what you make for dinner and pack for lunch?)

  3. I got excited. I said way too much.

    1. Oh no you didn't! I am thrilled I have gotten so many enthusiastic responses about this post.

      The Whole30 has become my food cult ... I have been heavily recruiting my family and friends to join ... If you need any convincing you should read their book "It Starts With Food"

      And I would love to share recipes of real foods that kids will eat! I already have one winning recipe ... Pumpkin pancakes

  4. Awesome! Way to go, Dolores! Keep us posted!