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A carb-counting question from a novice

Discussion in 'Ask A Question' started by EJMJones, Sep 1, 2019.

  1. EJMJones

    EJMJones · Member

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    Hi all
    I am what my nurses call "still newly diagnosed" (I began type 1 treatment in mid-July having been wrongly diagnosed as type 2) and have only just been introduced to carb-counting. My nurses recommended "Carbs & Cals" app and book. Today we went out for lunch and I looked up the menu and calculated my carbs for a cheese panini and a handful of chips as 87. My next bg test showed a huge spike and it reminded me that I have always had large spikes after eating either a cheese roll or this cheese panini. Now Carbs & Cals lists cheese as 0 carbs. Is it possible that I react weirsly or strangely to cheese, even though it has 0 carbs? Are there foods that certain people react to differently to the textbook?

    Can carbs & cals be trusted?

    I have so many questions and my nurses are becoming irritated that I contact them for help too often, which has also put my back up a bit!
     
  2. MeiChanski

    MeiChanski Type 1 · Well-Known Member

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    Hello, welcome!
    Carbs and cals is a good starting point for carb counting, have you tried bertie online course? https://www.bertieonline.org.uk/
    I think it's the panini roll that spiked your BG, along with chips. However both of those sound really fattening, fat slows absorption of carbs. (fat in cheese and chips) We have to split dose for high fat foods. Also with your timing of your insulin, your insulin may not have started working yet so food spiked your BG first. So there is a lot to learn, please speak to a dietitian for more information but Bertie online course would be good to help you get started. It's also best to bear in mind that we all spike after eating carbs, whether you stay high or not is another hurdle.
    The problem with carbs and cals is it is a rough estimation, depending on your carb to insulin ratio, you might need another tweak.
     
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  3. EJMJones

    EJMJones · Member

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    Thank you. I generally have high numbers as I was diagnosed so late on, as I say I was doing type 2 treatment for 2 months when I had type 1 all along. But my pre lunch reading was 16.9 (which as I say was par for the course and not concerning), I did 12 dials of insulin to match the 90 carbs plus 3 to go to my target, and my pre tea bg was 22.8. ketones are 0.4.
    I haven't been told about carb peaks and insulin peaks - I don't know what they are at all. Obviously they are things I need to find out about
     
  4. EJMJones

    EJMJones · Member

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    thank you. It's very complicated isn't it?! I'll get there. I am aware of Bertie online, and am yet to be referred to DAFNE. I think by the sounds of it I have been treating carbs from Carbs & Cals as gospel and need to consider fats too. I am going to contact my nurses again too after this, as I feel I have been left to sink or swim a bit and I want to do everything completely correctly.
     
  5. MeiChanski

    MeiChanski Type 1 · Well-Known Member

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    Oh dear, is your BG okay now? It's complicated at first but you'd get the hang of it. When you gain more knowledge, with 16.9, we would have corrected first then waited for it to come down before eating. I know we are human and we cannot wait for insulin to work before eating because we are hungry. I do force myself to wait while drooling over my food. But running high when eating isn't comfortable in my opinion, I feel quite unwell. So yes, DAFNE is indeed helpful for you. There's a book called sugar surfing which might help you as well. When I was running high, I'd correct and go do laundry or cleaning for a bit. Test again and if it's in range, I'll have breakfast.
    If I did my maths correctly, when you did 12 units for 90g of carbs thats a ratio of 1:7.5, I think your ratio might need some tweaking, especially since your numbers are quite high, taking into consideration you did another 3 units.
    Do you think you can call your nurse tomorrow to discuss it again for correction advice and a change of ratio. I don't know what insulin you're on, but it's best to learn about their insulin profiles - when it peaks and when it finishes. For fats, we always have to split dose because our fast acting will finish working but the fats slow down the carbs, so we'd end up high when insulin finishes.
    As time goes by, we have to consider protein as well as fats. I hope things get sorted for you, you must feel absolutely rubbish. Keep an eye out on your levels and ketones, if you need to go to A&E, please do.
     
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  6. EJMJones

    EJMJones · Member

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    no - I did 12 as I did 9 for the 87 carbs plus the other 3 to take into account my target of 8.5, so 9 + 3 = 12. That's what I have been told to do
     
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  7. EJMJones

    EJMJones · Member

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    my ketones are ok at 0.4. Its not an a & e matter, I'm sure of that - but as my earlier posts explained, my numbers are generally in the teens as I was wrongly diagnosed, and therefore treated, for the first 2 months. They don't want me to come down too quickly over fears that my eyesight will be affected...so it has been softly softly
     
  8. EJMJones

    EJMJones · Member

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    I have contacted my nurse by email so I will get a reply in time. I'll be ok, but I have certainly never heard of split dose before
     
  9. kaylz91

    kaylz91 Type 1 · Well-Known Member

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    To be honest at levels that high I wouldn't have eaten that amount of carbs xx
     
  10. eventhorizon

    eventhorizon Type 1 · Well-Known Member

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    Don't beat yourself up too much about it. A meal like that would spike me as well. It was your starting number at 17 that is the problem. A rise of 6 for a carby meal like that isn't terrible. It's just the 23 end result is pretty high. Also before attempting to fine tune your bolus ratios you've got to get your basal spot on.
     
