Carb counting - what did I do wrong?

[trophywench]

Try having half the correction dose you'd normally have. I think you are correcting too aggressively as well as the ratios etc, and it all becomes a vicious circle.

You're better off getting stable BGS and it doesn't matter if they are stable at 8 or 9 or whatever to begin with. Once you've successfully stopped the see-saw - then you can gradually reduce that 8 or whatever it happens to be.

Frustrating at times, cos you want it quick, but slow but sure gets you there quicker in the end in this case. I know it myself - cos I was exactly where you are now about 15 years ago - and so bloody frustrated not getting any sense or help out of the NHS I started Googling ....... LOL

 

[Sprogladite]

Try having half the correction dose you'd normally have. I think you are correcting too aggressively as well as the ratios etc, and it all becomes a vicious circle.

You're better off getting stable BGS and it doesn't matter if they are stable at 8 or 9 or whatever to begin with. Once you've successfully stopped the see-saw - then you can gradually reduce that 8 or whatever it happens to be.

Frustrating at times, cos you want it quick, but slow but sure gets you there quicker in the end in this case. I know it myself - cos I was exactly where you are now about 15 years ago - and so bloody frustrated not getting any sense or help out of the NHS I started Googling ....... LOL

That's EXACTLY what's going on with me right now...I am so worried about being too high for too long now that I'm showing actual signs of damage instead of just hearing about them constantly that I'm doing everything in my power to correct highs when I see them. And yes I'm just getting frustrated and angry with it all, especially when I have non diabetics telling me "just don't eat sweets! And then you'll be ok!" Really gets my goat, I know they have good intentions but quite frankly I still want to punch them LOL

 

[trophywench]

That's EXACTLY what's going on with me right now...I am so worried about being too high for too long now that I'm showing actual signs of damage instead of just hearing about them constantly that I'm doing everything in my power to correct highs when I see them. And yes I'm just getting frustrated and angry with it all, especially when I have non diabetics telling me "just don't eat sweets! And then you'll be ok!" Really gets my goat, I know they have good intentions but quite frankly I still want to punch them LOL

I was standing in Tescos one day rattling a bucket for DUK when one pillock came out with that. Had it been my bucket and we didn't have all the DUK adverts plastered about our persons as well as the bucket, I'd have quite happily swung it straight at the side of his head.

You know, most people I wouldn't wish diabetes on. However, sometimes you just happen to come across somebody ..... LOL

 

[Sprogladite]

I was standing in Tescos one day rattling a bucket for DUK when one pillock came out with that. Had it been my bucket and we didn't have all the DUK adverts plastered about our persons as well as the bucket, I'd have quite happily swung it straight at the side of his head.

You know, most people I wouldn't wish diabetes on. However, sometimes you just happen to come across somebody ..... LOL

Gosh id be dangerous with a bucket lol. Especially when I dignify their stupid comment with a response along the lines of "no it doesn't work like that, it's much more complicated" and then they say "oh, well my aunty/grandma/cousin does that and it works for them"

Like seriously. Those people can usually tell they need to remove themselves from my vicinity IMMEDIATELY lol!

 

[KookyCat]

Hi Sprogladite
Don't be hard on yourself, that was a tricky meal to start carb counting with. My best advice for practicing carb counting and testing ratios is to go simple, really simple. I used M&S ready meals when I was doing it mostly because I couldn't use my right arm or stand for very long so I couldn't really slave over a hot stove, but the principle is sound (what an excuse 🙂). At this moment you don't know your ratios so that's one unknown so you want to rule out as many of the other unknowns as possible. By simple I mean stuff you can weigh and be almost certain about the carb value (the wet weight and dry weight of pasta got me several times), don't guess, weigh is my mantra for the first stages. It's overwhelming enough without adding in the extra layer of horror around estimating skills (mine were shocking, they're now pretty good 😉). So boring old chicken, a baked spud and some veg, or more exciting flavours but with controlled amount of carb.

