The Weight

Mushmouth is unimpressed by everything diabetes has to offer,

Mushmouth is unimpressed by everything diabetes has to offer, and has no illustrative photograph. Also she is ashamed that she wrote this post instead of walking the dog.

Yesterday. Visit endo re possible Inset 30 allergy.

That moment, site (12 hours old) not inflamed. Therefore allergy unconfirmed by science. Bigfoot try release Rapidly Worsening Allergy narrative, follow medical advice, put RWA theory out of mind, just change site every 18 hours until metal sets arrive on scene.

But wait—more: yesterday endo notice insulin total daily dose (TDD) low for Bubs-size/age person.

Weight/calculations w. computer. Never noticed this variety calculation before. Bubs TDD (insulin, natch) approx. 0.5u/kg body weight. More normal for age/weight is 0.8u/kg.

(But isn’t it a good thing to be insulin sensitive? He is healthy, happy, growing, and strong. Why would it be beneficial for him to require more insulin? )

Another clue: lost 1/3rd pound since January. [Had gained some significant amount like 2 or 3 or 4 lbs. between October-January (upon beginning GF diet.)]

But…grew taller. So…BMI down. BMI 16.22, 31.26%ile for age. (Height 84.72%ile; weight 55.7%ile <—sounds fine this mother.)

(Aren’t some people just naturally slim? And isn’t the percentile variety of statistic inclusive of the infamous post-millenial American (obese) end of the spectrum? Why is it relevant how much slimmer he is than the average American child when we know the average American child is a metabolically dysfunctional chubalub? And not being average doesn’t mean he’s not healthy. Right?)

More science opinion: not so bad not gain weight, but not good/actually pretty bad lose weight while grow taller.

(Why? Do weight and height always increase in lockstep in a healthy child? Don’t kids sort of famously chub up, then grow taller and thin out?)

(NB: Bubs is not skinny. He is not even noteworth-ily thin. No one would ever say, “Look at that skinny kid.” He is just kind of tall and narrow, a la Michael Cera in Juno, but younger/no wristbands.)

@office, only question actually find route out of mouth = So he needs more insulin to gain weight? And then we’d need to feed him more carbs?

ENDO: (Silent w. eye contact over reading glasses vibe Bigfoot interpret as “You got it, babe.”)

BIGFOOT: Why would we want him to take more insulin, just to eat a bunch of carbs?
ENDO: It’s not really that. It’s more that we don’t want to see him not gaining weight

BIGFOOT: But so like if we have bagels, I always slice them thin, because I think it’s better to have 40 grams of junky carbs than 80 grams, and also then he’ll have more room for other, more nutritious stuff. Do you mean it would be better for him to have the whole 80 grams of gluten free–you know, total crud–bagel carbs?

ENDO: You could get more nutritious bagels

BIGFOOT: Well but the paleo bagels don’t really have carbs–they’re just like…egg and flax

ENDO: Well, there you go. Flax is full of carbs

BIGFOOT: (((?)))

Really, impossible discuss high carb diet Bigfoot. Unbeliever. So skeptical traditional advice, but then…who else turn to? No doubt endo well-informed, caring, smart. But…child healthy, happy. Why necessary plumpify?

Anyway, @home use BMI calculator. Calculator reveal healthy range 4′ 11″ eleven-year-old boy = 72 – 100 lbs. So Bubs, @81.3 lbs., not even near skinny end of spectrum. Medium. Middle. Happy. Healthy.

What if alternative universe Bubs 90 lbs? Dr. would advise weight loss? Because so important child hit bullseye 50%ile?

Think maybe best practice = eat real food, bolus insulin match g CHO. Not slip into “how to create the most average-size child in the world” statistical death spiral. Deep breath. Hard think all day: How can I best take care of my child? And always turn up no satisfactory answer.

Someone Facebook group post simple, obvious, true thing. Rang in heart like bell, can’t stop turn over in mind: Why can’t diabetes just mathematically make sense? Add, divide, inject = perfect. A carb should = a carb. One unit of insulin should reliably cover a set number of carbs. Ugh.

Same same! Bad enough require continuous number-crunching/needles/care, but then for effort not –> desired result? Feels freshly ferned up.

 

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18 responses to “The Weight

  1. mollyjade

    The way I’ve heard it before is that it’s not so much where a kid falls on the height/weight percentile, but rather that he stays on a consistent curve. It’s not that it matters what end of the pack he falls into, but that he keeps his place where he is.

    Either way, why not gain weight by eating more protein and fat? They have calories, too.

    Like

    • Katy

      Ah–yes! I remember this now. It’s like–if he was *always* that percentile for height and that percentile for weight, fine. But if his %ile for height is staying the same but for weight is dropping…yes. Bells ringing.

