My questions my seems silly, but hey it is what it is...
Recently I went to a new Endo, after presenting my 7.1 A1c to her , she told me that its not good enough , that she is switching me from Regular to Humalog, which I gotta tell you at first really bothered me, but now after only two weeks of making this transition , on the verge of capitulating, I nailed it, peak times a little different, the big difference with this med , is the precise-ness that you match your instant release insulin with the amount of carbs you are ingesting over the next hour maybe hour and 1/2, with regular I had a three hour window; for me covered two meals.So no real sweat , just if you had a small breakfast , increase lunch intake or vice versa , so this brings me to the Jeopardy question in that is a Carb a Carb, so If I eat a Luigi's sugar-free Italian ices( well it has one gram of sugar) but 20 grams of carbs none the less... does that equal the same as say a slice of wonder bread that is and always has been a quick spike to my sugar... and then again does those same twenty grams of carbs manage , because the endo told me to count carbs directly relating to how much insulin one injects , Im doing pretty successful thus far , but that brings me to the question... I know I can just use the trial and error method of Diabetes, as I have come accustomed to over my 27 years with the disease, just would like some feedback ; o)
If you want to get real particular and confused, a carb is not a carb… there are fast acting and slow acting carbs…
Thats the whole concept behind the ever confusing Glycemic Index idea… but as youve seen, bread is usually a fast acting carb… a slower acting carb usually involves a food with fat in it… But for MDI and sanity sake, you might want to do the basic take the total carbohydrate and subtract fiber (which slows down the carbs)… and do your I:C based on that… but keep in mind that you might have to correct for the slower acting carb later…
When counting carbs and figuring your insulin dose you would use the same amount of insulin for 20 grams of Italian Ice or 20 grams of bread. With that being said all foods will digest in your body differently. Like white bread has a lot of refined sugar and white flour so it will give you a good spike because it metabolizes (converts the carbs to sugar/energy) very quickly. If you take more insluin to avoid a spike with your white bread, once the insulin peaks you will end up low. Other carbs like whole grains, milk, apples, etc.metabolize more slowly and raise your blood at a more even pace avoiding a spike.
For me… Italian Ices, Rice, Bread, pasta etc. spikes me within an hour or so… BUT something like pizza or burgers (anything that is fatty and packed with protein) doesn’t spike me until hour 3. I took about a week eating a range of foods and did the trial and error method. I know some about the glycemic index but as a general rule of thumb, the more processed something is, the sooner I expect it to spike me. If I or someone else made it with my own hands and it’s higher fat or high in protein… I know to extend my insulin a little.
Magic,
Not silly, in fact this will be helpful to others. These guys are right. Not a simple question nor a simple answer. I’ll try 2 b quick.
Always subtract fiber, b/c those carbs are not metabolized. (Some experts say only subtract fiber if you are eating 3 g or more per meal) Like an apple with 17 g carbs has 4 g fiber, and therefore you would figure 17-4 = 13g carbs that count.
Protein can raise blood sugars. You have to figure out how much each gram of protein affects bg, as well as how long it takes your bg to rise. I haven’t figured out my numbers for protein, but some people have figured 40 and others have figured 50% of their protein grams are equivalent to carb grams. Life if you have 40%, then if you eat 10 g protein, then eventually, like maybe like 4 hours later, you will have the equivalent of 4 grams of carbs.
You should consider reading either “Think Like a Pancreas” by Gary Schindler or Using Insulin (Pumpin Insulin if you are on a pump) by John Walsh. They give good basic info for people like us. I’ve been D for over 25 years now.
People have talked in the past about protein affecting bs, but I can’t seem to find the link I want. I did a search for “protein blood sugar”, and I found these, plus others:
For me, a carb is a carb – as least when I determine the insulin dose (except fiber which is not a carb and I subtract it out if there is more than 2g).
Some carbs raise my blood sugar more quickly (fruit, anything with sugar, pasta)… some more slowly (high fiber or eating with lots of fat), but they require the same amount of insulin. The only thing that I change is the timing of the insulin. I try to take my insulin 10 minutes early for slow acting carbs, 15-20 minutes early for fast acting carbs. (These are just rough estimates).
I think that you will enjoy the Humalog! Google “carb counting” for more tips
In these situations… This is a good idea to get a pump (if you can afford it). Pumps has the ability to brake out bolas insulin at different times. Tanya, in my opinion, I only focus on carbs, and just correct if need be later… Simply because everyone’s body is so different. Our I:C ratio’s are different, our digestion rates are different, how our body response to various nutrition elements are different, etc., I’m not sure if knowing the protein/sugar rate is worth it? Their just too many variables to worry about. However, I do think it’s important the both fatty foods, and foods with a lot of protein does effect you sugars (slowly)…
Quicky or slowly, a carb is carb to my body. As far as glycemic index goes, this is of questionable use to Type 1s. Research to determine GI didn’t include diabetic test subjects.
I subtract fiber only when there’s a lot. Nutritional labels on packaged foods aren’t terribly accurate for carbs or fiber.
Your purest gram will be those in glucose tablets. Divide one in half when you haven’t eaten for a while, test to get where you’re at. Eat the half, letting it stay in your mouth, chewing it. You’re taking 2 grams. Wait a half hour and test. What did it raise you? Divide how far it raised you in half. That is what one gram will raise you.
ok now you can figure that every carb gram you put in you is going to be some multiple of that. In that way, a gram is a gram. But as the others have said, some go faster than others, and fat slows it all down. The amount of insulin I figure is based on how far up the number of grams I’m going to eat will take me - and my insulin sensitivity. How far DOWN will one unit take me? That, too, can be researched in your body by you.
If one gram raises me 6-7 mm/dl, then 10 grams raises me 60-70. 20 grams raises me about 120-140.
If one unit Humalog lowers me 60, I need 2-3 units for 20 grams carb, no matter what kind. But because a high fat (pizza) will slow absorption down, however, I might reserve some for 3 hours later when my blood sugar will go up.
Hope that tells you how I look at grams of carb. A gram is a gram is a gram.
