# struggling with carb counting



## 1997 (Feb 13, 2009)

I was put on a carbohydrate counting course when my HbA1c was much less than perfect. The idea was that it would get my levels back in order, but all it served was to confuse me more.

I went from having a good estimate of what certain meals were to having to perform all sorts of ridiculous estimates and calculations in my head.

It was like being given a series of hurdles but with the first one being set at a level that would test an olympic high jumper.

I expect the week long or few day courses are better than the afternoon course I received. The nurses did an admirable job in the afternoon course, but I don't think an afternoon only course is appropriate for someone struggling to get to grips with their control.

It seems to me that a stand alone carbohydrate counting course is something which should be taught as for those looking to go from relatively stable control to advanced control rather than those like me who were a bit all over the place.

Soon after my course I gave up trying my best to estimate carb numbers and then perform a division with a factor based on guesswork. I went back to knowing what insulin amounts worked for certain meals and stuck with that.

I've recently got into the sort of control that allows me to start to look at what my conversion factor might be. Going by what I have for lunch the conversion factor looks to be about 1 unit = 8.5g carbs.

Maths is a strong point for me but the thought of having to work in factors of 8.5 is a nightmare. Add to this fact that the conversion factor tends to be different at different times of day and I can see why giving up seemed the only appropriate option just after my course.

Has anyone else had struggles with carb counting and any ways of coping?


----------



## diagonall (Feb 13, 2009)

Hiya, carb counting is very simple.
But the medical peeps seem to want to confuse people as much as they can. 
Buy yourself the book called carb counter (Collins Gem) it has lots of foods in it. 
http://www.bdec-e-learning.com/  this is the on line version of carb counting
Sort your basal 1st http://www.diatribe.us/issues/13/learning-curve.php

How to work out your carb factor. http://www.diabetesnet.com/diabetes_food_diet/500rule.php

Many people have different ratios for different meals so a little bit of tweaking might be needed.

Sue


----------



## bev (Feb 13, 2009)

Hi Sue
I tried clicking on you links but nothing happened! Is it just my computer? Bev


----------



## C*5_Dodger (Feb 13, 2009)

Type1_Sue said:


> Hiya, carb counting is very simple.
> But the medical peeps seem to want to confuse people as much as they can.
> Buy yourself the book called carb counter (Collins Gem) it has lots of foods in it.
> http://www.bdec-e-learning.com/  this is the on line version of carb counting
> ...


Hi  All,

These should work

http://www.bdec-e-learning.com/
http://www.diatribe.us/issues/13/learning-curve.php
http://www.diabetesnet.com/diabetes_food_diet/500rule.php

Regards  Dodger


----------



## Lizzie (Feb 13, 2009)

bev said:


> Hi Sue
> I tried clicking on you links but nothing happened! Is it just my computer? Bev



You could also try highlighting the links with your mouse, then right clicking and go to 'copy', then paste into your address window at the top of the page, by highlighting the address, right clicking and choosing 'paste'. Or instead of right clicking you could highlight, then go to the Edit menu and use the same commands, copy and paste. Then press enter.


----------



## Einstein (Feb 13, 2009)

Hi, 

I found the short carb counting course run by a local dietician to be an excellent basis to start carb counting, although I am on 1:10, I do still find estimating carbs to be difficult when I am out.

The Collins Gem book is great, most of the Atkins diet books also list all the common carbohydrates for various foods.

At home the best thing I did was buy some accurate digital scales, I tried the ones with the foods programmed so you told it what you were weighing and there was your carbs for the amount you'd weighed on the display, far easier to look at the packet!

Where I do struggle it when eating out, here you don't know what a portion size is, and its very hard work to try and keep up, I tend to work slightly under what I think is on the plate and hope for the best... not scientific, but its the best practicable solution I have found to the problem.

What I did discover very quickly after the course was that my insulin and a such portion sizes reduced drastically, rather than eating to my insulin, I was injecting to what I was eating - sometimes, realistically I was consuming five times more insulin than I needed to and that had to be made up somewhere with food intake.

Worth working on, but I don't envy you the 8.5:1 ratio and the calculation off the top of your head every time!

In addition to paper and online carb lists, there are also a few programs to download for Smartphones and Blackberrys that can be referenced while you're out. I find the one on my Blackberry is great if I am away for a few days and eating out all the time, at home I eat a reasonably constant diet, so life and injections are regular.

Hope it starts to work for you soon.
David


----------



## 1997 (Feb 13, 2009)

I'm glad I asked the question now. I never knew about the 500 (450) rule before.

Sure enough my 63 units in a day get the 1 unit = 8g

I've just injected 15 units of insulin to cover my 110g of carbs for lunch (which is about right; 110 / 8 = 13.75 and I gave myself 15 instead of 14 because I was just over 8 mmols/l).

