Carb counting vs. meal size

After one year of living with my three year olds type 1 diabetes, I feel I have become quite familiar with determining insulin, ratios and all that jazz. That is why when my dad was diagnosed last week, I was completely thrown for a loop when his doc told him counting carbs was useless, the “small meal, large meal” method would yield the same if not better results…
I cannot fathom how this would be accurate, any thoughts or experience behind this? And to be clear, his diagnosis is Type 1…

Wow, your father was just diagnosed with type 1 as well?? Very interesting....

Anyway, was this doctor to whom he was speaking an endocrinologist or a general practitioner? Either way, I think he should seek out a new doc. With regard to type 1 diabetes, I've never heard about the "small meal, large meal" method. Seems way too subjective IMO.

Is he on insulin?

40u lantus, scale for novolog based on bg and meal size…

Ridiculous. There are so many docs out there that don't know what they are talking about. I was diagnosed in 1966 and even then we used "exchanges" which is actually similar to carb counting (1 bread exchange was 15g of carb). I would find another doc if you Dad wants to get good control.


Hi, how old is your Dad? How old is the MD? Some older practitioners treat insulin in older people using older methods. They forget their older patients are living longer.
Encourage your Dad to get on tudiabetes and read.
Encourage him to get to a specialist, an ENDO with a TEAM.
And if, God forbid, he gets with a TEAM that gives him high carbs, encourage him to change ENDOs.
Second opinions are good.
Everyone can self-refer to a specialist.

Never heard of the meal size method. I don't know how you would determine insulin requirements simply by the size of the meal.Regardless of what the Dr. says your dad will have to find his own best way to control BG and get the nutrition he needs.Why he was told carb counting is pointless is a real head scratcher. Being T1 and diagnosed at 55 years old myself, I find carb counting very easy and predictable. I agree with Busted, seems a different Dr. is in order. Encourage your dad to study for himself. Relying on anyone else (including your medical team) to be the sole director of your D care is selling yourself way short. This site and Bloodsugar 101 are great learning resources as I'm sure you know. I wish him the best.. Encourage him to check out TuD to find answers to his questions and probably questions he never thought of.

The most important thing is what happens to BG after the meal, and carbs are the key 'ingredient' that controls the BG rise.
Is he getting 'normal' BGs most of the day ?

Also wonder if your Dad might still be producing some insulin of his own, as many 'adult-onset' type 1's do for a while. So if his pancreas is still making insulin his body can deal with some food that is not 'counted'. And if he is still making insulin, many believe that reducing carbs helps preserve the working beta cells as long as possible. There's a blood test the doctor can do to determine if he is still making insulin.

You said " scale for novolog based on bg and meal size"

What does he use to 'quantify' the meal size for the bolus / novolog ? Calories ?

I guess I'm a little confused. Were you with you dad at the Dr's office? Did you hear the Dr use the terms "small meal, large meal" and state that carb counting is useless. If so - I agree 100 % with the others and would be shopping around for a new dr.

However, if this is what your dad is relaying from his appt with his dr, you may want to dig further. I sure remember getting things mixed up when I was first dx'd. Perhaps it is just a case needing further education/clarification. Maybe the dr's not as wacky as this first reads?

But in general, this is a pretty crazy statement! And it certainly warrants follow-up, IMHO. Keep us posted; I am curious to know how it will turn out. Good luck!

Sorry about the late response- yes, I was at the Doctor with him, and straight from his mouth heard him state that his "small meal/ normal meal" system will yield the same, if not better results- that the carb counting method was useless- as different foods with same carb values would have different results based on glycemic values.

I did learn after the fact there is a little more that goes into the small meal/ normal meal preparation, as it should contain a fist size portion of each food group (which my dad failed to mention when informing me of how his insulin was done). I guess it makes it better, but still leaves a lot to be desired as far as I'm concerned.

my dad just celebrated his 60th birthday. The doctor is likely the same age. Out of curiosity, I looked up the Dr.'s credentials, and he is actually a Nephrologist (which makes sense why my dad sees him as he had a kidney transplant 10 years ago). I am pretty confused by this, as he sees most of our cities adult diabetics...

Surprisingly though, Dads numbers have been relatively good... STRANGE!

The ONLY time I eat a fist sized portion of ANY carb is when I have popcorn (about 15 carbs in a 1 1/2 cup serving). He's right about the varied affect of different carbs, but how does that change with his system? It all boils down to handling the conversion of food to glucose. Counting carbs AND understanding how they differ is the most direct and accurate. This portion size method sounds more like SWAG to me.

Sorry about the late response-I did learn after the fact there is a little more that goes into the small meal/ normal meal preparation, as it should contain a fist size portion of each food group (which my dad failed to mention when informing me of how his insulin was done). The doctor must have assumed I knew this when I questioned his statement about carb counting.
His method for dosing is a chart based on his BG level- if he is between ___ and ___ give _x_ units for a small meal, __y_ units for a normal meal. Seriously- that's it.

yeah, the worst part is convincing my hardheaded dad that it makes no sense- despite everything I have been telling him, he still is following dr's orders!
They started him on 40u lantus which my my calculations he should have been on 34-36 at most. Did not find out till about a week later that he was having to get up multiple times during the night and snack to keep his bg from bottoming out! And he didnt even bother telling the doctor, I had to mention it so that the doctor would give his blessing and re-affirm what I had already told him- that the dose was too high.

I love my dad, but I already have one child to care for with type 1- I dont have the energy to battle him too!

It is a similar idea to what I was told on diagnosis as a T2. Small meals are a good idea, but very little guidance as to what they should contain, you could have a small meal of meat pie, mashed potato and mashed pumpkin or a small meal of grilled fish and salad - big difference in bgs.

Fathers are created equal, all over the world ;-)
You have to work with his doctor, you can tell your father nothing to change his mind. You are only his little daughter ;-)

Time for a new doc! I see a lot of patients whose doc has told them that they NEED to eat 60-8- gr of carbs per meal. It's nearly impossible to control blood sugars with numbers this large. Even a very low carb meal can raise blood sugar levels if you eat too much of it, due to how the body responds to the mass of food entering that digestive system. So, carb counting is really the only method that works well, but portion size is also important. Dr Bernstein's book The Diabetes Solution discusses this and helped me to figure out why my blood sugars would go up for no apparent reason!

there are many children who indeed eat 60+ carbs per meal who need those carbs and calories and do quite well. anything can and does raise blood sugar, even proteins (no carbs), it's balancing the carbs with insulin.

Not only children. I eat 60-70 net carbs (backing out 100% of fiber) for breakfast and the next 4-6 hours are usually the flatest of my day. Some of us can manage more carbs - you don't know until you try.


yeah..and we're both rather thin. I''m trying to actually NOT do low carb. I find, actually, the more carbs I eat, usually at lunch, I have the best numbers and flatest time of day too. my endo told me i'd get better numbers, my body and insulin would work better if I ate more far, I've found this to be true. All this low carb stuff..nonsense..ha!