I’ve been and gone and got a bit cross and shouty about diabetes care. While occasionally visiting forums far less erudite and witty than this one it has come to my attention that newly pancreatically-challenged types are being put in a very tricky situation for no good reason. In the good old days it made sense to tell people who were sticking rapid-acting insulin into their systems 3 times a day that it might be a good idea to eat the right amount of carbs to go with it. Nowadays it seems that’s considered rather too confusing and old fashioned.
Carb counting seems to have become an optional extra.
Some people go for years before being given any help. Others ask for some guidance only to be told, “We don’t do carb counting in this area”. Madness.
Oh, I’m with you on this one, @mike. Here, they wait for problems to arise, then you get to go on a carb counting course, then you get a pump if wanted/needed. (I went on the course in order to get a pump. No-one else on the course wanted a pump, just better control.) I’ve carb counted all my life, and was astounded to hear that some of the newbies on the course didnt know that you had to ‘match’ insulin to carbs – they thought it just kind of sorted itself out, and you couldnt eat puddings because they didnt sort out. Our DSNs are doing their best to get everyone who wants on Carb courses, but they can only bend the rules, not break them.
As far as I know, this has only been the case for the last 10 or 15 years. I’d love to see a graph of what happened to average HbA1cs after they took the decision that teaching carb counting was too much bother.
I left hospital in 1976 with an A4 piece of paper which said Foods you cannot eat on one side and foods you can with weights and approx tablespoonfuls. Infact I still have a copy and most of the info is still up to date!
By taking carb counting away it allows people more freedom (which is good) but for many diabetics they haven’t learnt the basic understanding of insulin:food ratio. Instead they just shove food into themselves and can only suffer the consequences.
I was amazed and learnt very little when I went on my pump/carb course (apart from 2 jelly babies are good for hypo’s)
Again its up to us to seek the help needed nothing is ever explained properly and no one is bothered. No one cares if your up all night because you’ve not carb counted and the curry you had was at bit more than you anticipated!
Id like to know before the meters were introduced did I actually ever have a true hypo or was it just the sensation of a hypo as my bloods had dropped from say 15 to 10?
‘zactly Tim, yet it seems there are hundreds, perhaps thousands of T1s (and basal-bolus insulin using T2s) for whom ‘inexplicable’ highs and mega lows are a direct result of the lack of information they receive at diagnosis and/or following a move to insulin therapy. People get told fixed doses to administer, and that’s it.
I wasn’t told anything about carb counting when I was diagnosed. But logic applied to the reading material given and a little internet research told me that I should adjust my dose with the different amount of food. So I have developed a rough carb counting scheme, without even knowing! A course would have been helpful though – it took me a while to realise that meat isn’t full of energy! Cue MANY after roast hypos
So it is completely do-able – until the last 6 months my HbA1cs have been around 7-9.
I’m going to see a diabetes nurse tomorrow, so I will ask about a course and see if I’m in a carb counting area! I have found that my doctor and nurse at my surgery seem to think they can say ‘try this amount for this meal, and see if it improves’. I just took it to mean ‘try a bit more, cause you’re running high’. I have found I am better at fixing problems on my own, I just need a kick up the arse to care about my bloods again every now and then…
@neobrainless – Sounds like you’ve pretty much worked it out for yourself. Something I wish I’d worked on years earlier (but was too dim and/or lazy to do) was identify my insulin:carb ratio. Essentially how many grams of carbohydrate match one unit of insulin. Easy enough to do if you have a few fairly standard meals which work most of the time with your regular dose (lunchtime for example). Once the basics are in place, and you’ve identified any changes over the day (I need more insulin in the mornings) it becomes less of a ‘stab in the dark’ process working out your doses, sort of: “This meal is 70g carbs, I’m 1u:10g so 7u should cover it…”
My diabetic experience has been pretty similar to @neobrainless‘. Nobody has ever mentioned carb counting to me, though I had an understanding of basic nutrition, so I understood the concept of carbs/as energy/as blood glucose. As most of you know I’m shooting up ox-killing quantities of insulin, but the only system I’ve used is morning test, test before meals, plus occasional random tests, though sometimes I’ll not test at all for a day. Generally I’ve equated insulin use to total calorific intake rather than isolating carbs; one chocolate bar=one spag boll; one cream cake=egg and chips, and so on.
Apart from occasional lapses when I’ve abandoned testing altogether and eaten anything that didn’t moo or move, my HbA1c has been around 7.5. Anything as precise as @Tim‘s, “This meal is 70g carbs, I’m 1u:10g so 7u should cover it…”, seems to belong in the realms of sorcery or science-fiction! My biggest problem is that, living alone, I cook for myself so I always overeat (I’ve overeaten since I was a child, it’s a long story), psychologically I’m almost incapable of throwing food away and supermarket portioning is usually aimed at couples.
Still nobody ever said life was going to be easy did they?
I was recommended the “map fat and calorie counter” by Roche book which gives most food in 100g weight and how many carbs per 100g. Freephone support line 0800 731 7138 you may get some help there @Rohan.
Obviously, reading the backs of packets/tins etc is useful too. Working out ratios needs a bit more of a controlled habit like @Mike says you may need to compare the same meal over a few days without different ratios but generally its not to bad to achieve.
It is disgraceful though that the level of diabetes care differs all over the country. I’m lucky I live in one of the best areas.
@teloz From what you say you seem to have a system in place that sort of works for you. If you are interested in adding a little structure to your tests though I found it helped me to record dose/grams carbs and test pre-meal/1 hour after/2 hours after for a few weeks (well for me 1.5 hours/3 hours after but the trick is to spot the bg peak after eating). I’ve only started doing this in the last year, and I don’t do it all the time, but it has been a big help in watching meals go through my system and spotting which ones popped me into the teens, and which left me reaching for the jelly tots.
@Teloz: I hear you on the overeating when living alone! Happens every night without fail – no matter how hard I try to reduce the meal on past experience, I end up eating too much…
After the most in depth discussion of my diabetes and how I’m coping with it to date, and the look of shock/horror on the nurses face today when I said I’d never even been offered a nutrition/carb counting course, I think I’ve moved into one of the better areas in terms of Diabetaids support! The nutritionist happened to be free, and was happy to give me a 25 minute crash course to get me started! Made me late for another date, but can’t have everything
That said I’m not sure how much use I’ll find it. I’ll try, but carb counting for everything seems like a helluva ball-ache to me :S Until recently I have muddled along pretty well, and I think I’ve got a handle on it all again now. Still, I’ll try and see how it works for me Might get me some time off work anyway
@Mike I think I may have to start recording more stuff, the BG booklet from the doctor has helped a bit, but I think I may try a more comprehensive version (size of meals/excessive exercise, etc) and see if it helps. It will soothe the inner-nerd at least
Carb counting is indeed a ball-ache at first, but once you’ve got the hang of it you can guestimate pretty much all of the time. I can calculate the carb content of a random plate in a restuarant from 50 paces now!
@Annette Lol, definitely more in general! I have far too few female friends now I’ve moved, yet again… (OK, so I moved over a year ago now, but I am in Coventry, so everyone seems to be pretty chavvy. Also, I’m a bit fail at being sociable )
TBH, I think I lie a little – weight concious women are totally uninteresting! I like a woman that’s not afraid of the odd cream cake…