Chocolate

[Willowz]

from what I've been reading recently on here and other places, it is possible for diabetics to eat chocolate. N is really missing chocolate, it's been a month now and I haven't let her have any at all. I was wondering about buying a bar and maybe allowing a couple of squares. Also from I've been reading I've discovered it's better to have the chocolate after alot of starchy carbs?

Is this correct and do you think it would be ok.

 

[Northerner]

Yes, she can eat chocolate! 🙂 There is no real problem with it, especially since she can cover it with insulin. The dark chocolate is best, if she likes that, as it has less sugar in it. Ideally, it would be eaten after a meal as this would help slow the digestion and lessen any spike. The meal does not need to contain lots of starchy carbs, just a balanced meal is fine 🙂 I personally find that a chocolate digestive is sufficient to remove my chocolate craving.

 

[katie]

Do you and N carb count yet?

Diabetics can eat whatever they want, especially when on insulin as it can be covered by the insulin 🙂

 

[everydayupsanddowns]

I'd say chocolate is completely fine. Just a question of moderation and observation. If an occasional treat now helps avoid a later rebellious overindulgence then go for it.

It's not advised for a 'proper' hypo treatment because it's actually not all that speedy into the bloodstream (the fat in chocolate slows it down) but for many years I've used funsized chocolate bars to bring levels up from those kinda 'gentle' low-level dips. Where you've been 4.5 for a while but have just dipped under to 3.9 or 3.8 and would rather rise more gradually to 5.5 than instantly zoom up to 10.something. I particularly like mini Curly Wurlies and individual Twirls... Mmmmmmm... And with Christmas on the way Quality Streets will begin to come into their own 🙂

If you are worried, or want a decent picture of the effect on N's levels make it a 'condition' of the chocolate that you test 1 hour and 2 hours after for a few times to get an idea of the effects of smallish portions.

Mike

 

[bev]

Let N have chocolate - there is no reason not to - as long as you make sure N has enough insulin for it then it should be fine. I cant remember if you are on MDI or mixed insulins - if you do carb count then just add on the carbs and its best eaten after a meal as it helps to lessen the spike.🙂Bev

 

[Willowz]

We're not carb counting yet. She's on Levimer and Novorapid. Still trying to the dosages correct though because the base dose seems to need changing every week. Then we add 1/2 a unit per 4 points.

for example base dose for tea is 3 units but with a blood sugar of 9.6 we'd add another half.

 

[bev]

We're not carb counting yet. She's on Levimer and Novorapid. Still trying to the dosages correct though because the base dose seems to need changing every week. Then we add 1/2 a unit per 4 points.

for example base dose for tea is 3 units but with a blood sugar of 9.6 we'd add another half.

Its great that N is on MDI - but not sure why you are on fixed doses. The point of MDI is to enable the child/person to eat the portions that they want and also to snack when they want - you need to be able to carb count so you can give N a bar of chocolate and the appropriate amount of insulin for it - have your team told you about ratio's for foods yet.🙂Bev

 

[Northerner]

Its great that N is on MDI - but not sure why you are on fixed doses. The point of MDI is to enable the child/person to eat the portions that they want and also to snack when they want - you need to be able to carb count so you can give N a bar of chocolate and the appropriate amount of insulin for it - have your team told you about ratio's for foods yet.🙂Bev

Willowz daughter has only been diagnosed just over a month bev, probably not reached the stage of carb counting yet 🙂

 

[everydayupsanddowns]

Hi Willowz

Forgive my complete confusion... and I'm sure your team are great and you've had full support and education, but you've just made the hair on the back of my neck go up.

I completely understand the fixed-doses approach to get people started. But the 'not carb counting' never makes any sense to me. I'm yet to have a conversation with any DSN where they can satisfactorily convince me that unmoderated/unmonitored carb intake combined with fixed doses of insulin will lead to anything other than confusion, anxiety and yo-yoing BG levels.