Sometimes it feels like a jigsaw. If there's a key piece or two missing you can feel you're getting nowhere then all of a sudden someone hands you one of the pieces you were looking for and things are good again.

thanks everyone!


----------



## diagonall (Feb 13, 2009)

1997 said:


> I'm glad I asked the question now. I never knew about the 500 (450) rule before.
> 
> Sure enough my 63 units in a day get the 1 unit = 8g
> 
> ...



Glad it is making more sense to you now.
As a general rule 1 unit of insulin will also drop you down 3 points when using a correction.
You also might find you get even better control if you don't inject more than 7 units in one go. means an extra jab or cutting down the amount of carbs eaten though.


----------



## Admin (Feb 13, 2009)

*That is so accurate!*

I am impressed I have been carb counting for my entire life - but never done it with such accuracy! I tend to round up or down...there is no rule of thumb for anyone really. Good on you!


----------



## 1997 (Feb 14, 2009)

sometimes the whole diabetes carb counting can be funny.

I'm back home to see my dad and have some slightly better meals than i usually do.

So my dad's making lunch and brings out 2 largeish potatoes and says: "this is 32g and this one 34g"

So I assume he's brought out a couple of shop bought ones with an estimate of the carbs on the labels. I work out my insulin 8g per unit, so 4 units should cover the one potato I'll have.

Halfway thru lunch I think, I wonder why the carb levels are different. Were they from different packs?

So I ask my dad: "how did you know they were 32g and 34g?"
He said, "that's how much they weighed." Ok so the packets must have given the carb value per 100g.

So I ask: "How did you calculate their carbohydrate?"
He didn't get my question and could only say, "I weighed them."

After a bit of discussion, it turns out he thought the potatoes themselves weighed 32g and 34g. My dad's far from thick, I think it must be that he has maybe never got his head round metric.

I knew the potatoes couldn't possibly have weighed such a small amount and so to prove himself right my dad got the scales out.

Turns out my dad was imagining a decimal point that wasn't there! To give a bit of credit the gram symbol was in a funny position which could look like a decimal point.

So I can tell the weight of the potatoes must be 320g and 340g but I don't know off my head what their carb content is.

Off to wikipedia which tells me that a potato is about 20% carbs. So this tells me I must be having about 66g of carbs, which sounds about right.

So instead of injecting 4 units for the potato, I should have injected 8 units.

If I'd not been so persistent in asking my dad how he calculated the carbs, I could expect myself to be, at the least, 10 mmols/l higher this afternoon.

Crazy stuff.

It really illustrated some of the important things we have to think about. I think my dad's received a bit of an education today.


----------



## tracey w (Feb 15, 2009)

Type1_Sue said:


> Glad it is making more sense to you now.
> As a general rule 1 unit of insulin will also drop you down 3 points when using a correction.
> You also might find you get even better control if you don't inject more than 7 units in one go. means an extra jab or cutting down the amount of carbs eaten though.



Hi sue, interesting what you say about better control if you dont inject more than 7 units. If you need more to cover your meal, but only give 7 when would you give the rest, maybe 2 hours later? I am interested in getting better contol over my bs and if it means more jabs then im ok with that.

thanks


----------



## Freddie99 (Feb 15, 2009)

Hi All,

It was suggested to me the I attempt to do carbohydrate counting by my consultant. I thought that it might work but I just never got around to doing it. Well, I say that but I do it when I can easily find out the carb content of some food - i.e. from the packet but otherwise I simply do what I have been for the past thirteen years. I know what some foods do to me and I know how to adjust my insulin to deal with that.

Tom H


----------



## tracey w (Feb 15, 2009)

Type1_Sue said:


> Hiya, carb counting is very simple.
> But the medical peeps seem to want to confuse people as much as they can.
> Buy yourself the book called carb counter (Collins Gem) it has lots of foods in it.
> http://www.bdec-e-learning.com/  this is the on line version of carb counting
> ...



Hi,

I have bought the collins gem recently and already finding it useful, struggle when eating out though and i like to eat out quite often, usually guesstimate then but working ok.

I have also worked out my ratio using the 500 rule,,  but i have a question with this. My ratio works out at 1:15, however i find i am actually more like 1:11.5, (taken me couple of weeks to suss this but think this is accurate now!) What i want to know is insulin requirements for bolus more because i am not on 60% basal. I take 15 basal and approx 18 bolus including corrections. Hop this makes sense.  

I think this basal is right although not quite sure as i can do massive drops in bs even 6 hours after meals, but dont think this is due to basal, i have very active job/lifestyle. My basal hardly touches me during the night and can wake up higher than going to bed. Thanks for any advice, i have learned all these things on this site and not from my team!


