Article in today's Times

[Dillinger]

It goes something like this,

Firstly you test to see what your BG is..
Then you work if and how much active insulin you've got on board, from previous bolus or correction injection
Then you workout any adjustment factors, which are
Exercise already done
Exercise you'll going to be doing
Stress (are you or are you going into a stressful situation etc)
Then ambient temperature

Once you've worked out this and what adjustments you need to make, you then

Count your carbs, to get insulin figure then decreased/increase the dose by your workings out above...

What adjustments to you make for stress and ambient temperature? How do you quantify them?

Dillinger

 

[jopar]

That is, a T1 looks at the amount of carbs they are going to eat and injects an amount of insulin accordingly.
A T2 (diet) looks at the amount of effective insulin available (fixed) and takes an amount of carbs accordingly.

Sorry but this is wrong..

Firstly, For T1's to work out your correct dose of insulin is a lot more complicated than just inject for carbs you eat!

It goes something like this,

Firstly you test to see what your BG is..
Then you work if and how much active insulin you've got on board, from previous bolus or correction injection
Then you workout any adjustment factors, which are
Exercise already done
Exercise you'll going to be doing
Stress (are you or are you going into a stressful situation etc)
Then ambient temperature

Once you've worked out this and what adjustments you need to make, you then

Count your carbs, to get insulin figure then decreased/increase the dose by your workings out above...

Secondly I would point out, that for T2's insulin isn't 'Fixed' it fluctuates, and it's generally insulin resistance and/or the body's ability to utilize the insulin produced effectively... For some it will be the response time/lag of producing the insulin causing problems..

Jopar,
Firstly I thought it apt as a simple level of explanation to an MP, I really did not want to get into the finer scientific points of how a Type 1 diabetic works out their dosage, or Type 2 checks how many carbs are in what foods, and I thought Borofergie explained it simply and quit well. If she wants to examine the details ! which I am sure she wont, unless she happens to be diabetic her self, I furnished enough links in the email to check those facts out. Secondly my point was not to explain in any great detail the where and why fores, but more aimed at the level of service most of us receive from our NHS, GP's and DSN's along with Poor diet advice and the fact they will not give the vast majority of us (type 2's) meters and strips, so I tried to explain the importance of those points. Poetic Licence comes to mind, and your missing the point of the email entirely to my MP not the forum.

Problem Roy,

Portraying diabetes in simple terms people see it in simple terms, so we never move forward and constantly stuck with the 'One Mantra, One Regime' Fits All.. And to give this simple version incorrectly compounds matters even more!

You see the currant 'dietary mantra' as wrong based on that it doesn't work well for you as an individual...

But you are forgetting that I and others aren't you, others such as myself, may not need, want or various reasons can't do as you do, so for us your 'mantra' wouldn't work..

So replacing one mantra with another one, isn't the answer at all and does actually lack benefits and impacts elsewhere...

We need to get people to recognise that we need many different 'mantra' so individual need, wants etc are catered for..

And the only way to find out what somebody's needs are, is by using Test Strips! Bingo a very much better argument to why Test Strips need to be given to T2's...

After All, we all succeed with more success when we are doing something by choice rather than being enforced to do something..

That is something I've learn't as a diabetic...

When I first was diagnosed, it was a case Carbs and Insulin were prescribed to you, you ate regularly at the same times of the day, everyday... Up at 7am everyday for my first injection, breakfast was at 7.30am had to take into considerations playschool runs in the week! You then had to eat the prescribed carb amount otherwise you would suffer a hypo... It was pretty much a miserable existence really, now I have total control eat when I want, what I want, go to bed and get up when I want... Because I have the knowledge and understanding plus the kit, to enable me to make some very basic decisions in my life...

So we need to impress on others the complexities and the need to have fundamental choices along side the necessary kit... That way more people will succeed with a lot more success than now..

The reality, is that there will never be a time where a level of control safeguards all or prevent long term complications for all, purely because the human race is pretty fickle in ways, so there will always be, those who can't or won't for various reasons, do what's required to maintain control, whether a single mantra or multi mantra regime is promoted!

All we can do, is go with a multi-regime approach, so we limit complications etc for as many people as possible.

