Carb Counting Insight

I’d like to know people’s views on carb counting. I feel that CC has helped maintain a better A1C, and I started CC within my first year of being diagnosed with T1D at age 23.

Honestly, I don’t know what the alternative to carb counting is- now that I’ve been doing it for roughly 99% of my diabetic life. It can be a minor issue when I eat out at restaurants (I usually end up high) but this happens more often at night than compared to the afternoon.

So- here are some questions to consider for people interested in this topic.
Do you carb count?
How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?
Has carb counting improved your A1C or reduced your overall highs?
Does your Endo / CDE understand carb counting more / less than you do?
What are some challenges that arise when you carb count?
Feel free to add your own considerations!

And the final question I want everyone to answer (please!)
How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included?

Do you carb count?

Yes. I have the nutritional data on all the standard meals I eat at home. I dose my insulin not only based on carbs but I also dose for 50% of my protein grams and 10% of my fat grams.

How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?

I use a digital food scale and Calorie King to quantify what I eat. My most common few dozen meals I store in a spreadsheet format to calculate my meal dose. For every meal I deliver an immediate bolus to cover the carb content and then an extended bolus to cover the protein and fat.

Has carb counting improved your A1C or reduced your overall highs?

Yes. But I give more credit to carb limiting than I do to carb counting. I only eat about 50 grams of carbs per day. If I ate 200 grams of carbs per day, even if I meticulously counted and dosed for them, my A1c, and more importantly, my BG variability would increase.

Does your Endo / CDE understand carb counting more / less than you do?

I assume my endo knows the basics of carb counting. I’m certain she does not appreciate a low carb high fat way of eating and how dominating a factor it is with my BG control. She certainly does not have a handle on dosing for protein or fat.

What are some challenges that arise when you carb count?
Feel free to add your own considerations!

I can’t or don’t want to weigh restaurant portions so I do like everyone else and just guess. I have some standard restaurant meals that I’ve learned to dose for using trial and error. I also know that even the perfect carb count will not stop variability of insulin absorption, variability of food absorption, the relative insulin sensitivity/resistance of my body, and the variability of how recent exercise has on my blood glucose. The whole concept behind carb counting being a way to nail down a perfect dose is flawed. We live with BG variability every day. We must be capable of responding, in the moment, to our trending blood glucose. Diabetes is not a static disease governed by static formulas. It is a dynamic disease and we must roll with the punches.

And the final question I want everyone to answer (please!)
How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included?

Reading nutritional labels (which can be and often are incorrect) helps get me into the right neighborhood insulin dose. If this data were not available, I would do the trial and error test and develop my own dosing, much as I have already done.

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Do you carb count?

I did count carbs most of the time my first year on insulin and to some extent during the previous 1.5 years my doctor was treating me as a type 2 on oral meds. But I’ve gradually dropped most of the carb counting and wing it at home or estimate on the rare occasions we eat out. Just as I used to maintain close to the same weight for years at a time without ever counting calories, I’ve learned to limit my meals to the amount of food I can have with seven or eight units of bolus insulin without actually counting most of the time. (Occasionally I have reason to change from 7 or 8 units, but not very often.)

I don’t think I do too badly for winging it so often. My bedtime readings three or four hours after dinner bolus the past eight days were 100, 142, 106, 100, 83, 79, 108 and 87 without needing to treat any evening lows and only for that 142 did I need to give a correction bolus before bed.
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How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?

I have a kitchen scale I used extensively when I was learning. Now I use it on those occasions I eat rice, as I limit myself to 2.5 ounces, and I weigh my bread because I bake my own and the slices can vary a lot in weight and I really have to limit my carbs at breakfast. I also weigh my occasional Chinese take out foods, as I know from past experience that I have to make one order go for three meals on my “carb allowance” or I’ll go higher than I like.

Has carb counting improved your A1C or reduced your overall highs?

