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[IPk] Re:

In message <email @ redacted>, Louis Anson
<email @ redacted> writes
>what do you mean by 'calorie assessment'??  This sounds very interesting

'Calorie assessment' is assessing the number of calories you put in your
mouth, as 'carbohydrate (CHO)assessment' is measuring the number of
carbohydrates you put in.  Calories are important because they, like
CHO, have an effect on the blood glucose.  Fat, protein and to a certain
extent alcohol all slow down the arrival of CHO as blood glucose.
Protein is actually converted to glucose.  However, compared to the
effect of CHO, it's minimal, so most diabetics are not taught about it
(except alcohol has its own rules).  This is 'assessment' not 'control'
- the aim is not to loose weight, or to eat healthily - those are
decisions you make with a different bit of your mind!  The aim is to
assess the food, so that you can inject the right amount of insulin, at
the right time, and achieve non-diabetic blood glucose levels all the

Most pump users find 'carbohydrate assessment' is the way to go: that
for every 10g of CHO they bolus 0.9 of insulin - or whatever.  Some
people, however, find that 10g CHO (which is 40 calories) has a very
different insulin need if it is eaten with 40 calories from fat and
protein, and if it is eaten with 100 calories from fat and protein (say,
the difference between a fat-free fruit yoghourt on the one hand and
half a slice of fried bread, a sausage, and a fried egg on the other!  

A few people find that what matters is not so much the CHO, but the
total calories, so they base their insulin dose on calories.  Far more
find that what they have to do is assess both CHO and calories (this is
what I do).  Some do it in the kind of vague way I do - i.e. assess the
CHO down to the gram, and think 'and is this a very fatty meal?' and
adjust the insulin dose and time by guesswork to compensate.  Others
deal with it by always keeping the CHO to calories ratio steady - so
they might eat twice as much yoghurt, but they'd never have a fry-up.
Some do it by assessing both precisely.

Another thing you might want to look at is that some people find that
the ratio of insulin to food varies during the day.

All this is much easier to work out on the pump, because you can work
out what is going on with the long-term, basal needs, and then work out
what you need to bolus.  But it's possible with multiple daily
injections, if you're lucky.

With best wishes,

dm 30+ (using CHO assessment for most of that time), 508 pumper 1 year+
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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