----------



## diagonall (Feb 15, 2009)

tracey w said:


> Hi sue, interesting what you say about better control if you dont inject more than 7 units. If you need more to cover your meal, but only give 7 when would you give the rest, maybe 2 hours later? I am interested in getting better contol over my bs and if it means more jabs then im ok with that.
> 
> thanks



Hi Tracey, with me it does depend on the food type being eaten. But yes you can go up to 2 hrs later. That's for pizza and pasta. There is no exact science to it. You have to find what works for you. I use a 40/60% split over 1 1/2 hrs when I eat pasta this works fine for me. Look up the profile of your bolus insulin and see when it peaks for optimum control. Keep a diary of what you did and the result. This way you can work out what works and what doesn't work.


----------



## diagonall (Feb 15, 2009)

[



Tom Hreben said:


> Hi All,
> 
> It was suggested to me the I attempt to do carbohydrate counting by my consultant. I thought that it might work but I just never got around to doing it. Well, I say that but I do it when I can easily find out the carb content of some food - i.e. from the packet but otherwise I simply do what I have been for the past thirteen years. I know what some foods do to me and I know how to adjust my insulin to deal with that.
> 
> Tom H



Hi Tom,
Looking at your HbA1c it obviously is not working for you. There is something badly wrong somewhere to have an A1c as high as that.
You were talking about having a pump.
There are no if's or buts you need to carb count to have a pump.
Carb counting is very simple to do. If you can not master it or how to correct your highs, then pumping is not for you.
Read the links I put on this thread and learn how to carb count and work out your ratios.
Ask to go on a DAFNE course so it gives you a good insight to what you are meant to be doing.
Best wishes
Sue


----------



## diagonall (Feb 15, 2009)

tracey w said:


> Hi,
> 
> I have bought the collins gem recently and already finding it useful, struggle when eating out though and i like to eat out quite often, usually guesstimate then but working ok.
> 
> ...



People who are more active tend to have a lower basal so don't worry about it. You need what you need for your life style 
The 500 rules is great as it gives you a fairly good guess as to what you require and then you can tweak it to your own needs.
Your basal doesn't sound quite right from what you are saying. Have a go at the basal test. Then you can see what is going on.
Do you split your basal? Many people find that Lantus and Levemir do not last 24/7
So again worth considering, have a talk with your team and see what they say.
If they unhelpful ask for a pump 

Sue


----------



## 1997 (Feb 15, 2009)

Type1_Sue said:


> Hi Tom,
> Looking at your HbA1c it obviously is not working for you. There is something badly wrong somewhere to have an A1c as high as that.
> You were talking about having a pump.
> There are no if's or buts you need to carb count to have a pump.
> ...



Hi Tom

I agree with Sue on most (if not all) counts - but would say that sometimes carb counting can be more tricky than at other times.

If your daily routine is fairly dependable, I'd recommend starting to do a bit more carbohydrate counting.

If you know what effects things have on you then you could work out your insulin doses as you usually do but have a go at counting the carbs and write them down along with your test results and the insulin you take. You could then look back after a week and see if you can spot what may be causing higher levels and what may cause the lower levels.

Can I ask - do your write your results down?


----------



## Freddie99 (Feb 15, 2009)

1997 said:


> Hi Tom
> 
> 
> If your daily routine is fairly dependable, I'd recommend starting to do a bit more carbohydrate counting.
> ...



Fire away 1997! I do write down what my bloods are and the insulin doses that I give myself. I use spreadsheets and it's fairly easy to spot trends. My routine is for the most part dependable but sometimes it can be thrown quite easily.

Tom H


----------



## diagonall (Feb 15, 2009)

Tom Hreben said:


> Fire away 1997! I do write down what my bloods are and the insulin doses that I give myself. I use spreadsheets and it's fairly easy to spot trends. My routine is for the most part dependable but sometimes it can be thrown quite easily.
> 
> Tom H



Hi Tom, have a look at this site it shows what your A1c converts too on a daily bases.
http://www.phlaunt.com/diabetes/A1ccalc2.php
8.7% = 11.3  which is very worrying for your long term health.
Your A1c needs to be nearer 6.5 but below 7 at least.
Please please don't think I am having a go at you because I am not. I'm just trying to pass on info so you can help yourself and avoid complications in the future.
Best wishes
Sue


----------



## 1997 (Feb 15, 2009)

Tom Hreben said:


> Fire away 1997! I do write down what my bloods are and the insulin doses that I give myself. I use spreadsheets and it's fairly easy to spot trends. My routine is for the most part dependable but sometimes it can be thrown quite easily.
> 
> Tom H



Good to hear you're reviewing your levels regularly. It's quite possible that it may be your 'unseen' sugar levels that are higher than you'd like.

I've only recently started to check my levels two hours after eating and it's been interesting and useful to see the results of these after eating tests.

A lot of one's waking day is spent between meals so it's important that your levels are not straying too high between meals.

