People with type 1 diabetes and those with type 2 diabetes who take insulin may find the technique of counting carbohydrates to be the easiest for them. You still need to know how much carbohydrate you should eat in a given day. You divide the total into the meals and snacks that you eat and then, with the help of your doctor or certified diabetes educator, you determine your short-acting insulin needs based upon that amount of carbohydrates and the blood glucose that you measure before that meal.
For example, suppose that a person with diabetes is about to have a breakfast containing 60 grams of carbohydrate. He has found that each unit of lispro insulin controls about 20 grams of carbohydrate intake in his body. Figuring the proper amount of short-acting insulin can be accomplished by a process of trial and error: knowing the amount of carbohydrate intake and determining how many units are needed to keep the blood glucose level about the same after eating the carbohydrate as it was before. (The number of carbohydrate grams that each unit of insulin can control differs for each individual, and another person might control only 15 grams per unit.)
In this example, the person's measured blood glucose is 150 mg/dl (milligrams per deciliter). This result is about 50 mg/dl higher than he wants it to be. He knows that he can lower his blood glucose by 50 mg/dl for every unit of insulin he takes. Therefore, he needs 3 units of lispro for the carbohydrate intake and 1 unit for the elevated blood glucose for a total of 4 units. For more information on lispro, other types of insulin, and figuring out insulin sensitivity, see Dr. Rubin's book Diabetes For Dummies, 3rd Edition (Wiley).
He has a morning that is more active than he expected. When lunchtime comes, his blood glucose is down to 60 mg/dl. He's about to eat a lunch containing 75 grams of carbohydrate. He takes 4 units of lispro for the food but reduces it by 1 unit to a total of 3 units because his blood glucose is low.
At dinner, he is eating 45 grams of carbohydrate. His blood glucose is 115 mg/ dl. He takes 2 units of lispro for the food intake and needs no change for the w blood glucose, so he takes only 2 units.
IffOjl To be a successful carbohydrate counter, you must
✓ Have an accurate knowledge of the grams of carbohydrate in the food you are about to eat and how many units of insulin you need for a given number of grams of carbohydrate.
✓ Measure your blood glucose and know how your body responds to each unit of insulin.
You can make this calculation a little easier by using constant carbohydrates, which means that you try to choose carbohydrates so that you are eating about the same amount at every meal and snack. This approach makes determining proper amounts of insulin less tricky; just add or subtract units based upon your blood glucose level before that meal. A few sessions with your physician or a certified diabetes educator can help you feel more comfortable about counting carbohydrates.
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