struggling with carb counting

[1997]

I was put on a carbohydrate counting course when my HbA1c was much less than perfect. The idea was that it would get my levels back in order, but all it served was to confuse me more.

I went from having a good estimate of what certain meals were to having to perform all sorts of ridiculous estimates and calculations in my head.

It was like being given a series of hurdles but with the first one being set at a level that would test an olympic high jumper.

I expect the week long or few day courses are better than the afternoon course I received. The nurses did an admirable job in the afternoon course, but I don't think an afternoon only course is appropriate for someone struggling to get to grips with their control.

It seems to me that a stand alone carbohydrate counting course is something which should be taught as for those looking to go from relatively stable control to advanced control rather than those like me who were a bit all over the place.

Soon after my course I gave up trying my best to estimate carb numbers and then perform a division with a factor based on guesswork. I went back to knowing what insulin amounts worked for certain meals and stuck with that.

I've recently got into the sort of control that allows me to start to look at what my conversion factor might be. Going by what I have for lunch the conversion factor looks to be about 1 unit = 8.5g carbs.

Maths is a strong point for me but the thought of having to work in factors of 8.5 is a nightmare. Add to this fact that the conversion factor tends to be different at different times of day and I can see why giving up seemed the only appropriate option just after my course.

Has anyone else had struggles with carb counting and any ways of coping?

 

[diagonall]

Hiya, carb counting is very simple.
But the medical peeps seem to want to confuse people as much as they can. 😡
Buy yourself the book called carb counter (Collins Gem) it has lots of foods in it.
http://www.bdec-e-learning.com/ this is the on line version of carb counting
Sort your basal 1st http://www.diatribe.us/issues/13/learning-curve.php

How to work out your carb factor. http://www.diabetesnet.com/diabetes_food_diet/500rule.php

Many people have different ratios for different meals so a little bit of tweaking might be needed.

Sue

 

[bev]

Hi Sue
I tried clicking on you links but nothing happened! Is it just my computer? Bev

 

[C*5_Dodger]

Hiya, carb counting is very simple.
But the medical peeps seem to want to confuse people as much as they can. 😡
Buy yourself the book called carb counter (Collins Gem) it has lots of foods in it.
http://www.bdec-e-learning.com/ this is the on line version of carb counting
Sort your basal 1st http://www.diatribe.us/issues/13/learning-curve.php

How to work out your carb factor. http://www.diabetesnet.com/diabetes_food_diet/500rule.php

Many people have different ratios for different meals so a little bit of tweaking might be needed.

Sue

Hi All,

These should work

http://www.bdec-e-learning.com/
http://www.diatribe.us/issues/13/learning-curve.php
http://www.diabetesnet.com/diabetes_food_diet/500rule.php

Regards Dodger

 

[Lizzie]

Hi Sue
I tried clicking on you links but nothing happened! Is it just my computer? Bev

You could also try highlighting the links with your mouse, then right clicking and go to 'copy', then paste into your address window at the top of the page, by highlighting the address, right clicking and choosing 'paste'. Or instead of right clicking you could highlight, then go to the Edit menu and use the same commands, copy and paste. Then press enter.

 

[Einstein]

Hi,

I found the short carb counting course run by a local dietician to be an excellent basis to start carb counting, although I am on 1:10, I do still find estimating carbs to be difficult when I am out.

The Collins Gem book is great, most of the Atkins diet books also list all the common carbohydrates for various foods.

At home the best thing I did was buy some accurate digital scales, I tried the ones with the foods programmed so you told it what you were weighing and there was your carbs for the amount you'd weighed on the display, far easier to look at the packet!

Where I do struggle it when eating out, here you don't know what a portion size is, and its very hard work to try and keep up, I tend to work slightly under what I think is on the plate and hope for the best... not scientific, but its the best practicable solution I have found to the problem.

What I did discover very quickly after the course was that my insulin and a such portion sizes reduced drastically, rather than eating to my insulin, I was injecting to what I was eating - sometimes, realistically I was consuming five times more insulin than I needed to and that had to be made up somewhere with food intake.