In an ideal world, you'd want your sugar levels to remain significantly under 10.0 mmols/l two hours after eating.

If your sugar levels are above 10.0, I'd start to think about changing what you're eating. Any significant change in diet should really be agreed with your healthcare team, however, beware that your healthcare may sometimes give a false impression of what's acceptable. I've had consultants that were quite happy for my HbA1c results to be too high.

When it comes to the post meal results, I'm now of the opinion that it's much better to know what levels I'm getting than being blissfully unaware like I used to be.

Do you tend to check your levels after eating (2 hours after, ideally)?


----------



## Freddie99 (Feb 15, 2009)

Hi 1997, 

I don't check about two hours after meals. I probably should. You probably have a point that my bloods between meals might be higher than they should be. My consultant is happy with my HbA1C but we both know it should be lower.

Tom H


----------



## diagonall (Feb 15, 2009)

Tom Hreben said:


> Hi 1997,
> 
> I don't check about two hours after meals. I probably should. You probably have a point that my bloods between meals might be higher than they should be. My consultant is happy with my HbA1C but we both know it should be lower.
> 
> Tom H



Tom,
If your consultant is happy with an HbA1 of 8.7% then ditch him/her.
S/he is doing you no favours at all.
I am horrified that your consultant is happy with that A1c 
All you are doing is kidding yourself.
In a few years time when the complications set in you will be saying I wish I had looked after myself.
Take the bull by the horns and control your diabetes and not let the diabetes control you.


----------



## Freddie99 (Feb 15, 2009)

Ahem Sue, at eighteen it is a little hard to get things perfectly under control and even after thirteen years I'm still learning every day.

Tom H


----------



## tracey w (Feb 15, 2009)

Type1_Sue said:


> Hi Tracey, with me it does depend on the food type being eaten. But yes you can go up to 2 hrs later. That's for pizza and pasta. There is no exact science to it. You have to find what works for you. I use a 40/60% split over 1 1/2 hrs when I eat pasta this works fine for me. Look up the profile of your bolus insulin and see when it peaks for optimum control. Keep a diary of what you did and the result. This way you can work out what works and what doesn't work.



thanks, i will try this when i have a large meal, usually evenings for me


----------



## tracey w (Feb 15, 2009)

Type1_Sue said:


> People who are more active tend to have a lower basal so don't worry about it. You need what you need for your life style
> The 500 rules is great as it gives you a fairly good guess as to what you require and then you can tweak it to your own needs.
> Your basal doesn't sound quite right from what you are saying. Have a go at the basal test. Then you can see what is going on.
> Do you split your basal? Many people find that Lantus and Levemir do not last 24/7
> ...



thanks again. have read about basal testing a bit, is it where you have a carb free meal and no insulin and see what bs results are? I have actually gone without lunch a couple of times as i work shifts and just didnt fit in, have found bs rise slightly, is this the same thing?

i would love to try a pump but know going about is is probably going to be a nightmare. Am going to ask about though next time i reach dns. Last time i got a reply was only because i was in tears of frustration on the phone, miraculously someone was available ( I know it was only because i was upset though). thanks for all yur help


----------



## 1997 (Feb 15, 2009)

Hi Tom, I think the age you're at is one where, make no bones about it, control is harder and it's really good that you are keen to look at how you're doing. Several years ago, when I was your age, i was starting to neglect my type 1. it's a good sign you're keeping your mind on how you're doing.

I think consultants tend to look at teenagers and even those, like me, in their mid-twenties and think, well an A1c of 7% or 8% is ok because most of their patients of that age are often doing worse.

The truth of the matter is that those of us who have had it a while (I've had type 1 for a similar length of time as you; 15 yrs as opposed to about 13 yrs) can't afford to spend too much of our lives being high.

I've found that many consultants tend not to be very strict, and this is probably exaggerated around teenage years. They don't want to jump on you and i think the fear is that you may start to fix results. I used to do this despite the fact that my consultants were too easy-going with me anyway.

i don't think consultants are really happy to see high results but it's something that's become a part of the culture. if you sit with your consultant and say, "you know i'm really not _completely_ happy with the A1c results i've been getting.", you'll probably find they agree with you and start to work with you to find some solutions.

if however, your consultant actually disagrees with you and says that they're "perfectly fine" and refuses to accept that there's some work to be done, then it's worth seeing if you can see a different consultant. however, be aware that sometimes this may always not be possible.

i'm lucky that nowadays i have a choice of two consultants (one good and one bad, in my opion) but just over a year ago there was just one consultant, and unfortunately, he wasn't the good one.

currently my clinic lets me choose which consultant i see and for that i'm thankful. i don't know what rights we have to get see a different consultant when there isn't a choice though.

fingers crossed that your consultant is the kind that will respond well and will work with you improving your overall control.

it may not be the first appointment that sees a difference but if you let your consultant know that you're keen to improve your control, then i think it's reasonable to expect your consultant to offer some advice and solutions by the following appointment. this is just based on what i'd find acceptable though.


