# Diabetics: How do you satisfy the nom nom nom? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [January 2, 2013, 2:49pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831 "2013-01-02T14:49:23Z")\ **Posts on this page:** 15\ **Page:** 5
**Author:** ![aruvqan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aruvqan/32/2891_2.png) [@aruvqan](https://boards.straightdope.com/u/aruvqan)\ **Post date:** [January 7, 2013, 7:12pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/81 "2013-01-07T19:12:01Z")
> [@tdn](#): > > This is very helpful, thank you. It’s pretty easy to feel guilty over one transgression. I was doing great all Saturday… until we heard “Would you like any coffee or dessert?” Oops. > > But my BG was 199 this morning – an all time low since late September. Well, that is good. But the best advice is to not sweat it, make the changes you can and let them build up. Hell, after 30 years I still screw up occasionally \ put it down to being organic and not a machine. if you had been hovering at 300+ for a year and managed a 199, it _is_ an improvement! [I found an empty tube of urine test strips - the ‘active range’ on the damned things was like 200-300:eek: and went up to 1000 :eek::eek::eek::eek: I can’t imagine a BG reading of 1000] ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 7, 2013, 7:14pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/82 "2013-01-07T19:14:08Z")
> [@Athena](#): > > Not following you on this one. You’re saying 1 gram of carbs will vary depending on how you measure it? The results of an analysis will depend on the methodology used, yes. That’s a pretty basic concept in analytical chemistry. ---
**Author:** ![Tim\_T-Bonham.net](https://avatars.discourse-cdn.com/v4/letter/t/46a35a/32.png) [@Tim\_T-Bonham.net](https://boards.straightdope.com/u/Tim_T-Bonham.net)\ **Post date:** [January 7, 2013, 7:33pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/83 "2013-01-07T19:33:02Z")
> [@tdn](#): > > This is very helpful, thank you. It’s pretty easy to feel guilty over one transgression. I was doing great all Saturday… until we heard “Would you like any coffee or dessert?” Oops. > > But my BG was 199 this morning – an all time low since late September. I think it’s much smarter the way they do this nowadays. I was depressed enough about the diagnosis, had I also faced _never eating a piece of chocolate again in my life!_ I don’t know if I could have faced that. But being told to limit it to 2 pieces a day – well, hard, but acceptable. I remember in the 50’s, my Grandma, in her late 80’s, being denied all desserts, candy, cake, etc. – a real trial for her. So bad that she took to stealing the baking chocolate from the cupboard and eating pieces of that. She couldn’t understand, or couldn’t accept these restrictions on her life. I’m glad they don’t do things that way now. ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [January 17, 2013, 11:14am UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/84 "2013-01-17T11:14:51Z")
> [@smaje1](#): > > Back to the issue of medical professionals not always knowing what they’re talking about when it comes to diabetes… > > A few years back when pregnant with my first child, I had horrible morning sickness (the Princess Kate kind) and ended up in Urgent Care. The doctor had me take my blood sugar – it was 156 – so he rushed off to get me a can of juice and told me to drink it. I gave him a look and asked “Why would I do that?” He actually \*argued \*with me that my blood sugar was too low. I refused his juice and went to a real hospital. > > And when I got my appendix out about 15 years ago, the nurse refused to give me access to my insulin after the surgery. She said I couldn’t eat anything, and therefore didn’t need any insulin. I tried to explain to her that I needed insulin (long-lasting insulin, not fast-acting) even if I wasn’t eating, and she told me I was wrong. My mother, an RN, kidnapped me out of the hospital the day after the surgery and brought me home to recuperate…and get some o’ that sweet insulin. > > So I no longer believe everything the “experts” in the medical field tell me. It’s one thing to study a disease in a book – it’s another thing to live with it for 25 years. > > Diabetes education classes are great, espcially if they are free. I’m glad, tdn, that you have access to something like that. When I was pregnant, my doctor sent me to a dietary specialist who taught me a LOT I didn’t know, especially about carbs and their effect on my blood sugar. > > Athena – I just got the CGM too (because I’m all pregnant again) and it’s amazing! The constant alarms drive me a little batty, though – I know I can adjust them, but I love knowing when my BG is dropping or heading up. Really eye opening! Yep. I’ve had many of these (I’ve been type 1 since 1993). Two that spring immediately to mind were: A doctor claiming that 3.8 (68.4, apparently) was a perfectly normal blood sugar level that would see me feeling normal. A nurse that in response to crashing blood sugar (I was rather ill in hospital) decided to give me a glass of milk rather than, you know, glucose tablets. Yes, milk has sugar in it, but not that much and when your sugar is dropping (it was already under the 4.0 threshhold) that milk is going to do nothing. ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [January 17, 2013, 11:18am UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/85 "2013-01-17T11:18:33Z")
