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Carb content and meal size ruled biggest factors in type 1 carb-counting errors

Discussion in 'Diabetes News' started by DCUK NewsBot, Sep 19, 2019.

  1. DCUK NewsBot

    DCUK NewsBot · Well-Known Member

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    The type and size of a meal are the two most important factors when carb counting, for those with type 1 diabetes, researchers have said. An Italian team involved looking at health data taken from 50 adults with type 1 diabetes from a study based on carb counting. Carb counting errors are common and can impact upon one's health. Inaccurately estimating the carbohydrate content of a meal can lead to errors in insulin dosing. Underestimations can lead to hyperglycemia (high blood sugar), while overestimations can result in hypoglycemia (low blood sugar). For three days, the participants were asked to guess how many carbs they were eating at each meal. Their estimates were then compared to calculations made by a dietitian. The researchers assessed how much effect various factors had on carb counting errors. These factors incldued education, duration of insulin treatment, age, body weight and the carb, protein, fat and fibre content of each meal. Having assessed all of the different elements, the team found that the carbohydrate content and size of the meal were the key elements in how accurately carbs were counted. They discovered that larger meals, such as lunch and dinner, led to more carb counting mistakes when compared to snacks or breakfast. These results perhaps lend credit to Dr Richard K. Bernstein's 'rule of small numbers', which states that a smaller amount of carbohydrate in a meal will lead to a smaller error in the counting and so a smaller error in amount of insulin injected to cover that carbohydrate. Study author Dr Martina Vettoretti, from the University of Padova in Italy, said: "Glucose control around meal times remains challenging for people with type 1 diabetes. "Our findings underscore the need for better information to help patients better estimate the carbohydrate content of their meals. "Once included in type 1 diabetes computer simulations, our model will enable researchers to assess the impact of carb counting error on blood sugar control and, more in general, to help study behavioural risk factors for hypoglycemia and assess the potential benefits of addressing them." The research is part of the European research project, Hypo-RESOLVE, which aims to provide researchers and clinicians with more data on hypoglycemia. The findings were unveiled at the 55th annual meeting of the European Association for the Study of Diabetes (EASD) in Barcelona, which is running from 16-20 Sept.

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  2. Muneeb

    Muneeb Type 1 · Well-Known Member

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    No ****. As if they needed a study to know that there's more relative error in larger numbers than smaller ones.
     
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  3. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Yep -- small numbers = small errors of dosing. Also means you do not have to eat next to a weighing scale or do maths before dinner then wonder why it went wrong when you did not factor in the other variables....Thank you Dr Bernstein!
     
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  4. Shiba Park

    Shiba Park Type 1 · Well-Known Member

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    Mathematically, yes but in practice not necessarily; for those that are on MDI and very sensitive to insulin, small carbs can be a problem to dose for - even with half unit pens. For such people, the only way this is workable is with a pump.

    We're all different, YMMV etc.

    Shiba.
     
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  5. Muneeb

    Muneeb Type 1 · Well-Known Member

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    You start by saying not necessarily, but then contradict that with what you say. The fact pump's wok better than MDI's for some people is because they administer small doses, which comes back to the original point of smaller doses have smaller error. Don't really get what your point is here.
     
  6. KK123

    KK123 Type 1 · Well-Known Member

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    I think Sheba means that although low doses might mean smaller errors, some people on low doses still have a devil of a time trying to manage levels. Sometimes this 'low dosage, low errors' mantra implies everyone can skip along happily.
     
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  7. Shiba Park

    Shiba Park Type 1 · Well-Known Member

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    What I meant was that the granularity of pens doesn't allow the calculated dose to be administered. For example, 20g carbs:
    ICR of 1unit:10g gives 2 units of insulin
    ICR of 1 unit:30g gives 0.66 units of insulin.
    There's a +50% to -25% error immediately because a pen can't do less than 0.5 units...

    I think most people can guess carbs more accurately than than, let alone count them!

    OTOH, a pump will dose in increments of about 0.05 units, so practically no error introduced .

    Hope that helps,

    Shiba.
     
  8. Muneeb

    Muneeb Type 1 · Well-Known Member

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    I get that, but the principal still holds. That just depends on what your conditions for lower doses are. Using a pump of 0.05 units compared to 0.5 units from a pen, is still lower doses = lower margins of relative error.
     
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  9. Muneeb

    Muneeb Type 1 · Well-Known Member

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    I get that, but as above the principal still holds. Lower doses - lower margin of error. The report didn't mention anything about specifically using injections.
     
  10. Shiba Park

    Shiba Park Type 1 · Well-Known Member

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    While I agree that for large quantities of carbs that is true, the inverse isn't automatically true. You need to look at all the sources of errors, and for very small quantities of carbs, the dosing granularity becomes significant if not dominant.

    I'm not saying people shouldn't eat small amounts of carbs, but be aware of the limitations of what can be dosed for.

    Another example: suppose I fancy a biscuit - about 5g carbs. With an ICR of 30g/unit I cannot dose for it. But I can for 3 biscuits...
     
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  11. porl69

    porl69 Type 1 · Well-Known Member

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    No **** Sherlock!!!!
     
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  12. Muneeb

    Muneeb Type 1 · Well-Known Member

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    Ah I kind of get what you are alluding to. Its not that lower insulin doesn't have smaller relative error. Its that for such low amounts, the current administering solutions are not satisfactory.
     
  13. Shiba Park

    Shiba Park Type 1 · Well-Known Member

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    With MDI, yes for some people.

    Going back to post #3 in this thread, as a former engineer I would expect Bernstein to consider this but I haven't seen any reference to it in his books.

    Shiba.
     
  14. tim2000s

    tim2000s Type 1 · Expert
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    He states that his preferred method of dosing is to use syringes, and you can get 0.3ml syringes that he would recommend going down to 0.25u by using the midpoint on the gradations. That's about as far as he goes.
     
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  15. KK123

    KK123 Type 1 · Well-Known Member

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    I get that too, I was trying to explain what I thought Shiba meant.
     
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