Today was particularly stressful and chaotic. Today was first day of school! I woke up made my breakfast, packed lunches for school for kids, packed lunch for my husband, and as the rest of the house was waking up to the excitement of the first day of school, I kissed everyone goodbye and dashed out the door. That got me thinking about my patients. Imagine, adding to this morning madness, need to check blood glucose and specially make decisions on how much insulin to take, based on that blood glucose!
Carbohydrate (“carb”) counting is a daunting task. For everyone. It’s difficult for my young patients with busy lifestyle and families, stressful jobs and other demands from life in general. It is difficult for my elderly patients, who are too afraid to make changes in their regimen on day to day basis. What if they make a wrong decision and suffer a severe low?
But I still bring it up often during visits and always assess my patients’ ability to count carbs. Why? The most important reason is carb counting offers flexibility and actually provides more safety against hypoglycemia when used correctly. Carb counting means taking 1 unit of insulin for certain amount of carbohydrates consumed. And the number is decided based on degree of insulin resistance. What that translates into is this: Sometimes I will say if you eat 15 grams of carbohydrates by eating one piece of toast, you need 1 (or perhaps 2 or 3) units of insulin. That means when you feel like eating two pieces of toast, you will take double the amount. This allows flexibility of diet. This allows the patient to eat when hungry and not force themselves to eat when not too hungry. Counting carbohydrates is like learning to ride the bicycle. Once we learn the carbohydrate content of our regularly consumed items, it keeps getting easier. Once a patient is comfortable with counting carbs, it’s a very empowering tool.
Diabetes is a difficult disease to manage, especially for those patients who take mealtime insulin. I encourage patients to consider carbohydrate counting as a tool in our toolbox, and not hesitate to use it when necessary.