Shoot Up or Put Up

La fée verte

I was idly rummaging through my old notes, leaflets and booklets that I was given by the DSN when I was first diagnosed. I did because I wanted a) clear some space in my drawers; and b) remind myself how many bad habits I’ve picked up in the last five years.

One booklet in particular did leap out at me. And that was a useful guide produced by the Royal Infirmary which gave the carbohydrate contents of various meals one might encounter out on the high street. After flicking through it again, I was reminded that there are 83g of carbs in a McBigMac, 45g in a McMuffin and 99g in a KFC Family Bucket (whatever that might be).

However, this led me onto thinking that while somewhat useful, it doesn’t really help the posh diabetic. Those within the pancreatically-challenged masses who dine on fine food and eat in exclusive restaurants. So, dear reader, I’ve done some research and calculated the carb contents of some fabulous meals for poshos:

Pheasant & port

Like most right-minded Englishmen, I like to start each morning with a good, sturdy breakfast and like nothing better than a roasted pheasant, a large glass of port and a copy of the poems of Blake propped up against the tea pot. Sets you up for a day on the rugger pitch (in winter) or an afternoon in flannels listening to great, English sound of willow against leather (in summer). Ruddy marvelous!

Carb content: 15g (depending on amount of port)

Narwhal & absinthe

Of course, some of our readers will tend towards the more bohemian echelons of upper society; so I have included this classic dish of narwhal steak, washed down with a soupçon of la fée verte. Best enjoyed with close friends at a left-bank bacchanalian feast, you won’t even be able to even feel your legs after the first course, so taste is fairly academic.

Carb content: 22g

Ortolan

Finally, a particular favourite of mine – Ortolan. Illegal in most countries (even France, for heaven’s sake), an ortolan is a small bird which is drowned in brandy and then roasted whole. Pausing only to cover your head in a large, linen napkin (to hide your shame and gluttony from God) you consume the bird whole, biting through bones, beak and sinew. An added bonus is when said bones pierce your cheeks, mingling your own blood with the bird’s flavours. The best bit is, of course, when you bite through to the lungs and stomach, which burst and release the delicious brandy within. Best enjoyed with one of the better clarets. Yummy!

Carb content: 97g

So there you have it; please feel free to add your upper class eating favourites in the comments below. Bon appétit!

I recently discovered that if I spend long periods of time online looking at websites that contain images of carb heavy foods, my blood sugar rises. It seems that I need to take account of the carbs I’m exposed to online when calculating my insulin dosage.

Sorry, that’s complete garbage, it just sprung into my head when I wrote the title of the post and seemed a more interesting opening paragraph than “I’ve found a cool online carb counting course”.

That is what I actually wanted to say. I have found a cool (and free) e-learning course that will help you to work out how to count carbs and adjust insulin doses accordingly.  And if you’re a particularly interesting diabetic who thinks their life should include alcohol, exercise and eating out, there’s an advanced section which covers that too.

If you’ve heard peeople enthusing about DAFNE (Dose Adjusting for Normal Eating), BERTIE and various other amusingly named courses that help you to work out how to adjust your insulin according to what you eat and do, this is a very similar thing. Except it’s online rather than in a darkened room in a hospital basement.

Take a look - www.bdec-e-learning.com

And lo! the scales fell from my eyes

During the summer last year we went round to some friends of ours for a dinner party. Yes, a dinner party – now that I have reached my thirties, I no longer have the desire to frequent sweaty nightclubs of a Saturday night, downing expensive, sticky drinks and being much, much too close to the dripping unwashed masses.

So being unrelenting and incurably middle class, I now spend Saturday nights with friends, supping fine wines and discussing the issues of the day (I say that, but this particular dinner party ended up being somewhat rowdy, with broken glasses and minor chaos – we eventually left our host in the early hours with an uncontrollable bout of booze-induced hiccups).

Anyway, I digress. I bring up the whole dinner-party thing because I noticed on that particular evening that our host had a rather fancy-pants set of scales which gave you the various nutritional values of whatever you happened to be weighing. I saw that it did carbohydrates and duly lodged this diabetic-friendly piece of information away in the recesses of my brain.

So it came to pass that when our crappy set of TESCO scales gave up the ghost (thanks TESCO – that was £12 well spent, I think not) I finally fulfilled my ambition and purchased a set of said fancy-pants scales.

As I think I’ve mentioned before, I religiously carb count. I mean religiously in that I strictly carb count about as frequently as I attend church (once on Christmas Eve and the occasional wedding). Most of the time I fly solo and make an educated guess for carb contents and insulin doses. But every once in a while I properly check and log everything for a week or so – sort of like a diabetes refresher course – to check I’m doing things well.

It’s therefore when I’m doing a periodic refresher that these scales really come into their own. Can’t be bothered to work out the carb content of your glass of breakfast orange juice? Easy – just bung the glass on the fancy scales, hit 878 (the code for orange juice), fill up with orange and hey presto! up comes the carb content for that exact amount of fruity juicy goodness. Yum!

