Carb Counting
First things first remember that the formula for this again is not going to be magic and work immediately you are going to have to put in a lot of work to figure this all out but once you do figure this out you will have far better flexibility in your diet and far better Blood Glucose control.
What you need (Ingredients for success)
- You need to first of all down load a carb counting app. I have tried a few and have found that MYFITNESSPAL is one of the better apps for Carb counting Android APP link APPLE APP LINK Here you can add a recipe, as well as add your food (there is plenty of South African brands)
- A scale I have a small electronic one but you can get a simple Weight Less type one as well. Don't worry I don't carry this around in my handbag on occasions that you have not weighted your food you get better at making an educated guess. It even has a name SWAG (Scientific Wild Ass Guess) counting. Use your weighting tools at home so that you will get better at SWAG counting.
- Plenty of Blood Glucose Test Strips (You are going to need a lot to start.)
- A calculator or a calculator APP ( it does not need to be fancy)
- Hand cream for the lancet attacked fingers. Hint Try and rotate your fingers used. This is my method I am left handed so Right is odd and Left is even (that helps me remember) On Monday you will look at the date if it is an Odd number I will be use my Right hand each day go through each finger and on Saturday and Sunday use you 2 favorite fingers. If Even I use the Left Hand.
Formula Time
Once you have all of the above you now need to work out your Insulin Carb Ratio there are 2 steps
- The usual calculation for insulin you require is your weight (KG) x 0.55 = total daily insulin.
E.G 70 kg x 0.55 = 40 units (Short and long acting insulin)
You can use this formula to check or add up what you are currently taking as your total daily insulin dose.
2. The next part I used a formula that is most often given out. Personally if it works first time for you , you are very lucky. It is called the 500 Rule - They are assuming that the amount of carbs you eat plus the amount of glycogen your liver secretes is equal to 500g not always the case but this is where you start.
- Add up all the insulin you take each day (or use the formula in step one to calculate this) (include both the short acting as well as the long acting insulin) Insulin before breakfast, lunch and Supper as well as your Long acting insulin at bedtime. EG 40 units total
- Do the sum 500 / 40 = 12.50 ( Round it off to 13)
- This means that for every 13g of carbohydrate you are going to need 1 unit of insulin.
This is what you will start with. Write this down so you don't forget this number.
The next step is very important . You need to work out your
insulin correction factor.
A formula again 100/TDI (40 units) = 2.5
so in our on going example 100/40 = 2.5 this means that 1 unit of insulin lowers your blood sugar by between 2 and 3. So if your blood sugar is 7.5 and you want it to be 5.5. (7.5-5.5 =2 therefore you need to take 1 unit of insulin to reduce your blood sugar by 2 mmol/l. NB This is used if your BS is high or low if it is low -(minus) the dose if it is high +(Plus) to the dose
To summarize
you now know that for e
very x grams of carbohydrate you eat you need 1 unit of insulin. You also know that if your blood sugar is not in a good range you need to take
1 unit of insulin to lower your blood glucose by X mmol/l.
(Word of warning this is where you start the process that comes next is to get it right. You need to make this testing phase your priority in the next week)
When you are ready you will need to use your MYFITNESSPAL app and your scale.Often you will be able to find the carb count per serving on the packaging you can use that but putting the info into the app first of all adds it up for you and you can copy previous meals to todays diary. Often you will eat the same thing for breakfast and you will soon know what insulin to take for this meal. Maybe you want to get a notepad to jot important information down. The beginning is tough but it gets easier and the rewards are great.
I am ready to count and experiment.
If you want to have a bowl of Bran Flakes you need to search for this on MYFITNESSPAL you can change the serving size and everything once you have found what you are looking for.
40g ALL Bran Flakes - 26g Carbs
0.5 Cup of 2 % Milk - 6g Carb
Total Carbs - for breakfast all added up is 33g
Now Mr Example guy thinks his Insulin Carb Ratio is 13g so he will do the sum 33/13 = 2.5 so he will inject 3 units of insulin.
