And why? This question would likely apply to long-time Type 1s who started out with exchange lists for diet. Switching from MDI to a pump might be one reason but other than that, why do it? Carb counting and calculating doses accordingly seems like a lot more work for MDI than the previous method of diet and insulin management. Does it get better results? I’m curious about this.
Has anyone changed from an Exchange diet to carb counting?
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Interesting question.
When I was diagnosed in 1970 I was on fixed doses of insulin and carbs but carbs were used instead of exchanges.... So I carb counted but didn't calculate doses. Not really sure of the difference between carb counting and exchanges though. Aren't exchanges just a different set of units??? (1 exchange = 15g of carbs?) I understand that this might be easier for mental arithmetic though.
Happy to be told I'm completely misunderstanding the system, as I'm pretty sure I am.
I have not heard of this exchange diet before.
Is it fixed list of food that is similar in carbs?
Is it fixed list of food that is similar in carbs?
Before carb counting, the exchange diet was the norm in the U.S. It was based on daily caloric intake, divided into nutritionally balanced meals of protein, carbs, fruit, A and B vegetables, fat and “free” foods with little or no caloric value. Minimum for adults was 1800 calories per day but 2400 was average. It was basically a flexible meal plan designed to balance your insulin requirements and activity while ensuring balanced nutrition. Glycemic index was something you could also factor in.
The beauty is, there is no reliance on insulin-to-carb formulas that may or may not apply well to your case and no calculating of every insulin dose (although adjustments are sometimes necessary). Basically, not a lot of arithmetic to do. It’s a bit more “seat of the pants” and it becomes second nature. Honestly, it seems a lot easier to live with than carb counting. But I can’t testify to that since I never tried carb counting myself. My guess is, if you ask your doctors about this, you will get a blank look. This is a shame because day-to-day living with Type 1 doesn’t need to be as hard as the current thinking is making it. Or so it seems to me.
The beauty is, there is no reliance on insulin-to-carb formulas that may or may not apply well to your case and no calculating of every insulin dose (although adjustments are sometimes necessary). Basically, not a lot of arithmetic to do. It’s a bit more “seat of the pants” and it becomes second nature. Honestly, it seems a lot easier to live with than carb counting. But I can’t testify to that since I never tried carb counting myself. My guess is, if you ask your doctors about this, you will get a blank look. This is a shame because day-to-day living with Type 1 doesn’t need to be as hard as the current thinking is making it. Or so it seems to me.
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@david4503 Times and technology move on and with it a better understanding of diabetes management. I myself have always been on a carb counting and insulin ratio routine. However, I remember my brother back in the day on fixed doses and a balanced diet. It may have been done slightly differently to the US. He is now on carb counting, a pump and Dexcom with the best management he has ever had.
The question has to be, do you have a good HBA1C and daily TIR from a CGM? If you do then you have cracked it and stay where you are. If not, consider that the more modern way may be better.
The question has to be, do you have a good HBA1C and daily TIR from a CGM? If you do then you have cracked it and stay where you are. If not, consider that the more modern way may be better.
Yes, whatever works well and whatever you can adjust to while minimizing the downsides is a good solution. Personally, I feel that some of the newer technology and methods are more about making different trade-offs than actual progress. You have to look at the results you’re getting but you also have to look at the kinds of sacrifices you’re making to get there. Not all of them are automatically good, healthy or even necessary.
In that regard, having more choices is a good thing and the so-called latest and greatest is not necessarily the best answer for any particular patient. Type 1 diabetes is no different than other diseases in that some of the best therapies were developed decades ago. Newer isn’t necessarily better and sometimes it’s worse. Some of the issues I’m reading about on this forum are specific to the technology and methods being used and many people are struggling with both. Success stories are great but inspiration will only get you so far.