I’ve had an A1c between 5.5 and 5.9 each time since I’ve been on insulin. My lowest one was the most recent, when I was winging it most of the time. But I’m sure I wouldn’t be doing so well if I hadn’t gone though the dedicated carb counting months. To avoid highs, I typically super-bolus before a meal, then save some of the carbs for a snack an hour or two later. That’s the only way I can get away with consuming 120-150 and occasionally up to 170 carbs daily without having my BG reach into the 200s. I do have a fair amount of lows, mostly when I lose track of time and don’t get my snack on time. (I have postprandial hypotension and am supposed to eat five or six times a day, but I don’t want to have to bolus each time. Thus the super-bolus before the main meals.)

Does your Endo / CDE understand carb counting more / less than you do?

Well, he told me to carb count when he first put me on insulin, so I assume he knows it well.

What are some challenges that arise when you carb count?

My partner and I are “creative cooks.” By that I mean that we don’t follow specific recipes. One homemade chicken vegetable soup might have three times the carbs of another one, depending upon what we decide to throw in it. Much of our cooking is that way, so it is difficult to look up how many carbs are in the dishes we make. There are a few special recipes I make that I took the time to run the calculations of all the ingredients with the associated carbs and how much that would be per serving. But for most of our cooking that just isn’t practical.

How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included

I rarely use the printed nutritional information because we cook from mostly fresh produce, meats, eggs, etc. I used the numbers on the FitDay website for most such foods when I was keeping careful track of everything I ate. I totally ignore dietary fiber in my calculations.

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First thing’s first:

Like @Uff_Da, I spent years learning how to estimate calories and other macro-nutrient content of foods in order to lose weight and maintain my weight over an extended period of time. In addition, I follow some strict dietary restrictions (religious), so I have a long-standing habit of knowing exactly the contents of the foods I eat, at least in general terms, if not proportions. As a result of that, I had a pretty good idea what I was eating before diabetes ever came into my life.

Do you carb count?

Yes, in the sense that I calculate my insulin doses primarily based on the carbs that I eat. I am still fairly new to diabetes and insulin, so unlike @Terry4, I have not yet developed a good estimate regarding the effect of proteins and fats – I do not deduct anything for fiber, which perhaps has given me a good 'fudge factor" to accommodate my limitations here. It’s a learning process that will take time.

How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?

First, I habitually read food nutrition labels. Second, I bought two scales - ones to take with me, one for home. That’s as far as I’ve gotten with that. Good intentions for exact measurements, but just as I was never able to develop a habit if weighing and measuring food when my main concern was “calories,” I have not been able to do so now. Still, I was successful at gauging my food then via estimation, and have been fairly successful much of the time now. Like @Terry4, I generally limit my total carbs most of the time to what I think is reasonable for me, which makes the task a bit easier.

Has carb counting improved your A1C or reduced your overall highs?

Since focusing on carbs for insulin dosing (call it carb counting :smile:), I have kept my A1c between 4.9 and 5.6. That seems like success. I still have a way to go in figuring out how to handle some significantly larger meals (especially holidays!), however, but I haven’t given up hope there yet.

Does your Endo / CDE understand carb counting more / less than you do?

I honestly haven’t discussed carb counting too much with my endo; however, I know that he knows that I am taking this approach, and he supports it. I believe that he understands carb counting, and recommends it for patients that can manage it, in his opinion. He certainly understands the impact of fat and protein on BG and the challenges involved there.

What are some challenges that arise when you carb count?

As I indicated above - I have not yet mastered managing larger meals. Restaurants pose similar challenges, especially food that have any kind of sauces involved, as they are hard to estimate. Like @Terry4, I have some meals that I have learned to manage better thru trial and error. In the end, I have to watch and adjust when things go other than expected or desired. Perhaps to my detriment, I am a believer in adjusting diabetes management to my lifestyle, rather than the other way around. Not that I plan on living an otherwise “unhealthy” lifestyle – I have long ago made adjustments in that direction – but I do have certain preferences that I hope to maintain (in reasonable moderation, of course). The trick is to find the right balance.

