Carb Counting Advice?I'm Lost

[StephenFromScotland]

Hi All,
As I was only put on insulin not that long ago I would really like to know more about counting carbs between meals,it all just seems daunting to me just now.

I see carbs like ie.carbs 24g and then of which sugars 1.8g, which one is it i go by? and what is the average ideal carb intake per meal?
I know everybody's insulin intake is different but is there a happy medium ideal for carb intake?
Any advice would be greatly appreciated.
Thanks in advance.
Stephen

 

[Pattidevans]

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by StephenFromScotland</i>
<br />Hi All,
As I was only put on insulin not that long ago I would really like to know more about counting carbs between meals,it all just seems daunting to me just now.

I see carbs like ie.carbs 24g and then of which sugars 1.8g, which one is it i go by? and what is the average ideal carb intake per meal?
I know everybody's insulin intake is different but is there a happy medium ideal for carb intake?
Any advice would be greatly appreciated.
Thanks in advance.
Stephen
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

Stephen

I think you might have it the wrong way round (I'm not surprised since the education handed out to diabetics is lacking in the extreme). The idea is that you adjust your insulin dose to the amount of carbs you intend to eat at any meal. In order to do this you need to know what your insulin to carbs ratio is and everyone is different.

I seem to recall you posted somewhere that you were prescribed a dosage? I can't imagine how you can work to a fixed dose of insulin. I can give you some starting pointers to help but you really need to work it out for yourself.

Take a look at http://www.diabetes-support.org.uk/DAFNE.htm Follow the links from there to look at the BERTIE program. I can't recall if you are a T1 or T2 on insulin. If you are a T1 push for the DAFNE course, if you're a T2 you won't get it. However, if you follow a link from the link above you will find a link to an online course you can undertake.

In addition check out http://www.diabetic-talk.org/jennifer.htm which is the best advice you could find ever!
Your meter is your best friend and the best weapon in your armory against diabetes. If you would like more information/advice on testing visit http://www.diabetes-support.org.uk/testing.html

Patti
On Levemir/Novorapid. Last hba1c 5.3

 

[martinbuchan]

Stephen - we will have the same diabetologist. He wants me to learn carb counting ( I am a type 2 on insulin). DAFNE is the only wholly validated course for carb counting. He tells me everyone puts on weight after it as they invariably dose adjust upwards to account for bigger portion sizes!

Lsdt month's HBA1c was 5.9%. I think I make a good estimate for my insulin dosing. I don't think I will improve on that apart from significantly reducing my portions. I have only been diagnosed and treated since Nov 2006, so still learning and experimenting.

Also, last year the local hospital's dieticians could not teach carb counting. Bit of a waste of time for me to see them. I thought their advice was shocking really.

Marty B

 

[Pattidevans]

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
<br />Stephen - we will have the same diabetologist. He wants me to learn carb counting ( I am a type 2 on insulin). DAFNE is the only wholly validated course for carb counting. He tells me everyone puts on weight after it as they invariably dose adjust upwards to account for bigger portion sizes!
Also, last year the local hospital's dieticians could not teach carb counting. Bit of a waste of time for me to see them. I thought their advice was shocking really.

Marty B
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

Martin, Is it the actual DAFNE course you are going on? I was looking at the DAFNE site and in the FAQ page -http://www.dafne.uk.com/scripts/typeonediabetes/faqs.html - scroll down, it says it's definitely not for T2s. I wonder if you are going on a different course?

Patti
On Levemir/Novorapid. Last hba1c 5.3

 

[martinbuchan]

That is what he said. Although I am type 2, I have very low inherent insulin production now I am told.

I think the distinctions get blurred between type 1 and type 2 as time goes on (type 1s get insulin resistance late on and 50% of types 2 go onto insulin)

Marty B

 

[Abi]

I would contest that weight gain after DAFNE is amost universal. It would be interesting to see statistics, but I have heard plenty of anecdotes of people gaining the confidence to adjust doses so they can eat less and also reduce doses for excercise rather than dealing with excercise by eating more. Also it's not uncommon for people to be on too much basal insulin and hypo during the night- I am told that this is not an infrequent finding- leading to either excess consumption to treat the hypo- or waking up with high levels - at any rate a reduction in basal insulin would be beneficial in those who are gaining or have gained too much weight- assuming it can be done without resultant hyperglycaemia

 

[martinbuchan]

I think the basal dose thing is interesting. I swtiched to teice daily levemir just as my foot infection presented so went from 64 lantus to currently 46,70 levemir. Increased my bolus novorapid by about 10-15 /day on average. As I hsve been off work I have been more adventurous with my larger meals witht the novorapid (biggest bolus last year 22, this year 38). Seems to work as I am very keen at monitoring my 2 hour post prandial BGs. I have learned to adjust the dosing myself and I get it right nearly all the time (A1C 5.9% last month).

