Can someone please explain counting carbs?

[jbrowning2612]

Hello all. I've been a diabetic for a little over 3 years now. Since I was diagnosed, my doctors have had me on Lantus and a sliding scale with Novolog for meals and corrections. I've been reading more and more about counting carbs for my meals, but I'm still not understanding it fully. Can someone please try and explain this to me so I know if I want to talk to my new doctor about it. I bought a book that tells about a million different foods and how much calories, fiber, carbs, etc they have in them. So I'd like more info on counting carbs and how much insulin you give per so many grams of carbs. Thanks ahead of time! :confused:

[xMenace]

and a sliding scale with Novolog for meals and corrections.

First, how does your sliding scale work?

[UpNorth]

Carb counting basically means you find out how many carbs one unit of insulin covers for you and then read on packages/weigh/guess how many carbs you eat, and inject accordingly. Gives more freedom than set doses... You cover what you eat, instead of feeding insulin.

It's the most simple way to explain it i guess...

[jbrowning2612]

My sliding scale right now is this:

If my blood sugar is less than 160 before I eat, then I take no Novolog.

If my blood sugar is between 161 and 200 before I eat, then I take 2 units.

If my blood sugar is between 201 and 240 before I eat, then I take 4 units.

If my blood sugar is between 241 and 280 before I eat, then i take 6 units.

If my blood sugar is between 281 and 320 before i eat, then I take 8 units.

If my blood sugar is between 321 and 360 before I eat, then I take 10 units.

If my blood sugar is betwen 361 and 400 before I eat, then I take 12 units.

If my blood sguar is over 400 before I eat, then I still take 12 units.

Then I am supposed to check my blood sugar 1 hour after I eat.

The more I'm on this sliding scale, the more I'm realizing that it just doesn't work for me. I usually have to give myself at least 4 more units than what is recommended for it to not go out the roof. Then I usually have to take more a couple hours after I eat for correction purposes. I'm going to my doc on July 1 to talk to him about this and about changing to counting carbs.

[notme]

This isn't making any sense to me. Maybe I don't understand sliding scale. So if your blood sugar at lunch time is 140 and you eat a sandwich, then doesn't your blood sugar go up through the roof after you have eaten? Why would you not take novolog when you are going to eat food? :confused: :confused:

[jbrowning2612]

I'm still trying to figure that out myself, notme. I just feel helpless in all this and I want some answers from my doc that he apparently can't give me and I just want to FEEL healthy again.

[notme]

I bet you do. Generally counting carbs is a way of making sure you blood sugar stays low before, during and after eating. From the sound of it, you are always chasing high blood sugar with the sliding scale system you are using.

When you check your blood sugar before a meal and it is in the semi normal range of 100, you would take insulin based on how many carbohydrates you are eating and your insulin to carb ratio. If you don't know that ratio, you would generally start out using a 10 to 1 ratio. That would be for every ten carbohydrates you eat, you would take one unit of novolog. Everyone is different, but this is generally the number you will start out using and tweak it from there. If your number was greater than say 120 before your meal, you would take the number of units to cover your meal and how ever many more units you would need to lower you to 100. Usually for me, one unit of insulin would drop my blood sugar down 60 points. So, if my blood sugar was 160 before a meal, I would take 1 unit to drop me to 100 and if I were eating 20 carbs I would take two units with a 1 to 10 ratio. So in total you would take three units. If your blood sugar was exactly 100 when you tested before your 20 carb meal, you would take only 2 units of insulin to drop you to that magic 100 number two hours after your meal.

There are lots of variations you would use depending on what you are eating, but this is sort of a basic description of how it works. If you eat a fatty meal, you may have to do a correction bolus after that meal as fat will tend to make some people's blood sugar rebound after two hours.

Hang in there. Your asking questions and that is good. You will figure this all out and do much better in the future. If your doctor isn't giving you what you need, you need to find a doctor or endocrinologist that can give you better information.

Welcome!!!

[jbrowning2612]

Thanks notme! Thanks makes more sense than what I'm doing now. I have recently moved to where I am now, so I have a new doctor that I'm going to see the 1st of July and a new endocrinologist I'm going to in Dallas around the 1st of September. So hopefully within the next 6 months or so I'll be all straightened out.

[Alice]

I was under the impression that "sliding scales" were an out-of-date form of treatment. If you are new to Dallas, I highly recommend Dr. David Feinstein in Medical City on Forest Lane. He is my most favorite endo of all time. (I've lived in every major city) I saw him back in his early days out of med school. He had enthusiasm which I haven't seen since. Especially with young people.

[notme]

Glad to hear it! Carb counting has helped my blood sugar control dramatically. When I first found out that what the doctors told me in 1986 was almost the complete opposite of what I had been doing, I wanted to cry. I was put on a high carbohydrate, low fat diet and never could get control. I was taking NPH and REG insulin. We have come a long way!

