Tuesday, February 12, 2013

Living with Diabetes: Carb Counting 101

One of the first things people say when you tell them that your daughter has Type 1 Diabetes is, "Wow! That must be a bit of a lifestyle change." Or "I suppose that means a big change in diet." Or "Poor thing, does that mean she can't eat sugar?"

Well, the answer to the last question is no; for the others yes, but perhaps not for the reasons first imagined.

The major changes to our lifestyle and diet with regards to diabetes have been things like looking at portion control and watching what the Chief eats like a hawk. In order for us to better manage her diabetes it is important that we understand what affects different foods, and the amount of carbohydrates in them, have on her blood glucose level.

Enter carb counting.

There have been four main stages to our carb counting since Miss Chief's diagnosis 3 1/2 months ago:
  • No counting; let her eat anything and everything.
  • The Carbohydrate Exchange system
  • Mix and Match
  • Measuring, analysing and reporting

No counting

For a few weeks after diagnosis we didn't even think about what Miss Chief was eating beyond, "How much? You could feed an army on that!" During this time her insulin requirements were fairly high, as were her BGLs and her appetite was enormous as her body hungrily and eagerly replaced all the weight lost prior to diagnosis.

As time went on she entered what is known as the honeymoon phase, where the pancreas starts producing small amounts of insulin. Her synthetic insulin doses fell and her BGL started to stabilise. We noticed certain periods of the day where she would have spikes and her glucose levels would shoot up. That was when the paediatrician suggested we start looking at the amount of carbs she was eating.

Around the same time I became a little paranoid about the possibility of coeliac disease as Chief complained on and off of a sore tummy. Coeliac disease is not uncommon amongst Type 1 diabetics and Chief's original screening at diagnosis had been inconclusive. So I started a food diary.

Carbohydrate Exchange System

I started counting the carbs Chief was consuming using a book given to us at diagnosis called The Traffic Light Guide To Food - Carbohydrate Counter (download the PDF here). It defines one exchange, or serve, as being an amount of food that contains approximately 15 grams of carbohydrate and lists all the major foods and the approximate carbs in grams and serves. It's called the exchange system because you can exchange one serve of carbs for another. For example, an apple, one slice of bread and 1 cup of milk or yoghurt all contain approximately 1 serve of carbs, so if you generally aim to have one serve at morning tea you could choose any one of these snacks.

It shows how far I have come that I just rattled that list off without checking any of it. The stressful thing around this time was answering other people's questions when I was only just getting my own head around it. Understandably well-meaning family and friends wanted to know what to give her. Well, she can eat anything. The trick is in knowing how much she usually has, how much insulin she usually has to cover that, and how far under or over that usual amount she's gone. These are all things you just can't possibly know in the early days. The food diary has been a massive help.

Mix and match

After a short period of using the exchange system I found it necessary to branch out a bit. I didn't always want to give her half an apple for morning tea. Before diagnosis we would have fruit salad and yoghurt at mid-morning. So, using the book, I worked out a number of combinations of foods that could be given, for example, half a cup of rockmelon, plus a handful of blueberries and half a cup of yoghurt. Some mornings she would have a higher BGL than usual, but not enough to warrant extra insulin, which I wasn't particularly confident in giving anyway. So I worked out half serve snacks. Some packet foods, such as biscuits, would give a serving size as 20g carbs so I would work out how many serves per biscuit and before I knew it I was dealing in fractions such as 1/3 serve. My inaccurate old kitchen scales started getting a bit of a workout and I have never hated them more.

Measuring, analysing and reporting

After a weekend away at the in-laws who did not appear to own (or be able to locate) a single food measuring device* I stumbled across a digital weighing spoon on special in Aldi. Along with a great website and iPad/iPhone app called Calorie King I was now able to measure serves more accurately. I could weigh food and then enter the weight into the app which would give me a carb count in grams. What do you know, all of a sudden I was actually counting grams of carbs.

Then someone posted on one of the oh-so-wonderful Facebook parental support groups that they'd just picked up a set of nutritional scales in Aldi for the bargain price of $15. I immediately sent Map Man out to purchase a set and my life changed forever. For most foods I could remove the extra step of looking the food up and get the weight of carbs straight from the scales. It sounds like a small thing but it saves so much time in my day. It is so quick and easy, Map Man has started doing it too.

Once I had a few weeks of data, I loaded all of the BGL data from our meter into an Excel spreadsheet. I added columns for carbohydrate intake, insulin administered and over a number of weeks input the data from my food diary and added tables, graphs and charts. This allowed me to start looking at the relationship between insulin, BGL and food and to understand the amounts of carbs Chief generally consumes at different times of the day. It has helped immensely in my understanding of what we're doing and has given me the confidence to start experimenting with insulin dose changes. But it's a work in progress and we still have a long way to go.

I am gradually getting better at this whole carb counting thing and I will continue to do so over the next few months and years, but right now it is still quite a large part of my day. In the morning we weigh Chief's cereal and check the back of the packet for the amount of carbs. This has become easier since we started buying packet bran rather than bulk-buy bran flakes from the health food shop. Then I prepare her food for daycare, which is becoming easier now that we've been carb counting a while and have a good idea of the average amounts she likes to eat at each meal. First I weigh a selection of chopped fruit and yoghurt until I have approximately 10g carbs. Then I make a sandwich or wrap and add some veg, fruit or a biscuit so there is about 30g carbs. Afternoon tea is often low carb but I do worry about her getting a bit low in the afternoon. I tried packing some extra snacks just in case but it served only to confuse her teachers who then withheld food from her when she wasn't low. They like me to label everything so they know what to give her when, which removes her freedom to eat what she wants when she wants. Once I've calculated the carbs in all her food, and provided a couple of extra "free" snacks that contain no, or very few, carbs, I write it all down in the food diary. Sometimes I forget and catch up when I get home from dropping the kids off, other times I spend tea time trying to remember and grilling Map Man about what he gave her for breakfast.

The most difficult times are social events, which will be the subject of another post entirely, but even just sharing food with friends has its challenges. For example, my friend often brings healthy baked goodies to our swimming lessons but I'm still not very good at guessing carbs in home-baked foods so I often end up getting the recipe from her and working out the carbs later. Cooking something for the first time takes a bit longer as I have to weigh all the fresh ingredients and look up a lot of other things to calculate the carbs in the meal. But then I have to guess what proportion of that meal Chief has consumed in order to figure out the carbs she had. I often cook vast quantities, enough to feed the family twice over, and Map Man and I have the lion's share of it so this can actually be quite tricky. Thankfully the bulk of our carbs are in easily measurable foods, such as pasta, rice, bread and quinoa. I enjoy mixing my own muesli and usually just chuck a selection of ingredients into a large cereal container and shake it around a bit. No more. Now I have to weigh each ingredient, calculate the carbs in it, work out the total weight and the carbs per 100g. It takes a lot longer than it used to.

It is slowly becoming a natural part of our day and in future, no doubt, it will be something that we just do. Even Miss Chief has been known to get the scales out and pop a piece of fruit on it, demanding "Weigh this, Mummy", when she's sick of waiting for me to give her something to eat.

* I did eventually stumble across a rather random 1/3 cup and using this determined that some plastic beakers were exactly 1 cup in volume. Where there's a will, there's a way.

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