Worth working on, but I don't envy you the 8.5:1 ratio and the calculation off the top of your head every time!

In addition to paper and online carb lists, there are also a few programs to download for Smartphones and Blackberrys that can be referenced while you're out. I find the one on my Blackberry is great if I am away for a few days and eating out all the time, at home I eat a reasonably constant diet, so life and injections are regular.

Hope it starts to work for you soon.
David

 

[1997]

I'm glad I asked the question now. I never knew about the 500 (450) rule before.

Sure enough my 63 units in a day get the 1 unit = 8g

I've just injected 15 units of insulin to cover my 110g of carbs for lunch (which is about right; 110 / 8 = 13.75 and I gave myself 15 instead of 14 because I was just over 8 mmols/l).

Sometimes it feels like a jigsaw. If there's a key piece or two missing you can feel you're getting nowhere then all of a sudden someone hands you one of the pieces you were looking for and things are good again.

thanks everyone!

 

[diagonall]

I'm glad I asked the question now. I never knew about the 500 (450) rule before.

Sure enough my 63 units in a day get the 1 unit = 8g

I've just injected 15 units of insulin to cover my 110g of carbs for lunch (which is about right; 110 / 8 = 13.75 and I gave myself 15 instead of 14 because I was just over 8 mmols/l).

Sometimes it feels like a jigsaw. If there's a key piece or two missing you can feel you're getting nowhere then all of a sudden someone hands you one of the pieces you were looking for and things are good again.

thanks everyone!

Glad it is making more sense to you now.
As a general rule 1 unit of insulin will also drop you down 3 points when using a correction.
You also might find you get even better control if you don't inject more than 7 units in one go. means an extra jab or cutting down the amount of carbs eaten though.

 

[Admin]

That is so accurate!

I am impressed I have been carb counting for my entire life - but never done it with such accuracy! I tend to round up or down...there is no rule of thumb for anyone really. Good on you!

 

[1997]

sometimes the whole diabetes carb counting can be funny.

I'm back home to see my dad and have some slightly better meals than i usually do.

So my dad's making lunch and brings out 2 largeish potatoes and says: "this is 32g and this one 34g"

So I assume he's brought out a couple of shop bought ones with an estimate of the carbs on the labels. I work out my insulin 8g per unit, so 4 units should cover the one potato I'll have.

Halfway thru lunch I think, I wonder why the carb levels are different. Were they from different packs?

So I ask my dad: "how did you know they were 32g and 34g?"
He said, "that's how much they weighed." Ok so the packets must have given the carb value per 100g.

So I ask: "How did you calculate their carbohydrate?"
He didn't get my question and could only say, "I weighed them."

After a bit of discussion, it turns out he thought the potatoes themselves weighed 32g and 34g. My dad's far from thick, I think it must be that he has maybe never got his head round metric.

I knew the potatoes couldn't possibly have weighed such a small amount and so to prove himself right my dad got the scales out.

Turns out my dad was imagining a decimal point that wasn't there! To give a bit of credit the gram symbol was in a funny position which could look like a decimal point.

So I can tell the weight of the potatoes must be 320g and 340g but I don't know off my head what their carb content is.

Off to wikipedia which tells me that a potato is about 20% carbs. So this tells me I must be having about 66g of carbs, which sounds about right.

So instead of injecting 4 units for the potato, I should have injected 8 units.

If I'd not been so persistent in asking my dad how he calculated the carbs, I could expect myself to be, at the least, 10 mmols/l higher this afternoon.

Crazy stuff.

It really illustrated some of the important things we have to think about. I think my dad's received a bit of an education today.

 

[tracey w]

Glad it is making more sense to you now.
As a general rule 1 unit of insulin will also drop you down 3 points when using a correction.
You also might find you get even better control if you don't inject more than 7 units in one go. means an extra jab or cutting down the amount of carbs eaten though.

