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Re: [IPk] Carb Counting in the UK

>Sadly it is true. They don't like carb counting over here because
>essentially "it's too complicated and unnecessary". Yes, we are going
>back into the dark ages :-(
>I brought this up at the diet workshop at a recent BDA conference.
>The dietician's answer?
>"If we taught people carb counting instead of healthy eating they'd all
>go off and eat Mars bars all the time instead of a balanced diet".
>My response (or at least a curtailed version):
>1. At least their BG will be under control.
>2. The sort of person who is going to just eat Mars bars isn't likely
>to be particularly bothered about carb counting anyway.
>3. With carb counting you can eat like a "normal" person.
>4. Non-diabetic people don't, as a rule, eat Mars bars all the time
>just because they know their body will automatically match their insulin
>intake to their carbs.
>Soon developed into a big argument. She admitted that it might work
>for some people, but wasn't prepared to agree that it shou;d be
>prescribed, rather than just "permitted".

We need to clear up what is meant by carb counting. When I was diagnosed in
1977 I was put on a fixed-carb diet, with a fixed twice daily injection.
The carb for meals and snacks was something like 50g, 20g, 50g, 20g, 50g,
30g. I was taught to know/count/assess the carb content of what I was
eating so that I could achieve the target for each meal. Some achieved
similar aims with a fixed calorie diet instead.

It worked moderately well, until I got out into the real world and found
that my life simply wouldn't fit into these tidy fixed-size meals. Enter
flexible insulin therapy, where you alter your insulin dose in relation to
what you may or may not eat.

Carb counting in this context is entirely different since you're not aiming
for targets - you just need to know how much insulin to take. And out of a
pump context that can be extremely difficult, since on
NPH/Ultratard/Insulatard/whatever you do not know with any certainty what
your basal rate is. The meal bolus and the basal are often

For this reason, the NHS in Britain simply advocates "healthy eating".
Regular meals. Not too much. Not too little. The beauty of this approach is
that "heathy eating" brings many other advantages. Achieving normal bg
levels is not the only aim of good diabetes treatment. Diabetes raises the
risk of heart disease. Healthy eating lowers it. So you can cancel the
heart disease risk. Likewise with "exercise".

Its not dark age stuff - it's more risk control. Carb counting has been
tried in the real world, and it's been found that you get better long-term
results but advocating "healthy eating". Hence the dietician's comment
about Mars Bars, Di. I assure you there are LOTS of people out there who
live off Big Macs, Mars Bars and Coke for most of their calories. And they
may ultimately have a very poor health outcome.

With a pump, carb counting is the best way to calculate your meal bolus -
provided your basal rate is correctly set. But fat and protein also affect
the bg - often in very unpredictable ways. That's why healthy eating, with
complex foods with slower digestion help to smooth the whole thing out.

Hope that explains things a bit Paul! I don't usually praise the NHS, but
clearly the British policy does something right, since the average HbA1c is
much lower in Briatin than in the States, as is the incidence of


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