Using the internal memory, you can quickly tot up the total carb content of your entire breakfast (which is usually, for me, a pint of heavy claret and a whole roast pheasant and trimmings) and log and inject accordingly.

So while not entirely world-shattering, my new fancy-pants scales are actually quite good with helping me to carb count. More importantly, they look really cool. So – in summary – they’re probably a worthwhile spend of £36. If you care, my Salter “Nutri-weigh Slim” electronic scale can be found on the John Lewis web site; if you don’t care, what technology-of-the-future do you use to help carb count?

The thills and spills of formulae

In an idle moment and for a bit of fun – I use the term “fun” advisedly here – I decided to knock up a diabetes spreadsheet.

I thought it would be interesting (again the term “interesting” is relative here) to log my insulin doses, carbohydrate intake and resultant blood glucose. By comparing the carb to insulin ratio – over, say, a 14 day period – to the resulting BG target-range hit-rate, I could objectively calculate my ideal ratio at different times of day. From this data I could then create a personalised insulin calculator. I could type in the time of day, my proposed carb intake and from that calculate the correct dose of insulin to stick in – all based on the data I collected earlier.

I don’t need to tell you, it was a dull, rainy weekend.

I know that the minute I publish this, someone will say in the comments below “Ah yes, the ‘Carbotron-XP’ software can already do this for you”. However, despite that inevitability, it was an interesting exercise to work out the formulas, etc., by myself.

This was mainly because I quickly realised how insanely complex it is to note all the relevant factors and come up with objective calculations. Measuring and logging my BG, carb and insulin intake before and after meals is pretty straightforward (if incredibly, incredibly tedious) but then it gets more complex.

What if my BG is high before my breakfast banquet and I stick in a correcting dose – in addition to an amount to cover the roast pheasant and flagon of port I have each morning? If I simply divide the number of carbs by the amount of insulin I’ve put in then that screws up my carb:insulin ratio calculation, as it doesn’t take account of the correction. So corrections have to be recorded separately.

To keep things simple, I’ve also divided the day into eight separate blocks – that is before and after meals and two night-time blocks. But what if I have a mid-morning snack which I might cover with a unit or two? If that’s not recorded then, it too, will screw up my calculations. I’ve therefore had to cheat and lump my elevenses in with my breakfast. While this is probably near enough, it starts to add a margin of error into the equations.

More errors inevitably creep in as the spreadsheet doesn’t take account glycaemic index, exercise, stress, phase of the moon, tide times and everything else that affects my blood glucose.

And so, in the end, my highly objective exercise results in a rough guide to carb:insulin and requires quite a lot of finger-in-the-air guestimating to get it to work. If carefully recorded data and the massive computing power of Microsoft Excel can’t come up with a useful guide to diabetes, then it’s no wonder I manage to completely cock-up my doses from time to time. I suppose what is more interesting is that – apparently against the odds – I manage to get it right quite so often. Go me!

Do I really believe that?

When I was a child my mother used to carry an uncooked baking potato in her handbag. She knew that potato contained 30g of carbs. When my meal arrived in the restaurant she’d get the raw potato out of her bag and compare it with the one on my plate. Ta-da, a very early version of carb guestimating technology.

Now, I will admit that it isn’t practical to carry in your bag a ready weighed version of all the food you intend to eat. I’m the woman who whinges about the amount of diabetes junk I have to take on holiday, a life size specimen of all foods I may encounter certainly isn’t going in my hand luggage.

Over the years lots of people (ok, more than 10, less than 100) have said to me that we should campaign for all restaurants to publish carb counts of their food. Sounds sensible.

However, I’m a big fan of self sufficiency. I don’t want to be dependent on someone else publishing carb counts when I go out. Surely it’s better to learn the skill of guestimating carbs with the help of a good book and some trial and error rather than rely slavishly on companies to publish the data? That way, you can go anywhere.

I’ve already recounted the Chinese dumpling banquet debacle. A label on each dumpling wouldn’t have helped, there’s no way I would have believed they contained so many carbs and I wouldn’t have been brave enough to put in the full bucket of insulin required.

McDonalds do publish carb counts and if I inject according to their carb count I’m on the floor within 2 hours begging for sugar. I’m sure it’s factually correct; it’s just that the fat content is so high it slows the absorption of the carbs. It doesn’t tell you that on the box.

I’m all for a bit of help to make life easier. However, I also like to pick my battles. Getting CGMS funded by the NHS? I’ll fight til I drop. Getting insulin pen needles on prescription when the Govt refused in the early 1990’s? Done it. Campaigning to ensure that all people with diabetes have access to decent patient education and support? Oh yes. Pushing water up hill to get all restaurants to publish carb counts? Nice to have but if I put my efforts into getting decent education and support for people with diabetes, this one almost becomes an irrelevance.