It's great that you are on a MDI (Levemir/Novorapid), however just because you are not changing your doses doesn't mean monitoring carbs is any less important. When I was first diagnosed 'exchanges' were the thing. I was put on fixed doses of insulin AND told how many 'exchanges' of carbohydrate to try in order to match those doses. These days they call 'exchanges' CP's (carbohydrate portions) but it still boils down to units of 10g of carbs. The slower release the better.

This meant that I knew I needed to have 40g of carbs for breakfast, 50g at lunch and 60g at dinner (or whatever it was). I began to get to know what 60g of pasta looked like on a plate. To make a guessed allowance for a sauce and knock a bit off. To know that for a potato something about the size of a hen's egg is roughly 10g. Slice of bread? 15g - 20g depending on med or thick sliced. All meals became a question of sort of mix-and-match adding up of whatever was on the plate to reach the 'right' amount of carbs.

Now there is no need to keep those meals absolutely set in stone of course. You can eat more and inject more, eat less and inject less. But there is so much to learn in the early days that a few fixed-points were incredibly helpful to me. They helped me to build a database of portion sizes and carb values on which I could base some pretty accurate guesses if eating away from home.

I sincerely hope that you have been told all this already. I expect you have. But just in case, here is the truth of it. Insulin doses need to be balanced or 'matched' with carbs. There's not a lot of option about it. Unless you measure/monitor the amount of carbs you are eating you have no way of making informed changes to insulin doses to get them right. Blood glucose readings after meals only make sense of you can see the insulin dose AND the estimate of the amount of carbs eaten.

Good control is a lot of work. Carb counting will feel like a bit of a faff for a while - well, until you begin to find yourself guestimating meal content from 50 paces! By then guessing carbs will be second nature and you'll find it easy enough to take a much more flexible approach to meal sizes. Eat out with confidence and have much more of a chance of understanding what has happened when those nasty high or low readings rear their heads.

Good luck!
M

PS sorry! that went on longer than I was expecting it to.

 

[Bartmanblues]

Willowz,

I was put onto insulin a few months back, but did not get to start carb counting unil last month. As everydayupsanddowns says above, I just don't see how injecting can work without carb counting. Obviously there is the issue of educating about carb counting which currently is not done straight away after going onto insulin, hence the delay for me and for your child where you are injecting set amounts each day (works sometimes, other times not). So hopefully you'll be down to look at carb counting soon?

It's brilliant, though i'm very new to it and sometimes fail spectacularly. Overall it works very well.....and means chocolate (as I sit here munching on chocolate raisins) is very much allowed. 🙂

 

[Phil65]

Hi Willowz

Forgive my complete confusion... and I'm sure your team are great and you've had full support and education, but you've just made the hair on the back of my neck go up.

I completely understand the fixed-doses approach to get people started. But the 'not carb counting' never makes any sense to me. I'm yet to have a conversation with any DSN where they can satisfactorily convince me that unmoderated/unmonitored carb intake combined with fixed doses of insulin will lead to anything other that confusion, anxiety and yo-yoing BG levels.

It's great that you are on a MDI (Levemir/Novorapid), however just because you are not changing your doses doesn't mean monitoring carbs is any less important. When I was first diagnosed 'exchanges' were the thing. I was put on fixed doses of insulin AND told how many 'exchanges' of carbohydrate to try in order to match those doses. These days they call 'exchanges' CP's (carbohydrate portions) but it still boils down to units of 10g of carbs. The slower release the better.

This meant that I knew I needed to have 40g of carbs for breakfast, 50g at lunch and 60g at dinner (or whatever it was). I began to get to know what 60g of pasta looked like on a plate. To make a guessed allowance for a sauce and knock a bit off. To know that for a potato something about the size of a hen's egg is roughly 10g. Slice of bread? 15g - 20g depending on med or thick sliced. All meals became a question of sort of mix-and-match adding up of whatever was on the plate to reach the 'right' amount of carbs.

