Do you look at total carbs or only net carbs when you calculate insulin dose?

I was wondering if calculating total carbs is more important than net carbs.

I understand carb fiber as not digestable and does not metabolize like the rest of the carbohydrates. Therefore I subtract all carb fiber and just dose my insulin on net carbs.

Some people say to only subtract the carb fiber if it's over 5 grams. I don't know what the reasoning is with this. Giving more bolus insulin than actually needed will cause a later need to correct or even a change in basal rates which would further confuse the situation.

i had 150 grams of mixed berries with a total carb of 22.5g with a little heavy cream. i thought that amount of carb would be too much for me in one meal, but the carb as fiber was around 9 or 10 grams. so i figured eating this meal with a total carb count of about 13 grams of carbs wouldn't push up my blood sugar that much. but one hour later i went from a fasting of 105 to 140. i don't take medicine at this point as my A1c's have been under 5.7 since going low carb, and my last one in august 2014 was 5.5. i did a half hour of slow exercise biking and dropped it right down to 86. now i am wondering if i should just look at total carb, or maybe now even 13 grams of net carb at one time can push me up 35 points? any thoughts?

ps is it better for someone who doesn't take any medicine to try to keep their bg stable though carb counting, or does it make no difference if i get a high bg number (140-200)at the hour mark, but drop it down to 80's 90's with exercise? in other words, is it healthier to keep fluctuations to a minimum in the ranges i mentioned, or does it make no difference if you are back to normal at the 2 hour mark? again, this is in the context of no meds and no insulin. thanks.

here's a couple of discussions on this

thanks, marie! are there any threads on minimizing fluctuations in the parameters i mentioned?

I've rarely thought about glucose metabolism without adding insulin to counteract nutrition. So, I know that a healthy pancreas releases a first phase of stored insulin in response to rising blood sugar after eating. I then understand that a second phase is released over a longer duration to clean up what extra glucose is left over.

Your one-hour post-meal BG of 140 seems like your first phase response may be a bit tepid but not all that far off of a healthy metabolism. I, as a T1D, find this BG response respectable. You may prefer to compare your results to a non-impaired glucose metabolism. I can't cite the literature off the top of my head but there are graphs of BG response to measured glucose challenges. In general, a healthy metabolism deals with BG rises quickly, limits the BG peak, and returns to nominal 75-95 mg/dl within a few hours or more.

Your tactical use of post meal exercise is a great idea. I use moderate-paced walking in much the same way.

For the sake of your analysis, I would still recommend using net carbs. If you wanted to experiment, you cold try eating 100 grams of berries and compare results. I successfully used a 170 gram raspberry snack yesterday in response to a late afternoon low angle descent toward my hypo range.

Overall, I think your attention to your BG status while using carb counting is an excellent idea. I think you're heading off or greatly delaying bigger trouble. You are way ahead of the game when compared to the general population! I definitely recommend that you try to keep post meal BG surges to less than 140. The science is not conclusive about this at this time but I think keeping BGs under 140 will be better for you over time. I do know that staying under 140 will do you no harm.

As far as whether the 1-hour or 2-hour post-meal number matters more, I think keeping BGs under 140 for the entire post-meal BG-excursion is a worthy goal.

Always net carbs for me. I don’t consider fiber a carbohydrate at all, I think it is silly that fiber is counted in total carbohydrates in nutritional labels in the USA. I’m not sure why it is.

thanks for the ideas and encouragement, terry.

thanks sam.

i never subtract fiber. i mean unless I am eating sticks. Then I have to ask why am i eating sticks? Seriously I think it depends on your insulin to carb ratio. A dietician once advised I subtract half the fiber. i cna barley figure the total fiber let alone half, So the CDE thinned out my insulin to carb ratio a little and I just count total carbs and correct when necessary...............rick

I look at the carbs and subtract the fiber which is I believe the net carbs. It seems to work well for me. I don't do it with raw/cooked veggies usually.

It's great if you can keep surges under 140 using diet and exercise alone, but there is no scientific data yet that clearly states or even suggests that is where we start to get damage. I do feel not that great most of the time at or above 150, but at other times it seems more like a minor spike if it comes down quickly on its own and it has been shown people who have no diabetes do go even higher with a high carb meal. My father can eat 90 grams or more and end up at 90 bg 2 hours later, I'm not sure what his typical spike is though.