You might be like me and see this and say hell no then drop or up the ratio straight away (say down 4 )in Mr Example guy's case he will then do 33/9 = 3.6 and take 4units
Before I did this I had been eating bran flakes for Breakfast as a diabetic for 30 years so I must have certainly known roughly what to inject.
I would certainly do the formula above but your first calculation try and stick to something you eat often and sort of know what dose works for it then you can say I usally inject 4 units for those all bran flakes so 33/8 = 4.125 so the new factor to try is 8.
You have now worked out the insulin to cover the carbs you are eating, now you need to test your BS if in range you will inject the amount you worked out above Mr Example Guy will inject 4 units.If he tests and his BS is 7.5 and he wants it to be 5.5. 7.5-5.5 = 2 x0.5= 1unit this will be added to the 4 units so he will take 5 units. If it is 3.5 and he wants it to be 5.5 (3.5-5.5=2x0.5 = -1 unit - reduce your insulin by 1 unit.
TOTAL CALCULATION
CARBS /insulin carb ratio = units insulin to cover carbs (33/9=4)
BS reading - required BS = BS variance x 1/mmmol/l 1 unit insulin reduces by (7.5-5.5 x 1/2(0.5)=1)
Carb calculation = 4 + correction dose 1 (if high) - correction dose (if low)= 5 units
Now you will have to
test 2 hours after each meal to check if the ratio is correct if you are
high you will have to
lower the ratio so If Mr Example tests 2 hours later and it is high next time he should try lowering the ratio so if the 9 factor did not work he would next time use 8.
33/8=4 that works out the same so make it 7 33/7=5. If
you are low you need to
increase the ratio 33/10 = 3 try 10.
Eventually you will get it correct.
To complicate matters even more you might have different ratios for different times of the day. You will find that there is sometimes a certain time in the day when your hormones and your liver decide to dump a load of glycogen for a lot of people it is in the morning (see articles on the dawn phenomenon) so the ratio will need to be lower in the morning than at lunch time and night time. Remember also that exercise can change this and if you are going to exercise you need to reduce your insulin or eat more carbs (that you don't inject for.)
These sheets might help you:
My Formulas
3 Day Glucose Log Sheet
Remember these 12 points.
1. Starting is the
hardest part.
It's getting past that initial 'I can't do it,The first days and weeks
are the hardest. Anyone can change.
2. Know what you're
counting.
Count total carbohydrate grams not only the sugars.
3. Your meter is
your best friend.
"The only way you can really know what your blood sugar is doing is
if you have a reading. Checking before a meal and about two hours after the
first bite shows you how what you eat affects your blood glucose.
4. Try an app.
Use an app like MyFitnessPal for carb counting and reviewing data in
chart form. "It is probably the most valuable free thing that any person
with diabetes can possess.
5. Read the
nutrition information.
"Look at labels to check out the carbs, the calories, and the fiber
content," says Walker. Other nutrition facts you might want to consider:
total and saturated fat grams and sodium.
6. Some things are
out of your control.
You can eat the same meal at two different times, and your blood sugar
might be different each time.
7. Plan ahead.
"When we go out to eat at a regular restaurant, you kind of have an
idea of what you are going to order,You can then use the app to determine carb
amounts
8. To fine-tune mealtime insulin, check after you eat.
Finishing a meal isn't when dealing with a meal ends," Checking
before you eat and two hours after the first bite of food can tell you how well
you "matched" your insulin dose to the meal, so you can adjust in the
future as needed.
9. Go easy on
yourself.
Don't punish yourself if your sugars aren't perfect
10. Your carb needs
may change.
Additional exercise or the desire to lose weight may require a change in
your eating plan. "Your diabetes changes over time, so you have to
continually change your diet
11. Learn from your
mistakes.
Don't waste time beating yourself up over mistakes "The more time you
spend tearing yourself down, the less time you spend learning from it."
12. You'll get the
hang of it.
"If you do it long enough, it becomes habit,It's like breathing. It
becomes second nature.
Happy CarbCounting
Kim