Now there is no need to keep those meals absolutely set in stone of course. You can eat more and inject more, eat less and inject less. But there is so much to learn in the early days that a few fixed-points were incredibly helpful to me. They helped me to build a database of portion sizes and carb values on which I could base some pretty accurate guesses if eating away from home.

I sincerely hope that you have been told all this already. I expect you have. But just in case, here is the truth of it. Insulin doses need to be balanced or 'matched' with carbs. There's not a lot of option about it. Unless you measure/monitor the amount of carbs you are eating you have no way of making informed changes to insulin doses to get them right. Blood glucose readings after meals only make sense of you can see the insulin dose AND the estimate of the amount of carbs eaten.

Good control is a lot of work. Carb counting will feel like a bit of a faff for a while - well, until you begin to find yourself guestimating meal content from 50 paces! By then guessing carbs will be second nature and you'll find it easy enough to take a much more flexible approach to meal sizes. Eat out with confidence and have much more of a chance of understanding what has happened when those nasty high or low readings rear their heads.

Good luck!
M

PS sorry! that went on longer than I was expecting it to.

Great post Mike!!
But remember to look at the GI Index/load as well as the carb count, A bowl of pasta will act very differently to orange juice and a banana even if the same carb count, good luck to N, I am sure that it will become almost automatic in the future! 🙂

 

[everydayupsanddowns]

Absolutely Phil. As I say, the slower release the better. Er except when it isn't of course... In which case pass the jelly babies

 

[bev]

Willowz daughter has only been diagnosed just over a month bev, probably not reached the stage of carb counting yet 🙂

I never understand the idea of not starting off with carb counting though - you will have to learn it sooner or later so why not from day one. We had fixed doses for about a week I think and it was useless - then we learnt carb counting (only took a one hour session) and things just got better from there. The idea of giving three units for pasta and three units for a bowl of soup just doesnt make sense does it. Then what happens is that people become 'comfortable' using the standard units and they find it difficult to get their heads around ratio's and carb counting - I think all teams should start people off on carb counting and MDI as at least it gives people the idea that what you put in - you have to cover with the right amount of insulin - rather than a 'guesstimate'.🙂Bev

 

[Northerner]

I never understand the idea of not starting off with carb counting though - you will have to learn it sooner or later so why not from day one. We had fixed doses for about a week I think and it was useless - then we learnt carb counting (only took a one hour session) and things just got better from there. The idea of giving three units for pasta and three units for a bowl of soup just doesnt make sense does it. Then what happens is that people become 'comfortable' using the standard units and they find it difficult to get their heads around ratio's and carb counting - I think all teams should start people off on carb counting and MDI as at least it gives people the idea that what you put in - you have to cover with the right amount of insulin - rather than a 'guesstimate'.🙂Bev

I think there is some benefit from fixed doses at the beginning. I know I would have found it extremely difficult to take in carb counting right at the start with everything else I had to consider. My DSN kept in regular contact about adjusting doses based on my levels, and I sort of started guesstimating doses before I actually started carb counting, which was about three months after leaving hospital, I think! I do agree about not starting on two injections though - that would have really messed things up for me.

 

[bev]

I think there is some benefit from fixed doses at the beginning. I know I would have found it extremely difficult to take in carb counting right at the start with everything else I had to consider. My DSN kept in regular contact about adjusting doses based on my levels, and I sort of started guesstimating doses before I actually started carb counting, which was about three months after leaving hospital, I think! I do agree about not starting on two injections though - that would have really messed things up for me.

I completely understand and agree with what you are saying - but a parent is coming from a completely different perspective, and when you see your child in the high twenties and dont understand why - you would move heaven and earth to help. So if there is an *answer* (i.e. wrong doses) any parent would rather suffer the stress of carb counting and working out ratio's to see a number under ten - than put lots of effort in and seeing awful results. If you are the person with diabetes, then its a whole different story - you are tired and feel ill - and the idea of counting how many beans your about to eat wouldnt fill you or anyone with joy.....😱. Although a parent might feel devastated, they are not physically ill themselves and so probably have more mental strength to feel able to cope with carb counting.🙂Bev

 

[everydayupsanddowns]

The idea of injecting insulin and not measuring the carbs you are eating is completely crackers.