 

[RoyG]

I am deeply sorry Grazer, but in my creative mode, I must have gotten confused, not hard these day's for me. I am glad you have not taken offence, an excellent simple description, and I shall let Borofergie answer your comments himself :wink: :wink:

 

[Grazer]

Thank you Roy :lol: . And well done on at least trying to help things by writing to someone! Your point was well made. "Keep it simple" is the Mantra when explaining things to a lay person.

 

[jopar]

It goes something like this,

Firstly you test to see what your BG is..
Then you work if and how much active insulin you've got on board, from previous bolus or correction injection
Then you workout any adjustment factors, which are
Exercise already done
Exercise you'll going to be doing
Stress (are you or are you going into a stressful situation etc)
Then ambient temperature

Once you've worked out this and what adjustments you need to make, you then

Count your carbs, to get insulin figure then decreased/increase the dose by your workings out above...

What adjustments to you make for stress and ambient temperature? How do you quantify them?

Dillinger

As you know with purely by knowledge gained by experience!

I use less insulin in winter months than I do summer, if the temperature rises in the summer I need to increase my pump TBR (Temp basal rate) by 10-20%

You use the experience gained from previous adjustments form the same/similar situation and make an educated guess!

 

[RoyG]

Jopar,
Fine you email your MP and mantra him/her to death, I will email mine. At least I am being proactive and voicing MY concerns with MY MP. When and if they begin to listen, I'm sure you will have the opportunity to voice your mantra's and get them out in the open.

 

[xyzzy]

All we can do, is go with a multi-regime approach, so we limit complications etc for as many people as possible.

That's a good statement as effectively I interpret it as the same as "Eat to your meter" i.e. people do what's required to keep themselves complication free. The only issue is, in my opinion, when DUK, the NHS or individuals attempt to limit those choices and effectively rule out a good fraction of the regimes in what you describe as a multi-regime approach.

The obvious issue is when someone like myself finds that to be complication free we need to drastically restrict our carbohydrate intakes then it would appear that is not one of the regimes we are allowed to choose. To me it's that single issue which is at the root of all of the debate and certainly not that a multi-regime approach is somehow invalid. Personally as an advocate of "Eat to your meter" then I support any method, including non low carb ones, that keep people safe. I just wish DUK, the NHS and others would allow me the same choice.

 

[noblehead]

I use less insulin in winter months than I do summer, if the temperature rises in the summer I need to increase my pump TBR (Temp basal rate) by 10-20%

Shows how we are all different Jo, I always use less insulin in the summer months than I do in the winter :crazy:

 

[benedict]

That is, a T1 looks at the amount of carbs they are going to eat and injects an amount of insulin accordingly.
A T2 (diet) looks at the amount of effective insulin available (fixed) and takes an amount of carbs accordingly.

jopar makes a valid point that there is more to picking insulin amounts than just carbs. As a one sentence simplification for an MP, I think the summary is decent.

We could also add that a person with type 2's insulin tank may have variables that affect things too -eg improved insulin sensitivity following an hour of playing squash or variations due to temperature. However, I can see that keeping things simple in this case has its merits.

Benedict

 

[Robinredbreast]

However, I can see that keeping things simple in this case has its merits.

Benedict

When it comes to any government MP, simple is definately best :lol: RRB

 

[benedict]

:lol:

I know if I were an MP being mailed about something that's far from my specialist subject, I'd appreciate something I could understand without over-straining my grey matter. :crazy:

To be fair to them, the range of issues they get contacted about must vary an awful lot.

Benedict

 

[RoyG]

Thank you Roy :lol: . And well done on at least trying to help things by writing to someone! Your point was well made. "Keep it simple" is the Mantra when explaining things to a lay person.

Fixed it now, oh so sorry Mr Grazer.

 

[Scardoc]

[quote="benedict
To be fair to them, the range of issues they get contacted about must vary an awful lot.
Benedict[/quote]

Maybe we should also be fair to GP's too then as they are "general practitioners" and get contacted on a massive range of issues.

Simple is most definitely the way forward, a thousand simple mails/letters saying T2's need testing strips or your dietary advice is codswallop will be more effective than a thousand long winded stories of personal experiences.

Seems to me that now might be the time for some "activists" on this site to contact the Times and other newspapers and ask them to tell the story of the people who have been low carbing for years. Strike while the iron's hot!

