Diabetes 1 course

[grahamrb]

I joined my wife on the first of an online weekly course today.
Todays session was on carb counting and I have to say that I admire all you people who’ve been weighing food and calculating your insulin dosage for every meal including snacks etc
How do you find time to do anything else?
Based on previous records we have been given a target of 8 units of insulin before every meal
We have a ratio of 1 to 10 carbs and if the answer comes to 12 we have to adjust it based on 1 to 3 to get to 8 units of insulin
What a nightmare
We have to forget anything we have done previously
If there is one thing to spoil the fun of eating it is to spend half an hour working out the carbs either by weighing or food labels etc before cooking
Previously told that we had to have 60 g of carb, each meal that is now out.
It is useful to write this down since it clarifies the thoughts in my tired old brain
From an intellectual viewpoint it is very interesting, from a practical viewpoint it might be challenging
We start the process tomorrow

 

[EllieM]

We have a ratio of 1 to 10 carbs and if the answer comes to 12 we have to adjust it based on 1 to 3 to get to 8 units of insulin

I've got to say that I don't understand what you mean by this sentence???

(edited for typo)

 

[Hopeful34]

Mmh seems a funny way to do it, to adjust your food intake to a fixed dose of insulin. Can't figure out what they mean by adjusting it based on 1 to 3? My lunch ratio is 1:10, and as I eat the same lunch every day with 30g carbs, I take 3 units of insulin. However, if I wanted to take 40g of carbs, I'd just take 4 units of insulin etc.

I wonder if they mean to aim for a blood sugar of 8 before meals, and the 1 to 3 is that 1 unit of insulin lowers your blood sugar by 3?? I could be completely wrong though.....

Trust me, it will get easier as you go along. It's a lot to take in at first, but becomes very automatic the longer you do it.

 

[grahamrb]

Mmh seems a funny way to do it, to adjust your food intake to a fixed dose of insulin. Can't figure out what they mean by adjusting it based on 1 to 3? My lunch ratio is 1:10, and as I eat the same lunch every day with 30g carbs, I take 3 units of insulin. However, if I wanted to take 40g of carbs, I'd just take 4 units of insulin etc.

I wonder if they mean to aim for a blood sugar of 8 before meals, and the 1 to 3 is that 1 unit of insulin lowers your blood sugar by 3?? I could be completely wrong though.....

Trust me, it will get easier as you go along. It's a lot to take in at first, but becomes very automatic the longer you do it.

Ratio is 1 to 10
Correction is 1 to 3
Target sugar level is 8
If sugar reading is 12 this is too high by 4
Divide 4 by 3 = 1.3
If carbs is say 57 then divide by 10 = 5.7
Therefore total insulin dosage is 1.3 plus 5.7 = 7 units
This is how I think it works

 

[EllieM]

Ratio is 1 to 10
Correction is 1 to 3
Target sugar level is 8
If sugar reading is 12 this is too high by 4
Divide 4 by 3 = 1.3
If carbs is say 57 then divide by 10 = 5.7
Therefore total insulin dosage is 1.3 plus 5.7 = 7 units
This is how I think it works

That makes perfect sense, as a way to calculate the insulin you need if you start at 12 and want to have 57g of carbs. Those ratios sound like the standard ones that T1s start out on, so they may change.

Based on previous records we have been given a target of 8 units of insulin before every meal

I think you may have meant to say a glucose reading of 8mmol/L before every meal?

Anyway, sounds as though you are getting the hang of things. Carb counting should get easier with time.

 

[In Response]

Todays session was on carb counting and I have to say that I admire all you people who’ve been weighing food and calculating your insulin dosage for every meal including snacks etc
How do you find time to do anything else?

I do not weight everything I eat.
Most people eat about 10 or 12 different meals and learn the carb content for each of these. From then on, we can adapt by eye when we have less pasta or potatoes in our curry or ...
If you find the insulin calculations complex, some meters will do it for you or there are some phone apps. You need to config them with your insulin to carb ratio, your correction rate and your target level. Then when you eat, add your current blood sugar level plus how many carbs you are eating and out pops the required dose.

 

[Harrysdad]

If you download the RapidCalc App to your phone, input your ratios and let the tech take the strain.