My confidence will not be as high when I get back to exercise in the next 2 months. Having not really had the chance to over the last 14 months since diagnosis. Can you lose weight without exercise as an insulin user like me? Also, when I get back to doing some weights to put muscle bulk on , my metformin will have a bigger effect too.

SO many experiments to look forward to. Also looking forward to getting my hospitals 48 hour continuous BG measuring machine.

Anyway, carb counting is only a part of dose guessing and people will use what ever works best. My paediatrician type 1 neighbour doesn't carb count and gets her A1C 4.9-5.6%. I suspect there is a long learning curve in dose adjustment when first using carb counting unless you have exactly the same meals all the time.

I suppose as i am fairly insulin resistant that an increase bolus dose of 4 units has far less impact than in a type 1.

Marty B

 

[StephenFromScotland]

Thanks for the advice guys
I totally aggree martin, I think its a bit shocking, I havent really been told anything and certainly nothing about what to do, I remember my nurse put me on that avandamet last year when there was the big scare about it all over the new about causing heart attacks.
Anyway i went on the strongest avandamet and it done nothing but make me feel sick and my bloods stayed around 10-25 i felt ill.
when i got my results from the nurse,her words were.
"i have discussed your bloods with the doctor and we both reckon that you are just abbusing your diabetes" i was flabergasted after months of feeling ill and scared to eat anything.

eventually it was the hospital that phoned me and put me straight onto insulin but they told me to take 8u and that was that,i phoned 3 days later that my bloods were 12.7 and concerned and they told me to up the dose to 9u and remain on 8u at evening meal times,erm thats a much heavier meal? no no just take 8u in the evening.
so thats what i was told and i decided to up the insulin on my own accord,i am really scared of taking a hypo in the small hours though as im sure everyone is, but this is all i really know,its a bit shocking.
stephen

 

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
<br />

My confidence will not be as high when I get back to exercise in the next 2 months. Having not really had the chance to over the last 14 months since diagnosis. Can you lose weight without exercise as an insulin user like me? Also, when I get back to doing some weights to put muscle bulk on , my metformin will have a bigger effect too.


Marty B
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

Marty, be careful when you change your regime. 2.5 weeks ago I started a supervised diet. I battled for the best part of 2 weeks with incredible ongoing hypos (nothing I couldn't manage, but irritating inasmuch as I had to eat stuff I didn't want to treat them)... I have now decreased my basal from 31u to 26u and decreased my novo by incredible amounts. Overall almost 30% less insulin intake now! Although I'm quite used to adjusting this has come as quite a shock in it's intensity.

Stephen

It's sad the lack of education we get as diabetics, but a year or so from now I would guess that if you keep at educating yourself you will know more than that nurse by a long chalk. She's not that bright if she says things about you abusing your diabetes, even if you were it's hardly an approach that would encourage you to take control is it?

I rang my nurse the other day re: what I was saying to Marty above. Now I like my nurse and she's helpful, she said to me "Patti, you know as much as I do, and more about your own diabetes!" Whilst that's flattering, on occasions it would be nice to have someone to ask who knows a bit more - but the way things are where I live getting an appointment with a specialist is about the same chance as meeting an alien from another planet in the high street!

 

[Pattidevans]

Sorry, keep forgetting to log in - that' s me above and there's no way to edit if you do. Aplogies!

 

[Pattidevans]

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
<br />That is what he said. Although I am type 2, I have very low inherent insulin production now I am told.

I think the distinctions get blurred between type 1 and type 2 as time goes on (type 1s get insulin resistance late on and 50% of types 2 go onto insulin)

Marty B
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

Martin, it wasn't me querying whether T2s could do DAFNE... if you followed the link I posted it was the DAFNE people saying that T2s definitely could not do the course irrespective of their inherent insulin production or any other factor. But, if you get to do it then good luck with it!

Patti
On Levemir/Novorapid. Last hba1c 5.3