I need some help

Hi my name is Jen...I'm 28 and I have been Diabetic...for 13 years now... I know this may sound stupid to some of you but I don't know how to count carbs or how much to give at correction? I can't use this insulin pump because they still haven't sent out my infusion sets. I'm at a loss as to how to count carbs or how much of this novolog to take. My endo is mad at me because I haven't seen him in six months but I don't have insurance. He is also mad because I have gotten more tattoos....I work the front at a tattoo shop and my fiancee is a tattoo artist. I've worked here for awhile... and I've never had problems healing or anything...I keep the shop immaculate and sterile and of course the artists use brand new needles with EVERY client. Yet he still gives me crap about it everytime I would go who wants to go to an endo like that? Not to mention he's like a thousand years old so I guess that might have something to do with it. I'm really just asking how to count carbs? How do you know how much to take??? I take too much it's 30 I don't take enough it's over 600 and an ambulance is called. I cannot win.

Get a book called "Using Insulin" by John Walsh. I got a carb counting book from the ADA for the counting and techniques. In "Using Insulin" there are methods of determining what your I:C ratio and your Sensitivity Factor (for corrections). It will give you a place to start. There are lots of diabetic folks who have tats. You may be dealing with certain old fogey prejudices.

I got this book w/ my pump called "Calorie King" that has a pretty comprehensive list of food, both 'raw' and quite a bit of processed/ restaurant stuff all w/ notes about how many carbs are in it and how big a serving is? You should have a 'ratio' of carbs to insulin like 8-1/10-1/2-1, whatever so if you are 8-1 and eat 16G of carbs, whether it's 1/2 a donut or 1/2 an apple, you take 2 units of insulin? That's sort of the gist of it.

If your endork hasn't figured out a reasonable ratio (I think they guesstimate it by age and size, perhaps adjusted for their perception of your activity level...), I think that "Using Insulin" and "Think Like a Pancreas" both have the #s so you can guesstimate it yourself.

Once you do that, I would be lazy and get processed food w/ carbs printed on the box or weigh your food carefully (perhaps this sounds dorky but it works...) to get really precise measurements of what you are eating for a few days, see how the calculated number works and maybe adjust it a little bit, like 8-1 to 9-1 if 8 is too much insulin or 7-1 if it's not enough? I hope I'm getting the math right b/c I am totally lazy about stuff like that but if you can get it right, I suspect it will be much easier to deal with?

Re Endos, I have always picked the youngest and most seemingly foreign endo I can find, reasoning that they will be easier to book appointments at than the old guy who has gazillions of patients w/ complications and has to visit w/ them all. The ones I have seen have been brilliantly sharp at math, although one slashed her finger open playing around w/ a Silhouette infusion set needle but it was some comic relief when we were meeting to discuss the pump.

I just learned corrections recently and I've been a diabetic for almost 4 years now. SF pete comment is great. I read Using insulin as well and gotten more info from that book than my endo. My dr isn't happy about my tattoos either but at the end of the day, its your body.

qacidrock2 explained carb counting and giving insulin perfectly. I do a 1:10 ratio. So if i eat 34 grams of carbs total I give myself 3.4 units of insulin. I'm not on the pump yet so I only give myself 3 units of insulin. If I ate 35 grams of carbs but need to give myself 3.5 units, I give myself 4 units as again, the pens do not allow the point 4 or point 5. Once I am on the pump I can give myself the 3.4 or 3.5 units.

With carb counting, I read the labels and if it says 1/2c of soemthing is 15 grams of carbs but I plan to eat a cup, its 30 grams of carbs. If I go to mcdonalds for instance I plan on having a cheeseburger (34g) and a small soda (48g) thats 82 grams of carbs total. reading labels and keeping a log in a notebook of that item and the serving size and the amount of carbs has helped me a great deal in learning carb count.

I would start with the standard 1 unit of insulin for 15 grams of carbohydrates. If that's too much, go to 1 unit for 16 grams (or for a bigger change, 1 unit for 20 grams). If it's not enough, go to 1 unit for 14 grams (or for a bigger change, 1 unit for 10 grams). You get the idea. Make changes slowly. Test out new ratios for a day or two (unless they appear to be WAY off) before changing them. Use resources like calorieking.com for those foods which aren't labeled with nutrition facts. I find that getting the most accurate count of my carbohydrates requires me to use a kitchen scale. I got a nice one at Target for $20.

Oh and something I've been told (but don't always do - it depends on the food (I know my reactions to certain foods)) is that you can delete fiber from the total carbs if the fiber content is 5 grams or more per serving.

Hi Jen - There are a couple of good books that you should probably read to give you a basic idea about counting carbs and the basics of insulin use - "Think Like a Pancreas" by Gary Scheiner and "Using Insulin" by John Walsh. Since you're going to be starting on a pump, you could look at Walsh's "Pumping Insulin" as an alternative.

Counting carbohydrates is easy. You measure (or better yet) weigh your food and then calculate the total carbohydrates from the nutrition information on the package, a book like "Calorie King" or an online database. Salton has a scale that not only weighs the food but also provides nutrition information from a built in database.

To do anything with the information you need to have your basal insulin reasonably set. Does your blood sugar stay within a range of about plus or minus 30 points when you take your basal insulin (Lantus/Levemir) and skip a meal? If it doesn't then you need to work on your basal before you can figure out your carb ratio which would tell you how much insulin you require per gram of carbohydrate. Setting your basals is the first step in setting up a pump so you're going to have to do this as soon as the sets arrive anyway.

You shouldn't have to do a pump start by yourself. Does your endo have a CDE who can help you with the pump settings and ratios? The CDE could also look at your blood sugar logs and help you set a preliminary insulin/carb ratio. When I went on a pump a couple of years ago, I was already under pretty good control and while I probably could have done the pump start without help, having a CDE work with me made the process simpler and safer.

Good luck,