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Re: [IPk] Carb counting training

In message <008601bf05eb$52903860$email @ redacted>, John hughes
<email @ redacted> writes
>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 agree, but would add further that some people (me, anyway) find that
the balance of calorific sources within a meal has a profound effect
(i.e. if lunch is pringles, Chinese chicken wings and a sour cream dip,
I get far better results than I do with a salad sandwich!)  

>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.

I like this term!  For most diabetics, 'healthy eating with carbohydrate
assessment' is all that is needed.

For a few like me, 'healthy eating with carbohydrate assessment, and
other environmental impact assessment' is needed - this would cover
everything from the effects of exercise, calorie source balance,
menstrual cycle position, alcohol, glycaemic index (an iron-age meal
with oats as virtually the only CHO nearly had me in hospital), time of
day, etc. etc. which _can_ affect _some_ diabetics. 

Conceptually, it could be presented like this:
First, explain why having good bgs all day every day is important both
short-term, and long-term (the DCCT stuff)
Then, let the patients play with the AIDA diabetes simulator - or a cut-
down version which just plays one meal and 'insulin'.
Second, explain why, long-term, diabetics need to eat healthy diets
(i.e. the risks are more for us than the mundanes).  
Third, admit that it's actually quite complicated to predict what's
happening (talk about things like the menstrual cycle, alcohol, calorie
source balance, etc.).  So stress the importance of blood glucose
measurement both as a check of current state (are you fit to drive?) and
as a source of statistics which will help you predict things better.

Best wishes to all,
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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