If not carb counting... then what?

[SacredHeart]

After I was diagnosed, I remember coming out of the hospital, and not having a clue what to do. I stood in the supermarket and cried, because I just felt on my own. Thank goodness for Andrew, who almost literally took me by the hand, and made sure I bought things that wouldn't rock the boat too much, as it were.

I was on mixed insulins to start with, and because I was on fixed doses, I wasn't sure where carbs fitted in. I'm loathe to talk badly about my team, because they've been wonderful, but there was a point where I believed that I had to eat as few carbs as possible, and was eating 30g or less per meal (which is really little for me), but obviously not adjusting my fixed doses, because I wouldn't DARE!

I'm pretty sure that contributed to the fact that mixed insulins failed miserably for me. I didn't know how much carb was GDA or anything like that, and that was what I really needed to know. Silly amounts of hypos on NovoMix. Ah well, it got me onto MDI at any rate!

I did a carb counting course, because I asked if I could, but they never figured out my ratios for me, because my insulin intake was (and still is) so small. So I worked it out myself by trial and error, and have come up with something that seems to work for the most part.

 

[katie]

Does anybody know why some Type 1s are still put on mixed insulins first instead of MDI?

 

[SacredHeart]

'Easing you into it', I suppose? Or because it's cheaper and they want to see if it works?

 

[mikeinspain]

Mike - 100000000% agree. It can make a huge difference to people who are MDI as much as Pump Users and I hope that Health Care Professionals, understand this and teach people about the importance of carb counting.

I am doing it myself via Trial and Error, fingers crossed we are going ok at the mo and will speak with the doctor again soon.

Becky - I completely agree. When I was diagnosed I spent some time with the DSN's at the Bristol Royal Infirmary and not at any stage did they mention anything about carbs and carb counting. I was clueless to be honest, still am before anyone says anything!! 😛

I think the DAFNE scheme was fairly new, but still they knew it existed and understood the benefits of the course.

Katie - I think Novo Nordisk are tackling that issue themselves by withdrawing the Mixtard. Starting in Scotland if I'm not mistaken.

 

[everydayupsanddowns]

It can make a huge difference to people who are MDI as much as Pump Users and I hope that Health Care Professionals, understand this and teach people about the importance of carb counting.

That's what most baffles me. The fact that after the exchanges/lines schemes were dropped (which while limited did at least tell you to eat set grammages of carbs for each meal). With that understanding as a basic framework you at least get an idea of ratio, even if only meal:dose rather than units:gCHO

Oddly it was the (in my experience excellent) team at the BRI who
a) Moved me on to basal bolus in the early/mid 90s and said that it meant I could miss or delay meals, and also that I could alter my dose if I was eating more or less
and also
b) Was the place I first heard that dreaded phrase 'we don't really do exchanges (ie carb counting) any more'

M

 

[Robster65]

I know when I was first diagnosed, the consultant I was under knew very little about diabetes (he started me on a mix of 2 insulins that should never have been together) and was very pompous. I doubt this situation has been completely eradicated so possibly, there are consultants, doctors and nurses who only know some of the facts and a whole lot of guesswork and out-of-date practices.

This could be why there are still newly diagnosed patients on mixtures and why a lot of patients (especially long-term) who never get to know about carb-counting and ratios.

It's always seemed to me that the nurses who see patients day-to-day treat it as a bit of a black art and are a bit reluctant to advise someone who may tell them to mind their business. Hence, no incentive to keep bang up to date and probably no opportunities of they wanted to. The old line of "the patient knows best" has been recited many times to me over the years. I used to believe it but recently I've discovered that there is a time when the NHS needs to be a bit more assertive, ensuring that they give the correct information via properly informed staff.

Rob

 

[sofaraway]

Katie - I think Novo Nordisk are tackling that issue themselves by withdrawing the Mixtard. Starting in Scotland if I'm not mistaken.

They are only withdrawing it because far more people use novomix30, so I doubt it's going to make any difference on people going to basal bolus rather than a mix.

Basal bolus isn't sutiable or desirable for all people with type 1, so i think it's important to have mixes as an option.

 

[everydayupsanddowns]

Basal bolus isn't suitable or desirable for all people with type 1, so i think it's important to have mixes as an option.

I do think it is seen as an 'easy start'. Fewer injections, fewer variables, more structure. Oddly though I found it much harder to get along with than Basal Bolus. Everyone's different I guess.