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Re: [IPk] carb counting, fats and proteins etc

>Thanks for the messages which seemed to emanate from Pat's response to my
>statement that I eat low carb (50-80g per day) but still have problems with
>getting good fasting bgs.  It is really helpful (though a bit confusing!) to
>hear a bit more on this topic.  When I was "taught" carb counting I wasn't
>told anything about fats and proteins (except of course that fat is
>baaaaaddddd), glycemic index etc. etc.  Basically I was just told to count
>the starchy carb in a meal and give 1 unit humalog for every 10-15g.
>Wouldn't it be great if life were that simple?  (I wouldn't be in this
>discussion group and fighting for a pump for one thing!)

Hi Louise -

A few musings... diabetes is a guessing game. If anyone (consultant,
doctor, DSN, friend-with-diabetes etc) tries to persuade you otherwise,
they are wrong. At least that's my opinion. With a pump, we have strategies
for accurately guessing how much insulin we require, but it will be wrong.
Before the next meal, at the next test, we take a (hopefully small!)
correction bolus to get things back in line. That's the strategy for pump
therapy. Bad guesses over many years can result in early death from
complications, good guesses can delay or prevent it. It's a private choice
we all make daily in our lives. Di tells a tale of guy who died from comps,
and before he died said if he had his life again, he wouldn't run it any
differently. Good for him? I don't know.

One of the many reasons for this apparently random nature of diabetes is
that fats and proteins *are* at some point converted into glucose in the
blood, but we cannot predict when and to what extent. (Pat, I'm very
sceptical of your attempts to quantify it...) How are your liver's glycogen
stores this morning? Without intense medical investigation I'm not aware
that such things can be quantified, and that in turn will affect how and
when fat and protein is converted to glucose (your muscles help out as
well). Essentially, it's too unpredictable to predict. That's why we check
our BG before the next meal, and take any correction bolus at that point.

>GI - do people use this?  I was a total convert to low GI for a few months
>but suspect that humalog action was finishing before the slow releasing
>carb, so getting good bg at +2 hours but rising several points at +4 hours.
>When I do eat carb now I tend to go for higher GI e.g. potatoes.

Personally I don't use GI. Some swear by it. Others swear at it. I find
that in a mixed balanced meal (like we all eat all the time... ;-) it's too

Incidently, someone (was it Franco?) told me that a lot of carbohydrate
passes out of us undigested in our poo. So for all our accurate carb
counting, some of it may never even see an insulin molecule. Food for
thought there.

>I seem to need about 1 unit of humalog for every 5g CHO which seems really
>high .... But 1 unit of h does lower my bg by 2.5 - 3 points which is
>apparently typical, so can't quite figure out whether I am insulin sensitive
>or not.

Within reason, we need what we need. Some are very insulin sensitive (and
probably benefit from U40 rather than U100 insulin). Others are insulin
resistant and may use U500 insulin. One chap formerly in this group claimed
to be on 3000 (yes! three thousand...) units a day, and wore 2 pumps
simultaneously to deliver sufficient insulin to his body. Galling. Makes me
appreciate how relatively simple is the chaos of my own diabetes...


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