Thursday, May 9, 2013

Not Forbidden Anymore

A lot of things about living with Type 1 Diabetes have changed since I was diagnosed almost 20 years ago. (EEK! 20 years! I'm not old enough for this!).  New insulins, better technology, and more research have all led to significant changes in how people manage their diabetes.  I am no exception.

One thing that has also changed: the way we deal with food.  I was diagnosed under Ye Old Exchange System.  A set injection of Regular insulin, a set number of  exchanges of carbs, protein, and fats allotted at each meal.  This is just how it was.  The exchange system was what doctors believed to be best at the time.  And for some people, it was and may still be the best thing.  But it wasn't for me.

Today, the exchange system has pretty much (thankfully) gone by the wayside when it come to Type 1 Diabetes.  We count and bolus for carbohydrate content, not exchanges.  Yes, protein and fats sometime require insulin as well, but that's a whole 'nother blog post.

Another pearl from the exchange system?  No sugar.  As in none.  As in my mom would buy me sugar free chocolate as a treat for dinner sometimes.  I only ate sugar free ice cream.  Trick or treating on Halloween?  You betcha!  Eating any of the candy I collected?  Nope.  Cake at a birthday party?  Maybe sometimes, only if the frosting was scraped off first.

Is it any wonder that a lot of adults with Type 1 Diabetes have a skewed relationship with food?  Sheesh.  Not the best environment for fostering a healthy relationship with food.  I was discussing this with my mom, and looking back, she feels terribly guilty.  About the disordered eating I have now, as if she could have stopped it.

Mom, it's not your fault.  Not at all.  You did exactly what the doctors told you to.  What they thought was best at the time.  The exchange system was the standard.  In no way is any of this your fault.  Besides, disordered eating is complicated, as are the causes.

Today, I am SO HAPPY to see many posts and pics from parents of children with diabetes that show their kiddos having fun.  Eating some of their Halloween candy.  Enjoying some cake or a cupcake WITH FROSTING at a friend's birthday party.  It makes my heart sing!

Thankful is how I feel.  Thankful that the exchange system is gone.  That the psychological and emotional well-being of the children is important too.  That no foods are completely forbidden.  I'm not advocating that kids eat junk all the time.  Nobody needs that, diabetes or not.  But to be included with your friends.  To eat that birthday cake and have fun.  I'm sure this makes some parents want to pull their hair out, because these things aren't nice to blood sugars.  But a few high blood sugars on special occasions is, in the grand scheme of things, not that big of a deal.  I think it's a small price to pay.

I truly and sincerely hope that future generations of kids with diabetes will have healthier relationships with food when they grow up.  I hope for this with all my heart.


  1. I was up eating a granola bar in the middle of the night a few days ago and started thinking about this. (The granola bar was 1 1/2 starch exchanges.) Such a bizarre-o way to eat. Glad it's gone.

  2. I was another who began on exchanges - though they were a bit more relaxed over here in 1991, fats and proteins weren't counted.

    Glad to have the flexibility we have now of course, but personally I'm thankful for an introduction that taught me about the relationship between carbs and insulin. Some folks in the UK dxed a little after me completely missed that nugget where exchanges went out of fashion but weren't really replaced by anything before insulin:carb ratios came in. Now that really is scary.

  3. I wonder when the exchange system officially went out of style in the US. In 2003 that is still what I was started on and it was not until I got my pump that I found out there was anything different.

  4. Ditto Sara. Never, ever heard about counting carbs until I got my pump (which was almost 20 years into diabetes myself). Thanks for the look back. I'm happy to be here today.

  5. Sometimes I wonder which came first, the chicken or the egg with my food issues.

    I had this discussion not too long ago with a friend who is also a T1 and she said "well to put it simply food was always medication to us, of course we're fucked up about it!"

    So there's that. Sorry for the profanity, just direct quoting ;)