----------



## diagonall (Feb 15, 2009)

Tom Hreben said:


> Ahem Sue, at eighteen it is a little hard to get things perfectly under control and even after thirteen years I'm still learning every day.
> 
> Tom H



Ahem Tom, No one is perfect or expecting you to be perfect. 
But your A1c is more than double that of a none diabetic.
Yep even after 44 years of diabetes I am still learning.
At 18 you should be down a lot lower than you are.
A realistic level to aim for is 7%
It's your choice what you do about it. After all it's your eye sight/kidneys/limbs that are at stake not the consultants or anyone elses.
You have the info at your finger tips to help yourself.
As I said before if your consultant thinks that's OK then time to ask for a referal to another consultant. You are entitled to that 2nd opinion.
Younger children than you are expected/encouraged to have lower A1c's than you have.
Please don't leave your wake up call until you have eye damage.
There is a 20 year old on another forum who has damaged his heart due to high A1c's he also has eye damage. He has been type one since the age of 13
Unfortunatly he didn't heed what he was told. He is also now in panic overload due to  the enormity of whats going to happen to him has hit home.
Complications wait for no man.


----------



## diagonall (Feb 15, 2009)

tracey w said:


> thanks again. have read about basal testing a bit, is it where you have a carb free meal and no insulin and see what bs results are? I have actually gone without lunch a couple of times as i work shifts and just didnt fit in, have found bs rise slightly, is this the same thing?
> 
> i would love to try a pump but know going about is is probably going to be a nightmare. Am going to ask about though next time i reach dns. Last time i got a reply was only because i was in tears of frustration on the phone, miraculously someone was available ( I know it was only because i was upset though). thanks for all yur help



Hi Tracey, this is the link for basal testing. It explains things a lot better than I can 
http://www.diatribe.us/issues/13/learning-curve.php

RE. the pump. Have you read the guidelines? If you qualify do not take no for an answer. Ask for a referal to a pump consultant at another hospital if you have too. They are well worth fighting for.
http://www.nice.org.uk/nicemedia/pdf/FinalAppraisalDeterminationIP.pdf

Sue


----------



## 1997 (Feb 15, 2009)

I checked all the labels of things I usually tend to eat, added them up and found that the amount of carbohydrates I was eating each day totalled 330g.

Today I managed to stick to eating a total of 65g. That's less than a fifth of what I would usually have in a day.

Just in case anyone's interested, I had

breakfast: greek yoghurt + sliced and crushed brazil nuts - 10g
I went shopping in the morning so didn't even have to inject and knew there was no chance i was going to end up very high

lunch: turkey and vegetable casserole with mixed beans - 35g
took 5 units (i usually inject at least 13 for lunch)

tea time: cauliflour cheese - 20g
took 3 units

So i've gone from injecting at least 35 units of short acting down to just 8 units today.

It's made a big difference to my sugar levels. Before I was playing a lottery of results between 3.0 and 10.0. On reduced carbs my levels are playing a much tighter game. I've been below 6.0 for every test I've done today (includes post meal tests).

When you're having just 20g carbs for a meal, you've got to have something pretty out of the ordinary happen for your figures to jump too far out of range.

This is just day one of starting to try a low carb diet but it's already looking like a no-brainer.

The only question I can't figure out is why it's taken me 15 yrs to realise this?


----------



## Copepod (Feb 15, 2009)

*HbA1c - not the be-all and end-all*

Tom & Sue

Can I raise the thought that, while HbA1c is important, other things are equally important in a person's life? In fact, I suspect that HbA1c gets most emphasis because it's easy to measure - and it's a scientific principle that things that are easy to measure then to get get measured, rather than the most important, but more difficult to measure, things. The diabetes clinic I attend doesn't record even estimates of activity levels, and while they record body weight, they don't record what clothes are being worn, nor record hieght accurately - many people think they are several cms shorter or taller than they really are, as I discovered when working on Gateshead Millennium Study, weighing and measuring skinfold thicknesses, heights, waists, hips and body composition of children born 1999 - 2000 and their mothers.

I didn't have diabetes as a teenager, although I did have the great pleasure of having a lad, with diabetes, aged about 18 years in my "fire" (group)  on a 6 week expedition in South Greenland. If I think back to my teenage years, I know what was important to me - and, I think, gave me many skills etc that I am still using now. As well as gaining O and A levels (as they were then), I gained qualifications in first aid, lifesaving, Guides, Sea Rangers and Duke of Edinburgh's Award Scheme, learned hill walking, mountain weather, caving, kayaking, sailing etc, cycled lots around local countryside with friends my own age and blind men on tandems, made & shifted scenery for Gang Shows and pantomimes, went on 6 week expedition to Greenland and Iceland, spent a summer teaching archery & mountain activities, then a few weeks as a postman, so I earned enough to spend 4 months travelling in the Middle East and Europe, returning just in time to start my nurse training, and beginning a "career" in writing, intitially travel articles for free magazines I found in London etc. 