In that regard, having more choices is a good thing and the so-called latest and greatest is not necessarily the best answer for any particular patient. Type 1 diabetes is no different than other diseases in that some of the best therapies were developed decades ago. Newer isn’t necessarily better and sometimes it’s worse. Some of the issues I’m reading about on this forum are specific to the technology and methods being used and many people are struggling with both. Success stories are great but inspiration will only get you so far.
I was originally taught to carb count using what I believe was called Lawrence's Line Ration Scheme. You were allowed so many Black and so many Red Lines at each meal. For example, my breakfast in 1964 was three Black and two Red. In hospital. This took the form of bacon and egg with a small piece of bread, plus a bowl of Rice Crispies. Red was protein.One Black Line was 10g of carbohydrate, so you multipled by ten to go from Black Lines to grams of carb. This happened after three or four years, (?) when fashions changed. Counting in chunks of ten made calculation straightforward. Like Ellie, I was on a fixed diet and fixed doses of insulin. I didn't find switching to grams of carb a problem. I still think of carbs in chunks of ten as a matter of fact. In hospital, I was drilled on how much boiled potato, (2 ozs) or plain biscuits (2) , or cooked carrots (8 ozs) , or Rice Crispies (two thirds of an ounce) constituted one Black line. The nurses and doctors trained me.
I reckon the use of black and red was down to the printer's inks most readily available.
I reckon the use of black and red was down to the printer's inks most readily available.
I grew up using the same black and red lines principle as JMK1954, with initially 1 injection a day, then moved to 2. Changing to carb counting and MDI later followed by a pump, made my control much better, and not having to eat at set times and set amounts, to fit in with when my insulin was working, was a real game changer.
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I did that at the same time as getting me first glucometer, after a somewhat diabetically unregulated teenage phase. Complete game changer.
So, the U.S. version of the exchange system and the UK version seem similar, although the U.S. one might have been a bit simpler than calculating meals based on black and red. In any case, what strikes me is that when MDI became standard in order to achieve good control, the exchange system was soon abandoned in favor of carb counting and calculated dosing. That, in turn, seems to have increased the burden on Type 1s in their everyday managing and micro-managing of both dosing and eating. Not surprisingly, “never getting a break” seems to be one of the top frustrations mentioned in another thread that’s active now. And never getting a break takes a real toll on people.
Now, healthcare in the U.S. has its problems where diabetes is concerned, no question. But one good thing is that the system generally doesn’t pressure you into making changes you don’t want or need. It does care about results but not so much about how you get them. Which is why I, and who knows how many other Type 1s, are using a modified version of the old exchange system and fixed dosages. It incorporates the newer insulins, primarily rapid-acting, basal and bolus doses, testing as needed, and flexibility in adjusting set doses based on current or anticipated circumstances.
It combines the benefits of the old system in terms of not having to constantly think about and work at maintaining control with the benefits of the carb/calculated dosing routine, mainly good results and the flexibility to adapt to changing circumstances and eat pretty much what and when you want, with obvious limitations. I would say it’s best suited to experienced Type 1s, not new patients or kids. And, of course, there’s a learning curve.
You wouldn’t see the powers that be embrace this approach (assuming they know of it, which I doubt) because, from their point of view, it leaves too much control in the hands of the patient and is therefore risky. The carb/calculating dosing regimen has at least the appearance of a rigorously scientific and predictable system, which is what patients and the people approving healthcare funding want to hear. The problem is, patients soon discover all the flies in the ointment and realize that the medical establishment was never the authority on living with diabetes. They are.
Now, healthcare in the U.S. has its problems where diabetes is concerned, no question. But one good thing is that the system generally doesn’t pressure you into making changes you don’t want or need. It does care about results but not so much about how you get them. Which is why I, and who knows how many other Type 1s, are using a modified version of the old exchange system and fixed dosages. It incorporates the newer insulins, primarily rapid-acting, basal and bolus doses, testing as needed, and flexibility in adjusting set doses based on current or anticipated circumstances.