How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included?

Years of experience help make estimates fairly good, with or without the nutrition labels. And, as @Terry4 said, labels themselves are frequently wrong or misleading. (A particular brand of pita bread comes to mind - label says 1 pita = 17g carbs – but experience says it’s more like 60g! At least the front of the package is right - it is a PITA! :wink:) In the end, I expect to make mistakes when encountering new foods and hope that thru trial and error, those mistakes become fewer over time.

Do you carb count?
No. I don’t carb count. I swag it most of the time.
However, I do eat very low carb nearly all the time (mostly avoid grains, potatoes, sweets). And I know by now (after 7 years), roughly how much insulin I need for what foods. Further, if I’ve eating something unusual, I will test more frequently and do corrections as need be. I am also pretty good at doing this correctly.

How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?
Just avoid starchy carbs and sugars. If one can’t estimate how much and proper dosing, then test frequently enough to catch any highs or lows. Don’t go to bed with significant fast acting insulin on board, ever.

Has carb counting improved your A1C or reduced your overall highs?
Nope. Because I don’t consciously do it. However, my Hba1c has been consistently around 5 (highest 5.6, lowest 4.9), so I think I’ve got my own unique way of managing this down to a pretty fine art. I use about 40 - 50 units of insulin a day on an average low carb day (with about 40 units of this being long acting), though my doses do change based on time of the month.

Does your Endo / CDE understand carb counting more / less than you do?
My Dr has no idea how I do what I do, and is only mildly curious. But he is glad it works for me.

What are some challenges that arise when you carb count?
Unknown foods and eating out when one can’t choose what to eat, are the biggest issues. In these cases. Swag it to my best ability, and check frequently enough to catch highs or lows.

Feel free to add your own considerations!
Managing diabetes is an art and a science. We have to be our own experiment. For me the most important parameter is to be able to test frequently enough to get feedback about what is or isn’t happening.

How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included?
I think it is useful for some. I don’t look at that. I more look at preservatives and total carbs if I am buying packaged foods. That said, I rarely eat packaged foods, nuts are an exception.

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Do you carb count?
Yes. I also count 50% of protein grams as though they were carbs.

How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?
I eat many of the same meals, for which I already know the insulin dose.
I eat very little pre-packaged food.
When I eat out, I always have a salad. My ham radio group like a particular local diner, and they have a marvelous Greek salad which I’ve eaten enough that the insulin dose is very well tuned.
When making a new recipe I use a kitchen scale set to grams.

Has carb counting improved your A1C or reduced your overall highs?
Yes. When first diagnosed, I was put on the standard ‘heart healthy’ diet. This endo treats all new diabetics as though they’ve had a heart attack because coronary issues are so prevalent with diabetics. After 3 months my A1c was in the 8s. After a conversation with my pump-wearing veterinarian, I switched to a low carb diet. A1c now hovers in the high 5s. A ‘high’ BG reading now would be 160.

Does your Endo / CDE understand carb counting more / less than you do?
The CDE did advise carb counting, but her advice was clearly for an audience which was trying to get a handle on portion sizes. So ‘a slice of bread is how many carbs?’ and ‘where can you see the carbs on this label?’ I understand her dilemma; many people have genuine issues with portion control; adding carb counting on top of that can seem like a lot of work.

That got long, quickly. Sorry. I bet my CDE has a perfect command of carb counting and I also bet she doesn’t get a lot of opportunity to show it.

What are some challenges that arise when you carb count?
New food. I have to tear a new recipe into pieces, weigh everything, and look it all up. Eating out, like the county fair and a sausage and pepper sandwich without the bread is a guess. How many grams of protein? How many grams of peppers? Does the mustard have sugar? If I get to eat the same meal multiple times, I will get better at matching the insulin to the meal.

