Doctors, carb counting etc

Ive just been to my endo for the first time since my discharge from hospital following diagnosis. She was not pleased that im counting carbs and adjusting insulin dose accordingly. She told me that I should have a basis bolus amount, eat the same number of carb portions at each meal and only adjust the dose when im say above or below 80. Basically, she things that day to day variations in cab quantity and insulin bolus dose is a bad idea. I was feeling quite confident about the whole thing and now i just dont know. My numbers were good, almost all between 60-140.
Secondly she told me i was testing my blood sugar too often, for the past week ive been doing 10 a day. They thought it was crazy.
Im confused as to wheter its best to keep ‘doing my own thing’ or listen religiously to the doc…maybe somewhere inbetween…
Do you change your carb each day or do you stick to a set routine, say 5 at breakfast, 5 lunch, 5 dinner?
Oh confusion!

Eva :slight_smile:

I think you’re better off finding a new doctor.

Hi and welcome to the world of diabetes! You are very smart questioning this "END"o. I would hope that you live in an area where you can get to a teaching hospital and get into diabetes education classes. How did you figure out to count carbs? Did the dietician at the hospital come and show you how or did you speak with a CDE. Why are they questioning 10X testing? Sounds like old timer with no clue about diabetes. Hey, one more thing…don’t use alcohol swabs to clean your fingers or injection sites unless you can’t get to a restroom where there is soap and water. The alcohol dries out your skin and can help calluses form on your fingers. I use Dove soap for showering before a pump change. I use regular hand soap and warm water for finger sticks. My Physican’s Assistant can’t believe that I have been testing 4-10 times a day for 25 years because my fingers are very soft and have no calluses on them. Also, use the sides of your fingers. It will hurt much less. Can you feel the big hugs being sent by all of us???

This doctor’s objections don’t even make sense. What harm can there be in varying carb intake and bolus? What possible harm can there be in testing, especially early in your diagnosis when you need more information. The only basis I can think of for this endo’s objections is that she doesn’t trust your ability to monitor your own diabetes and/or feels threatened by people who do so! Work on developing an Insulin:Carb ratio which may differ for your three meals (start at 1:15 and work up or down till you see what works) and test, test, test. What you get is a ratio that helps you determine dose; it is not random, you are not guessing. You are the one who knows your body and who tests your response to certain foods. If it is not broken, don’t fix it! (And either smile politely and tell your doctor this or find a new doctor who will be a supportive and helpful part of your team.)

Find a new doctor! Educate yourself. You should be able to vary your carbs. to what YOU want to eat and bolus the amount of insulin that works for YOU.
Again, find the right doctor for you.


Hi Eva, I have been advised this as well. Your doctor is right ONLY under one condition: if a person does not understand their diabetes and how insulin works in their body. The doctor’s advise assumes that the patient is uneducated and does not want to or cannot learn…

I know that endos think that we are incapable of counting correctly. My endo also thinks that I should eat the same amount everyday and only test 5 times a day. I just stopped writing down my carb intake for him. I just show him my blood sugar readings, which are good (much better than his other patients) and he says to “keep doing what I’m doing”.

So he doesn’t know it, but he agrees that carb counting is better!

I have a good friend that follows this doctors advice and does not count carbs. His control is not horrible (you can have good control like that), but we have about the same level of control and I live a much more flexible lifestyle. But I do have to check my blood sugar more often to make sure that I gave the right amount of insulin.

Wow, Eva, I also hope you are finding a new Endo. This method of treating your diabetes is very “old school” and I honestly had no idea docs were still telling patients to deal with their D this way! Not that its wrong for everyone - some people like doing it this way and have wonderful control but its definitely not the norm from what I know - especially with the rising number of insulin pumpers!

Re testing - I test at LEAST 8 times per day! AT LEAST! I am a strong believer in testing as much as necessary to have adequate BG control…some people can get away with less and more power to them! I cannot :slight_smile:

As for eating - one of the great things about carb coutning is being able to eat when you want and how much you want. I remember the days of fixed exchanges - ugh, even when I didn’t feel like eating I had to eat something to cover the insulin I HAD to take. It was so frustrating!