It combines the benefits of the old system in terms of not having to constantly think about and work at maintaining control with the benefits of the carb/calculated dosing routine, mainly good results and the flexibility to adapt to changing circumstances and eat pretty much what and when you want, with obvious limitations. I would say it’s best suited to experienced Type 1s, not new patients or kids. And, of course, there’s a learning curve.
You wouldn’t see the powers that be embrace this approach (assuming they know of it, which I doubt) because, from their point of view, it leaves too much control in the hands of the patient and is therefore risky. The carb/calculating dosing regimen has at least the appearance of a rigorously scientific and predictable system, which is what patients and the people approving healthcare funding want to hear. The problem is, patients soon discover all the flies in the ointment and realize that the medical establishment was never the authority on living with diabetes. They are.
I had never heard of the exchange system until this thread but it strikes me as restrictive.
Whilst MDI and carb counting may put more onus on the person with diabetes, it seems to put more emphasis on the person rather than the diabetes. I think the change has been a positive one. We are all far more than just our diabetes - MDI allows us to LIVE with Type 1 rather than just SURVIVE with Type 1.
Whilst MDI and carb counting may put more onus on the person with diabetes, it seems to put more emphasis on the person rather than the diabetes. I think the change has been a positive one. We are all far more than just our diabetes - MDI allows us to LIVE with Type 1 rather than just SURVIVE with Type 1.
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Yep, I had it when diagnosed in 76 on fixed dosage of porcine. A regimented lifestyle.
I was told to eat certain times, snack in between. Even before bed. (I was advised to eat before going to school swimming class too.)
No leeway.. It was all about “fuelling” the dose. Not flexibility on choice.
I prefer to forget it.
I didn't find the fixed doses of insulin and carbs restrictive. I was well-controlled and stable. My parents and me were told that if I was going to a birthday party or if it was Christmas or a family celebration of some kind, it was okay for me to depart from the usual carb count and eat extra carbs as a one-off. The consultant pointed out that otherwise it was possible/likely that any child would take the opportunity to do this anyway. Raised levels for 24 hrs or so were not a big problem in the grand scheme of things. What counted was consistency over weeks and months. A walk was recommended to bring down higher BS levels. This worked for me, though I understand that it wouldn't do so for everyone.
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I think this just shows that just as there's more than one way to skin a cat, there's more than one way to successfully manage your diabetes. Personally, I love to hear about the different methods that people use to manage those pesky pancreases and their inability to produce insulin.
Thanks for the interesting topic @david4503
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Yes, that’s the way it was taught but that’s not nearly the way it’s been with me since 1997, when Humalog was introduced. You have to understand that what I do is not an off-the-shelf system at this point. Nobody teaches it anymore and there was only a period of less than ten years or so when some Type 1s in the U.S. were using it (in-between 1997 and the introduction of Lantus and then carb counting).
Since then I’ve made some added refinements which make it virtually as flexible as pumping without the risks and hassles. There are no set schedules, mealtimes or diets and believe me, I’m the priority not the disease. There are obviously trade-offs between different regimens and diets but I’ve had the option of going for the pump or any other therapy on the market and think that what I do is the best of all worlds. Unfortunately, it’s not an option you can just go ask for — any more than you can get Ford or Toyota to put a radio with buttons and knobs in your new car instead of a video screen with a menu system. Good luck changing stations in traffic.
So what’s the point of even mentioning any of this? Just to point out that you, as Type 1s, should never stop looking for a better way, never accept that whatever issues you have are something you have to live with because some expert, white coat or no, says so. Type 1s, in my experience, often innovate and customize things to meet their needs. What they tend not to do is buck the system by sounding off to the powers that be about how what they’ve been sold too often isn’t as advertised. The status quo will only improve if you demand it
There’s an MIT engineer over here who was royally ****** that his daughter now had Type 1 and the artificial pancreas was going nowhere fast. He broke the logjam by creating a workable algorithym that forced the NGOs and pump makers to get off their behinds and develop a testable prototype. Now it’s in trials. Sorry for the rant but it needs to be said. Nobody but us is going to change anything.