Hi sue, interesting what you say about better control if you dont inject more than 7 units. If you need more to cover your meal, but only give 7 when would you give the rest, maybe 2 hours later? I am interested in getting better contol over my bs and if it means more jabs then im ok with that.

thanks

 

[Freddie99]

Hi All,

It was suggested to me the I attempt to do carbohydrate counting by my consultant. I thought that it might work but I just never got around to doing it. Well, I say that but I do it when I can easily find out the carb content of some food - i.e. from the packet but otherwise I simply do what I have been for the past thirteen years. I know what some foods do to me and I know how to adjust my insulin to deal with that.

Tom H

 

[tracey w]

Hiya, carb counting is very simple.
But the medical peeps seem to want to confuse people as much as they can. 😡
Buy yourself the book called carb counter (Collins Gem) it has lots of foods in it.
http://www.bdec-e-learning.com/ this is the on line version of carb counting
Sort your basal 1st http://www.diatribe.us/issues/13/learning-curve.php

How to work out your carb factor. http://www.diabetesnet.com/diabetes_food_diet/500rule.php

Many people have different ratios for different meals so a little bit of tweaking might be needed.

Sue

Hi,

I have bought the collins gem recently and already finding it useful, struggle when eating out though and i like to eat out quite often, usually guesstimate then but working ok.

I have also worked out my ratio using the 500 rule,, but i have a question with this. My ratio works out at 1:15, however i find i am actually more like 1:11.5, (taken me couple of weeks to suss this but think this is accurate now!) What i want to know is insulin requirements for bolus more because i am not on 60% basal. I take 15 basal and approx 18 bolus including corrections. Hop this makes sense. 🙂

I think this basal is right although not quite sure as i can do massive drops in bs even 6 hours after meals, but dont think this is due to basal, i have very active job/lifestyle. My basal hardly touches me during the night and can wake up higher than going to bed. Thanks for any advice, i have learned all these things on this site and not from my team!

 

[diagonall]

Hi sue, interesting what you say about better control if you dont inject more than 7 units. If you need more to cover your meal, but only give 7 when would you give the rest, maybe 2 hours later? I am interested in getting better contol over my bs and if it means more jabs then im ok with that.

thanks

Hi Tracey, with me it does depend on the food type being eaten. But yes you can go up to 2 hrs later. That's for pizza and pasta. There is no exact science to it. You have to find what works for you. I use a 40/60% split over 1 1/2 hrs when I eat pasta this works fine for me. Look up the profile of your bolus insulin and see when it peaks for optimum control. Keep a diary of what you did and the result. This way you can work out what works and what doesn't work.

 

[diagonall]

[

Hi All,

It was suggested to me the I attempt to do carbohydrate counting by my consultant. I thought that it might work but I just never got around to doing it. Well, I say that but I do it when I can easily find out the carb content of some food - i.e. from the packet but otherwise I simply do what I have been for the past thirteen years. I know what some foods do to me and I know how to adjust my insulin to deal with that.

Tom H

Hi Tom,
Looking at your HbA1c it obviously is not working for you. There is something badly wrong somewhere to have an A1c as high as that.
You were talking about having a pump.
There are no if's or buts you need to carb count to have a pump.
Carb counting is very simple to do. If you can not master it or how to correct your highs, then pumping is not for you.
Read the links I put on this thread and learn how to carb count and work out your ratios.
Ask to go on a DAFNE course so it gives you a good insight to what you are meant to be doing.
Best wishes
Sue

 

[diagonall]

Hi,

I have bought the collins gem recently and already finding it useful, struggle when eating out though and i like to eat out quite often, usually guesstimate then but working ok.

I have also worked out my ratio using the 500 rule,, but i have a question with this. My ratio works out at 1:15, however i find i am actually more like 1:11.5, (taken me couple of weeks to suss this but think this is accurate now!) What i want to know is insulin requirements for bolus more because i am not on 60% basal. I take 15 basal and approx 18 bolus including corrections. Hop this makes sense. 🙂

I think this basal is right although not quite sure as i can do massive drops in bs even 6 hours after meals, but dont think this is due to basal, i have very active job/lifestyle. My basal hardly touches me during the night and can wake up higher than going to bed. Thanks for any advice, i have learned all these things on this site and not from my team!