 

[Juicyj]

Hello @grahamrb

Yes it all does seem like alot of faff at the start, but when you put the effort in and learn at the start it get's easier over time. There are also shortcuts that most of tend to refer to once we know the effect of carbs eaten on our glucose levels, so learning that a 'handful of this' or this many chips looks like that, also food packaging although not always correct provides us with more info. Then there is intuition and guesswork too as we generally can't ask for weights in restaurants so have to estimate based on sight, Carbs and Cals app is good for this as it goes by a visual representation of food on the plate.

Also bear in mind that ratios will change in line with the weather/exercise/stress/illness etc etc..

 

[NicoleC1971]

I joined my wife on the first of an online weekly course today.
Todays session was on carb counting and I have to say that I admire all you people who’ve been weighing food and calculating your insulin dosage for every meal including snacks etc
How do you find time to do anything else?
Based on previous records we have been given a target of 8 units of insulin before every meal
We have a ratio of 1 to 10 carbs and if the answer comes to 12 we have to adjust it based on 1 to 3 to get to 8 units of insulin
What a nightmare
We have to forget anything we have done previously
If there is one thing to spoil the fun of eating it is to spend half an hour working out the carbs either by weighing or food labels etc before cooking
Previously told that we had to have 60 g of carb, each meal that is now out.
It is useful to write this down since it clarifies the thoughts in my tired old brain
From an intellectual viewpoint it is very interesting, from a practical viewpoint it might be challenging
We start the process tomorrow

I think you are right that it is practically daunting.
2 things:
A you can use a bolus wizard on many blood glucometers that knows your carb:insulin ratio and critically, how much insulin you have on board from a previous bolus + knows a correction dose basd on your correction ratio (how much does 1 unit of insulin bring your bg down?).
B - eating low carb means the calculation errors are very much reduced aka The Law of Small Numbers.
I am far too lazy to weight out my meals or scan bar codes. It goes against cooking family meals from scratch and encourages eating of prescribed carb portions made in a factory which must be a bad thing for health overall.
We do not need carbohydrates from a physiological point of view although culturally they are a mainstay.
Meal by meal I've ditched rice, pasta, potatoes and minimised bread whilst being weight stable and enjoying plenty of meat, fish, eggs and cheese etc.! I do eat green carbs for t he sake of my gut health.

 

[StewM]

Hello @grahamrb

Yes it all does seem like alot of faff at the start, but when you put the effort in and learn at the start it get's easier over time. There are also shortcuts that most of tend to refer to once we know the effect of carbs eaten on our glucose levels, so learning that a 'handful of this' or this many chips looks like that, also food packaging although not always correct provides us with more info. Then there is intuition and guesswork too as we generally can't ask for weights in restaurants so have to estimate based on sight, Carbs and Cals app is good for this as it goes by a visual representation of food on the plate.

Also bear in mind that ratios will change in line with the weather/exercise/stress/illness etc etc..

Btw just a note the Carbs and Cals app is not what it once was. They're trying to move to a subscription model. So they now offer two tiers. There is a free tier that has less stuff in it than the existing app and the subscription tier, which has more stuff in it, but comes a quite a high price. Anyone who bought the old app, can keep the old database, but that's it.

 

[TriciaWs]

I carb counted everything when I went low carb - measuring or weighing and the focus on the diet took a lot of time and energy. But after a while I had most meals sorted out eg three spoons of my flaxseed based breakfast plus a half milk coffee is 18g of carbs and the alternative of low crab bread with sugar free marmalade works out the same.
My lunch if I have one is carb free, so that just leaves dinner and for familiar meals I just need to know how many spoons=x carbs.

 

[Juicyj]

Btw just a note the Carbs and Cals app is not what it once was. They're trying to move to a subscription model. So they now offer two tiers. There is a free tier that has less stuff in it than the existing app and the subscription tier, which has more stuff in it, but comes a quite a high price. Anyone who bought the old app, can keep the old database, but that's it.

Thanks for advising, the money grabbing thieves ! Probably best to buy the book then !