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Funny you mention the MIT engineer.. There are some bright sparks in Europe that have developed two great free apps Diabox or XDrip, just a matter of preference.) That make using the Libre a more personal bespoke experience too..
I would agree with @EllieM . There is more than one way.. & That includes a mod I made to my Jap import van to get a CGM heads up display..
When 1st diagnosed with Type 1 nearly 30 years ago I was on a fixed insulin regime. I hated it. Set carbs & fixed meal times with no room for movement. Any adjustments had to be done by my diabetes team. I eventually moved to DAFNE (Dose Adjustment For Normal Eating if anyone doesn't know) & have never been happier. I take a fixed dose of basal insulin twice a day
I was diagnosed Type 1 nearly 30 years ago and was lucky with my consultant who was considered a'whizz ' in the diabetes medical profession & strongly believed that patients know their diabetes best & should be in control of their diabetic care.
Recently I complained to my current consultant that every time I have a review with a registrar or anyone other than him it feels like I am spoken to a though I am an idiot & know nothing about diabetes, when i actually know a great deal about the condition. His response was that, in his experience, most patients don't want to take responsibility for their diabetes and want to rely on their doctor to tell them what to do. I was truly shocked.
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When 1st diagnosed with Type 1 nearly 30 years ago I was on a fixed insulin regime. I hated it. Set carbs & fixed meal times with no room for movement. Any adjustments had to be done by my diabetes team. It was highly restrictive and I hated it.
I eventually moved to DAFNE (Dose Adjustment For Normal Eating if anyone doesn't know) & have never been happier. I take a fixed dose of basal insulin twice a day and rapid insulin whenever I eat carbs. Meal times are no longer set in stone and I no longer HAVE to eat carbs. If I'm not hungry I can skip a meal, taking an adjustment if insulin if my glucose is high.
Initially it took some effort having to work out how many carbs a meal/ snack had but I quickly learned the carb content of different food so now I can look at a meal & know fairly accurately how many carbs are there. The insulin I take is an agreed ratio of carbs:insulin. If I see a pattern in high or low blood sugars I adjust my basal insulin or my rapid insulin ratio. If I'm worried I speak to me diabetes nurse for advice. The freedom DAFNE had given me to manage my own diabetes and the freedom over food is immeasurable. If I'm ill, often the last thing I want to do is eat. I can manage insulin myself because I was taught what to do. DAFNE involves a 5 day course and then plenty of support from the diabetes team if & when needed so you're never truly alone.
My control has been so much better since i moved to DAFNE & my Hba1c dropped from 64 to 50. I was clinically very obese for years but since taking control of my insulin i have dropped nearly 40kg. Still have another 20 to go but being able to be flexible about foodI makes it so much easier. I have now have as close to perfect blood sugar controlI as I think I'll ever have. I would definitely recommend it to all Type 1s.
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Great going on what you’re doing! I’ve been very intimate with DAFNE
for a long time but I didn’t know her name. God only knows what the name is here in the States (probably something like SCARLET, whatever that might stand for). As far as how you decide on dosing, it seems to me that it matters less whether your judgement is rooted in the older exchange system or the newer carb/insulin ratios; the point is that it becomes second nature and you’re not spending time and energy trying to arrive at some pseudo-scientific solution after consulting your trusty calculator app.The condescension issue you mention above is certainly disturbing. I’m with you on that. What the heck is a registrar (and couldn’t they come up with a nicer title, like DAFNE?)? Sounds like there are a lot of cooks in the kitchen there in the UK, if that’s where you are. Also, do you tell your consultant or registrar or whoever about skipping meals and all the other liberties you’ve taken since DAFNE? If so, what do they think?
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