Start on one unit of insulin to 10 grams of carbohydrate and then see where that gets you. Don't panic on the correction front, think of this as an experiment, correcting with a hair trigger will stop you from getting where you need to be. In fact unless you're going extremely high I wouldn't correct at all for the first week. You need to see how your body is reacting to the insulin and the food, but that has to be your choice. Now this is the hard bit, and even though I'm saying it like it's easy believe me when I say I really understand it isn't, distance yourself from the emotion of the blood sugar levels, if you feel the panic about a double figure, breathe and tell yourself it's OK. I know your brain knows it's not OK and you want it to be lower, but the way to get that is control and you'll get it if you can chew on that leather strap and take the pain for a little while. Consider this a totally fresh start, the most valuable thing you can do is to understand how your body works with insulin, because in my experience that's the key to it all. Getting into a cycle of correction is easy to do, but really hard to get out of I know, but if you can convince your brain to stop reacting so quickly you'll be able to see a pattern, and when you can see the patterns you can find an action that will work. You can always post readings here and we'll help you interpret and adjust, there's a lot of experience here and we're always happy to help 🙂.

Now for my cheerleader bit (imagine I have pom-poms ). After 23 years of poor advice, you're here, feeling vulnerable and frustrated, the important bit if that is "you're here" putting yourself on the line and giving it a whirl. That's mettle if ever I saw it. Don't let that little shrivelled pancreas get the better of you!

 

[DeusXM]

As others have said, there's a lot going on here. The most obvious point to look at is your carb ratio. You've assumed 1:10. Evidently that's not correct. So the important thing is not look on this whole thing as 'what did I do wrong'? The important thing is to look on it as 'what did I learn?'.

Based on what you've suggested, we can say that probably your ratio isn't 1 to 10, which means your correction doses are likely incorrect too. As others said, you also didn't account for the sauce. I apologise if this comes across as a little patronising, but just because something is homemade doesn't mean it doesn't have any carbs!

I would say before you even start carb counting, you need to get your basal set correctly. If your basal isn't right, you can't find out your ratios.

Finally...look, if you're serious about getting your blood sugar under control, having spaghetti as a meal choice isn't the best idea. And honestly, why on earth are you drinking full sugar Ribena? Depending on the size of your glass and the strength you make it, it's got as many carbs as another half bowl of pasta. Even if you don't buy into low-carbing, there is literally no reason why anyone with diabetes should be drinking regular squash and soft drinks.

 

[Ginny03]

Agree with DeusXM on the ribena, particularly when you're starting from circa 13.0 (I'd save it as a 'low' drink), but pleanty of squash and soft drinks are low in carbs - not everyone likes water!

Although foods that are easier to calculate carbs exactly are better for counting, I see nothing wrong with spaghetti as a food choice - just don't expect a perfect blood result 2 hours after - leave it 4 hours at least. I afraid I don't buy into low carbing for type 1s (though clearly there are limits to the amounts you should be having in one go). For me you should be able to live a 'normal' life with diabetes, without having to cut 1/5 of foods out of your diet.

 

[Northerner]

I would start with very simple meals, with only a moderate amount of carbs - something like a sandwich and a yoghurt for lunch, for example. This will all take time and experience, so record everything - timing of injection before eating, amount of units, amount of carbs (in grams), what the meal was, BG level before, two hours after, four hours after, level before next meal (if longer than 4 hours). It does take a while, but if you are methodical then it should fall into place - but you do need to be patient, and I would avoid doing corrections between meals, instead include them in your next meal bolus - this will avoid the problems of 'stacking' and not knowing how much 'active insulin' you have on board.

But, as @DeusXM rightly says, you must first check that your basal insulin is set correctly. This should keep your levels steady when you are not eating and is designed to deal with th slow trickle of glucose released by your liver day and night to keep your body supplied with energy at all times (for your heart, lungs, brain, digestive system etc.).

This is a helpful explanation of basal testing, it's written for pump users, but the same principles apply to injections:

https://diatribe.org/beyond-basals-–-part-ii

 

[Ljc]

Hi. I'm not posting to give you any advise, for one thing you have been getting lots of helpful advise from some very knowledgeable people on here plus I'm T2.
Ive just come here to reassure you that it can be done, these guys here helped me an awful lot when I first started on MDI. My practice nurse was more flummoxed than I and that's saying something 😱 plus my maffs left a lot to be desired, over the past year my maffs has improved so has my nurse 🙂
Be patient , you will get their, honest !

