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Re: [IPk] Carb counting training


Most clinics I travel to in the UK regard the need for calorie counting as a
retrograde step as this was done in the exchanges system.  The reason given
is that the emphasis is now on healthy eating.  I fail to see how healthy
eating and assessing the carbohydrate content of a meal to (gauge the
correct amount of insulin required), are mutually exclusive.

I suggest we use a different term such as carbohydrate assessment - this
denotes a less regimented approach that does not imply the use of scales.
People going on to the pump for the first time feel that assessing their
carbohydrates and matching up their insulin dose is logical and helps them
to understand insulin adjustment

Best wishes

John H (Disetronic)
-----Original Message-----
From: Julette Kentish <email @ redacted>
To: 'email @ redacted' <email @ redacted>
Date: 20 September 1999 16:36
Subject: RE: [IPk] Carb counting training

>thanks or your help - everyone is so wonderful!!
>I have experience with type 1 patients but ths is definitely new.
>Unfortuniately most people are really into GI here, particularly up
>north and see it a bit backward to carb count again. I plan to bring in
>food and the equations i know so it should run smoothly. I have taken a
>previous/injection only group to a canteen - i don't know if this will
>be a as valuable to this group as we are meeting after dinner.... Any
>other suggestions would be greatfully received. I will let you all know
>how i get on. julette :)
>> -----Original Message-----
>> From: John Neale [SMTP:email @ redacted]
>> Sent: 20 September 1999 15:14
>> To: email @ redacted
>> Subject: [IPk] Carb counting training
>> >Thanks for your input. I have an education session first one for pump
>> >ptients here on wednesday and i like equating carbs to food as you
>> >suggested. I generally relate most things to one piece of bread
>> equals
>> >15g and compare foods from there. I am thinking of bringing in some
>> food
>> >samples and illustrating how much carb there is in each plate sample.
>> I
>> >know it is trial and error against personal BGL with regard to
>> insulin
>> >sensitivity and how long digestion takes etc.. but what do you think
>> of
>> >the pracical? Any other examples you found useful? thanks for your
>> help
>> >julette:)
>> Julette - Hi :)
>> I've had diabetes for 22 years, and have used a pump for the last 2
>> years...
>> From my experience, it seems that different clinics have different
>> attitudes to carb counting. Some feel it unnecessary, others believe
>> patients don't do it even if you tell them to, so they don't bother to
>> tell
>> them...
>> Crazy!
>> For me, with a pump, carb counting is absolutely essential in order to
>> reap
>> the benefits a pump offers: to be able to actively control your bg
>> throughout the day and night.
>> I'm not sure how much you know about pumping, but to recap: each
>> patient
>> must establish how much carbohydrate is metabolised by one unit of
>> insulin.
>> There are procedures for doing this which your clinic will be familiar
>> with
>> if they support insulin pumps. Once you have this ratio, the door to
>> the
>> kitchen is unlocked, since you can meet any reasonable amount of food
>> with
>> the correct amount of insulin.
>> I don't know what others feel, but I believe there are 3 stages to
>> becoming
>> a professional carb counter:
>> First you must be able to accurately calculate the carb content of any
>> food
>> within the home. This means being able to interpret the nutrional
>> panel on
>> most prepackaged food, and doing the associated maths, and knowing the
>> carb
>> content (g per 100g) of most food ingredients. General lists are good,
>> and
>> I also find the Collins Gem Calorie Counter a very good resource -
>> everything is listed (apart from Magnum Classics! ;-) Add it all up on
>> a
>> calculator, divide by your carb ratio, adjust it for your existing bg,
>> and
>> you have your required insulin dose. And it works! That's what is
>> amazing.
>> The second stage is being able to accurately guess the carb content of
>> a
>> plate of food, just by eyeballing it. This takes practice and
>> experience,
>> but eventually you can get there. Pick up a piece of cake, feel it,
>> take a
>> bite to see how fatty or starchy it is, and say I reckon that's 65g of
>> carb... If necessary, guess the content, then calculate it, and see
>> how
>> close you were, and work out where you went wrong, and how you can
>> improve
>> your guess next time. Obviously, you need this skill to eat in
>> canteens and
>> restaurants where you may not have seen the food being prepared - and
>> it's
>> not practical to be piling food onto a set of portable scales :-)
>> The third stage is being able to guess directly the insulin you
>> require:
>> look at a pile of pasta, and say that looks like it needs 4.5 units of
>> insulin... again, it's a skill that you build up with experience.
>> As Di says, bring real food in. Do a shop at the supermarket, buy
>> light
>> bread, heavy bread, cakey things, big orangess, little oranges... and
>> let
>> us know how you get on :-)
>> John
>> --
>> mailto:email @ redacted
>> http://www.webshowcase.net/johnneale
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