So, my take on the situation is, while Tom's HbA1c could be better and he should work towards this, there are many other important aspects of his life - education, youth groups, sports, friendships, travel etc.


----------



## aymes (Feb 15, 2009)

Copepod said:


> Can I raise the thought that, while HbA1c is important, other things are equally important in a person's life?
> 
> 
> So, my take on the situation is, while Tom's HbA1c could be better and he should work towards this, there are many other important aspects of his life - education, youth groups, sports, friendships, travel etc.




Seconded! 

I think we all draw our line somewhere differently for that balance of what is important and the impact that has on our diabetes. It's certainly taken me a long time to find my balance between keeping my diabetes in check but drawing the line where I don't want to make certain sacrifices. For example I have total admiration for those of you who stick to very low carbs, and it is something I have done in the past with great effects but it's not something I feel I want to do all the time. So my 'buy off' is that I go for low GI where I can and do a lot of running, most of the time this works.....!


----------



## Adrienne (Feb 15, 2009)

Hi

I won't preach to anyone, I don't believe in it, I just want to help everyone that I can with diabetes, especially children.   My daughter is nearly 9 and had her first insulin injection at 5 weeks old, she had her pancreas removed.  I know lots about diabetes in children (type 1), and often help newly diagnosed parents.   

I 'met' Tom at the Facebook DUK site a month or so ago (you probably don't remember me Tom) but I am amazed you are only 18.  You have a very wise head on your shoulders and you said some terrific things to help others on the facebook pages.   You also asked the question about pumps, should I or shouldn't I.

For an 18 year old who is obviously interested in his diabetes and also helping others, I think in these last few messages of yours and other's replies you have now answered your own question.  You should.  You HbA1c could be better, yep we know that, as could my daughters and she is pumping.  But to have the ultimate freedom of a type 1 diabetic to do these things that a teen and young 20 year old wants to do (except the drinking), then pumping is the way to go.   I can't stress enough how easy you will find it and how much freedom there is.  It is strange to begin with to have this thing part of you but my daughter and everyone I know wouldn't be without it.

I hope that when my daughter reaches your age, she will be as level headed, friendly and cheerful as you are Tom, personally I think you are an inspiration to all the type 1 teens out there.   Good on you, go get your pump, you qualify.  Don't dither any longer.

Take care
Adrienne


----------



## Adrienne (Feb 15, 2009)

Ooo just want to add that my last post wasn't supposed to be patronising, so please don't read it like that, I am quite a bit older than you, Tom, and I meant every word.

Adrienne


----------



## Northerner (Feb 15, 2009)

Adrienne said:


> Ooo just want to add that my last post wasn't supposed to be patronising, so please don't read it like that, I am quite a bit older than you, Tom, and I meant every word.
> 
> Adrienne



Well said Adrienne - Tom I think you are a credit to your generation and a real asset to this group.


----------



## Freddie99 (Feb 16, 2009)

Wow, Adrienne, Northerner,

Thank you. I'm trying to avoid blushing here 

Copepod,

Good point, I do have other things to get on with in my life. The most important thing to me is to not let diabetes get in the way of my life in any way.

Thank you again,

Tom H


----------



## Freddie99 (Feb 16, 2009)

Hello again,

Out of curiosity, I've read that being on a pump reduces the daily insulin intake? How true is this? I know that I would have to become more active (well, I'm starting more active now, my running has started up again) Seeing as I'm on 49 units of Levemir per day and 46 units of novorapid per day would my needs for this go down? I know that I would have no need for the levemir due to the way that I would be constantly recieving the novorapid.

Thanks,

Tom H


----------



## diagonall (Feb 16, 2009)

Tom Hreben said:


> Good point, I do have other things to get on with in my life. The most important thing to me is to not let diabetes get in the way of my life in any way.
> 
> The trouble is Tom with your A1c as high as it is it's not today you have to worry about it's the tomorrows. And mark my words diabetes will get in the way of your life in a big way unles you bring down your numbers.
> This is what is concerning me big time with you.
> ...





Tom Hreben said:


> Hello again,
> 
> Out of curiosity, I've read that being on a pump reduces the daily insulin intake? How true is this? I know that I would have to become more active (well, I'm starting more active now, my running has started up again) Seeing as I'm on 49 units of Levemir per day and 46 units of novorapid per day would my needs for this go down? I know that I would have no need for the levemir due to the way that I would be constantly recieving the novorapid.
> 
> ...