 

[everydayupsanddowns]

Ah Sprogladite! I'm so sorry your first try wasn't more successful for you.

Just wanted to add more encouragement though that this IS something that you can get to work well for you. Managing diabetes with carb counting is like a big machine with lots of cogs in it. Starting from where you are, you need to get all the right cogs in the right places - and this most likely won't happen immediately. And then once you've got things a bit more sorted (and you WILL honest!) you may find that some of the cogs change size slightly and you need to tweak and adjust things again. This isn't about getting the 'right numbers', it's about getting the right numbers for now, and seeing how they go, and then slightly adjusting when things start to drift off track.

The suggestion of starting with basal is a good one. As is experimenting with smaller meals - spaghetti and pasta generally have a bit of a reputation for being tricky and people often find they need special handling.

There is also a rule of thumb that suggests your 'normal' insulin:carb ratio often only works for carb loads up to a certain point. Usually it's approx grams of carb equivalent to your weight in kilos (so if you weigh 70kg it'd be meals up to 70g Carbs). Above that point many people find they need extra insulin.

As for starting doses/ratios, you could always check with the TDD 'rules' (which are more averages / guesses / starting points):

1. Assuming you are not permanently hypo OR permanently in double figures start by calculating your Total Daily Dose (TDD). That's all your meal doses, corrections and basal insulin.
2. Most people's basal will be approx half of their TDD. For some it will be 60:40 for others 40:60, but it's likely to be around that
   
3. For insulin sensitivity calculate 100 divided by TDD. This will be how much BG will drop in mmol/L from 1u of insulin
4. For meal ratio calculate 500 divided by TDD. This will be the grams of carb that are covered by 1u of insulin

These aren't likely to be perfect, but they might give you a bit of a start. Obviously in an ideal world you'd want to discuss this with your clinic/Dr/nurse before making any changes. Certainly don't make *drastic* changes off the back of these rules without speaking to someone - but they are ones that have been given to me in clinic.

 

[Sprogladite]

Finally...look, if you're serious about getting your blood sugar under control, having spaghetti as a meal choice isn't the best idea. And honestly, why on earth are you drinking full sugar Ribena? Depending on the size of your glass and the strength you make it, it's got as many carbs as another half bowl of pasta. Even if you don't buy into low-carbing, there is literally no reason why anyone with diabetes should be drinking regular squash and soft drinks.

Sorry I should have specified it's the light blue one...the no added sugar kind!

I would start with very simple meals, with only a moderate amount of carbs - something like a sandwich and a yoghurt for lunch, for example. This will all take time and experience, so record everything - timing of injection before eating, amount of units, amount of carbs (in grams), what the meal was, BG level before, two hours after, four hours after, level before next meal (if longer than 4 hours). It does take a while, but if you are methodical then it should fall into place - but you do need to be patient, and I would avoid doing corrections between meals, instead include them in your next meal bolus - this will avoid the problems of 'stacking' and not knowing how much 'active insulin' you have on board.

But, as @DeusXM rightly says, you must first check that your basal insulin is set correctly. This should keep your levels steady when you are not eating and is designed to deal with th slow trickle of glucose released by your liver day and night to keep your body supplied with energy at all times (for your heart, lungs, brain, digestive system etc.).

This is a helpful explanation of basal testing, it's written for pump users, but the same principles apply to injections:

https://diatribe.org/beyond-basals-–-part-ii

Thank you, I will have a read of the link. I agree that basal is the starting point and I will be discussing this with my DN on the 23rd when I'm due to see her. I am also recording everything I'm doing, BG levels before and after eating, what I ate, how I worked out my dosage etc etc.

Hi. I'm not posting to give you any advise, for one thing you have been getting lots of helpful advise from some very knowledgeable people on here plus I'm T2.
Ive just come here to reassure you that it can be done, these guys here helped me an awful lot when I first started on MDI. My practice nurse was more flummoxed than I and that's saying something 😱 plus my maffs left a lot to be desired, over the past year my maffs has improved so has my nurse 🙂
Be patient , you will get their, honest !