I don't care if a person does it by ratios, fixed doses, round up&down guesswork, gram-perfect measurement, dry weight before cooking or plate-on-the-scales... whatever your doses, whether you change them yourself or let your DSN suggest changes for you it doesn't matter...

Carbs need to be measured and monitored. End of story.

The suggestion that people can 'worry about carb counting later' is utterly nonsensical. I'm not sure how it applies to T2s, but no T1 should be put on insulin without some basic instruction about measuring and monitoring their carb intake.

But people are. Every week.

Told to eat 'a balanced diet which contains "some" carbohydrate'.

Insanity!

[Sorry... thread hijacked!]

 

[Northerner]

Something else that needs to be borne in mind immediately after diagnosis is that the basal dose will quite possibly be way out, so trying to carb count until you have at least some information about what levels are doing from a fixed starting point would be very prone to error anyway. Depending on how you were diagnosed, you might vary considerably over the following weeks until you have recovered sufficiently to be fairly stable. Also, if you lost a lot of weight prior to diagnosis then things would also be subject to change.

My fixed doses were based on what I had been receiving during my 8 days in hospital, then modified once I was back in a home environment.

Certainly different when you are not the person in recovery and having to do everything for yourself - I totally accept. I think that, by the time I received my carb counting instruction the DSN was better able to make decisions about ratios etc. As I said earlier, I did start adjusting 'up and down' fairly soon after leaving hospital so I didn't stick rigidly to fixed doses, just applied a bit of commonsense (but no scales!) 🙂

 

[HelenM]

I was on fixed doses at the beginning but they were to cover a fixed carb count. Everyday in hospital the dietitian taught me a bit about diet and went through the carb counts for the meal (expressed in gms for everything , including the lettuce, on my daily menu sheet. They thought it very important, I've got vivid memories of the consultant sitting on my hospital room floor drawing pictures of fruits with their carb counts!
Strangely, though, that's what they continued to expect me to do. Fixed meals, fixed times, fixed doses. I know from courses I'm almost unique in my area. Most feel they have to keep to a fixed regime.
Counting a set number of carbs for each meal helped me enormously though. It worked as the team had worked out excellent ratios whilst I was in hospital and naturally it worked when I realised that I could vary the carbs and adjust the dose. Even now, whilst I can vary things when I want to eat out or don't have a 'normal' day, when at home I stick to roughly the same amount of carbs I was originally prescribed (though carb ratios have changed a bit)

 

[Willowz]

wow didn't I start a discussion 😉

I make sure she is having some carbs with each meal. Our DSN's are great if I'm at all worried I phone them and we adjust the doses. Since she went back to school and is having school dinners they suggested adding an extra unit for pudding for example.

I suppose from the point of view of being a parent. I kind of agree with Bev you would do anything to get those levels down, but then the other side is all of sudden you've got this massive life changing thing to deal with and I felt so guilty I had missed the signs for almost 6 weeks when she was diagnosed. I was confused, upset, exhausted and emotionally drained. She spent 3 days in hospital and I took so much information on board about the basics. I'm really not sure I could have coped with anything else. We have a clinc appointment in a few weeks and I wonder whether carb counting will be discussed then, to be honest I will probably ask, and after almost two months from diagnosis feel I am in a better place to understand everything. 🙂

BTW thanks guys because this site has been invaluable and I am in no way knocking your opinions.

 

[Northerner]

Sorry we wandered away from chocolate a bit Willowz! 😉 It's an interesting discussion though, and I can certainly see it from your point of view. Please don't feel guilty about missing what was wrong though, many doctors fail completely to recognise and associate symptoms with diabetes.

HelenM, typical of the French to do something sort of the same, but different to the British! 🙂