  11. EJMJones

    EJMJones · Member

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    thank you...but please note my other replies...the starting reading of 16 is not high for me, as I have been coming down from 30 as I was wrongly diagnosed and treated for the first 2 months. They thought I was type 2 and put me on metformin, which did nothing as I was really type 1. The nurses do not want me to come down too quickly as they had fears about my eyesight
     
  12. EJMJones

    EJMJones · Member

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    Thank you...I have no idea what BASAL or BOLUS means I'm afraid!
     
  13. EJMJones

    EJMJones · Member

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    Thank you...that is part of what I'm asking on here. I am a complete novice and feel very in the dark and left to my own devices far too soon with too little coaching about how to carb count. That's why all the replies here have been so helpful
     
  14. EJMJones

    EJMJones · Member

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    but also, as I say these levels aren't high for me...I have been coming down from 30 due to 2 months of incorrect treatment
     
  15. Daibell

    Daibell LADA · Master

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    Basal insulin is your 24 hour insulin and Bolus is your meal-time insulin. This assumes you are on the regime with the two insulins also called MDI (Multiple Daily Injections). Some people are started on a mixed insulin twice a day which may be OK to start with but not long-term.
     
  16. Marie 2

    Marie 2 LADA · Well-Known Member

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    We are all different in the insulin units needed per carb. There is no right or wrong, it's just what we need. A lot of us even use a different ratio for morning versus night.

    I too will wait to eat almost always until I have a normal or lower level of BG. it always seems like a lot harder to try to lower a high BG number than to stop it in the first place from occurring. I always try to prebolus for my meals and if it's something high fat I will take part of my dose either a half hour to an hour after I eat. Some people even take doses hours after they eat something like pizza.

    But any carb counting guide can only tell you an average for a certain portion size. Portions/sizes can vary all the time and changes in recipes can vary, so it can be a guessing game.

    There is a vegan meatloaf I get at a restaurant and it's made of lentils, veggies and quinoa and has a vegan gravy with it. And because it's not a chain the portion really varies with different chefs. It's delicious BTW, but a nightmare trying to figure out dosing.
     
  17. EJMJones

    EJMJones · Member

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    thank you. I am learning a lot
     
  18. EJMJones

    EJMJones · Member

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    thank you. Yes I am on nurorapid pre breakfast, pre lunch and pre tea, and Levemir overnight
     
  19. MeiChanski

    MeiChanski Type 1 · Well-Known Member

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    Yes its important to do it gradually. I'm sorry I got it wrong, you also have to take into consideration that we experience some degree of insulin resistance when our numbers reach a quite high range, so some need extra units to bring it down. I wasn't taught how to carb count at the beginning so I wouldn't be too down about it, it's a long learning process and we are all unique. You just need to adjust your carb ratio according to the carbs you're eating, some carbs break down sooner than others so you need to probolus before hand to minimise the spike and some need a split dose when fat is involved, like takwaways etc.
    I know it sounds pretty overwhelming right now, but do take it easy. I'm a bit worried about your high numbers, it's scarily high. But let us know how you eat on with your nurse, you just need to know a few things at the moment:
    You'll learn everything through time, through your team and through DAFNE and Bertie.
     
  20. Scott-C

    Scott-C Type 1 · Well-Known Member

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    Hi, @EJMJones , the way you are analysing numbers as a newly dx'd T1 is pretty impressive, and will serve you well once you get levels down to the more usual 4 to 7 range.

    But don't be in too much of a hurry to get there. Your nurses are correct: if your bg drops too low too quickly, that can be damaging. A deep sea diver gets brought up from depth in stages to avoid the 'bends'. So it is with T1 too: a slow, staged reduction over a month or so. You're in the T1 game for decades now. What happens in this first month or two will have no long term consequences.

    I do a face palm every time I read T2s telling newly dx'd to immediately cut out all carbs. That's pretty much guaranteed to over-express vascular endothelial growth factor, vegf, which will damage eyes. Ignore anything a T2 tells you - it is an entirely different medical condition.

    You're working the numbers well, but the reason they're not working out as well as you want is that your levels are high.

    Injected insulin works in different ways depending on levels. The numbers you mention would probably have worked well if you were in a 4 to 7 level, but not so much in the teens. Be patient, you'll get down to 5 eventually and the calculations will become more predictable then.

    Although, having said that, it's T1, so, sometimes, they just won't!
     
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