Relearning the Basics

You would think as a dietitian, I would know how to carb count. Well if you did think that, you’re right——I DO know how to count carbs.

When I’ve worked with diabetics in the past, granted mainly Type 2 diabetics, I’ve gone through basic carbohydrate counting. Actually when I first started, I’d teach perople how to count carbohydrate servings. What a freakin’ pain that was—-essentially it was 15g=1 serving of carbohydrate. As an example, you might “be allowed” to have 4-5 servings of carbohydrates a meal. It was called a consistent carbohydrate diet where you tried to prevent blood sugar spikes. For type 1’s, it makes SO much more sense to actually count the amount of carbs in grams and add up what you’re eating. Now granted my focus for education was with Type 2 diabetics, and the majority of them were taking oral medications and REALLY trying to stay off of insulin. As a type 1 diabetic, you really don’t have that luxury. So again, makes so much more sense to count the amount of grams at a meal and give the amount of insulin you need for that many carbs.

It’s all simple math then, right? I can add numbers up, so I got this. We will have the best controlled blood sugars ever. I thought this was true——until I actually had to start doing it with my own kid.

Now first comes in the whole figuring out your basal rates, and then the carb ratio at meals. And there are some basic guidelines to find starting points for this but honestly it’s also a trial and error. And oh yeah, you’re a kid so you have growth hormones to contend with, and since you’re growing you may have figured out all your insulin amounts but that didn’t stay true for more than a few months. My daughter takes fast acting insulin, which I’m guessing many other T1’s do too. How deceiving is that name? You’d think fast would be fast—-and not require a 15-20 minute pre bolus. Try telling your kid who comes home from school and immediately wants a snack that. It’s hard enough to get her to decide WHAT she actually wants for a snack. Apparently spending like $300 on groceries every week is a waste, cause it still means that (cue whiny voice) “there’s nothinnnnnnnnnnnnng to eatttttttttttttttt". So now I have to tell her to bolus for said snack, and if this wasn’t painful enough, we then wait 15 minutes before she can even touch it, while her siblings all inhale snacks like animals that haven’t been fed in days.

And prebolusing is always fun. You want to have insulin in the body to prevent the spikes in blood sugar. But again, kids. Kids who say they want to eat something, but then in those 15 minutes decide they want something completely different. Or nothing at all. Or double what you originally bolused for. You also need to consider where you’re getting those carbs from. Apparently cereal is the devil. So is pizza. I can’t figure those assholes out yet, but I continue to try. The math seriously doesn’t add up. So do you give all the insulin up front? Do you extend it out and deliver maybe half of it now, and half of it an hour from now? No one prepped me for this part.

But now the fun part. The part they REALLY don’t teach you in school, or at the hospital, or honestly much of anywhere so far that I’ve been able to come across. Remember that celiac diagnosis? Apparently gluten free carbs don’t act like their gluten containing friends. A gluten containing carb is all cute. It’s like hey I’m 45 grams, so I”ll act like that. Then the gluten free one is is like double or nothing, bitches.

THIS is what has caused me to go gray. THIS is what I feel like I should’ve picked up on way sooner than I actually did. And it’s the part that I’m really still struggling to figure out. I so want to be able to go by labels. I have a recipe for scones that I make her and she loves to have at breakfast. I’ve done the math. They have 45 carbs per scone. I weigh everything out, and know my portion size is spot on. So you’d think I would have her bolus 45g. Know what we ACTUALLY have to bolus? Freakin’ 80g. Almost double what you would think you should. THAT’S the scary part. But it’s also the necessary part. If I were to only to bolus for 45g, her blood sugar would be in the 300’s. And I know the carb ratio doesn’t need to be adjusted, because for carbohydrates that normally wouldn’t contain gluten, there’s no changing the amount that is on the label. It’s the gluten free stuff.

So I’m taking what I’ve learned about carb counting, keeping it in my back pocket but trying to remember that every body reacts differently. And relearning how to ACTUALLY count carbohydrates in a way that works for us.