Carb counting...

[donnellysdogs]

Reading alot of the postings on here, I am quite staggered about the amount of diabetics that aren't actually told the in's and out's of carb counting...

When I was diagnosed type1 26 years ago, I was initiated well and truly in to the practice of 'exchanges'-(yes the old way-now superseded by the carb counting).

I would just like to enquire how newly diagnosed (last 10 years) are introduced to carb counting-is it all being done on a dafne course-which so many people don't appear to be able to get on easily?

This site is wonderful, and gives so much help, but I still get amazed that it appears that NOT all diabetics whether type 1 or type 2 are given carb counting books and clear instructions as to how to really control and help their diabetes.

Just an enquiry really, would love to know how newly diganosed diabetics are managed nowadays....

 

[ams162]

dylan was diagnosed 4 years ago but we were only told about carb counting in the last year when we asked about a pump and after 3years of very poor control with hba1c over 10 everytime. we were wrongly looking at sugars on all packaging but had no idea this was wrong.

when we enquired about a pump for the first time we were told we needed to carb count and go on the choice course (dafne for kids ) but i was told the basics early to try and help dylans control as he was suffering really bad hypos to the point of being carried out of assembly by 2 teachers and not knowing where he was to. we then had to wait 6 mths to get on the course by which time i had it down but to get the pump we had to have officially done the course :roll:

the DSN told me they would like to put everyone through the choice course at diagnosis but that it was all down to money, which is really bad when u have struggled for years to help a child or anyone really who is so unstable.

anna marie

 

[Sue o2]

when i was diagnosed the first thing they did was to get me an appointment at the local hospital,

i was told i could take a friend so i took my husband, when we arrived we weren't the only ones there was about 20 other newly diagnosed T2 diabetics,

we were shown into a classroom, given a folder with info and a tube of urine sticks, had a lot of opportunity to ask the doctor questions,

then a dietician came in and told us we weren't to eat anything that was above 10gr of fat, she then warned us about root veg being high in sugar if you cook it to long,

she also told us to eat as much pasta as we liked :shock: (i hate pasta) but decided id eat it if it was good for me LOL but soon stopped as it made my bloods too high, :lol:

they did seem to be more worried about the fats than the carbs, its only by me feeling ill and testing that i knew carbs weren't a good thing, oh and they said we could eat up to 4 squares of chocolate a day we were there for about 2 hours, complete waste of time, Ive learnt more on this forum in a short time than what i learnt from the class,
Sue

 

[leggott]

It shocks me too! We were told not to worry about carb counting! Our kids were just weighed and we were told to give a certain dose based on this! We decided that we would carb count from day 1 and I'm so please we did. it can be a bit hard at the beginning getting ratios and basal correct, but once you've sort of cracked that, it does make things much easier.

My care team are all lovely, but most of the time I think I know more than them! They always compliment me on my childrens HBA1c's and acknowledge the fact that I work hard to achieve these, but I don't think they acknowledge that it is mainly down to the fact that I am meticulous about carb counting.

Whenever I have any issues this site is the first place I come for some good solid advice...

 

[cugila]

I too when diagnosed was only advised to look at 'sugars'.....no mention of Carbs at all, that was 14+ years ago. Needless to say I got progressively worse, complications just kept rolling up !

Then I did my own research and then came here a few years ago.......what a revelation. It was the so called 'healthy' carbs at every meal that was my problem. Started to low carb and found the numbers all started to go down, complications reversed, weight dropped off me, although I did have to give up on the high fat side of things quite quickly, I just couldn't tolerate it. Well, despite all the doomsayers telling me it must be low carbs/high fat, low fat and low/reduced Carbs worked for me. Still does. That and low GI, Low GL. I eat more carbs now than I used too. No problem there.

So, has anything improved ? NO ! Newly diagnosed are sometimes still only being told to be careful with sugars.......as many of us know, that is very misleading to many Diabetic's. My own Diabetic Clinic however is giving out good advice which does put a certain emphasis on reduction of Carb's. The same area but conflicting ideas if you read below !

I am doing an X-Pert Course at the moment because I wanted to see for myself what is being promoted. The advice.

The people involved first of all are telling everybody that a level of no more than 10 mmol/l is what should be aimed for ! Despite NICE guidelines telling T2's no more than 8.5 mmol/l and T1's no more than 9 mmol/l ??? Why tell people this ?