> [@Athena](#): > > Yup. “12 carbs” means “12 grams of carbs”. It’s just shorthand. Most insulin-dependent diabetics dose their insulin based on how many grams of carbs they eat. You have a ratio - so let’s say your ratio is 7 grams of carbs needs 1 unit of insulin, 12 grams of carbs would required you to dose about 1.7 units. > > I think a unit is something like .001 mL, but don’t quote me on that. It’s really, really tiny. I go through about 1 tiny vial - about 2" high - of insulin per month, I think it contains 1000 units. > > Non-insulin-dependent diabetics also are aware of carbs, because they may need to regulate how much they eat at once or per day in order to keep their blood sugar in the correct range. > > (note: there are other methods of insulin therapy other than the one I describe above, but they’re less common nowadays.) I haven’t counted carbs since, oooh 1995 or so. No diabetes specialist that I have spoken to, in two different countries, in that period has recommended it. I think a large part of it is due to the glycaemic index, you need to think not just about how many carbs but also how your body will process them and thus adjust you short acting/long acting balance. These days I just look at what I am eating and guess how I think it’ll affect me. I am usually right. ---
**Author:** ![Athena](https://avatars.discourse-cdn.com/v4/letter/a/35a633/32.png) [@Athena](https://boards.straightdope.com/u/Athena)\ **Post date:** [January 17, 2013, 2:54pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/86 "2013-01-17T14:54:10Z")
> [@amanset](#): > > I haven’t counted carbs since, oooh 1995 or so. No diabetes specialist that I have spoken to, in two different countries, in that period has recommended it. I think a large part of it is due to the glycaemic index, you need to think not just about how many carbs but also how your body will process them and thus adjust you short acting/long acting balance. Really? In the US, carb-counting is still very much the standard teaching. How do they recommend new Type 1s learn how to calculate boluses? Personally, I haven’t had much luck with the glycemic index. Sure, some carbs are digested faster than others, but I still have to count the damn things and 18 carbs worth of whole grains need the same amount of insulin as 18 carbs worth of pure sugar, at least in my body. The curve is different, but not so much that I worry about it. Still, it’s intriguing - mind if I ask what your A1c is? No worries if you don’t want to get into that much detail, just wondering how tight of control you’ve been able to achieve with your methods. > [@](#): > > These days I just look at what I am eating and guess how I think it’ll affect me. I am usually right. I can do that too, with stuff I’m used to eating. There’s only so much variation in one person’s diet. But I do count when I’m eating something new, and especially at night, where mis-counting dinner means I have to set the alarm to wake up and check my blood sugar if I correct before going to sleep. ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [January 17, 2013, 7:28pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/87 "2013-01-17T19:28:06Z")
> [@Athena](#): > > Really? In the US, carb-counting is still very much the standard teaching. How do they recommend new Type 1s learn how to calculate boluses? Trial and error maybe? I mean that’s how I ended up going through about five different insulin types and regimes until I found something that worked for me. > [@Athena](#): > > Personally, I haven’t had much luck with the glycemic index. Sure, some carbs are digested faster than others, but I still have to count the damn things and 18 carbs worth of whole grains need the same amount of insulin as 18 carbs worth of pure sugar, at least in my body. The curve is different, but not so much that I worry about it. Still, it’s intriguing - mind if I ask what your A1c is? No worries if you don’t want to get into that much detail, just wondering how tight of control you’ve been able to achieve with your methods. 6.1. The previous time it was 5.8 and they said they were glad it had gone up as they felt 5.8 was too low, it is too easy to go hypo if your average is around there. > [@Athena](#): > > I can do that too, with stuff I’m used to eating. There’s only so much variation in one person’s diet. But I do count when I’m eating something new, and especially at night, where mis-counting dinner means I have to set the alarm to wake up and check my blood sugar if I correct before going to sleep. What do you do if you eat out? At a friend’s place? Anywhere where you didn’t make the food yourself? How do you calculate your change in dosage when you exercise? There’s a reason they don’t teach such rigidity anymore. ---
