Carb Counting Made Simple

Carb Counting Made Simple

Your body needs energy - Calories (or Kcal) - in order to work.

If you can eat it!!

It can pretty much turn anything you stick in your mouth into energy.  The UK Department of Health Estimated Average Requirements (EAR) are a daily calorie intake of 1940 calories per day for woman and 2550 for men.

There is a fiendish calculation that works out for your height, weight and activity level what your personal total should be, but we'll go with the average for now.

All of those scrummy calories come from whatever we eat or drink.  Different types of food yield different amounts of calories, for example:

• Fats - 9 Kcal/g
• Carbs - 4 Kcal/g
• Protein - 4 Kcal/g
• Alcohol - 7 Kcal/g

Ranked in order of how quickly your body can use that energy?

1. Alcohol*
2. Carbs
3. Protein
4. Fats

* 'cos whilst your body is processing alcohol it can't process anything else!

So if you have a nice cold beer and meal of say, steak & chips with a creamy pepper sauce and vegetables followed by a delicious new york cheese cake (mmmmm)  you would have a combination of fats, protein, carbohydrates and alcohol.

Now your body tries to convert everything you eat or drink into energy, glucose. Some stuff is too hard, even for you! Fibre is tough for the body to breakdown, raw starchy foods are hard work and most raw veg is quite a lot of work too. Carbs are easy peasy.

The body *loves* carbohydrates in all their delicious and addictive forms.  Carbs are easy to digest and turn almost instantly into glucose.  So fast is the process that before you have even swallowed your first bite of that sponge cake the enzymes in your mouth are breaking it down into glucose!

What happens next I hear you cry!  Well, sit back and let me explain.

Assuming you are not doing any exercise, as you digest your food and turn it into glucose you naturally experience an increase in the amount of glucose in the blood stream.  The increase in glucose levels, in non-diabetics, causes the pancreas to start delivering insulin to the body.

The body can do three things with the glucose:

1. It can use it to provide fuel to the cells of the body.  Every cell in the body needs glucose to live and function.

2. It can 'charge up' the liver, where is is stored as glycogen (think concentrated glucose)

3. It can be turned into fat

To get the glucose into every cell of the body, with the exception of the brain and autonomic system (think nerves/heart/spine) which can satisfy their needs directly from the blood stream, the cells need insulin.

Insulin 'unlocks' the cell door.  It transports glucose into the cell.  

No insulin, no energy in the cell.

So for you, you pancreatically challenged fool, if you don't inject insulin, you have no mechanism for transporting fuel to the cells in your body.

"But how much insulin do I need to inject", now the fun starts.  Remember I told you to test?  Remember I told you to log data?  Well this is why.  You are as strange and unique as the next diabetic, and your body will behave in its own beautifully independent fashion.  It will not conform to averages, 'normal' ratios or even guesswork!

You will need to learn!  

You will then need to learn to think like your pancreas. If you *really* want to control your diabetes you will need to grab a hold of it and make it a part of you, accept it, internalise it and get on with living with it - not have it control you!

Keep a paper diary, log everything - time you ate, what you ate, how many grams of carbs (its on the label!!), what was your bg before you ate, was it a meal out, were you socialising, what sort of mood were you in? 

Always check you bg 1.5hrs after eating, 'cos 50% of your bolus will have been used up by then so you should have peaked on you bg post meal and you can check to see if you got it right.

Only with your data can you make informed decisions.

Keep capturing the data and believe me you will soon spot patterns.

Next edition:  Why Low Carb - are you mad?

Testing Times!!

Testing Times!

Why oh Why - someone please tell me why I have to spear myself all the bloody time (& I do mean bloody!).

Simple.

Your BG Meter is the only tool you have to help you make informed choices about managing your diabetes.  Don't want to manage it?  Want to be one of these statistics?

• Kidney disease accounts for 21 per cent of deaths in Type 1 diabetes
• Cardiovascular disease is a major cause of death and disability in people with diabetes, accounting for 44 per cent of fatalities in people with Type 1 diabetes
• People with diabetes are 10 to 20 times more likely to go blind than people without.
• Diabetes is the most common cause of lower limb amputations.  Up to 70 per cent of people die within five years of having an amputation as a result of diabetes.
• Neuropathies (or nerve damage) may affect up to 50 per cent of patients with diabetes.
• Diabetes is the fifth most common cause of death in the world    
• The prevalence of depression is approximately twice as high in people with diabetes as it is in the general population

Source: www.diabetes.org.uk/Documents/Reports/Diabetes_in_the_UK_2010.pdf

Life expectancy is reduced, on average, by more than 20 years in people with Type 1 diabetes

Well I sure as hell don't, so given the choice, and it is MY choice, I want to manage my diabetes!