I got involved in quite a heated discussion about this prompting the organisers to discuss it between course days......result....they are still telling them no more than 10......because apparently it is demoralising to be told anything less when their levels are so high. The logic defeats me. I want the facts, not platitudes !

It's like telling somebody, you have passed your driving test, now you can drive at 90 mph.....it's Ok, don't worry. The fact that the National speed Limit is 70 mph doesn't matter ! Leave the driver to face the consequences of this ridiculous information. Only this time it's the poor Diabetic who has to face the consequences and possible complications further down the line.

Then there is a pre-occupation with sugars and Calories......I force them to give out the Total carb count as well. :twisted: Many there have never thought or heard about counting Carb's. They are mentioned but the emphasis is not on them, other than some with every meal. I go along with a certain amount but it is important as far as I am concerned to restrict them if your Bg levels are way too high.

Why do the NHS/DUK have a 'one size fits all' dietary policy in some areas.....most of the people on this Forum know we are all different in how we react to certain foods and there should be more education right from the start that individuals need to know what suits them, how to change the diet to suit. Avoiding or reducing those Carb's......the way to gaining good control if Bg levels are high. If you can manage a deal of Carbs and still have good daily Bg levels....great, if you can't then you should be given options to deal with it. Education is only as good as the teachers.......

I have to say the people running it are very nice and very well intentioned, BUT, I can't see many gaining control with such advice.

This week it's complications......... should be VERY interesting. :twisted: :wink:

 

[phoenix]

I was diagnosed in France, six years ago so obviously my experiences will be different to in the UK I spent the first 10 days in hospital and was taught daily by the dietitian and consultant about how MDI works, carb counting, the GI and balancing my diet. I still have a vivid memory of the consultant sitting on the floor drawing pictures of various fruits.
However the carb counting was not DAFNE style for dose adjustment but so I could eat a fixed amount of carbs for each meal with fixed insulin doses (just adjusted up or down for higher or lower readings or exercise.) For a while after, I saw my doctor very frequently and had to keep a quite detailed logbook.Actually, the really prescriptive approach really helped me . Far less to think about whilst I got used to coping and it taught me how I reacted to different foods. It was very easy after a while to teach myself (after reading various forums) to self adjust my insulin.
I've been on a couple of courses since then and the dietitian is pro dose adjustment and tries to introduce the idea but most of the other paticipants seem to want to be told how much to eat and what dose to take. The consultant isn't in favour of everyone being taught to self adjust in any case(he thinks it is too difficult and many can't understand it).
As to carb counting books, I was given a paper copy of this...just the thing you need on your next trip over the channel.
http://www.medtronic-diabete.fr/tl_file ... ucides.pdf

 

[sugarless sue]

I had a very heated discussion with a HCP over the advice they give out. In this case she was telling my husband, who was not at all interested being severely depressed anyway ,about his ‘sugars’ !

When asked about carbs she said ‘Oh yes, eat them at every meal’ . When asked how he was supposed to control his levels without a meter she went on about HBa1c testing. Needless to say we disagreed a lot on the subject !

The printed info we got is all about keeping levels at or below 10 mmol/L , same dumbing down as Ken had on his so called X-PERT course ! How are we supposed to know where the levels are with no meter !

Of course I have meters so can check his levels myself but it means using my meagre supply of strips for both of us ! I will also be feeding him so he will not be following their ‘healthy diet’.

The nurse, just before she left asked him facetiously , after I had been on about it, ‘I wonder what you will get to eat’ ! He replied, ‘Whatever she feeds me’ !...... He is not starving !

Why is it back in the 60’s and before, the emphasis was very much on carb counting etc and is now so different. Diabetes is Diabetes, that has not changed much.

 

[LaughingHyena]

I was diagnosed T1 last September. I was given a fixed dose of insulin to use for each meal in the hospital on the first morning but was told that this would only be till I got used to the injections, then I would start carb counting.

I think it was about a week later I saw the dietitian who gave me some ratios to work with, I was given a leaflet with a table of carb grams in common foods but advised to get a copy of carbs & cals and possibly another carb counting book, or to look other things up online.

The hospital team have always impressed upon me that I need to count total carbs, not just sugar but have not said anything about reducing them, or indeed making sure to eat them at each meal.

 

[donnellysdogs]

Laughing Hyena, I think you have a great HCP!!

