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Re: [IPk] Carb Book

>There has just (like, in the last few weeks) been announced the results
>of a study at (?Glasgow) which showed that matching grams to units
>works, no matter how many grams you eat!  (The truth we've known for

I'd be very interested to read that, Pat. Where's it been published?

The practice of taking pre-meal insulin in strict ratio to a variable carb
intake requires firstly Humalog which matches digestion well, and secondly
an absolutely correct basal insulin level. In practice I'm not sure that
many people achieve this unless on a pump. That's why, on MDI, carb
counting in practice tends to be a bit of a fiction, and the benfits rather
elusive. Many people find after starting on a pump that their carb-insulin
ratio drops dramatically, suggesting that pre-pump their variable meal dose
was supplying a lot of the basal as well.

I've discussed this at length with Edwin Gale, my endo in Bristol. He feels
that MDI is a myth. Great in theory. Doesn't work in practice. You need
fixed repeatable food intake, to match fixed insulin patterns. Diabetes
requires habits.

I've repeatedly explained to him that a pump turns the myth into reality.

>The two other things which they didn't test for, and are rarely
>mentioned, are the effect of other calories (I get the best humalog-to-
>CHO absorption match with only 30% or so of calories from CHO!), and the
>effect of starting bg (with a bg of 4, I need a third less insulin for
>the same CHO as I do with a bg of 8, and with a bg of 15, a third more.
>(NB that's to get the _same_ bg reading, 4, 8 or 15, after 5 hours, not
>to get it down to 4 after 5 hours.  And it works, whether I'm having 10g
>CHO or 100.

My belief, having read a lot of the research, is that carbohydrate has a
fairly predictable effect on the bg, in the hours following its ingestion.
That's why you can take insulin in proportion to it. Fat and protein also
play a smaller role, but it happens later, and you can't predict it. To
account for this, on a pump, you take a correction bolus before the next
meal. This is how you complete the loop.

Of course, the Glycemic Index (GI) which measures the total bg raising
power of a particular food (and _not_ the speed of digestion) throws the
cat amongst the pigeons. The theory of carb counting implies that all
carbohydrate is equal, once it's been digested. The GI theory suggests this
isn't true. I've yet to solve this conumdrum...

>I have never felt that the BDA has any great value for diabetics, apart
>from being a fund-raising source, and offering support to the newly

Me too. But we are trying to change this, Pat. "Our man", Steven Sexton,
who runs the www.diabetic.org.uk website, has just failed to get elected to
the board of trustees. This is a shame. But I do want to work to change the
BDA from within, rather than criticise it from without.


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