I think the effectiveness of carb greatly depends on the diet. If you eat very low carb, your bolus may depend more on the amount of food you are eating, aka Bernstein's Chinese restaurant effect. If you eat high carb, you may need that I:C ratio just to get an idea of how much insulin you need since your blood sugar will swing so much more.
For me, I don't even know what my I:C ratio. I don't count any of the macronutrients in my meals, and know that I generally eat around 100c/day mainly in the form of veggies. Ive found that, as long as I stay away from grains and processed foods, it doesn't matter if I eat 'high carb' carrots or 'low carb' broccoli for supper-I still base my boluses on the size of my meals and am able to keep my bgs in a +/-10-20% range this way.
I don't agree with steering people away from carb counting, as for a lot people insulin dosing would then become a shot in the dark and create many more hypo/hyperglycemic events. But, as everyone is saying, there are many other factors involved and carb counting may not be the most critical factor.
I absolutely agree that the conclusions presented here are bad, but the numbers say what the numbers say.
That doesn't make the study any less intellectually rigorous. Since this is essentially just crunching the numbers from existing studies, personally, I think it states the obvious concern that we all have as diabetics. More studies need to be done. I would probably look at the same studies, see the same results, and have to conclude the same thing, that current research does not indicate that carb counting alone is enough to affect blood sugar control.
I think this article speaks a lot to what get's lost, and what get's added in as filler from there, in the transition between the primary literature written for researchers and "popular" media written for lay people and mass consumption.
I have no doubt the research is as exacting as it can be and simply runs into the limits of research design. You can't break correlations or tease out details when you don't have the sample size, or statistical power, to differentiate between the different affect of carb counting versus carb restriction for example.
But, as we all know as diabetics, carb counting is a good thing to do. I think the research does admittedly show that, just not in the slam dunk fashion we want it to.
Let me try to be more clear. There are two parts of this: the research itself, and the conclusions based on it. I am criticizing the latter. Yes, the numbers are what they are, and they may have been compiled meticulously and with complete care and due diligence. That's not what I was commenting on.
To take a batch of data, no matter how clean it is, admit (albeit in a roundabout, backhanded way) that it may not measure everything relevant to the subject of the inquiry, and then go ahead and offer firm conclusions from it is lacking in integrity. It isn't intellectually sound. It just isn't.
Very true, Brunetta. Easy to forget that we are a self-selecting group and, as someone said, far from the heart of the bell curve.
Okay...this makes my brain hurt! I don't really understand how some of these studies are done and the statistical significance behind them, but the one major question I have is this: How can counting carbs NOT affect the insulin dose? Obviously if you're using an insulin-to-carb ratio and rapid-acting insulin for meals, then your insulin dose is affected by the amount of carbs you're going to be eating.
And, yes...I get that things like Chinese food and potato chips don't exactly respond correctly to the insulin-to-carb ratios (neither does binge eating...another story in itself), but if I'm eating relatively normal food, not necessarily super low-carbing, then my insulin regimen is what's keeping my A1c's down...what else could be doing that?
And how does this correlate with the latest from the DCCT trial which shows that intensive therapy DOES help?
Ruth
I had the same reaction, Ruth. This study is a bunch of clinicians making hay doing what they do and it is totally irrelevant to us. We all know the core of managing diabetes is to figure out how much insulin to take for a given amount of carbs. Sure, we decide the quality of the carbs we eat and how often to test, etc, but the core to keeping bg in control is obviously to match the carbs with the right amount of insulin!