Lol thank you @Ljc, I'm glad it's not just me who struggles with the joy that is maffs...thank goodness for calculators >.<

There is also a rule of thumb that suggests your 'normal' insulin:carb ratio often only works for carb loads up to a certain point. Usually it's approx grams of carb equivalent to your weight in kilos (so if you weigh 70kg it'd be meals up to 70g Carbs). Above that point many people find they need extra insulin.

As for starting doses/ratios, you could always check with the TDD 'rules' (which are more averages / guesses / starting points):

1. Assuming you are not permanently hypo OR permanently in double figures start by calculating your Total Daily Dose (TDD). That's all your meal doses, corrections and basal insulin.
2. Most people's basal will be approx half of their TDD. For some it will be 60:40 for others 40:60, but it's likely to be around that
   
3. For insulin sensitivity calculate TDD divided by 100. This will be how much BG will drop in mmol/L from 1u of insulin
4. For meal ratio calculate 500 divided by TDD. This will be the grams of carb that are covered by 1u of insulin

These aren't likely to be perfect, but they might give you a bit of a start. Obviously in an ideal world you'd want to discuss this with your clinic/Dr/nurse before making any changes. Certainly don't make *drastic* changes off the back of these rules without speaking to someone - but they are ones that have been given to me in clinic.

Thank you @everydayupsanddowns that is really useful. My doctor is impossible to get hold of and I really feel I have suffered as a result. I do however have an appointment (by a minor miracle) on the 23rd with the nurse so I will arm myself with all of this information to see if we can work out some sort of plan for me.

I really appreciate everyone's advice. It can be very overwhelming not knowing what you're doing, especially when you know how severe the consequences of getting it wrong are. I know that I have fallen into some bad habits over the years but I really do want to get everything sorted out. I have tried to do it on my own in the past and (obviously) failed which has just left me feeling so disheartened. I am hoping that if I can get enough information, both here and from the DN, then I might *actually* have a chance!

 

[Sprogladite]

Sorry another question - the BERTIEonline resource gives an example table which of carb foods and their CHO content. I'm a little confused as to what I should be doing - the bertie rouces says to do 1 unit per 10g CHO but some people are talking about total grams of the food itself rather than CHO content - which one should I be using??

Hi Sprogladite
Don't be hard on yourself, that was a tricky meal to start carb counting with. My best advice for practicing carb counting and testing ratios is to go simple, really simple. I used M&S ready meals when I was doing it mostly because I couldn't use my right arm or stand for very long so I couldn't really slave over a hot stove, but the principle is sound (what an excuse 🙂). At this moment you don't know your ratios so that's one unknown so you want to rule out as many of the other unknowns as possible. By simple I mean stuff you can weigh and be almost certain about the carb value (the wet weight and dry weight of pasta got me several times), don't guess, weigh is my mantra for the first stages. It's overwhelming enough without adding in the extra layer of horror around estimating skills (mine were shocking, they're now pretty good 😉). So boring old chicken, a baked spud and some veg, or more exciting flavours but with controlled amount of carb.

Start on one unit of insulin to 10 grams of carbohydrate and then see where that gets you. Don't panic on the correction front, think of this as an experiment, correcting with a hair trigger will stop you from getting where you need to be. In fact unless you're going extremely high I wouldn't correct at all for the first week. You need to see how your body is reacting to the insulin and the food, but that has to be your choice. Now this is the hard bit, and even though I'm saying it like it's easy believe me when I say I really understand it isn't, distance yourself from the emotion of the blood sugar levels, if you feel the panic about a double figure, breathe and tell yourself it's OK. I know your brain knows it's not OK and you want it to be lower, but the way to get that is control and you'll get it if you can chew on that leather strap and take the pain for a little while. Consider this a totally fresh start, the most valuable thing you can do is to understand how your body works with insulin, because in my experience that's the key to it all. Getting into a cycle of correction is easy to do, but really hard to get out of I know, but if you can convince your brain to stop reacting so quickly you'll be able to see a pattern, and when you can see the patterns you can find an action that will work. You can always post readings here and we'll help you interpret and adjust, there's a lot of experience here and we're always happy to help 🙂.