 

[Soplewis12]

Btw just a note the Carbs and Cals app is not what it once was. They're trying to move to a subscription model. So they now offer two tiers. There is a free tier that has less stuff in it than the existing app and the subscription tier, which has more stuff in it, but comes a quite a high price. Anyone who bought the old app, can keep the old database, but that's it.

Hi, I have the subscription app, think it was £35 for one year, it wasn't cheap but I love it. The other option is the book which gives as much information as the subscribed app, you can buy from Amazon @ £13.99 but it is bulky to carry if you are out & about.

 

[grahamrb]

Thanks all for your comments.
For the past three days we have religiously followed the formula as I described above
However the glucose readings are still very erratic and it is not possible to see any logic as to why the readings are so disparate
Admittedly the lowest has been 4 which is an improvement but apart from one being 28 there were lots of other high readings range from 12 to 18
It will be interest to see what the course leaders say about these results.
The very high reading was after my wife went on a short walk of about 1 mile no logic there, it should have gone down not up
As for missing a meal we have been told it is a no no.since it means missing your insulin dosage

I have stopped using the balance scales and bought digital scales which weighs in grams, ounces and also fluid ounces and allows for the weight of whatever container you are using

It’s all lots of hard work but you all say that it gets easier which is very encouraging
If only I could see the logic of the readings instead of them being random

 

[becca59]

@grahamrb there is no logic to this disease. Accepting that makes dealing with it on a daily basis much easier. Walking and indeed most exercise puts my levels up initially. The benefit in levels seems to happen much later.
Well done on the digital scales, wouldn’t be without mine. I am very strict.
It sounds as though when the course leader looks at your results they will suggest changes. Either to dosage or timing. Did the high readings (barring the very high 28) hang around for long, or was your wife back around her target range 4 -5 hours later. I question the missing dosage put forward as a reason for being unable to miss a meal. Unless your wife is on fixed doses which I don’t think she is then that is not factual. A basal bolus regime gives us the freedom to eat when we like. I myself have a very light breakfast and one meal between 1-3pm. I then do not eat again, unless low, until breakfast the following morning. However, their reasoning at present maybe they want more evidence to evaluate. Which is important. But in the future your wife should be eating in the way that she wants to eat. Not dictated to by the insulin she injects.

 

[grahamrb]

Dear Becca

We never used to eat at lunchtime perhaps just a snack
Then we were told to have 60 carbs each breakfast, lunch and dinner
So that meant wasting an hour or so at lunchtime measuring etc and eating
Consequently we are putting on weight
We have been following the rules diligently and apart from the 28 reading the range is now from about 3 + to 24+
I agree that the insulin dose or the target and correction factor or all three will have to change
My wife hates the thought of mealtimes since they are no longer enjoyable , but we have to eat.

 

[becca59]

@grahamrb look at this period as short term whilst they assess your wife’s insulin needs. Long term we type 1s now eat when, how often and however many carbs we fancy. Wether that be no carbs or lots of carbs. Set amounts of carbs is the old way to manage eating and insulin before the introduction of a basal bolus regime. My brother, diagnosed many years before me had the old regime for many years. And it took him a while to adjust that he didn’t need to eat set amounts. I was lucky enough to go straight onto basal bolus treatment. I had a fab DN and consultant. Went on to carb counting immediately with daily phone calls helping me to make adjustments.
Don’t lose heart your wife will be able to reach this point too.

 

[grahamrb]

Went to the second session of the course today
Tutors don’t seem worried about the readings but have put up the long lasting insulin dosage from 16 to 18 every morning.
Kept the same ratios etc.
Homework as well as the food diary is an exercise or activity diary

 

[becca59]

@grahamrb that sounds positive. They will want to see if the change to the basal has an effect first.

 

[grahamrb]

Still no logic, following the rules as instructed
By the time you have finished weighing, apportioning, logging and then taking blood sugar levels and then calculating the adjustment and injecting insulin,the food has got cold and you have lost interest in eating .
How do you all put up with it?
You can’t do anything spontaneously we wanted to go out but couldn’t because it was getting near lunchtime so we had to put off going out for two hours and everyone says diabetes doesn’t control your life
Doing all this stuff doesn’t make a scrap of difference to the readings they are still all over the place.