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[IP] Re:carb counting and... fiber,fat. alcohol...

Here are a few comments regarding carbohydrate counting and fiber and other
nutritional factors effecting bg levels, for those who haven't heard of this:

Many manuals or discussions of carbohydrate counting do not include the idea
of subtracting grams of fiber from the total amount of carbs contained in the
meal ( in order to more accurately estimate the effect the carbs will have on
bg levels). But the idea is not a new one. 

In fact, the idea of counting carbohydrates to help those with diabetes eat a
less restricted diet was taught over 25 years ago by materials distributed by
Texas University(?). It essentially stated that a carbohydrate is a
carbohydrate and that a Coke could be exchanged for an apple of equivalent
carbohydrate if you wished to do so.( It did not comment on fiber much at
that time.) It took years for medical professionals to listen to this advice.

Actually, carbohydrate counting, when taken to it's limit today, can include
looking at the effects of carbs, fiber and  how fat, alcohol, and even how
individual types of foods and whether they're cooked or not, can effect bg
levels as well. It's perhaps more accurate to say that you are creating your
own "glycemic index" ( a list that has been created by researchers
determining how different foods raise bg levels) by using certain general
principles as a guide and your own experiences as measured on your bg meter.
The techniques of counting carbs today can, indeed, get quite intricate and
detailed. My belief, as I have stated previously, is that diabetes can be a
disease of hassels. I have seen people, including myself,  try to control it
so carefully that the puppy dog's tail starts to wag them.  I try to keep
treatment as simple as possible while maintaining tight control of bg levels.
What I'm trying to say  here is that you may have been getting very good
results without considering the effects that fiber, or other factors, could
be having on your bg.   If that's the case, terrific. If your results, on the
other hand, have not been as tight as you like than you may indeed wish to
consider the effects of fiber on your bg levels. It is not too difficult to
include into your meal plan. 

In other words ,I have approached carbohydrate counting in a step by step
fashion. If step one doesn't work well, then try the others:

1. Try just counting up the carbs alone first. If this doesn't produce
satisfying  results...

2. Include the calculation of fiber and the effects of fats. Large amounts of
fat can delay the rise of bg levels. For example, when I eat a bowl of
ice-cream I know that my bg rise will be delayed, thus I will bolus a bit
later than I usually would. With humalog in my pump, that will usually mean
about 10 minutes after I start eating the ice-cream. Try this out for
yourself to see what you need to do. Incidentally, this is a good reason why
you don't want to be eating a typical candy bar or other high fat food to
correct hypoglcemia as it can take too long to raise bg levels. As your bg
level stays low immediately after eating the candy bar you may be tempted to
eat even more and raise bg way too high an hour later.

3. Consider the order and speed with which you eat your foods. Some people
really do eat a solid meal in 10 minutes flat which can cause a bg spike.
Some people eat their sugary dessert first and thier fish last! 

4. Are your fruits and veggies eaten raw or cooked? A raw version may raise
bg levels less quickly.

5. Remember that although alcoholic drinks can contain considerable
carbohydrates, the alcohol can inhibit the release of  glucose from the
liver, increasing the possibility of low bg, and you might need a bit less
insulin to cover them. 

6. Take a look at the Glycemic Index to get some idea of how certain foods
will raise bg.

Hope this helps.