How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included?
I eat very little prepackaged food. I tried a low carb tortilla the other day, because I’m trying to get a better handle on more diverse food. It advertises flax, oat bran and whole wheat flour and says 5 NET CARB HIGH PROTEIN in very large letters. The label on the back says 11g carbs, 6g dietary fibre, 1g sugar, 7g protein. The top 5 ingredients are water, wheat gluten, corn starch, flax, oat fibre. Hm, corn starch is the 3rd largest ingredient? I gave myself enough insulin as though I were eating for 15g of carbs, and ate one tortilla with 2 slices of American cheese and some butter. I should have dosed for 17g of carbs, but it was a pretty slow rise; not at all like a slice of bread.

So, between the carbs listed on the label and a peep at the ingredients, I came reasonably close for my first try. Without the label, I might have guessed at half the carbs and been quite off instead of a little off. But generally speaking I have to go through some trial and error with every new thing I eat, so it wouldn’t be a tragedy without the label; it would mean several more cycles of eat, wait, and test.

Bernstein’s idea of ‘smaller inputs, smaller errors’ makes so much sense to me, which is why I eat low carb. But thanks to this group, I’ve also read Ponder’s Sugar Surfing and I’m getting a new appreciation for actively taking control of my gluco-coaster (phrase cheekily stolen from @Terry4) so I’m not as… locked in to the same old food.

Do you carb count?

Yes. For my first 15 years of diabetes I didn’t, I used food exchanges and took two or three shots a day. My first attempt at carbohydrate counting was actually in 2005 when I was still on NPH, when I read about carbohydrate counting online or in a diabetes book. It didn’t work at all with NPH, of course, but shortly after that I asked my endocrinologist to switch to Lantus.

How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?

I weigh or measure everything I eat. I find accurate carbohydrate counting is vital. I’m really not good at estimating. I use Calorie King if I need to look something up. For lunches, I use little pieces of masking tape and write the carbohydrate count for each food on the container or bag so that I don’t need to think about it when lunch comes around. I almost never eat out due to multiple food allergies, but when I do eat out I try to order a salad (often, a modified salad is the only thing I can eat, anyway). Otherwise, I either eat at food or pack most of my own food when travelling for a day or even a week.

Has carb counting improved your A1C or reduced your overall highs?

When I first switched from NPH to Lantus (using carbohydrate counting), my A1c dropped from 8.3% to 7.1% within the first three months. But then it largely stayed around 7.0% - 7.5% for years while I was on Lantus and the pump. I think the biggest reason wasn’t the carbohydrate counting wasn’t working btu that after 15 years of a highly restricted diet I was suddenly told by a CDE that I could eat anything. Worst advice ever to give to a twentysomething who had never had a lot of the junk food out there—of course I ate anything I wanted now that I’d been given permission!

I got a Dexcom at the beginning of this year and with that I began limiting carbohydrates to about 40 grams per meal and also trying to keep meals low or medium on the glycemic index and making sure I pre-bolused for meals. That dropped my A1c from 7.2% to 6.1% within two months, and has kept my A1c around that level. So, for me, there’s more to good control than just carbohydrate counting, but carbohydrate counting is certainly better than food exchanges.

Does your Endo / CDE understand carb counting more / less than you do?

We’ve never really talked about it, but my endo has Type 1 himself, so I’m guessing he understands it just as much as I do.

What are some challenges that arise when you carb count?

I find pasta the hardest. I never know whether it should be dry or cooked when measuring. I also find that the carbohydrate counts on some things (pasta included) do not match up with what they actually do to my blood sugar. Some foods I need to bolus double for, others I only bolus half for. But, I tend to avoid foods like that, so don’t eat them very often.

How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included?

I don’t pay much attention to fibre, unless it’s a very high-fibre food, so I don’t think I would miss it all that much if it were gone.

Do you carb count?

Yes, and I count calories, protein, fat, fiber, etc…

How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)?