**Author:** ![Athena](https://avatars.discourse-cdn.com/v4/letter/a/35a633/32.png) [@Athena](https://boards.straightdope.com/u/Athena)\ **Post date:** [January 17, 2013, 8:33pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/88 "2013-01-17T20:33:42Z")
> [@amanset](#): > > What do you do if you eat out? At a friend’s place? Anywhere where you didn’t make the food yourself? How do you calculate your change in dosage when you exercise? > > There’s a reason they don’t teach such rigidity anymore. But they do teach it, at least in the US. Where do you live where they don’t teach it? Seriously - 4 years ago I visited one of the top (if not THE top) diabetes facility in the US, and they teach carb counting, and I highly doubt they’ve changed. You say “Trial and error” - but that has to be based on something, doesn’t it? I’m not trying to be difficult here, I’m just truly curious about how new Type 1s learn how to eat, if not through carb-counting. I guess I don’t really understand your question about what I do if I don’t make the food myself. I still count carbs, based on sight, which is mostly what I do at home. Sure, sometimes I weigh things at home, or check the packages, but it doesn’t take long to realize what 20 carbs worth of beans or bread or whatever looks like. How do you do it? As far as exercise, that’s trickier, but doable. I guess the big rule for exercise for me is 1) always take some fast-acting carbs with me and 2) check blood sugar every 45 minutes or so. I’ve found that if I work out with bolus insulin in me, I’ll almost certainly go low, so I either under-bolus if I know I’m going to be working out, or make sure to keep a close eye on it. Of course, that’s not a hard-and-fast rule, because it also depends on the exercise. Running, for example, is the opposite for me - if I don’t have some extra bolus in me, I go high from running. Do you have a pump? If you’re not carb counting, what do you do? Just dose in units rather than # of carbs? Every pump I’ve seen is set up to take carb counts, though most will allow you to type in units as well. Sorry for all the questions, I’m just curious! ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [January 18, 2013, 12:05pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/89 "2013-01-18T12:05:55Z")
> [@Athena](#): > > But they do teach it, at least in the US. Where do you live where they don’t teach it? Seriously - 4 years ago I visited one of the top (if not THE top) diabetes facility in the US, and they teach carb counting, and I highly doubt they’ve changed. You say “Trial and error” - but that has to be based on something, doesn’t it? I’m not trying to be difficult here, I’m just truly curious about how new Type 1s learn how to eat, if not through carb-counting. > > I guess I don’t really understand your question about what I do if I don’t make the food myself. I still count carbs, based on sight, which is mostly what I do at home. Sure, sometimes I weigh things at home, or check the packages, but it doesn’t take long to realize what 20 carbs worth of beans or bread or whatever looks like. How do you do it? > > As far as exercise, that’s trickier, but doable. I guess the big rule for exercise for me is 1) always take some fast-acting carbs with me and 2) check blood sugar every 45 minutes or so. I’ve found that if I work out with bolus insulin in me, I’ll almost certainly go low, so I either under-bolus if I know I’m going to be working out, or make sure to keep a close eye on it. > > Of course, that’s not a hard-and-fast rule, because it also depends on the exercise. Running, for example, is the opposite for me - if I don’t have some extra bolus in me, I go high from running. > > Do you have a pump? If you’re not carb counting, what do you do? Just dose in units rather than # of carbs? Every pump I’ve seen is set up to take carb counts, though most will allow you to type in units as well. > > Sorry for all the questions, I’m just curious! I haven’t been a new diabetic since 1993, but in the UK they stopped carb counting with me around 1995 and I have never, ever had carb counting presented to me as