Do you carb count or estimate your insulin dose based on previous experiences?
- Carb Count
- Estimate based on different factors or experiences
Do you carb count or estimate your insulin dose based on previous experiences?
I must confess we stop carb counting a long time ago, my son eats pretty much the same foods, and based on current bg, physical activity and previous experiences we estimate the dose.
It has been working wonderful for us, but our CDE was not happy about it.
I do count most meals but like everything with diabetes I guess sometimes. Most times I’m pretty close. Experience counts for many meals where I SWAG!
What she said!
I do the same, and haven’t seen a CDE since starting on pump 20 years ago. But my endo rolls his eyes when I told him that, and doesn’t ask anymore.
Provided your endo is not a diabetic himself, this would be a funny conversation…
Actually, the office I go to used to have a doctor that had T1D. He was not endo, but was primary care Dr for many T2 patients. He left a few years ago, but I think he really helped the endos at this office to better understand life with T1D.
Counting carbs isn’t super useful for me because I stick to a very low carb diet. It’s such a small part of my diet that things like protein end up being the things that affect my BG anyways. I’m also on Afrezza which means that my dose is set unless one dose wasn’t enough so calculating down to the gram isn’t useful because it won’t usually change my dose.
I eat a limited number of meals and know from experience how much insulin I need for them. I do have carb ratios programmed into my pump and use those ratios with initial meal boluses. Loop alters the meal bolus up or down based on many factors. I also depend on Loop with its subsequent high and low temporary basal rates to adjust what I need.
I think that doctors, nurses, or CDEs who roll their eyes when we report using our accumulated judgment to alter or decide how much insulin to take for a meal must really think dosing insulin is 100% determined by strict adherence to the formulas. Those of us who have carefully observed our insulin dosing and subsequent BGs know that the formula will only take you so far. You often need to also apply your experience and artfully finish what formulas started.
This combination of math and art that informs insulin dosing decisions reminds me of how a skilled jazz musician makes good music. They need to know all the rules so that they can skillfully break the rules using improvisation to produce a better outcome.
Medicos who don’t live with diabetes and roll their eyes at our attempts to live a better metabolic life are simply acknowledging their ignorance about how to dose insulin well.
Yes, what Terry said above!
The other part of the question might be, “When you do carb-count and bolus accordingly, does that work out perfectly, just the way it’s supposed to every time, or do you find yourself having to do corrections or treating a low anyway?”
Because for me the latter is the rule and the former is the rare exception. Like lots of others say, I’m mostly eating stuff I’ve had before and know from memory how much insulin I need. When carb counting mainly comes into the picture is when I’m eating something unfamiliar, which usually means a restaurant or a party where the exact portions and carb contents aren’t labeled, so I’m guessing anyway. Not to mention things like the Dread Pizza, where the number of carbs is only a (small) part of the story.
Carb counting is definitely better than the old exchange diet nonsense, but I think especially for medical professionals who don’t actually have the disease, it gives an erroneous impression that the whole business can be reduced to a formula that will reliably produce the correct results as long as you hew to it rigorously. The flip side of which is indoctrinating us with the idea that there’s a perfectly reliable, “scientific” way of managing artificial insulin dosing and only careless, thoughtless, Bad Diabetics ever get it wrong. All they need to do is plug in the correct numbers and everything will be perfect–problem solved!
ETA: as a musician, I have to say @Terry4’s rules + improvisation analogy captures it perfectly for me.
The two answers don’t necessarily operate in isolation, so it would be nice to have as a third option “Some blend of both.” I carb-count my meals because we rarely eat the same meal again. But for me the carb-count is just the starting point (like the suggested bolus from the bolus wizard). I then factor in the type of meal (carby? fatty? savory? sweet?), the type of carbs (slow or spiky?), the duration of the meal, the time of day of the meal, activity before, during and after the meal, the CGM trend, general stress/tiredness, and some good old intuition.
BTW, neither my endo nor my CDE roll their eyes at this approach. They both think it makes perfect sense.
Whenever I fill my Afrezza prescription and I tell the nurse at my doctor’s office that I need X boxes of the 4 unit cartridges and/or X boxes of the 8 unit cartridges, she always asks, “How much do you use for each meal?” I know that she’s only asking because the pharmacist requires it, but it varies so much from day to day that I really can’t answer that question.
Instead, we have to back into the prescription based on what my total usage was over the last 3 months. I’ve had a pharmacist get all flustered and tell me that I should be using the same amount at each meal and refuse to help me back into the amount that needs to be on the script to get the boxes I need. The prescriptions are much more complicated with Afrezza, and it can be a bit difficult to get the right combination of cartridges. Other pharmacists totally get it and are willing to help out.
I think this formulaic perception can affect us negatively in a bunch of different ways.
The best and simplest answer is just to say the max amount. That is how you can build a safety stash, and avoid the pointless conversations of why you don’t use the same amount every day.
Oh fertheluva… Where did that brilliant idea come from? Bad enough when non-specialist MDs (or even specialists) try to lay down rules like this out of sheer ignorance, but when a f’rcripesake pharmacist presumes to Know Better Than You Do about a disease you’ve been living with 24/7/365 for years… Grrrr.
I’m curious about how this works. How is he coming up with the dose? Are they just rounded numbers/units? This seems like wizardry to me.
Sort of! We have been doing sugar surfing for a while now, and we go by previous experiences.
This conversation is enlightening. I think if I read this years ago, I would have been very confused at the idea of non carb counting as that was how we were instructed, and early on with no experience, that’s the only tool we really had.
I can see that Caleb is doing what some of you describe - giving insulin based upon what he’s eating, but not necessarily a strict carb count and certainly inclusive of other factors.
What I find enlightening is the articulation of this method as a method. I shouldn’t because it’s what we’ve been doing for years, but I have viewed us as “carb counters” because that’s where it starts. It just doesn’t end there. There is so much more to it.
Hmm…my curiosity isn’t satisfied. Maybe this isn’t something you can be more specific about bc by it’s very nature it lacks specificity. Do you have a starting point? When Caleb was on injection therapy, his meals were 50 carbs and his dosing was based off of that. So is it something similar - emails are generally the same amount and you add or subtract based upon bg and activity and type of food?
And when you say sugar surfing, do you mean you are taking action multiple times throughout the day, not just at meal times, so the meal time dose because less important?
It’s a bit harder with Afrezza because of the cartridge combinations. With Humalog or Tresiba or any other insulin I’ve used, you can adjust the dose for each meal so a simple max per day works fine. With Afrezza, I want a certain combination of 4 unit cartridges and a certain combination of 8 unit cartridges. For awhile I was getting boxes that contained half of each, but I want fewer 8 unit cartridges now (3 boxes of 4s and 1 box of 8s). How do we write a script to do that?