All and sometimes none of the above. I still use exchange measures. Guessing is sometimes done.

Has carb counting improved your A1C or reduced your overall highs?

No, these are managed by the diabetic not the carbs.

Does your Endo / CDE understand carb counting more / less than you do?

My doc people (no endo or cde) understand just the right amount.

What are some challenges that arise when you carb count? Feel free to add your own considerations!

Can’t think of any challenges.

And the final question I want everyone to answer (please!) How would you feel if essential nutritional information (particularly dietary fiber) for many products where not included?

I don’t have feelings about stuff like this. I would gather the information if it was necessary before I ate something but I would not be emotional about it. As said earlier, I still use the old exchange measure from time to time, and it still works. Fiber is super important, but so are protein, fat, and all off the essential vitamins and minerals.

Pasta is a 4-letter word! Almost never get it right… :confounded:

Early on, I carb counted precisely and obsessively. More and more as time went on, over a couple years, precise carb counting has pretty much been replaced by experience with “this worked well last time” or “last time in this situation I underestimated so I better take a bit more this time” but the foundation for that was in depth study of carb counting.

Then afrezza came along and honestly since I’ve gotten used to it, I don’t carb count at all if I’m using it. I’d say with I observe carb-limits per say, but make no attempt to precisely match carbs to units with it. I do however pay attention to whether there’s a lot of fat, and timing with it though.

Without the solid foundation of carb counting I built early on, which is the foundation of everything, I wouldn’t never have gotten to where I’m at now though… So yes it’s reduced my a1cs and highs. My healthcare folks are supportive of that plan and have been pretty impressed when I showed them my exhaustive notes I took for every single thing I ate for the first year +.

how does afrezza affect weight? i lost a big tummy on strict low carb. the past 3 years i have been a little less strict and the tummy has come back a little. if i ate higher carb, but with afrezza, would i gain weight? right now i am just on metformin.

Hard to say…

I lost a lot of weight with initial diagnosis, and had a hard time putting it back on to where I felt healthy.

With afrezza I’ve been able to pack a few pounds back on to what I feel is a more ideal weight for me.

I suspect that people who have to carefully watch their weight would still have to. though I don’t see any reason that taking afrezza means you need to eat a ton of carbs…

i might not eat a ton, but just regular healthy carbs with a few pizzas thrown in every now in then is what made me overweight in the first place.

Thinking back to the questions that I asked and some responses, I probably should say that I’ve done carb counting as well as carb limiting in the past, but for the most part, it was all with the foundation of carb counting.

Do you carb count?

Yes. I use nutritional data when I can (typically Google). I learned a very basic form of carb counting (net carbs), so this is the first time that I’ve heard of counting 50% of protein grams as part of a carb counting plan.

How do you make carb counting work in an efficient manner (use of scales, pre-planning food, etc)

I use digital scales first and foremost. I typically pre-measure my fruits into 15g or 20g carb servings and then pop them in the fridge. I use Google (now wondering if calorie king is better) to get the majority of my information. I tend to stay away from processed foods, but since I’ve moved to Japan, that has become a bit difficult.

What was on my mind when I was thinking about this question is this- how to carb count while also taking consideration to time management. I even went as far as buying 200ml cups (liquids in Japan is measured typically by 100ml or 200ml servings) when I need to quickly spot out carbs for my journal.

Has carb counting improved your A1C or reduced your overall highs

I started thinking the answer to this question was yes, but after reading karen57, I have to take consideration for her input. I know my numbers go off when I don’t do my routine walks. If I walked 25km less in one week, I’d see a major difference in my weekly average. At the same time, I feel like carb counting as helped lay a foundation (much in the same way that Sam said) to assist my management.

I probably see a more significant drop in my A1C and overall highs when I routinely exercise as well as when I keep a log.

Does your Endo / CDE understand carb counting more / less than you do

All the CDEs that I have met thus far, as well as my Endo, understand and encourage carb counting, as well as how to manage insulin management when exercising. I’d stop there but of course, I moved to Japan.