 

[xyzzy]

Seems to me that now might be the time for some "activists" on this site to contact the Times and other newspapers and ask them to tell the story of the people who have been low carbing for years. Strike while the iron's hot!

Baggsie do the Daily Fail and tell them about the wondrous life saving powers of Mr Atkins diet :lol:

 

[benedict]

Maybe we should also be fair to GP's too then as they are "general practitioners" and get contacted on a massive range of issues.

Funny you should say that, that very thought crossed my mind as I was writing it

Seems to me that now might be the time for some "activists" on this site to contact the Times and other newspapers and ask them to tell the story of the people who have been low carbing for years. Strike while the iron's hot!

...and for impact, if that person had managed to come off medication or reverse the presence of complications and that person's GP/consultant were comfortable to back up the claims, that could make a difference. Opens the question of whether an NHS doctor/consultant would be happy to do that though :?:

Benedict

 

[Grazer]

That is, a T1 looks at the amount of carbs they are going to eat and injects an amount of insulin accordingly.
A T2 (diet) looks at the amount of effective insulin available (fixed) and takes an amount of carbs accordingly.

jopar makes a valid point that there is more to picking insulin amounts than just carbs. As a one sentence simplification for an MP, I think the summary is decent.

We could also add that a person with type 2's insulin tank may have variables that affect things too -eg improved insulin sensitivity following an hour of playing squash or variations due to temperature. However, I can see that keeping things simple in this case has its merits.

Benedict

I agree Benedict. Actually, the quote came from a different thread that I set up where i was trying, in a deliberately simplistic way, to show the difference in variables between a T1(or insulin dependant T2) and a T2 not on insulin.
That is, a T1 varies the insulin to match the carbs (YES I KNOW there are other things that effect this) whereas a T2 varies the carbs to match the EFFECTIVE (thus allowing for insulin resistance) insulin response available.
Of course exercise etc effects the equation, but the point was to show why T2s, especially diet only ones, fixate on carbs.
EFFECTIVE insulin available was also a point in showing why T2s on diet have to test; to see what their effective insulin is at different times and in different circumstances.
Sometimes, less words is best. Hence:-

T2s match carbs to insulin.
T1s match insulin to carbs

 

[Etty]

...

A couple of points from the previous discussion.
US terminology definitions
see: http://www.nap.edu/openbook.php?record_ ... 0&page=290

RDA for carbohydrates (this is national and thus reflected in the diabetes guidelines) This is set as the minimum amount necessary for 97-98% of the population. ( This is the same in the US whether for diabetics or the rest of the population. The RDA is set at a level that is equal to the EAR plus 2 standard deviations.
The EAR is the estimated average requirement (ie at the 50% of population level) This for carbs in the US is 100 so the RDA is 130 and is condsidered the amount for most people to remain healthy.
The 2008 ADA document (referred to in the 2012 guidelines ) the RDA for carbohydrate (130 g/day) is an average minimum requirement
http://care.diabetesjournals.org/conten ... f_ipsecsha

It is not the only recommendation the US also sets an Acceptable Macronutrient Distribution Range which for carbs is 45-65%

The UK gave up using RDAs in 1991. Since then we have various recommendations. That for carbs is a percentage of calories.
In the UK the DRV (dietary reference value) for carbs is 47% percent of energy
(the GDA is a part industry sponsored measurement , the GDA works out at 47-8% of the calorie figures they give which may be too high for many people)

Thank you phoenix for your comprehensive explanation. I think I understand now that the US RDA of 130g/day is the (average) minimum sufficient to meet the cho requirement for nearly everyone. But the Acceptable Macronutrient Distribution Range is 45-60%, which is in line with the UK Dietary Reference Value for cho of 47%. This level, it seems, comes about to meet energy needs while consuming acceptable levels of fat and protein.
So the Uk and US recommendations are about the same, but as Xyzzy says, the UK is a little more vague.

 

[RoyG]

Further to my Letter to Ms Rosie Copper, MP for west Lancashire. Yesterday I received her reply, which I shall post link to my Documents, https://docs.google.com/open?id=0B-H6Cm ... l91eW9NV2c for you all to see. It would seem some MP's are concerned about the level and standards of care that Diabetics are receiving. But I think it has some way to go yet, still if we all write to our own MP's who knows. It is a lengthy reply with different information so stick with it.
I don't think you can post PDF on the forum,