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A few things I have picked up over the years… (everyone got their egg inhalation gear ready?)
1. Get a good grip on your ratio. DAFNE types get introduced to this early on, but it took me years of winging it before properly thinking of adjustments in terms of 10g carbs = x units of bolus
2. Testing after meals. Testing before was always a given, but testing after will tell you a lot. Around 1-1.5 and 2-3 hours after are pretty useful. Helps you to identify which foods/meals are spiking your bgs
3. Watch high fat meals (slower carb absorption). And if low carbing don’t forget that your body will probably train itself to create bgs from proteins
4. For massive carb-fest blowouts get to know your insulin’s activity curve. If you suddenly whack in double your normal mealtime dose cos you’re on holiday and are having chips on the beach you may well find that you’ll go hypo after your meal (too much insulin all at once) and then drift high later (as your gut gradually chugs through the stodge). Consider splitting the dose into two or three staged deliveries an hour or so apart. -
I struggled with my ratios when I was first diagnosed, until my diabetes specialist Professor told me about circadian rhythms and that the ratio can change during the day. A big “ahhhhhh” lightbulb appeared above my head and I’ve since worked on adjusting the ratio throughout the day. Basically I put in twice as much insulin proportionately at breakfast as I do in the evening.
Works for me – but, as always, your diabetes may ;
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Ahhh Circadian Rhythms…. I loved their first album, but now they’ve gone really commercial
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I am lucky to be a steady 10g to 1u which makes it easy to count carbs and being on a pump any large stodgy takeaways are taken care of with a duel wave bolus (sorry to sound smug ) . Some of my counting is done via salter scales with built in database which is a godsend but most of the time I find a pretty good guess isn’t far off ,
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I only learned about carb counting a year ago (after 15 years in big D club)- my revelatory moment was realising that I had to do insulin for fruit juice! My brains were still working on the info I’d been given as an 11 year old, which was that a mars bar treated a hypo just fine, and that I should never ever fiddle with my insulin (the good old 2 injection a day years eh?)! Best piece of advice- read the nutrition labels on packaging! (and the salter scales are good too)
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Aha the old favourite, mars bar life saver ! So full of fat your flat out by the time any sugar kicks in ! A rumor started by dentists maybe ?
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@mike – sorry, I’ve cracked that joke before
http://www.shootuporputup.co.uk/resources/about-diabetes/circadian-rhythms/
“When I first heard of circadian rhythms I thought they were an electronic pop band from Manchester.
I then went on to imagine that they had a string of modestly successful hits during the late eighties and early nineties but split after irreconcilable creative differences opened up between the lead singer and the bass player who founded the band in the first place. After years of acrimony over unpaid royalties the members of the band (aside from the drummer, who died after a drugs overdose in 1997) reformed and had a successful reunion tour and an appearance on Later with Jools Holland.
It turns out, however, that my assumptions were wrong.”
He he he!
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The other thing to remember about circadian rhythms (other than the very poor jokes, thanks guys!) is that they are not fixed for life. After years of having steady daily carb ratios, I developed a greater need in the morning (for no apparent reason – didnt coincide with anything else happening).
It now appears to changed again, but that’s cos of the pump, I assume.
As for the carb counting, eggs. Not sucking, but the size of. 1 egg sized potato or lump of mash = 10g CHO. 1 egg sized lump of baked beans = 5g CHO. etc etc etc Work out how much your favourite foods count per size that suits you, then you’ll have a good starting point for guesstimating how much a meal counts. -
Now for a bit of hairsplitting carb cleaving: “Carbohydrates” can refer to starch, mono-& disaccharides and cellulose, which can be a bit misleading when one considers the avocado: it contains 18g of carbs, but unless you are blessed with bovine guts (and the accompanying bacteria), it’s going to leave you out at sea if you dared to shoot up accordingly.
@hils: Concerning your avataric frontispiece…is it caramelised Kentucky Fried Chicken in a cone?
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@ckoei – very good point re: avocados. They’re nice on toast though, eh?
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@tim: Nearly as scrumptious as toasted apple-and-oat-branned bread spread generously with butter and blue cheese.
And now for something completely different: Counting hypo-antidote can be taxing when one’s brain is a bit baboonish, so here follows amounts of sweetmeats (and sop) mostly and occasionally consumed by me that each contain ~15g of carbohydrate: 2 teaspoons of glucose powder (dissolved in water, very efficient), 14 Jelly Tots, 7 Fruit Pastilles (Frutips, seeing that {Rowntree’s}’s is now extinct in SA) and 100ml of orange flavoured Lucozade. Anyone else been counting their bonbons meticulously?
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@Cecile Fun size bars are good (I know, I know… too high in fat reeeeeeaaaaally – but they’ve kept me going for years). This time of year the multi-bags that include little packets with a handful of Skittles are particularly good as a) virtually no fat and b) virtually indestructible even in a jeans pocket on a sunny day.
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@annette: As long as the blob is as big as an egg (as laid by a hen, not painted by Jeroen), I’ll trust your estimation.
@mike: Skittles is an outlandish phenomenon I’ve never encountered, but in order to ingest 15g of carbs, you’re allowed to gobble up 17,5 Skittles (if the BBC h2g2 amount of 42 Skittles per 40g pack is correct)
Back to something that have a universal presence: marshmallows – 2 of them contains ~12g carbs.
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@annette_anderson …also available in approx 15g minibags in one of those Cadbury multipacks. With which you also get a ;
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@teloz – it’s not *that* bad surely? I started simple, with a 1:10 ratio – so 70 grams of carbs equals 7 units of insulin (I find carb portions too confusing – I’m quite simple).
Once you’ve got that roughly sorted you can start experimenting with adjusting the ratio depending on the time of day – I do about 1:6 in the morning 1:8 in the middle of the day and 1:10 in the evening. The critical thing is to experiment and note down **everything**!