a way of dealing with things in the thirteen years that I have lived here. “Trial and error” is based around trying a value and seeing if it works. That starting value can be based on anything, even just a “sod it, let’s go with ten”. I’ve done a bit of background reading and found this site which suggests that it went out of favour in the UK but in some areas it has been brought back in: > **[Carbohydrate counting in diabetes | Nursing Times](https://www.nursingtimes.net/diabetes/carbohydrate-counting-in-diabetes-09-10-2011/)** > > In this article… How the Dose Adjustment for Normal Eating (DAFNE) programme can help people with type 1 diabetes count their carbohydrates Different > [@](#): > > Over two decades ago, carbohydrate counting for people with diabetes went out of favour in the UK and was replaced with education that focused on qualitative methods of advising on food intake, such as the glycaemic index and healthy eating. > … > In 2003, the Dose Adjustment for Normal Eating (DAFNE) study group showed this programme could be reproduced in the UK, not only improving biomedical outcomes but also bringing other benefits such as a better quality of life. > … > As a result of this wealth of evidence, carbohydrate counting is now considered a normal aspect of the education and skills required to manage type 1 diabetes, and structured education has now become a core component of “normal” care in quality diabetes services. I haven’t live din the UK since 1999, so what they do there now is something I don’t come across. Here in Sweden, as I said, I have never even come across it. The absolute closest I have seen is when talking to a dietician she showed me the plate model. Maybe they feel they don’t need to because my control is very good? I don’t have a pump. I use Humalog with each meal, Lantus at 8pm every night and take 4-8 tests per day (at a guess). I also exercise a lot. Additionally, here’s an interesting blog post: [Every day ups and downs, a diabetes blog: Not counting - the cost. An open letter to Diabetes UK.](http://www.everydayupsanddowns.co.uk/2010/09/not-counting-cost-open-letter-to.html) > [@](#): > > The problem does not appear to be universal. Some HCPs still do things the ‘old way’ and provide information about measuring the quantity of carbohydrate to match insulin doses but in a few weeks’ research I have come across dozens of people, diagnosed over the last 10 or 15 years who were told little or nothing about the relationship between carbohydrate and insulin when they started a basal-bolus regime. > > Some patients have muddled through, working things out for themselves, others have sought help and advice from peers or online forums. Even more worryingly, some patients report that they have asked their clinic or surgery for more detailed information only to be told that, “We don’t offer carb counting here…”. I did some clicking around and unfortunately, as you’d expect, all the information for Sweden is in Swedish. This site is run by Novo Nordisk, one of the pharma companies specialising in diabetes care: [http://www.alltomdiabetes.se/website/content/living-with-diabetes/for-dig-med-typ-2/kost\_och\_diet/kost%20och%20diet.aspx](http://www.alltomdiabetes.se/website/content/living-with-diabetes/for-dig-med-typ-2/kost_och_diet/kost%20och%20diet.aspx) I can honestly not find anything about Carb counting in the food section. It covers GI, eating fibre, the plate model and whatnot, but no connection is made (that I can see) directly between the amount of carbs and the exact amount you should inject. The only slight reference is this: [http://www.alltomdiabetes.se/website/content/living-with-diabetes/for-dig-med-typ-2/kost\_och\_diet/bra%20matvanor.aspx](http://www.alltomdiabetes.se/website/content/living-with-diabetes/for-dig-med-typ-2/kost_och_diet/bra%20matvanor.aspx) > [@](#): > > Innan blodsockermätarnas tid > Innan blodsockermätarnas tid var diabeteskosten en kolhydratberäknad, fettreducerad bantningsdiet. Dessvärre fick de flesta samma kostråd oavsett om det var fråga om en växande tonåring med typ 1-diabetes eller en överviktig, stillasittande man med typ 2-diabetes. Which translates as : > [@](#): > > Before the time of blood sugar meters, diabetes food was a carbohydrate counted, reduced fat dieting diet. Unfortunately most got the same dietary advice no matter if it was a question of a growing teenager with type 1 diabetes or an overweight, inactive adult with type 2 diabetes. ---
