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Re: [IP] Re: Counting carbs



Scott:

One of the dilemmas with carb counting is how to estimate the carbs in
foods which have no labels attached to them (such as when dining out, or
trying "strange" foods). Naturally, labelled foods make life easier ...

You are correct in saying that the skill develops with experience and
through trial and error. Even after 19+ months on the pump, I still get
stymied on occasion. There are others who have a great deal of experience
with carb counting, but here's my .02:

Some tricks to try:

1)  Is the food similar to another food you have successfully managed
before? If so, estimate based on this past experience.
2)  If uncertain, it is generally safer to *under bolus* rather than *over
bolus*. I would rather deal with a high BG resulting from a meal, than deal
with a low BG resulting from too large a bolus.
3)  What has been your overall activity levels prior to the meal? If very
active, such as you might be when at a picnic with volleyball, etc,. it may
be *safe* to nibble or snack on familiar foods without the bolus. If
relatively inactive, you will probably need a higher bolus, or choose to
eat smaller portions (or forego some of the meal altogether).
4)  Someone mentioned to me that a *conservative* estimate for many carb
based foods is 10 grams of CHO for each *portion*. Obviously, this is an
estimate based on *normal size portions*, food not heavily sauced or
sweetened, etc. Initially, I was a bit skeptical of this approach, but have
been able to adopt it to my needs. It generally works well for me.

Of course, as Buddy mentioned, checking BGs frequently after eating new
foods will allow you to make adjustments if your BG is too high. Add the
results to your *database*, and your next experience should be a little
easier ;-)

I don't agree with the statement that "Something else you will find is that
EVERY meal you normally eat will require between 5 and 12 units of
insulin". I have never bolused 15 units for a meal at any time during my
pumping experience. Each of us requires a different insulin to carbohydrate
ratio, which is the basis for determining the amount to bolus for a given
amount of carbs. There are some users who only bolus a set amount for each
meal, with little variation in the meal content (probably not *true* carb
counting).

Personally, I use a ratio of 1 unit of Humalog to 20 grams CHO for
breakfast, and a ratio of 1 unit of Humalog to 15 grams of CHO for lunch
and dinner. For me, that means a typical breakfast bolus of 2 units,
anywhere from 5 to 8 units for lunch, and 4 to 7 units for dinner (actual
amounts vary, of course).

I think books do help. Corrine Netzer's is one I have looked at, but do not
own. Sometimes I will sneak into the bookstore when I am out, look up some
info, then jot some notes for later on. I can't recall the name of the book
I own (I think one of the author's names is Pennington), but it is a very
valuable resource, even with all the food labels that are available. It
also has references to *fast foods* which are useful. My wife is a very
inventive, wonderful cook, and this book has allowed us to really enjoy the
flexibility of the pump.

Your mileage may vary (YMMV) and this should get easier as you progress.

Best of luck to you.


Bob Burnett

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