Now for my cheerleader bit (imagine I have pom-poms ). After 23 years of poor advice, you're here, feeling vulnerable and frustrated, the important bit if that is "you're here" putting yourself on the line and giving it a whirl. That's mettle if ever I saw it. Don't let that little shrivelled pancreas get the better of you!

Also, thank you @KookyCat, that was such a lovely post and exactly what I needed to hear - everyone on this forum is lovely!

 

[Kaylz]

May I ask how much Ribena you had to inject for it as the Ribena page states that a 250ml serving as diluted only has 1.8 grams of carbohydrate and you say you took 2 units of insulin for it where you probably wouldn't have needed insulin for that x

 

[everydayupsanddowns]

I'm a little confused as to what I should be doing - the bertie rouces says to do 1 unit per 10g CHO but some people are talking about total grams of the food itself rather than CHO content - which one should I be using??

It should be 1 unit per xx g CHO (you will have to work out your own 'best fit' and may find you need a slightly different one for breakfast/lunch/evening meal.

Any reference to total weight of food would be a mistake/misunderstanding in the post. It's only the carbs you are looking at. 🙂

(was it a post which mistook you eating 200g in CARBS of pasta vs 200g in cooked weight of pasta - which is more like 60-70g carbs?)

 

[Sprogladite]

May I ask how much Ribena you had to inject for it as the Ribena page states that a 250ml serving as diluted only has 1.8 grams of carbohydrate and you say you took 2 units of insulin for it where you probably wouldn't have needed insulin for that x

It was a pint glass - I used the carbs and cals app, couldn't find Ribena of any sort on there so used 'squash' - I wasn't sure whether it was the right equivalent to use or not and looking at it again, there is a sugar free squash option which I missed last night, maybe I should have used that one? But I'm pretty sure the no added sugar one is not completely sugar free so I probably still would have used 'squash'? I knew I was probably doing too much for the drink but at the same time I was operating on the theory it wasn't going to be 100% first time and i'd rather deal with a hypo than a hyper! Which is why, in part, it came as such a shock that I went so high last night!

It should be 1 unit per xx g CHO (you will have to work out your own 'best fit' and may find you need a slightly different one for breakfast/lunch/evening meal.

Any reference to total weight of food would be a mistake/misunderstanding in the post. It's only the carbs you are looking at. 🙂

(was it a post which mistook you eating 200g in CARBS of pasta vs 200g in cooked weight of pasta - which is more like 60-70g carbs?)

Yes, I had 200g cooked pasta which worked out to 60g carbs so i figured 6 units for that! Thanks for clearing that up 🙂

 

[grovesy]

The bottle should have a Carbs on the label.

 

[Sprogladite]

The bottle should have a Carbs on the label.

Ok, do I take into account 'of which sugars'?

Also having a real 'duh' moment...I didn't even think to look at the label!

 

[grovesy]

Ok, do I take into account 'of which sugars'?

Also having a real 'duh' moment...I didn't even think to look at the label!

No the total Carbs.

 

[Sprogladite]

No the total Carbs.

Ok, I will have a look at that when I get home tonight for future reference. Thank you!

 

[DeusXM]

Just another point (and sorry if this one's a little disheartening!)...I would only go off the carb counts available on Carbs n Cals, BERTIE etc. when there is no information on the product itself. The carb information on both those sources is 'best guess' but products can have a lot of variability.

For things like sauces made from scratch, you almost need to start right at the beginning by looking at the carbs in the raw ingredients, adding it all together and then knowing how much is in the total amount of sauce (eg. you know you've put 30g of carbs in, and you've ended up with 250ml of sauce), then working backwards. So in this instance, say you know there's 100ml of sauce on your plate, you'd divide 30g by 250ml, and then multiply by 100ml to get 12g in your sauce.

That's a particularly fiddly example but shows how things can work. I know it's a real pain but doing a lot of the hard stuff up front leaves you with good estimating skills for the future - the best skill anyone who uses insulin can learn is how to eyeball a plate of food and make a pretty good guess of how many carbs are in it.