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I’m having a hard time persuading my DSN that I need a different carb ratio for the time of day. She thinks if I do the tests in the morning, then that gives me a ratio for the whole day, despite my knowing through experience that I have a higher (lower? Its 1:10 am and nearer 1:13 pm) ratio in the morning than in the evening. Sigh.
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@annette Has your DSN considered updating her training? Mine ;
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@annette – as Alison says. What about asking your DSN to persuade you that your ratios *don’t* change?
Anyway, who cares what your DSN says? I take my diabetic team’s advice and make decisions on how I control my diabetes myself. We usually agree on most things, but sometimes I have to put my foot down!
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Oh, she just says they don’t. It’s ‘illogical’. (To which my response was ‘since when has it been logical?’)
I’m now getting to the stage where I am confident enough with my pump and everything to do just that, @Tim, and am trying to do all the tests and stuff from Pumping Insulin to get my numbers sorted to my own satisfaction. It’s my diabetes, I’ll run it to my rules (or rather, its rules).
Question to @alison (and any other female pumpers/carbcounters out there): do your carb ratios change with your hormones, or are they fixed on a daily cycle? -
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Thanks @alison – that’s just what I needed to hear! Because that’s what I’m finding (over a longer time period, but exactly that), but my DSN didnt believe me. I wondered if I was doing something wrong, but now I’m more confident that it isnt just me – I have ammunition!
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hi guys yes insulin intake has ups and downs with those blessed hormones all you need is to be pregnant and you’ll find out !!!! out of control and its like a dog chasing its tail. As you know insulin is a hormone so why shouldn’t it change with our body. Who’d be a woman with diabetes?
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Was that 70 carbs = 7 units or 7 carbs = 70 units x 4 divided by the number you first thought of x pi + the circumference of the Nurburgring divided by the speed of light… bugger it, I’ll bung 60 units in and see what happens. Now do I shoot up 60 units and have a Mars bar or shoot up 60 units and keep a Mars bar handy? What about a Cadbury’s Creme Egg even? Does the fact it’s a bar of Fairtrade dark chocolate make a difference? Damn, I’d rather have a bacon sarney… with brown sauce… on white bread… with real butter… an’ fizzy pop… lots of fizzy pop… an’ sweeties… wine gums… us loves wine gums us does… (Teloz shuffles off into the darkness mumbling and drooling about chocolate, sweeties and cream cakes…)
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My DSN was unwilling to consider carb counting as I am a type 2 but as am on insulin basal/bolus it doesent make sense as the carbs will raise my bgs as much as a type1 so having a great time guestimating but dont go too low often so must be doing ok at it
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Hang on hang on. Am I missing something? @Alison and @Annette Anderson: On a pump, are we not supposed to fix our basal rate to be in line with our circadian rhythms, and then boluses remain the same all day? I thought that was (one of) the point (s) of a pump?
My blood sugar goes up a lot about 10 days before my period, but just for one day. Weird.
@Teloz – have a wee sit down chuck. It’ll all be okay…
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@caroline – apparently not…(despite what my DSN thinks, and with whom I am meeting this afternoon – going in armed with data galore to explain that I dont fit her ideal diabetic shaped hole).But the smart pumps have settings that you can tell what carb ratio to use at what time of day. And what would be the point of that, if it didnt change? Methinks the left hand (designer/developer/person with link to diabetic) isnt talking to the right hand (people who tell you what you are supposed to do be they marketer/health personnel/whoever).
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@Caroline I ;
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Well, I’m back from my meeting with my DSN, and, wonder of wonders, the regional pump specialist nurse was also there (I dont know what her official title is, but educator should come into it somewhere…). Each time I said ‘Well I find that…’ and my DSN said ‘Oh, that shouldn’t happen, should it?’ (or words along those lines), the pump nurse said ‘Oh right, well some people find that…’ or ‘Yes, I’ve come across that…’ So I got reassurance that I am working along the right lines, and my DSN has some valuable new knowledge. I now just need to work out the numbers more precisely than ‘try 1:12 and see how it works’.
(They both agreed that mine was a particularly complex case to sort out. Which, oddly, makes me feel better.) -
Always remember you are the one with diabetes and you are the one in control. Advice is all they can give. try eeek dare I say fasting to get the basal right. Then re ratios weigh and monitor rather tedious but once done! Just make sure its a stress free week and no eating out. Boring but it works. I was only granted a pump because I had to prove that my control was adversely effected by my hormones which was agreed by the dietitian who had been carrying out research using mobile phone and carb counting.
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@mustard – I just lost the will to live again…
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I lost it a long time ago.. my Mum always hated the term “death by chocolate” for a certain dessert – but I reckon that’s the way to go!!!
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I have never been told or taught to carb count… I have worked out what a plate of food is in terms of units of my own back though. I don’t think I could handle carb counting properly, would do my head in…
These points are very interesting/useful for me though:
2. Testing after meals. Testing before was always a given, but testing after will tell you a lot. Around 1-1.5 and 2-3 hours after are pretty useful. Helps you to identify which foods/meals are spiking your bgs4. For massive carb-fest blowouts get to know your insulin’s activity curve. If you suddenly whack in double your normal mealtime dose cos you’re on holiday and are having chips on the beach you may well find that you’ll go hypo after your meal (too much insulin all at once) and then drift high later (as your gut gradually chugs through the stodge). Consider splitting the dose into two or three staged deliveries an hour or so apart.
Thanks @Mike! I have just been told by my new specialist doctor to do record some after meal BG levels for him, and have realised I’ve been being an idiot not to do that anyway! It’s amazing how well you can control diabetes while not knowing some really important things! I suppose it just makes it harder not knowing…
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