People who are more active tend to have a lower basal so don't worry about it. You need what you need for your life style 🙂
The 500 rules is great as it gives you a fairly good guess as to what you require and then you can tweak it to your own needs.
Your basal doesn't sound quite right from what you are saying. Have a go at the basal test. Then you can see what is going on.
Do you split your basal? Many people find that Lantus and Levemir do not last 24/7
So again worth considering, have a talk with your team and see what they say.
If they unhelpful ask for a pump 🙂

Sue

 

[1997]

Hi Tom,
Looking at your HbA1c it obviously is not working for you. There is something badly wrong somewhere to have an A1c as high as that.
You were talking about having a pump.
There are no if's or buts you need to carb count to have a pump.
Carb counting is very simple to do. If you can not master it or how to correct your highs, then pumping is not for you.
Read the links I put on this thread and learn how to carb count and work out your ratios.
Ask to go on a DAFNE course so it gives you a good insight to what you are meant to be doing.
Best wishes
Sue

Hi Tom

I agree with Sue on most (if not all) counts - but would say that sometimes carb counting can be more tricky than at other times.

If your daily routine is fairly dependable, I'd recommend starting to do a bit more carbohydrate counting.

If you know what effects things have on you then you could work out your insulin doses as you usually do but have a go at counting the carbs and write them down along with your test results and the insulin you take. You could then look back after a week and see if you can spot what may be causing higher levels and what may cause the lower levels.

Can I ask - do your write your results down?

 

[Freddie99]

Hi Tom


If your daily routine is fairly dependable, I'd recommend starting to do a bit more carbohydrate counting.

If you know what effects things have on you then you could work out your insulin doses as you usually do but have a go at counting the carbs and write them down along with your test results and the insulin you take. You could then look back after a week and see if you can spot what may be causing higher levels and what may cause the lower levels.

Can I ask - do your write your results down?

Fire away 1997! I do write down what my bloods are and the insulin doses that I give myself. I use spreadsheets and it's fairly easy to spot trends. My routine is for the most part dependable but sometimes it can be thrown quite easily.

Tom H

 

[diagonall]

Fire away 1997! I do write down what my bloods are and the insulin doses that I give myself. I use spreadsheets and it's fairly easy to spot trends. My routine is for the most part dependable but sometimes it can be thrown quite easily.

Tom H

Hi Tom, have a look at this site it shows what your A1c converts too on a daily bases.
http://www.phlaunt.com/diabetes/A1ccalc2.php
8.7% = 11.3 which is very worrying for your long term health.
Your A1c needs to be nearer 6.5 but below 7 at least.
Please please don't think I am having a go at you because I am not. I'm just trying to pass on info so you can help yourself and avoid complications in the future.
Best wishes
Sue

 

[1997]

Fire away 1997! I do write down what my bloods are and the insulin doses that I give myself. I use spreadsheets and it's fairly easy to spot trends. My routine is for the most part dependable but sometimes it can be thrown quite easily.

Tom H

Good to hear you're reviewing your levels regularly. It's quite possible that it may be your 'unseen' sugar levels that are higher than you'd like.

I've only recently started to check my levels two hours after eating and it's been interesting and useful to see the results of these after eating tests.

A lot of one's waking day is spent between meals so it's important that your levels are not straying too high between meals.

In an ideal world, you'd want your sugar levels to remain significantly under 10.0 mmols/l two hours after eating.

If your sugar levels are above 10.0, I'd start to think about changing what you're eating. Any significant change in diet should really be agreed with your healthcare team, however, beware that your healthcare may sometimes give a false impression of what's acceptable. I've had consultants that were quite happy for my HbA1c results to be too high.

When it comes to the post meal results, I'm now of the opinion that it's much better to know what levels I'm getting than being blissfully unaware like I used to be.

Do you tend to check your levels after eating (2 hours after, ideally)?