can not

You can let your child eat whatever she wants, just cover it with insulin.

Can I really do that? I’m aware of the academic difference between “can” and “should.” To me, though, “can” implies that there is an authentic choice to be made, and that no outcome of that choice is likely to cause serious physical or emotional harm.

Here’s what I mean. Suppose a person with a severe nut allergy decides to eat peanut butter. In doing so, her body goes into anaphylaxis, an acute life-threatening condition. Can she eat peanut butter? If she makes that choice, her life will be in danger. To me, then, eating peanut butter is not an authentic choice for my friend.

I originally accepted the recommendation to allow Madeline to eat whatever she wanted (within reason, mind you: she wasn’t consuming snack cakes and soda whenever she felt the urge). In doing so–particularly, in allowing her to consume grain-based carbohydrates–here are the things that happen to her, every single time:

• Her blood glucose levels ascend wildly out of control for hours (translation: holding steady in the 300s). For example, it takes about 12 hours to regain BG control after eating two slices of pizza or one serving of pasta. During that time, the insulin might as well be water, and I’m duped into unnecessary infusion set changes out of concern that maybe it’s the set, not the carbs this time.
• She suffers from profound cravings for more carbohydrates, and turns into a raging monster in search of them from any source.
• She experiences sluggishness, mood swings, stomach pain, bloating and constipation. These symptoms are complicated by high glucose levels, as she usually begins to feel nauseous and starts vomiting when her BG level surpasses 350.
• Because that insulin seems no better than water, we end up having to “stack” insulin– giving doses two hours apart… and eventually, guess what? All that stacked insulin triggers lows…forcing me to have to give her carbohydrates again in order to “cover” the insulin in her system.
• The BG pendulum ride leaves her feeling sluggish, stupified, and completely confused about what her body signals mean.

These are terrible short-term outcomes; I won’t even get into the insidious and profound impacts on every single body system over time. So, then, can I really let Madeline eat whatever she wants and just cover it with insulin? The answer is NO. The price she pays every time this advice is followed makes this choice untenable for her.

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PS. Interestingly, these events never occur when I manage her carbohydrate intake under a certain threshold. Even when she’s consuming carbohydrate–if the source is vegetables, fruits and dairy–she feels fine and her BG levels remain nice and steady.

PPS. Madeline tests negative for Celiac disease every time it’s administered.