Carb Counting Basics

I know I have written several posts about carb counting, but because diet is probably the most important aspect of managing diabetes, I don't think it can be covered too much.  Understanding carbohydrates helps determine which foods affect blood sugar and how much insulin should be given for the food eaten.

The 3 main nutrients in food: proteins, fats, and carbohydrates all affect blood sugar levels; however carbohydrates is the main effector.  After carbs are eaten and digested, they become glucose and enter the bloodstream.  This causes blood sugars to rise and insulin is required to move the sugar into the cells for energy.  Some might think that carbs are bad; but in reality, they are the body's main source of fuel.

Foods that contain carbs are: starches (Breads, starchy veggies), fruits, milk products, and sweets.

Estimating carbohydrates can be done based on serving sizes (some call carb choices).  On average 1 serving size will have about 15 grams of carbohydrate.  This method is best used when there are not any food labels or when eating at a restaurant.  Examples of carb choices are: 1 slice of bread, 1/2 cup of corn, 4 ounces of juice, small apple, 8 ounces of milk.  Each of these would be considered 15 grams of carbohydrate.

Counting grams of carbohydrate is much more precise.  Reading food labels and meal planning books are the best way to count grams of carbs.  I recommend the book, Calorie King.  When using this method, food is measured and then the carbohydrates are calculated.  When reading food labels, its important to determine how many servings you are going to eat and then multiply that by the grams of carbs per serving. 

*Watch out for products that say they are "Sugar-Free" or "No Sugar Added".  Just because a product is sugar-free doesn't mean its carb-free.  So always check the grams of carbohydrate.

I thought I had it together.....ugh

So, today was our quarterly visit with the pediatric endocrinologist.  Interesting morning, to say the least.  To start things off, I didn't sleep well last night, so when the alarm rang this morning, I didn't want to get up.  Thinking maybe I shouldn't have....  We did Alyssa's normal morning regimen and she asked if she could have a little coffee this morning. So, since she was up earlier than she had been in a few weeks I thought a little 'children's coffee' might help her get going.  I measured the milk, sugar free creamer and mixed them with a little coffee.  I accounted for that with her Novolog dose and we hit the road to drop her brother off at his first day of driver's ed and then on the see the doctor.

When the nurse called us back, she wanted to check Alyssa's blood glucose levels and I thought for sure it was going to be within range.  At this time it had been 2 hours since she had eaten....but a reading of 405.  I was floored!  She hasn't had a reading like that is such a long time.  Re-check...305...better, but what the heck??  I felt terrible.... I mean, I carefully measured her food, counted the carbohydrates, and calculated the insulin dose.... all of a sudden I felt like the worst mom in the world.  I mean, I know realistically that things like this happen and diabetes is a very tricky disease.  Sometimes bg's fluctuate for reasons out of our control like stress or excitement.  I know Alyssa and I both were excited to discuss the insulin pump with the endo.  Another blow, her A1C was 8.2, up from the last visit.  Ideally, they would like to see it 8 or less.  Ugh!

Well, on a happier note we did discuss the pump.  We are scheduled for an insulin pump class on Tuesday evening.  After we pick out the pump we want, the next step will be to contact the insulin pump company to start the purchasing process and see what pump and how much our insurance company will pay for.  I'll go into more detail in another post about the process of getting Alyssa started on the pump and the steps we'll take in the near future.

Alyssa's Birthday!!

Alyssa celebrated her 9th birthday this past Friday on June 15th.  The first thing she said that morning was that she wished she didn't have to have diabetes on her birthday.  So, it became my goal to keep diabetes from the forefront.  We had a fun day hanging at the pool with friends.  I knew she would be swimming and running, so I let her eat anything she wanted.  (Of course I kept the meter close by :)).  But she had mini cupcakes, Doritos, chocolate pudding; and, crackers, ham, and cheese.  When we left the pool, bg was 112!  So we stopped at McDonalds for a happy meal where she had a burger and fries and an injection.  That evening she had a few friends sleep over so, we went out for pizza.  Bedtime bg was 200 even!  What a great day!

Now, her party was the following day and her bg's were a different story.  They started off well in the morning, but by the time of her party at 3 pm, she was around 80 ( a little low for her in the afternoon).  She had several friends over and I'm sure her low was because she was so active.  They played on the slip 'n slide and in the jacuzzi.  When it was time for cake, Alyssa went in to change out of her swim suite and it seemed to be taking her a long time.  I went in to check on her, and she was incoherent.  She was trying to put her dry clothes on top of her bathing suite and when I asked her if she was ok, she said she was very tired.  She was very pale and her eyes seemed to be in a daze.  After she answered me,  she immediately started crying.  I knew she was low.  I grabbed a juice box, a container of frosting, and her meter.  Luckily when I stuck the straw in her mouth she began to drink the juice and I checked her bg..... 30!!  That's the lowest I've seen it.  She quickly finished the juice and I started taking finger fulls of icing and putting in her mouth.  In just a few minutes I could see the color coming back into her face.  I helped her get dressed and held her....she continued to cry...she was scared and so was I.  Ten minutes later, bg's back up to 90!!  Relief!!


(We had 2 cakes, this one Alyssa and her friend decorated)

We went back out on the porch where our family and friends were waiting for us and I said, "take 2!"

Counting Carbs...highs and lows

Juvenile Diabetes is a condition where the pancreas produces very little or no insulin which is the hormone needed for glucose to enter the cells and produce energy. If there is not enough insulin, glucose remains in the blood stream and can result in heart damage, kidney damage, vision problems, and skin problems--just to name a few of the major complications.

Alyssa's diabetes requires her to have 4 injections of insulin a day. With her 3 main meals, she has Novolog which is based on the amount of carbs she will eat with her meal and her current blood sugar. In the morning she also has an injection of Lantis, which is a long lasting insulin. Her 3 main meals consist of 45-60 grams of carbs and then she has 3 snacks (mid morning, mid afternoon, and before bed) that consist of 15 grams of carbs each. Her glucose levels are checked 4-6 times a day, poor little fingers; including in the middle of the night. The purpose of this diet plan is to keep her glucose levels between 100-180 (as she feels symptoms when she gets below 100).

I have found that her activity level majorly affects her levels. Alyssa is a very active little girl and it did take some time to get her adjusted. When she was first diagnosed, I thought our biggest ploblem would be to keep her sugar levels down, but in her case, with the insulin and her activity level, we stuggle with lows. Since she was diagnosed, working with her physician, we have had to adjust her insulin several times. Just when you think you're getting balanced, she starts having highs or lows...sometimes both in the same day.