I like Sue, don't understand how things seem to have changed so much since the 60's and 70's. I actually wonder whether this change in the nformation being given is causing so many people to have such complications earlier. So far, I only have one eye with mild background retinopathy after 25 years type 1, and wonder whethr it is because the way that I was trained to manage my diabetes.

The postings so far on this have been startling to me, and have certainly made me appreciate the care and attention that my HCP's gave me then.

I hope that some HCP's may read this posting and find it startling too!!!

 

[SophiaW]

When Jess was diagnosed we were referred to the dietician at the hospital. She asked typically what sort of food Jess ate and concluded that we ate a healthy diet and should continue with that. She only warned of avoiding high sugar foods and drinks and never mentioned anything about carbohydrates affecting blood sugars, only to watch the sugar content of foods. As a result I had no idea that the carb content of foods was affecting her blood sugars, it's no wonder her rapid swings into high numbers were a mystery to me.

We were on the twice a day mixed insulin and the scary thing is that I was never advised to keep the carb content of each meal to a consistent amount. Some days she'd have a low carb breakfast and other days a high carb breakfast. It's no wonder one day she'd have a hypo and then the next very high readings.

This continued for about three or four years before we were invited to a carb counting workshop and I realised why everything was going so horribly wrong. It was around this time that I realised the only way forward was for me to gain knowledge myself rather than relying on health professionals to tell me what to do. I've never looked back and armed with some good books and this forum I feel we have much better control now. As a result of this forum and better knowledge I've been able to confidently question the advice I have been given on occasions and this is the reason Jess is on a pump now. Without the knowledge I think we'd still be struggling and accepting less than perfect readings as being okay.

 

[imalittlefishy]

I was diagnosed 8 years ago and put on two daily injections of mixtard 30, advised to cut out all sugary things, nothing at all mentioned about carbs. I have NO idea how I managed such "good" control for 6 years, probably a combination of eating the same things all the time and my very frequent hypos pulling my HbA1c down. I changed to basal bolus 2 and a half years ago, not because my control was poor but because I had such little flexibility with the mixtard and basically I was sick and tired of having to eat the same things at the same times without fail to avoid hypos.

Again, no mention of carb counting when I changed insulin, there was some attempt to discuss it about a year later but only when I asked about it, and of course the dietician was on long term sick leave :roll: I went on a young diabetics camp type thing every year from age 11-16, and I remember at the last one one of the girls there with me had just done a DAFNE type course. This was a mystery not just to us but to the DSNs and doctors who came with us! Worryingly this was only about 3-4 years ago. Even my mum who is a practice nurse and works with diabetics a lot didn't know anything about carb counting until I came across it.

Since changing to basal bolus my control has been appalling, HbA1c shot up from 5.5 at its best to 13 at its worst (currently around 9), I think a lot of this is due to me basically being told I could now eat whatever, whenever, but with no explanation of how to manage my insulin to actually make that possible. Also, being so restricted with my diet from ages 11-16 (I barely ate chocolate for 5 years...possibly one of my favourite things!) meant that when I was "let off the leash" I developed some really bad eating habits. It's only very recently that I've started to realise just how little I know about a condition that affects my life so much! I'm trying to get control back but it is a struggle. I just feel that with better information earlier on I would be in a much better position to manage my diabetes now.

Wow, sorry for the essay :mrgreen: Clearly I needed to let out some steam!

Maggie
xx

 

[annettekp]

Erland was diagnosed last February aged 20 months. He was put on basal/bolus straight away and we weren't allowed to leave hospital to go home until we'd had training from the paediatric dietician on carb counting. I think we had 3 sessions with her altogether.

Once we got home we saw the local dietician every time we met the DSN which was every week at start.

We haven't done a DAFNE course but the dieticians were excellent and I feel I have a good understanding of carb counting and how it affects Erland. It was a really steep learning curve though.

 

[Hazza]