Some people do reduce their insulin requirements others don't. Some infact need more due to getting to free with the bolus's and food intake.
You wont be able to have a pump though Tom until you learn to carb count and put it into practice with MDI.
You will be expected to keep a food diary insulin and blood sugars all recorded too for at least 6 mths. If you can't wont do this then They will just say you are not commited enough to pump.
A pump is no easy fix it's a lot of hard work and you do have to know what you are doing with your insulin. IE, carb counting/ratio's/corrections.
If you are serious about pumping you need start sorting yourself out now so that you have everything in place before you go to uni.
Missing uni for carb counting courses will not be good  I have no idea where your uni is compared to home. But if it's a dif PCT it will be a new consultant new funding issues.

Have you seen/bought the book pumping insulin? If not buy it and read it then you will see what is involved.


----------



## AJL (Feb 16, 2009)

I couldn't agree with you more.  I have had diabetes for 38 years and I do work hard to maintain control - but it is also about balancing it with other things in my life.  In my case with regard to my career, my home and other interests in my life.  My "best" HBA1C (I think in my life) has been 7.4/7.5 and that has been with a lot of hard work.  I know that personally, due to the ad hoc nature of my life, that when I try to keep control even better that I have too many low sugars that impact upon what I do.  I certainly can't risk having a hypo in the middle of giving a lecture to a large number of students so when I am teaching I have to keep my sugars higher etc 

We are all aware of the complications that diabetes can cause but also that we are all different with regard to how we balance the diabetes.  In my opinion, after a many years of experience of different things in life, I would say control your diabetes as best as you possibly can but balance that against the other areas of your life - life is for living.


----------



## tracey w (Feb 16, 2009)

Type1_Sue said:


> Hi Tracey, this is the link for basal testing. It explains things a lot better than I can
> http://www.diatribe.us/issues/13/learning-curve.php
> 
> RE. the pump. Have you read the guidelines? If you qualify do not take no for an answer. Ask for a referal to a pump consultant at another hospital if you have too. They are well worth fighting for.
> ...



thanks Sue, have read guidlines several times. My HbA1c has never been under 8 in the year i have been diabetic, and to be honest i will be shocked if it is much lwer on my next visit, next month. If not I think i have a good case for a pump as really trying on mdi. Tried to reach dsn again today but no call back (not unusual). I am fully prepared to tell my consultant that i dont feel i have had any guidance since going on mdi and i hope he will listen.

will re look at info on basal testing again, cheers


----------



## tracey w (Feb 16, 2009)

tracey w said:


> thanks Sue, have read guidlines several times. My HbA1c has never been under 8 in the year i have been diabetic, and to be honest i will be shocked if it is much lwer on my next visit, next month. If not I think i have a good case for a pump as really trying on mdi. Tried to reach dsn again today but no call back (not unusual). I am fully prepared to tell my consultant that i dont feel i have had any guidance since going on mdi and i hope he will listen.
> 
> will re look at info on basal testing again, cheers



Hi again sue, have read the info on basal testing again. It is very interesting and can see why its important. But am a bit confused as it meant for fine tuning when on  a pump? which i am not.  

Also, i would not find it a problem to do the overnight test but as for the others not sure how i would go without all those meals and feel ok, i am very active and my days off are always split, (IE not two together), not sure when i would find this easy to do. if on a pump and not working for a week i would have no problem with this though.


----------



## MarcLister (Feb 17, 2009)

tracey w said:


> I have also worked out my ratio using the 500 rule,,  but i have a question with this. My ratio works out at 1:15, however i find i am actually more like 1:11.5, (taken me couple of weeks to suss this but think this is accurate now!)


Tracey, could you help me work out my ratio then? Haven't really learned how to, and my DSNs certainly haven't told me that I needed to.

If it helps, I had a blood sugar level of 6.2 before breakfast and I took 9 units for 80g of carbohydrates. I had some toast with honey on one.  Then at lunch my blood sugar was 3.2, so way too low. So 9 units for 80g is 1 unit for 8.88g of carbohydrates. Which is too much for me. I don't know why I tried 9 units and not 8 as I could have tested 1 unit of insulin for 10g of carbohydates.

At lunch I had 92g of carbohydrates. I took 7 units of insulin. I went from 3.2 to 7.2 blood sugar from before lunch to before dinner. 7.2 is better for me than 3.2. 7 units for 92g is 1 unit for 13g. So I reckon I could be needing about 1 unit of insulin for 13.5g to 14g of carbohydrates.

How am I doing so far then on working my insulin to carbohydrate ratio? 

Just managed to get 8.9 for my 11pm Levemir shot which is within the 7 to 10 range I've set.


