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Correction to This Article
An earlier version of this article incorrectly described the title held by Fran Cogen, director of the Child/Adolescent Diabetes Program at Children's National Medical Center. She is not also head of endocrinology there. This version has been corrected.

The Blacks take micro and macro approach to son's diabetes

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By David Hagedorn
Special to The Washington Post
Tuesday, February 1, 2011; 2:27 PM

When Jeff and Barbara Black, chef-owners of some of the Washington area's most successful restaurants, discovered that one of their sons had Type 1 diabetes, they did what chefs do: They put on a good front, had a brief meltdown and then worked to get things under control.

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For Dad, control went micro and macro: better choices when he makes weekday breakfasts for Simon, 12, and Oliver, 10, and ambitious plans to help educate families with diabetic children.

For Mom, control became a crusade.

"I didn't realize how much garbage was in mainstream stuff: that there was high-fructose corn syrup in Ritz and Premium crackers, vanilla wafers, Campbell's tomato soup," Barbara says. "I threw everything out. We eat natural things as much as possible. We've really put an emphasis on fruits and vegetables."

During a regular checkup three years ago, the Blacks' family doctor found excess sugar in Simon's urine. A blood test confirmed diabetes. The doctor sent the Blacks to Fran Cogen, director of the Child/Adolescent Diabetes Program at Children's National Medical Center. The program handles 1,800 patients a year, 90 percent of whom have Type 1 diabetes, which develops when the body can no longer make insulin, a hormone that controls the amount of blood glucose.

Simon was upbeat, perhaps not thinking about how he might have to pass up spontaneous outings for pizza or ice cream with his buddies. He adapted quickly to three insulin injections per day, cutting out junk food and dealing with misperceptions. "A lot of people really don't understand what diabetes is," he says. "They think it' s like, if I eat sugar I'll die or something. But I just explain to them that I can have a certain amount. It just depends on the number I have from the blood tests."

According to the Centers for Disease Control and Prevention, nearly 26 million Americans have diabetes, including 215,000 who are age 20 or younger. (Type 2, which accounts for roughly 90 percent of total overall cases, is the form most often in the news lately, as it is closely related to obesity.)

For children with Type 1 diabetes, the key is controlling the amount of food they eat and understanding its cause-and-effect paradigm.

"Considering the fact that my parents' career revolves around food, I am exposed to lots of things, like seafood, Italian food, Chinese food," Simon says. "The only thing that diabetes gets in the way of is eating junk food. Stuff I used to love, like cotton candy, is 50 grams of carbs."

Simon's carbohydrate intake for meals is between 60 and 70 grams; for snacks, between 15 and 25.

He has a "good sense of what portion sizes are. . . . He reads labels voraciously and knows what he's looking for," Barbara says.

Control for Simon means eating a Fig Newton or graham cracker when he feels a blood-sugar "low" coming on. Taking the stairs or a quick bike ride helps when he's off balance in the other direction. And when the sixth-grader is at school - Norwood in Bethesda - he knows he can have a sweet treat if his lunch was a salad.


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