Lily was diagnosed in June 2010 and we were put on a set amount of insulin per meal to start with, but they stressed that we would need to count carbs in order to maintain good control. After a week of ups and downs we asked to start counting carbs and match insulin to carbs. We were given a ratio based on Lilys weight and to start there, testing 2 hours after meals to establish a proper ratio and adjust them accordingly. We were in contact with the dietician regularly untill we sorted it all out.
Once we had established her ratios we were also given a correction figure which also was modified over a period of months. It started at 1 unit to lower mmol by 15 which was way out so we changed it to 10 and it is now set to 5.
The team we work with are very hands on and we see them whenever we feel the need to. We also have access to them 24 hours a day and even the consultant does on call. They are more like a family than a health care team.
We also have a parent meeting at regular intervals and are setting up advocacy help for parents with newly diagnosed kids.
At the moment they do not offer Dafne courses and I'm not sure if we would get any more benefit from one than what we are already getting. The team are quite happy to sit and discuss anything.
We even have day trip outings for the kids all paid for by the parents group and with the support of the nurses who go along as well. Flamingo land was a great success last year and we filled 2 large coaches.
I feel that we are very lucky compared to some people and wish that all HCP were as good as ours.
When Lily went on the pump the nurse took her phone to bed with her in case we needed to contact her and she phoned us every night for over a week to check lilys numbers and suggested changes as needed. She also called in every other day to see how we were doing. Above and beyond I think.
It doesn't get better than that for me.

Harry

 

[donnellysdogs]

Gosh, Maggie you have really had a hard time without being advised about carb counting. I cannot believe there is such a difference between HCP's....why is there so much difference and surely carb counting is a basic to good control and eliminating hypo's and hypers? I am just so shocked....

 

[JUSTFOCUS]

Hi folks
if you think you had problems i don't even know what this hab thing you all talk about ?
I was diagnosed 10th Jan 2011 seen my DN twice . I don't know much about my diabetes but what i do know has been explained to me on this forum .I only recently discovered about hypo's and levels etc. Then my DN phoned me to see a dietiscion the other day .I told her not to bother as i am slowly loosing weight and i don't need a 45 stone dietiscion telling me to lose weight while eating a 12box of jam donuts and breathing carbo fire .Any way were was i "ah yea" this hba thing .What is it
JF

 

[sugarless sue]

Just for you JF. All about HbA1c.

http://medweb.bham.ac.uk/easdec/prevent ... _hba1c.htm

 

[partlyfallen]

My partner was diagnosed with Type 1 about 10 years ago. They only told him about sugars, no mention of carbs, and no one has ever re-educated him until I came along. It's no wonder he's got so many complications now. We're trying to turn things around (or at least I am) but have no idea where to start. I've bought some recipe books, joined this forum and also have a friend who's a dentist and counts carbs. Hopefully we'll save his feet.

 

[viviennem]

I'm quite astonished, reading 'newbie' posts in particular, just how few people seem to know anything about food groups, proteins/fats/carbs, and which foods contain what. I seem to remember being taught that in school, 40-odd years ago - probably in Biology or General Science. Don't they cover it any more? I'd have thought it was even more important these days, with so much junk food around!

Viv

 

[sugar2]

:shock:

I was diagnosed in 1977...and put on 1 injection a day, and was given my "rations".

Rations (in my 4 year old brain) was what I was allowed to eat...25 g carbs for breakfast, 10 for my sanck...and so on...could eat what I liked, as long as I counted the carbs (or my Mum did) I have been on the diabetic rollercoaster ever since, and it really encourages me that we are now almost back where I started...except, the very big difference for me, that now I alter my insulin to suit what I eat, not eat to suit my insulin.

My consultant, whilst I was pregnant had me on fixed doses of insulin beofre meals (basal bolus at the time) and would study my blood sugars, beofre teling me to "increase your before breakfast dose...he never once actually enquired what I had eaten. Fortunetly, I had the book I got when I was 6 years old, and this forum to help me through.

 

[phoenix]

I'm quite astonished, reading 'newbie' posts in particular, just how few people seem to know anything about food groups, proteins/fats/carbs, and which foods contain what. I seem to remember being taught that in school, 40-odd years ago - probably in Biology or General Science. Don't they cover it any more? I'd have thought it was even more important these days, with so much junk food around

Well it's been part of the programmes of study in Science (National Curriculum) for it must be at least the past fifteen years.

Pupils should be taught about
about the need for food for activity and growth, and about the importance of an adequate and varied diet for health

There is exactly same requirement at KS3, though it would be expected to be dealt with in more detail
This gives you an idea of the type of level of knowledge covered in kS2
http://www.bbc.co.uk/schools/ks2bitesiz ... ead1.shtml
and KS3
http://www.bbc.co.uk/schools/ks3bitesiz ... ise1.shtml
And it comes back in core science GCSE and also in the GCSE PE syllabus, though content depends a bit on the syllabus, some have more about it than others.
http://www.bbc.co.uk/schools/gcsebitesi ... nch1.shtml

So if you do science GCSE science or PE you should have been taught at least the basics 3 times!