      Like

  2. I don’t like drs do that. They only want him to fit a certain category to make their work easier (in my opinion). If he fit the bill for where they think he should be, then he would follow average guidelines. If his weight is in the proper bracket, don’t worry about it. My insulin needs have never equaled what they say I should be taking, and I’m not going to eat more to make my body fit that mold. Heck, I’m already overweight as it is, I’m not going to add more poundage to fit some doctor’s view of average insulin needs. That would be counter-productive, no?

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  3. This is a perfect example of over-quantification. The diabetes world focuses so much on the number, the average, the decimal points, and the percentages that we forget to look at the person sometimes. Is he healthy? Carry on.

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  4. If someone can look Bigfoot in eye and tell her to find a more nutritious version of food, then we are all “ferned”.

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    • Also, a fucking bagel of all things is an endocrinologists answer for the so called “problem”. He/she might as well have suggested pizza too.

      Like

      • Katy

        Amazingly, with the new settings she set up, his BG has been in range ALL DAY. I daren’t look at the site. It will probably not even be a tiny bit pink.

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  5. Cristin

    I have a similar problem with my son gaining height, but not weight. He’s the same age as Bubs, but can’t seem to get heavier than 60 lbs. The big difference is that his A1c is over 10. How it’s been explained to me: The lack of weight gain is not normal for a kid his age. For a kid with diabetes, it’s an indication that he isn’t getting enough insulin (see out-of-control A1c for confirmation, in his case). When the body doesn’t get enough, it gets it’s fuel from fat and protein – like an early stage of ketoacidosis, but no measurable ketones yet. This results in no weight gain, and eventually a slowed gain in height – so his growth is stunted because his cells are starving. In my son’s case, he has missed or delayed insulin shots and takes ADHD drugs that suppress his appetite during the day. He gets 80% of his carbs at night, but then goes and sneaks them without getting a shot. We are FINALLY starting the pump tomorrow and I hope it helps him be more engaged in his own self-care and more willing to get insulin for all those carbs. I just wish your Endo had a better answer for you because it sounds like you guys already have an A1c that I envy, a healthy diet and a better handle on the Big D.

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    • Katy

      This helps me understand. Thank you. I thought our endo was being extra-vigilant about weight gain because of celiac, but maybe it’s now celiac PLUS now the added clue of comparatively low insulin.

      Thanks again for telling me about your family’s experience. It makes the 1/3rd pound weight loss seem more meaningful and less ridiculous/confusing. I’m learning. S l o w l y.

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  6. NO ONE, diabetic or not, should eat a whole bagel in one sitting. I totally sympathize with the weight issue. Over one year post celiac dx, and I’m watching my boy grow taller and thinner everyday. Some days it bothers me, and i load him up with ice cream, but I end up kicking myself when I am up a few times that night bolusing… But when we went to visit his cousins recently, I was heartened to see my little 11 yr old nephew look all gangly, tall and thin, thin, thin. Watched him do amazing stuff on the soccer field. Everything seemed to be working just fine, knobby knees and all. And I remembered what a nerd my brother was when we were little- always growing taller than his highwater jeans…. I’d get a second opinion on that get more insulin/carb thing. We DO need carbs. Talk with an RD about appropriate amount of a boy his age and build. But I have yet to meet an American who didn’t eat enough (not including those with disorders). Please.

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    • Katy

      The RD we met post-celiac diagnosis did an official calculation and said he should eat, it was something like, 250g CHO/day. Even though this is the expert advice (for weight gain), 250g CHO sounds to me like cruisin for a high/low bruisin. I don’t know how I could fit that much CHO into him, as part of a “balanced” diet.

      Today I bought mini-bags of potato chips to add 12g CHO to his lunchbox. I also bought Minieggs. Don’t we have fun?

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  7. Wow, that does sound high as far as actual BG management goes. My biggest fear/ number one enemy would be lows, bad lows, and I figure the margin of error is much less on a 35 g lunch than an 80 g one, etc. We are not playing on the same field as kids not taking insulin. I guess I’d go against the Dr and the RD. When in doubt, I just go w NWA’s F da police. (But quietly, in my head.)

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  8. Now I have a bunch of old NWA songs stuck in my head…

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  9. statistical death spiral! i agree that none of this makes sense and am glad that people came forth in the comments to help sort it out!

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  10. It was suggested to me that I consume more carbs, too. I left that CDE visit ferning pissed. Not okay! I let go for a little while and chose still healthy but higher carb options. Result? I felt worse (guilt? lethargy?) and my sugars were a little higher. I think my low carb diet is half the reason my sugars stay decent. Someone said (maybe Katie?) that another reason they eat low carb is to not worry about having so much insulin on board. I feel MUCH safer that way.

    I saw a nutritionist last week. She said to keep doing what works. So there.

    Like

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