What Happened At Lunch. (Alternate title: Sorry, Mom.)
Way back when I was a young kid with type 1 diabetes, my school lunches were ruled by the American Diabetes Association exchange program. (That link takes you to their current iteration of the program.) The version I used looked like a meal card plan without any wiggle room, listing the food requirements for each meal. Lunch, for example, included two starches, one protein, one vegetable, one fruit, one milk, and one fat exchange.
Looking at this list now, I see things like carb counts and insulin-to-carbohydrate ratios, making meals seem like options and not force-feeding to chase the spike of NPH insulin. But back then, meals were carefully structured to meet the peaks of my insulin, and my mother took great care in planning my lunches so that I wouldn't tank during the school day.
I'd leave the house each morning with a brown paper bag that contained some combination of my exchange combinations, like a turkey and cheese sandwich (two starches, the milk, and meat, with the lunch meat weighed on the food scale at home) with some mayonnaise spread on the bread (the fat), a bag of carrot sticks (vegetable), and a pear (the fruit). And my mom was probably feeling pretty secure about the whole thing, knowing that she dosed me with my morning insulin shot (a mix of Regular and NPH) that would work to cover my breakfast and then the lunch. What happened at lunch, theoretically, is that I'd eat what she packed and birds would sing and squirrels would jig in jubilant step with one another and my blood sugar would be 104 mg/dL when I came home in the afternoon.
What really happened at lunch was that, like any other kid at school lunch, it wasn't about eating your lunch. It was about trading.
Which meant that my mom's carefully packed lunch, in line with my insulin dose and my food exchange to best take a bite out of type 1 diabetes, sometimes ended up being traded for Ring Dings and a piece of pizza. I felt bad about it, at the time (and still now), but I distinctly remember trading a plastic sandwich bag containing white rice cakes smeared with peanut butter for someone's Yodel (oh, Yodels). It was a normal lunchtime trade for the other kids, but for me, it was like the black market for snacks, gaining me access to the forbidden fruits (and Yodels) my parents avoided having in our home. In retrospect, I was following "the exchange system" too literally.
Most days, I ate what my mother packed for me, but on those days when I caved to the middle school bartering system, I went right off the rails. And then I'd marvel, alongside my mother, at the high blood sugar I'd be hosting when I came home from school. "I have no idea why I'm so high."
As a kid growing up with type 1 diabetes, I had the chance to make more than my fair share of less-than-optimal management decisions. But, like the time with the cupcake, it's the guilt that made its way into my adulthood than the impact of those off-days.
I'm thankful that the insulin options, both in actual insulins and delivery, have progressed to make meals times less stressful. At least then I would have had the wherewithal to bolus for that Yodel.