I’m having trouble finding an Endo (not sure if they have CDEs here) that understands carb counting, as well as other type 1 diabetics in Japan. I went to a clinic seminar in town last month and while I didn’t have much time to talk to the nurses at the seminar, but when I showed them my logs, they misread my ratios as the amount of insulin I take per meal.

What are some challenges that arise when you carb count? Feel free to add your own considerations!

The first actual challenge that I came up with carb counting for me was actually getting an accurate amount of carbs after cooking something such as zucchini. I’d fry the zucchini in olive oil and then measure it… wrong way to do it. Now I measure everything raw, and if it’s a large amount I do my best to get it as accurate as possible. Also, like Jen mentioned, pasta is a pain. I typically pre-measure my own pasta dry, boil it, and cook the rest of the pasta for my wife! Barley can be tough too, Cooking methods vary so much because of the amount of water it can absorb.

Time management can also be a problem, so I pre-plan and make the most of it.

How would you feel if essential nutritional information (particularly dietary fiber) for many products were not included?

This comes back to the fact that I’m living in Japan. Case in point, a while ago I bought a 12oz jar of peanut butter (no sugar added variety). Now, I know how much carbs are in peanut butter, so I don’t have to look at the label, but if I didn’t, I might end up assuming that there is no dietary fiber in peanut butter. Japan lists dietary fiber as “recommended information” for nutritional labels (out of three, compulsory, and optional). “Recommended” seems to get relegated to the same level as optional- it’s barely on any food label.

I also have to consider the fact that I speak English. I found a handful of websites in Japanese for nutritional information. I did a search for carrots on one of them and got a reading for carbs without fiber in a 100g serving. No information on net carbs.


So perhaps the overall consensus is that carb counting has helped, but it also has to start from the diabetic. I tend to feel that carb counting is just one tool in the toolbox. It’s probably just as important in my management to exercise and to keep records.

As far as my journey around Japan, I’ll have to get more information from the community here. I’m curious to see how diabetics in Japan tackle their condition.

Ohayo gozaimasu! As someone who counts protein this way, I would like to note that I got the general idea of considering protein as a BG influence from Dr Richard K Bernstein. The 50% number that I use was discovered by trial and error, and is more or less appropriate for my metabolism. I hope I didn’t come across as though this is an absolute rule which is appropriate for everyone, but if I did, I’d like to correct myself.

With respect to carb counts, I use a book called the NutriBase Complete Book of Food Counts because I like it better than most computer based resources I’ve tried. Personal preference. The United States Department of Agriculture have an interesting web site that has nutrition data: http://ndb.nal.usda.gov/

Yes this is something I haven’t heard of until today. The 50% protein. I have used CC since I’ve been a pumper. I’ve been doing it so long that I don’t usually weigh and measure every time save a two week refresher, once or twice a year. Is there any literature on the subject. I find it very interesting. I’ve been using an 8 to 1 ratio instead of ten to 1 because I feel like I have a little insulin resistance. I’ve even changed the brand of insulin I use in an attempt to fool the bodies defenses

I do this as part of a limited-carb diet. It’s my understanding that the body will convert some protein, about 50%, when it doesn’t have enough carbs for energy purposes. Carbs convert to glucose quite easily and it makes sense that the body will make the most efficient use of its resources and produce energy from carbs before it resorts to gluconeogenesis using the liver.

Yes, I carb count. I do it the old fashion way - reading labels. The improvement to my A1C has been great, along with reduced use of insulin. My PCP really doesn’t understand since he is stuck in the “a calorie is a calorie” mindset. I have free reign to adjust insulin or do just about anything I want, which is why I stay with my PCP instead of going to the local quack… errr I mean Endo. Having a cheat day has really helped stay with carb counting. If I go to the pool, toss around a kettlebell, or etc five days a week, then I get a day to eat whatever I want.

John

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