Once you're on insulin or other bg meds it is much more problematic to keep surges below that because it can cause lows, this is especially true if you have no natural insulin production left. I found trying to stay at 80-120 all of the time or 80-90 which I tried to do at first, to be too stressful and dangerous for me. I also think too much insulin in your system and continual addition for corrections etc. seems to cause physical stress for me, such as, hunger, palpitations and other physical manifestations.

meee, how about all the research jenny ruhl has collated?

what bg do you feel is dangerous if you are at that level for a prolonged time?

I have been stable for 5 years eating the same protein and carb portions for meals.

This avoids any issues with my injected insulin as all I need to do is inject basically the same amount each time.

Once calibrated I know how much 1 gram of carb will raise my BG (5 mg\dL) and what 1 unit of my fast acting (Novolog) insulin will lower me about 40 mg\dL.

So sticking to 6 g of carb at breakfast, and 12-12 grams for lunch and dinner I only need 4 units of fast acting and 7 units of long acting Levemir at bedtime. Then 1-2 u of fast acting on arsing along with 7 u of Levemir and I am good.

No roller coaster highs or lows and I have reversed the few complications that were developing.

Bottom line I do not follow the ADA guidelines that guarantees complications.

Current research indicates ALL BG values over 120 mg\dL contribute to complications.
Even for short times.

My goal is to maintain normal and healthy non-diabetic BG levels of 83-85 mg\dL.

Keep in mind a carb is a carb is a carb. There is no such thing as low carb grains, etc.
The Josselyn Diabetes manual has complexity new information for physicians.

Easy just do not eat fruits (ALL SUGAR) grains (all sugar) and most root vegetables and beans.

Hope that helps.

Huh? Fiber is listed on nutritional information as a subcategory of carbs, just subtract it, not rocket science. And half makes no sense, fiber is indigestible (that's the point). Since some foods have lots of fiber and others little or none, gaming it via a modified insulin to carb ratio is both crude and unnecessary. Sorry to be harsh, but this seems bizarre to me.

Hi vpre, you know I'm not sure really, but as I said I do feel worse at 150's and up for an extended period. I have read some of the articles at her site(not all), there only seems to be one study in pwd and non pwd who had spikes after carbs which suggested they both got some form of neuropathy from any brief spike at one hour above 140, maybe I haven't read enough of the articles. I'm not saying you shouldn't try to avoid those spikes, you have to decide what is best for you, but so far I haven't read anything that has fully convinced me, imo. On my dex my range is 80-140 and I try to stay in that range as much as possible. Sometimes I will correct if I see a spike starting but on insulin I'm much more cautious now because you can cause lows with overcorrections etc. I also can spike a lot from low carb high fat meals too, I sometimes have eaten a few nuts and gone from 70's to 150!

At the opposite end I often don't feel that great when I'm in the 80-90's either, I feel kind of weak and have blurry vision etc. I have a theory that for some pwd that range may be too low and we aren't getting enough nutrients or something like that, Again, this is just my personal theory due to my own experiences with this.

Another thing lately is I try really hard not to go up too quickly and or above 200 because after being on the pump and having 3 events or so where that happened, I felt soooo horrible, I could barely think and felt like I was going to have a stroke, seriously, and since I did have blood clots in dka, I am worried about that.

It took me awhile to normalize my BG, but it is well documented that people who have had elevated BG levels for long periods and try to lower into the normal non-diabetic and healthy range of 83-85 mg\dL may experience hypo symptoms. You need to slowly work your way down to levels that avoid complications.
Current research now suggests that the older 140 mg\dL level of complication onset is now 120 mg\dL and above contribute to kidney, nerve, and eye issues.

For me that was a no brainer to go low carb, reverse what I could and avoid the rest.
Also make life very easy always eating the same amount of protein and carbs per meal means my injected fast acting insulin is always the same so no hypos, no over shooting the mark and getting on the dang rollercoaster of highs and lows.

Hope that helps.

A1c 4.5, i see you are eating at bernstein levels. you have been successful, no doubt about it. can you tell me what kind of complications you were having and how long it took you to reverse them with bernstein level carb eating?

You may wish to join the "Dr. Bernstein Diabetes Solution Group." I'm glad you have had success, we all need to find our own way. The topic of low carb diets is a recurring theme here, but as even Bernstein ways "What works, works."

And as to the original question, Bernstein basically believes you should subtract all the fiber in order to get net carbs. However he cautions that due to errors and deception in nutrition labeling the fiber content is often systematically in error and overestimates fiber. Thus he modifies his advice by suggesting that you subtract half the fiber.