to 'low carb' or not to low carb!

[Debloubed]

For people using pumps it's fairly easy to manipulate insulin to work exactly as you want it, but for people using MDI (basal/bolus) it's a lot harder. Not everyone is able to use a 1:10 ratio all day long. They have to take into account the action of the basal insulin on bg levels as well as the effect of what the bolus is doing.

The deciding factor as to whether to snack or not depends what the bg levels are 2hrs after giving a bolus. People have also got to remember how much carb they ate and how much bolus they injected. If someone was following targets and wanted to try to be on 6 before they ate and then 2hrs later to be on 8 then unless they were hardly injecting any bolus due to low carb, they would need to use whatever amount of bolus it would take to get them that target. It might be a lot more than 1:10 or it could be something different.

My hospital clinic has issued a very easy to understand leaflet all about counting carb and advises that people eat a snack of 5-10g carb if their bg levels are below 9 two hours after the previous bolus. This is so that no one finds themselves going hypo.

As for putting on weight, I have remained a size 10-12 for all my diabetic life and have also eaten regularly.

Pumps can cause 'stacking' which is similar to what is described above (I am still quite new to pumping but have experienced stacking already!) but obviously the bonus is that you can bolus a lot less insulin for snacks as you have the constant 'drip' in the background all day long. When I used MDI I would snack as little or as much as I do now, it would just depend on how hungry I was. The pump hasn't changed my snacking regime as such but it has changed how much I bolus and has certainly made the bolusing easier to administer. The main difference would be that I can snack on smaller quantities as I can bolus smaller quantities.