Carb-Counting: If only it was that simple...

*DISCLAIMER - Please note in this article I am purely referring to Type One Diabetes. Remember Your Doses May Vary and all information found in this blog post is my opinion and what works for me ONLY and is not indented as medical advice. Please consult the relevant health care professionals if you feel the need to make a change to your treatment plan after reading this post*

Diabetes is a complex disease, where even after 3 (plus) decades you are still learning about symptoms and your body's responses to food, insulin and even the temperature changing out-of-the-blue and for no obvious reason. A common perception amongst people who don't have diabetes, is that once you are diagnosed and insulin doses are calculated, your life becomes straight-forward (again) and essentially we are 'fixed'. Unfortunately, as all people with Diabetes will discover promptly, insulin is just the first of many steps in regaining control over your life/health.

For those of us who are a little more experienced with Diabetes, we are often referred to Diabetes Education Programmes or a ‘Carb-Counting Course’ to refresh our knowledge as diagnosis was a long time ago. Some examples include but are not limited to; Dose Adjustment For Normal Eating (DAFNE), Dose Adjustment For Your Daily Diet (DAFYDD) and Juggling Insulin for Goals Success And Well-being (JIGSAW), all of which are offered around the UK.

Said courses are aimed at teaching those who have Diabetes to help control their blood glucose levels independently and to adjust insulin doses confidently and accordingly. Being aware of the carbohydrate content of food and drinks is an important factor of a well-balanced lifestyle for all people with Diabetes, however is it hugely significant for those who are Type 1 or on a Basal/ Bolus regime as it allows flexibility in terms of insulin doses and the amount of carbohydrates in what you are consuming. The fundamental idea behind these carb-counting education courses is to help individuals be conscious of the effects that different foods have on our blood glucose levels, which is a huge step when it comes to taking control of your Diabetes.

Nonetheless, one thing I have learnt in the years since I undertook my carb-counting course is that sadly it is not only carbohydrates that affect blood glucose levels. Our relationship with food in terms of how it is broken-down, how quickly our food is digested and the way in which carbohydrates are absorbed into our systems is affected by many other things other than just the amount we take in. 

The type of carbohydrate, whether low GI or high GI, the fat and protein contents of a meal/ drink also have a significant effect on how quickly they are processed by our body.

For those of you who are new to carb-counting or about to start on this approach, I want you to be aware that you may have to consider other factors and not just carbohydrates. This does not in my opinion necessarily complicate things, but rather, offer you alternatives to carbohydrate-based meals. You also need to explore how your body responds individually to both protein and fat, which in turn, will allow you to fine-tune your insulin doses accordingly.

Traditionally, a carb-counting course may view a meal of scrambled eggs as free or requiring no insulin as there is no real carbohydrate content to eggs. Any good health care professional would step in at this point to tell you that ‘Your Doses May Vary (YDMV)’ and that protein can cause some people’s blood glucose levels to spike and that is okay too. Therefore, many of us have our own protein ratios for insulin when eating such meals, but usually a much-reduced amount of insulin compared to that for carbohydrates.

Additionally, another food group that can affect blood glucose levels are fats. Although typically, fat does not have an instant effect on blood glucose levels as carbohydrates and sugar do, it can impact the amount of insulin that is needed. This is especially the case if a meal has a high-fat content and high calorie count. Similarly to protein, you will find many education courses will not teach you how to adjust your insulin doses for fats, because they have very little carbohydrate content. Unfortunately, widespread education on these food groups are often missed out or skimmed-over because of the fear of the unknown. Hence why I feel the need to share this blog with you.

A higher amount and/ or extended-bolus may be needed to counteract the insulin-resistant nature of high-fat foods- in other words, it may take a lot more insulin or more insulin over a number of hours in order to break-down/process the carbohydrates in high-fat foods.

This area was one that caught me out last week...

The graph above shows an evening where I ate 78g carbohydrates and where my blood glucose stayed in range. The following night I enjoyed an Indian at my local restaurant where I misjudged the effect the fat would have on my blood glucose levels, you can see this in the photo below.

Despite pre-bolusing 15 minutes before the meal and extending the insulin infusion over a number of hours (Combo Bolus/ Multi-Wave), my blood glucose levels rose substantially a number of hours after the meal, despite injecting for slightly more carbohydrates than I actually ate.

The meals on both evenings had a similar carbohydrate content and the only difference is that there was little protein or fat in the first meal when in contrast with my Indian treat the following night.

Retrospectively, for a meal high in calories, carbohydrates and fats, I actually needed an extended-Bolus over 7-9 hours rather than just the 2 ½ hours that I chose.

Please do not take this as a warning to avoid foods with high-fat or calorie content, but rather to plan for these meals and to be aware before the meal of the differing impacts that they can have on your blood glucose levels. This gives us even greater control over our food choices and subsequent blood glucose levels that will inevitably follow.

This means you can enjoy the flexibility of being able to adjust your insulin-intake to your chosen meal and whether you want to eat a large amount of carbohydrates or very little with ease and depending on how your mood takes you!

This post is all based on my experiences since I have started carb-counting and have noted the impact of different food and drink. Of course I would, as always state that ‘Your Doses May Vary (YDMV)’ and that you should seek the help of your Health Care Professional if you have any medical or dosing questions.

Thank you for joining me in my Type 1 Adventures in 2016.

I'd like to wish you all a wonderful and blessed Christmas and New Year!

Until next time, keep injecting 💉 or pumping 📟 insulin!
Ros x