I do hope that you can find a doc that is more aware of the current treatment option and one that will work with you - if you are comfortable it makes no sense to hold you back or limit your life in that way!

I change my carb each day and each meal, but I keep to a number total grams that I won’t exceed, since I know exceeding it would raise my one-hour test above 140. I have increased protein at each meal in order to lower my carbs and get greater satiety…
My guess is your doctor was trying to establish for HERSELF a bolus number, a units of insulin per grams number and was a bit thwarted. Smile. You can tell her next time what it is.
I test up to 10x a day what with activity changes and driving.
I agree with everyone who says to find a young endo, an endo with diabetes, or someone who’s really specialized so he can keep up with diabetes research changes. If you can’t find the perfect endo, it’s ok. You, yourself, are going to be responsible for reading and doing the job. GOOD JOB!

I do not think that you are the one that is confused it is your doctor. I would find myself another doctor and fast. You can not eat the exact same thing everyday for the rest of your life.

Good grief.

“Do you change your carb each day or do you stick to a set routine, say 5 at breakfast, 5 lunch, 5 dinner?”

I count carbs, and eat what I want, when I want, as much or as little as I want. So I test and bolus insulin accordingly. My A1C1’s are always in the low 6’s, which IMO is excellent for a type 1 diabetic.

I should have added to this:
She was trying to establish in her records what she needed to have in case you happen to land in the hospital unable to talk (due to accident or surgery). e.g., at the top of each visit’s notations are: daily basal dose, daily bolus each meal. After greeting my doc, for example, I tell him “Lantus, split, 7 am=7u; 10 pm =2u.” “Humalog, 1u to 10 gms”.
They want as close to what I use daily to be on the records in case they’re the ones stabilizing me or I’m in another hospital being stabilized, and they get phoned. Let’s say for some reason I can’t tell my caregivers at that time. The doc can adjust 5% dextrose in an IV or whatever he uses to give that proportion until I’m eating/choosing my food.
I also have this on a “Diabetic Management” note along with the doc’s phone/fax in my purse in case I land in a far away hospital, since I’m traveling quite a bit.
It is not a BAD thing for her to suggest the same carb numbers for each meal/time of day. She’s trying to figure out if you’re having regular resistance at a certain part of day, and that is one way to do it. If at breakfast you take 30 grams and you need 6 units to stay in your target but at supper you take 30 grams and you only need 3 units, it tells her there’s a bit of resistance - or something else - going on at breakfast or morning. Best wishes.

I’m wondering if that endo wanted you to do that because you are newly diagnosed and didn’t want you thinking that you can eat absolutely anything and make up for it with insulin. Most of the doctors I’ve been to have treated me like an idiot up until I made them realize I’m not. It’s seems to be a very common problem with that profession. I guess I can understand it though, since it’s their job to educate people on a daily basis which can lead to a natural way of thinking that they simply know more about everything than everyone else.
How old was your endo? I’ve found that the older ones seem to be bored with explaining the same things over and over again so they simply tell you what to do but not why to do it. Remember the old saying: "Get a young doctor and an old lawyer."
As far as the testing goes, however, I would tend to agree with the endo to a certain extent. Obviously it’s your body and your health, so it’s your choice, but if you are testing 10 or times a day and finding your numbers pretty consistent then I’d say that unless you still want to you don’t have to test that often. I wouldn’t say that it’s “crazy” to test that often.
So to conclude, I’d agree with your endo (if that’s what she meant) that until you become more comfortable and knowledgeable with diabetes you should stick to a strict diet (it won’t be for long). Carb counting is very important, but it can also be very tricky at first and the last you need is more confusion while you’re still trying to adjust to everything else.

I’d still look for a new endo though.

And this is why I think , that a CDE ( Certified Diabetes Educator) Dietitian is part of one’s Health Team ; this person should know the ins and outs of carb counting and coach you .Can you ask Endo for a referral ? Endo may feel better, if she knows , you saw a health professional ?. I actually do eat simelar breakfast , day in day out …my fruit may change . And then there is the time you will eat at a restuarant or ( ?) … we need to be educated how to deal with those situations .Good luck !