Easier said than done.....

Here is my first ever chart - the last week of January, my first few insulin injections and the first time I got the meter to say anything other than "HI"!

Max, Min and Average

I was very pleased with this.  Scared, worried that, as the GP had said "It'll take you eighteen months to get your bloods under control, and we don't recommend you do anything more strenuous than a gentle walk maybe once a day", but heartened that it was at least possible to get this thing under control.

One week of data, loads of reading, and no way I was going to have my life expectancy reduced by 20 years!  FFS that would only give me another ten to fifteen years.  Sod that.  Way too much to do yet!

I could barely wait for each new day and each new hour so I could capture more data, test, test, test.  I was racking up at least ten tests a day.  I knew that the more data I had the better chance I would have of being able to make sensible and informed decisions.

By now I had also decided to go  low carb.  I mean really low carb.  I was not my Dieticians favourite pupil any more.

Next edition:  Carb counting, Energy, Pseudoscience and Guidelines!

Reading Material

Reading Material!

Type 1 Diabetes then?  Wow.  At 44 years old?  Are they absolutely sure?

Having now met the Consultant and spent another two hours going through things in even more detail I was told that 

"Almost certainly you are a Type 1 Diabetic" 

There were other concerns with symptoms, which might be down to any number of things; coeliac, hyperthyroidism, cancer, fatty liver decease (?), aching kidneys, all of which could be due to high blood sugar levels over the last couple of months but still needed to be explained.  Doc explained that he thought my background level of fitness and consumption of gallons of water was one of the reasons I hadn't fallen over yet!!

Good job I love to read, study and learn new things.

Imagine my delight at dipping into the world of diabetes!  Brilliant.  No two 'specialists' can agree on anything.  If one says it's Black, the other says it's White, and both show 'studies' to prove the point. If the UK says its mmol/l the USA says its mg/dl - you work it out!

Have I mentioned Specialist Diabetic Dieticians yet?  

Wow, another whole world of psudo-science and government guidelines!  about the only thing that the Endocrinologists and the Dieticians seem to agree on is that the body needs energy! As if that wasn't enough to be getting my head around, along comes Carbohydrate Counting (Carb Counting), the joy!!

Fortunately I was pointed in the direction of  a few 'must read' books, each of which I will review individually in separate articles:

The Diabetes Solution by Dr Richard K. Berstein, MD was my first read.  Cover to cover, two day, job done.  So now I'm an expert eh? But hold on, everything he says is in direct opposition to the American Diabetic Association? Duh? Why?

POLITICS

Oh for the love of sweets!  Is there nowhere safe from the vested interests of capitalism?  Money + power = politics.  There, I've said it...now I'll have to explain it.  I promise to devote time to write a piece on just this, explaining what I have read, heard, found and observed over the last six months!

Back to reading lists.  So having read about the fight between Bernstein and 'the Establishment' I thought I had better read something from them too. 

American Diabetes Association (ADA) and the Medical Management of Type 1 Diabetes, fifth edition was my second read. Very useful, written for the medical community and surprisingly easy to follow, although I did have to keep the medical dictionary & google close to hand!

Next was Think Like a Pancreas by Gary Scheiner.  Bloody Brilliant, I'll say it again, brilliant!

Type 1 Diabetes for Dummies is exactly what it says it is.  Very 'on message' with the ADA.

Carbs & Cals by Chello Publishing Ltd who also have an iPhone app to go with it - very, very handy for carb counting beginners and experts alike.

Dr. Robert Atkins and Dr Atkins New Diet Revolution

The Glycemic Index for Dummies

Sheri R. Colberg and the Diabetic Athelete's Handbook

and several hundred research papers from institutes all over the world studying diet, exercise, insulin, complications (eek) and everything else affected by diabetes, which I will also share with you over the coming posts.

So what have I immediately learnt form reading all of the above?

One key thing:  I can manage my diabetes

Next edition:  Testing Times!

Someone Cares

Someone cares

Thursday 26th January 2012

The day it all began to go right again!