**Author:** ![Athena](https://avatars.discourse-cdn.com/v4/letter/a/35a633/32.png) [@Athena](https://boards.straightdope.com/u/Athena)\ **Post date:** [January 18, 2013, 2:52pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/90 "2013-01-18T14:52:56Z")
Many of the links you gave (I translated them with Google Translate) are talking about diet in general, not carb-counting for insulin dosing. In the “diet” sense, what we’re taught in the US is exactly the same as the links you provided - there is no “diabetes diet”, there’s no reason to restrict carbs beyond what is recommended as a healthy diet for everyone, diabetic or not. That said, we are taught to figure out carbs for insulin dosing. Personally, I agree with the letter you linked [here](http://www.everydayupsanddowns.co.uk/2010/09/not-counting-cost-open-letter-to.html). I can’t imagine just blindly using trial-and-error to figure out boluses. Seems foolhardy, and carb-counting really isn’t that difficult or “rigid” after the first month or two. I eat what I want, dose appropriately, don’t really spend more than a few minutes a day on diabetes management, and I’m happy with that. Any other US-based Type 1’s reading this? What’s your take? ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [January 18, 2013, 4:23pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/91 "2013-01-18T16:23:57Z")
> [@Athena](#): > > Many of the links you gave (I translated them with Google Translate) are talking about diet in general, not carb-counting for insulin dosing. In the “diet” sense, what we’re taught in the US is exactly the same as the links you provided - there is no “diabetes diet”, there’s no reason to restrict carbs beyond what is recommended as a healthy diet for everyone, diabetic or not. > > That said, we are taught to figure out carbs for insulin dosing. Personally, I agree with the letter you linked [here](http://www.everydayupsanddowns.co.uk/2010/09/not-counting-cost-open-letter-to.html). I can’t imagine just blindly using trial-and-error to figure out boluses. Seems foolhardy, and carb-counting really isn’t that difficult or “rigid” after the first month or two. I eat what I want, dose appropriately, don’t really spend more than a few minutes a day on diabetes management, and I’m happy with that. > > Any other US-based Type 1’s reading this? What’s your take? That’s kind of the point I was making. An in-depth site for diabetes, for Swedes in Swedish, makes next to no reference to it. Which goes a long with how I have never had it mentioned to me in the thirteen years I have lived here. And my centre for treatment is the specialist centre at one of the four main hospitals serving the capital city (S:t Görans Sjukhus in Stockholm). ---
**Author:** ![The\_Dord](https://avatars.discourse-cdn.com/v4/letter/t/3be4f8/32.png) [@The\_Dord](https://boards.straightdope.com/u/The_Dord)\ **Post date:** [January 18, 2013, 10:15pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/92 "2013-01-18T22:15:01Z")
I use ReliOn Prime Blood Glucose Meter since the strips per 50 is only $9.00. It doesn’t include a lancing device and you have to buy that separate. I swear my Bayer lancing device doesn’t work well when you put the lancet in properly in the device. (always have to pull it out ever so slightly or I won’t get a prick) ---
**Author:** ![kushiel](https://avatars.discourse-cdn.com/v4/letter/k/bbce88/32.png) [@kushiel](https://boards.straightdope.com/u/kushiel)\ **Post date:** [January 23, 2013, 3:00pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/93 "2013-01-23T15:00:15Z")
It amazes me what awesome NSA/low carb options are out there on the American market, especially for established brands. In Canada, we’ve caught onto low fat and low sodium, but not low carb. Y’all have low carb Heinz ketchup, Breyer’s SmartCarb ice cream, NSA Oreos…low carb in Canada is very much a niche market. I’m lucky enough to live in a part of Canada that has FlatOut wraps and we have a few online companies that ship cheaply, but I really wish I could shop more locally. The only reliable low carb products are diet soft drinks and Russell Stover candies. In other, related news, my most recent A1C was 5.9! 😃 ---
**Author:** ![The\_Dord](https://avatars.discourse-cdn.com/v4/letter/t/3be4f8/32.png) [@The\_Dord](https://boards.straightdope.com/u/The_Dord)\ **Post date:** [January 24, 2013, 7:01pm UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/94 "2013-01-24T19:01:48Z")
Got the Fastclix lancing device yesterday and its **MUCH** better than the Bayer Phaser™. (Real name Bayer Microlet 2) Congrats kushiel! 🙂 ---
**Author:** ![Seanette](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/seanette/32/9139_2.png) [@Seanette](https://boards.straightdope.com/u/Seanette)\ **Post date:** [January 25, 2013, 5:56am UTC](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831/95 "2013-01-25T05:56:26Z")
> [@kushiel](#): > > In other, related news, my most recent A1C was 5.9! 😃 Good job! [Previous page](https://boards.straightdope.com/t/diabetics-how-do-you-satisfy-the-nom-nom-nom/645831.md?page=4)