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Re: [IP] diets through the decades

On Sun, 18 Mar 2001 12:25:10 -0800 (PST), Heidi Vogan wrote:
>I was started straight-off with carb
>counting.Thats the first and only diet I ever
>followed, so I have difficulty understanding what the
>exchange system was and how it related to insulin
>changes.Did diabetics not change their insulin back in
>the old days?Why did doctors restrict sugar items but
>not regular carbohydrates?

You were lucky to have been started on carb counting. The exchange
lists were lists of foods of a similar type (meat, bread, veg 1, veg
2, milk, fruit), with the specified quantity of each item determined
so as to make each item on the list along with its quantity equal to
the same amount of carb, or protein, or fat. Diets were specified in
terms of a specific number of each type of exchange, and the units of
insulin were specified to match the patient to the specified
exchanges. Every day was supposed to be the same as every other day as
far as food exchanges and insulin were concerned. The patient was
allowed the freedom of choosing a different one of the various items
on each of the exchange lists. Any variation of exchanges or insulin
was considered to be very risky, too much trouble to figure out, and
to be asking for trouble. There were probably some of us who
experimented and perhaps figured out how to do a crude form of carb
counting. Many of us just got used to the daily routine, and probably
many more just couldn't handle it. We memorized exchange lists just
like we now memorize carb ratios.

Very few diabetics changed their insulin on their own because most of
the MDs laid down strict rules that patients were not to change their
insulin doses without approval by the physician. I was more fortunate
because I found that I could make minor changes in insulin doses
without getting into trouble with the MD. You have to understand that
patients had no way of testing their own BG. All we had was urine
sugar tests. And we now realize how useless those were. It was not
safe to have all the urine tests be negative, because there was no way
to know if a negative test meant that BG was just below the renal
threshold (180 mg/dL), or just above hypoglycemia, or into
hypoglycemia. So usually several or all tests per day were positive
(1+, 2+, 3+, or 4+) indicating that BG>180 and probably BG>>180.

And doctors DID restrict regular carbs. The prescribed diet allowed a
specific number of bread exchanges and a specific number of fruit
exchanges, etc.

Tom Beatson
dx 1942, pumping since 1995, age 68
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