Get on the carb counting bandwagon and then look into pumps. Your life will be so much easier and your health much much better. I am glad you are here.

[jbrowning2612]

Thank you so much for your kind words, notme. I'm really excited to get started with all this and hopefully start feeling much better and maybe even lose a few pounds on my new endeavors.

Alice - Thank you for the suggestion. I have already made my appointment with a doctor in the Endocrine Associates of Dallas, Dr, Audrey Miklius. A friend of mine that I work with goes to her and he only has good words to speak about her. Thank you for the suggestion though. If things don't work out with Dr. Miklius, I'll definately look into Dr. Feinstein. :)

[Jan B]

Example:

Not my exact numbers, but close:

1 unit of Humalog to lower BG 50 points & 1 unit for every 15 carbs.

BG 100 before a meal of 15 carbs = 1 unit of Humalog

BG 150 before a meal of 30 carbs = 3 units of Humalog (I would ideally inject and wait 1/2 hour before eating)

BG 200 before a meal of 45 carbs = 5 units of Humalog, but I would inject about 45 mins to an hour before eating.

I'm happy you are on the road to much better control!

[iDream]

Yeah that sliding scale makes no sense. Your sugar is 155 and you eat a slice a pizza and take no insulin to cover, that puts you at 300....As some of the previous posters said, injecting for the food that you are eating is the ideal scenario. You will have to determine your carb to unit of insulin ratio first. Maybe a pump would be a good choice?

[owlyn]

Here is counting carbs 101:

You basically need to determine two things:

1. How much 1 unit of (rapid acting, like Novolog) insulin will lower your BG.
2. How many grams of carb does 1 unit of this insulin "cover" for you?

In my case, my ratio is 1 unit rapid = 30 points of BG = 15 grams of carbs. FWIW, these numbers are fairly typical, though everyone is different, and there are plenty of times where this may not work, but that is in the Counting Carbs 102 course.

So, let's say I'm about to eat dinner, and my BG is 170. Well, I want to get it down to somewhere between 70 and 100. 3 units of insulin will llower it 90 points (to 80). then, I looked at all my food pacakages, calculated based on the recipe and portion size, and determined that I am about to eat 120 grams of carbs for dinner. So, 120/15=8 units. So, I will inject a total of 11 units. Unless I will exercise immediately after dinner, in which case I will take either 5 or 6 units (about half the total)

In Counting Carbs 102. we will discuss the part about stuffing a chicken in a paper bag and waving it over your head, phases of the moon, and whether today's Julian date is a prime number. This information will be important if you ate pizza, Chinese food, or Mexican food, as all calculations are wrong. If you know a voodoo practitioner, this may be a good time to make a phone call. Other topics include variance by time of day (taught by professor XMenace) and the many answers to the burning question, "So I can eat anything I want now?"

Oh, yes- how do you determine what 1 unit does? Write down everything. Your Bg, what you ate, the amout of Carbs in it, etc. How much insulin you took... You do this for about two weeks. You will need a starting point for what your ratio should be. I started with the one I still use, and it works pretty well for me, but everyone is different, so check with you Endo.

[barbarac]

When I did a sliding scale I would figure/guess about carbs in what I was eating. Then I would take either 1:10, 1:12, or 1:15 as we made adjustments and for different meals. That was for the food. I also in addition took 1 for each 50 I was over 150 (or maybe it was each 50 over 100). So I took for both the food and for being a little high. Does that make sense? I am on a pump now and sort of forgot.

[xMenace]

Your sliding scale appears to be for corrections only. You should be taking additional novolog for food.

The basics as already expressed are pretty simple. Eat x grams of carbs then shoot y units of insulin. We use insulin to carb rations such as 1u:10g - 1 unit of rapid insulin for every 10 grams of carbs we consume. The advanced parts are trickier so it's good to work with an endo or DE. We can help too, but you should become comfortable with the concepts, the math, and setting your own rates before you get too deep here. Eventually you'll be like most of us and not even consult our doctors.

I use three different rates:
1:4 at breaklfast,
1:10 at lunch, and
1:5 at dinner.

You also can't do this accurately if your basal rates are off. There's much testing you can and should do around them. Basically if your basals are off for a certain part of the day, your insulin:carb ratio only works for a fixed number of carbs. If you eat more or less, your sugars will go up or down depending on the nature of the gap. As I said, it can be tricky and frustrating.

Most of us agree it is much easier to achieve good numbers if you limit your carb intake. Pigging out on pizzas, Chinese, Big Mac's, or whatever can be very doable, but your ratios and carb estimation skills have to be near perfect.

[jbrowning2612]

Thanks for everyone's input! I'm starting to understand it all a little better now. So to determine how much 1u of insulin will drip by BG, how do I do that? Check my BG, take 1u of Novolog, and then wait how long to check it to get the correct response? I'm definately going to talk to my doc about all this, but I just wanted a better understanding before going in there and taking up a lot of his time. Everyone's posts have really helped me. Thanks again!