----------



## aymes (Feb 17, 2009)

MarcLister said:


> Tracey, could you help me work out my ratio then? Haven't really learned how to, and my DSNs certainly haven't told me that I needed to.
> 
> If it helps, I had a blood sugar level of 6.2 before breakfast and I took 9 units for 80g of carbohydrates. I had some toast with honey on one.  Then at lunch my blood sugar was 3.2, so way too low. So 9 units for 80g is 1 unit for 8.88g of carbohydrates. Which is too much for me. I don't know why I tried 9 units and not 8 as I could have tested 1 unit of insulin for 10g of carbohydates.
> 
> ...



Sounds like you've made a good start on it! One thing worthwhile mentioning is that a lot of people have different ratios for different times of the day so rather than comparing breakfast and lunch for example you may be better off keeping good records for say three days using what you think is likely to be your ratio and them comparing each time of day's numbers separately. 

I did the dafne course which really helped me with my ratios and on that we all started on a 1unit:10g carbs regeime and went from there, adapting ratios up or down by 5g carb increments until we got where we need to be. It's important if you can to try and only change one thing at a time (eg if you think your breakfast and lunch ratios need changing try just doing one, seeing how you get on with that for a few days then adapt the other) so that you know for sure what has caused any changes. And of course it's important to get your basal rate right first as that will give you a good basis for checking your bolus habits- if your basal is wrong it is difficult to get a good idea of what is happening. 

It's of course important to discuss any changes like the above with you dsn before starting them but I hope the above is of some use (and not too confusing!).

A


----------



## MarcLister (Feb 18, 2009)

aymes said:


> Sounds like you've made a good start on it! One thing worthwhile mentioning is that a lot of people have different ratios for different times of the day so rather than comparing breakfast and lunch for example you may be better off keeping good records for say three days using what you think is likely to be your ratio and them comparing each time of day's numbers separately.
> 
> I did the dafne course which really helped me with my ratios and on that we all started on a 1unit:10g carbs regeime and went from there, adapting ratios up or down by 5g carb increments until we got where we need to be. It's important if you can to try and only change one thing at a time (eg if you think your breakfast and lunch ratios need changing try just doing one, seeing how you get on with that for a few days then adapt the other) so that you know for sure what has caused any changes. And of course it's important to get your basal rate right first as that will give you a good basis for checking your bolus habits- if your basal is wrong it is difficult to get a good idea of what is happening.
> 
> ...


My basal is pretty good. It is about 6 in the morning on average. Very happy with that. I always take 12 units of Levemir so I can have a look at how my blood sugar changes from 11pm to breakfast knowing the Levemir is always the same amount injected at 11pm.


----------



## diagonall (Feb 18, 2009)

tracey w said:


> Hi again sue, have read the info on basal testing again. It is very interesting and can see why its important. But am a bit confused as it meant for fine tuning when on  a pump? which i am not.
> 
> Also, i would not find it a problem to do the overnight test but as for the others not sure how i would go without all those meals and feel ok, i am very active and my days off are always split, (IE not two together), not sure when i would find this easy to do. if on a pump and not working for a week i would have no problem with this though.



Hello tracey,
You do not need to miss all of those meals in one day  just do the test on different days. IE miss breakfast one day lunch another and evening meal on another.
The same rules apply whether it is pump or basal. Levemir and Lantus are known as the poor mans pump in the USA.
Doing the basal test you can show your team you have a major problem or not as the case may be. So it's your way into getting a pump.
So if you have 2 types of days do the tests on a more active days over a week or 2 if you need too. Same as none active days.
This again is more ammo for a pump. 

Sue


----------



## diagonall (Feb 18, 2009)

MarcLister said:


> Tracey, could you help me work out my ratio then? Haven't really learned how to, and my DSNs certainly haven't told me that I needed to.
> http://www.diabetesnet.com/diabetes_food_diet/500rule.php
> 
> If it helps, I had a blood sugar level of 6.2 before breakfast and I took 9 units for 80g of carbohydrates. I had some toast with honey on one.  Then at lunch my blood sugar was 3.2, so way too low. So 9 units for 80g is 1 unit for 8.88g of carbohydrates. Which is too much for me. I don't know why I tried 9 units and not 8 as I could have tested 1 unit of insulin for 10g of carbohydates.
> ...



You need to make sure your basal is correct through out the day before you try sorting your carb ratio. The link for basal testing is in this thread somewhere. Your numbers on the whole do not look to far out though so a bit of tweaking and you are there. Until it all changes again 

For some reason my link is not clickable so you need to copy and paste it.


----------



## Barb (Feb 8, 2013)

Excellent advice.


----------



## Barb (Feb 8, 2013)

Should have added AJL to last post!


----------



## everydayupsanddowns (Feb 8, 2013)

I agree Barb

However, to avoid confusion and people responding to earlier posts in the thread (which is 3 years old) I'm temporarily closing it until it drops down the list a bit more


----------