First though, remember my GP telling me that they had arranged an appointment with a specialist? So here I am, checked in at reception at the community hospital, sitting waiting my turn and soon enough I'm led though and introduced to?  A consultant endocrinologist? No.  A bloody nurse!

Fair enough, very nice lady, introduces herself as a Nurse Consultant (?), all I hear is 'nurse'.

Soddit.  Deep breath, calm, hold back the black thoughts of "just wait 'til I see the sodding GP".  Here we go again I thought, having to explain it all to someone who won't be able to do a damn thing about it, don't they get just how shitty I'm feeling?

As it turns out I was meeting with an angel.

Not only did she "get it", she asked incredibly good questions, dug into every aspect of the symptoms, checked and rechecked details, and with hindsight, I'm pretty sure she could have wrapped the consult up in about 30 min, but she let me talk and allayed my concerns for about two hours.

I finally felt as if someone was not only listening, but actually knew what my symptoms meant.  Knew what to do about it.  Could offer a solution!!

"Great" said I, "so do you now have to make an appointment for me with a consultant?" - thinking that, nice as this has been, I really need treatment of some sort and that means a consultant, right?

So she repeated, "I'n a Nurse Consultant specialising in Diabetes, I can write out the prescriptions for you right now"

Two hours later and I had all the supplies I needed to get started on injecting insulin!!

Next episode:  Graphs, Charts, Data - Why?

NHS Direct - bless !!

NHS Direct - bless!

Right then, cut our sugar eh?  

Easy peasy.  Delicious supper of vegetable chillie and rice. Loads of lentils, five different kinds of beans, basmati rice - delicious!!

I love to cook, and as we grow most of our own veg we tend to eat relatively healthily (hides the crisps & chocolate behind the fresh fruit!).

It must be noted at this point that at no time did the GP show any interest in my description of the "loose stools" that I had been suffering from for the last four weeks.  No questioning about the debilitating and constant headache, no perked interest in my description of blurry vision coming on over the last six weeks or so, and no surprise at the sudden loss of weight. They must be all meaningless then, eh?

Dinner was delicious.  I forgot to test before dinner, but did take a metformin tablet as the GP had told me I would need to take them twice a day for the rest of my life.  Settled back on the sofa, watching telly, feeling really crap.  Mrs B says, why don't you do one of those tests?  Great - why didn't I think of that?

Test kit out, check strips, stab self with lancet (ouch!), too bloody right I don't want to do that often, it hurts! Drop of blood on strip, *BEEP* - "HI".

Wow, thats nice, it's saying Hi....very cool and a good sense of humour these meter companies.

Wait, wait, wait....hang on....must have done something wrong.  New strip, another stab (dammit!), another drop of blood and.....

"HI"

???

Where's the sodding manual, did I chuck it with the box?

Ooops, manual says that HI means over 33.3 mmol/l - crap!!

What to do - is it serious?  What does Professor Google say?  Holy Candy Floss Batman, this isn't looking good!  Now the GP had said to call them if it went above 20, its 10:30 at night, should I call?  Yes!

Ring, ring, - out of office hours message tells me to ring NHS Direct, so I guess I'll do that then.

Ring, ring, NHS Direct, how can I help you?

Utterly charming, very calming.  No explanation of what a BG of over 33.3 was, no advice on what to do, no idea other than "speak to you GP in the morning"

Back to trusty old #doc & Professor Google

Some of the best advice and most reassuring help I have ever had.  The #doc helped a very scared, worried and frightened person cope with a 10 hour wait for the GPs office to open.

Before bed test was still HI.

Next morning it was 19.6

Ring, ring...ring, ring,  "Hello, can I speak to the doctor please"

I described the test results, said I was very worried, was told that they now thought they could get me an appointment with a specialist within a week!  Why I asked, what's changed?  Why the sudden rush?  No real answer to that other than that it was me, the patient, who wanted to see a specialist and they were only trying to facilitate that.

What about the bg test results?  "Well they are coming down, so just keep an eye on them."

That afternoon I had my second call from the GP.  They had managed to get me an cancellation appointment with a specialist for the following day. Could I come into the surgery and pick up the referral letter to take with me to the specialist?

Have I mentioned the darkness of my mood and my mega sense of humour failure?  Imagine a very grouchy, very tetchy, very moody, irascible and above all tired, physically and mentally knackered, man.  Got it?  

Well that doesn't even begin to describe how bad I felt.

Tomorrow's appointment with the specialist couldn't come quickly enough.

Next instalment: Someone cares!