[Real4]

My sliding scale right now is this:

If my blood sugar is less than 160 before I eat, then I take no Novolog.


To start with, this regimen will never bring you below 160 - that's much too high for a base. Second, it makes an assumption about how many units it takes to reduce you so many points (correction factor). This may or may not be correct. Three, it does not take into account what and how much you are eating.

An intentsive insulin approach fixes all three issues.

[Real4]

Your sliding scale appears to be for corrections only. You should be taking additional novolog for food.

No, this kind of "sliding scale" approach is the whole thing. I was given the same, when I went on insulin, but I already knew about intensive MDI treatment, so I thanked my doctor, and threw the paper away. (The doctor had prescribed Humalog and Lantus, so I was all set to go otherwise.)

[owlyn]

Thanks for everyone's input! I'm starting to understand it all a little better now. So to determine how much 1u of insulin will drip by BG, how do I do that? Check my BG, take 1u of Novolog, and then wait how long to check it to get the correct response? I'm definately going to talk to my doc about all this, but I just wanted a better understanding before going in there and taking up a lot of his time. Everyone's posts have really helped me. Thanks again!

Ah... the right question. very good.

Check at 2, 3, and 4 hours and don't eat anything during that time. If your BG is still dropping rapidly at 4 hours, check again at 5, if still coming down fast, check again at 6 hours. (as rapid is almost gone after 5 hour and gone by 6 hours.) You will then know how much 1 unit of insulin will drop your BG, (at least for that day and time). Now, what to do if your Bg is high? You can try using the ratio you just discovered, but be cnservative. Underdose by a coupe of units until you are sure. Anyway, repeat the test at the same time daily for two weeks. By the end of the two weeks, you should have a pretty good idea, and can start testing for foods to determine how many carbs 1 unit will handle. First, you correct for your BG level, because you now know what to do for that. Then eat a known amount of carbs, and use the ratio your doctor gave you for carbs to insulin to start with. After a couple fo weeks of messing around with carbs and insulin, you should be pretty much set. The rest is just math and voodoo.

[jbrowning2612]

I take 54 to 56 units of Lantus in the morning so how will that effect my results?

[sprzepiora]

When first diagnosed I was setup with a sliding scale because they thought I was a T2, when they changed diagnosis to a T1 they also switched me to a basal/bolus regimen and counting carbs.

I'll have you know after a week of sliding scale I did pretty **** good because I was still honeymooning, my pancreas just needed a helping hand. So it is doable, but you still have to be producing insulin.

I prefer the basal/bolus as now I am doing most of the work of my pancreas and it is helping me to keep even numbers...for now.

[jbrowning2612]

Yeah.. I think I'm definately past my honeymoon phase. I take 500mg of metformin with my nightly meal and that seemed to really help at first, but not quite as much now. :shrug:

[Alice]

I think a lot of people consider carb counting "sliding scale". The term means different things to different people. I'm old school where it meant you correct the past and took a pretty much "fixed" guess at meal...added together. Neither was a good approach.

Now, we count the future and dose for that...but still correcting the past and future as needed. But not using the past as a base.

[jbrowning2612]

Yeah.. It sounds like the one I'm on is your old school version. It's just not working for me though.

[Alice]

Just curious...was your previous doctor (at diagnosis) an internist or endocrinologist?

Most endo's dropped the sliding scale back in the 90's or so.

[jbrowning2612]

He called himself an endocrinologist. That's what it said on his door anyways. And he wasn't a big fan of the pump either and refused to put me on it. Maybe the new one I'm going to see in a few months will be much more open minded. *fingers crossed*

[xMenace]

You can try using the ratio you just discovered, but be cnservative. Underdose by a coupe of units until you are sure. Anyway, repeat the test at the same time daily for two weeks. By the end of the two weeks, you should have a pretty good idea, and can start testing for foods to determine how many carbs 1 unit will handle. First, you correct for your BG level, because you now know what to do for that. Then eat a known amount of carbs, and use the ratio your doctor gave you for carbs to insulin to start with. After a couple fo weeks of messing around with carbs and insulin, you should be pretty much set. The rest is just math and voodoo.

There is a direct relationship between correcting for BG levels and bolusing for carbs. The rule of thumb is that 10g of carbs is equal to 50pts. Gary Scheiner in "Think Like a PAncreas" adjusts this number depending on body mass. I can't find my copy at the moment. When my sugars are high I determine how many points I need to drop it, divide by 50, and bolus for that many carbs. A 150pt drop I 'd need to bolus for 30g of carbs. Many pumpers fail to coordinate their rates and pumps don't enforce this rule. I follow this rule religeously.

[jbrowning2612]

Very interesting. Something to definately think about. I much appreciate the info.

[xMenace]

If it hasn't been mentioned, get this book and/or "Using Insulin" by John Walsh. Must haves!