We stimulate a lot of questions near solid food and diabetes, especially as it pertains to count carbohydrates and dosing insulin for them.

So in this weekend's edition of our Ask D'Mine advice column,  our own Wil Dubois takes a view this topic erosion both his hat arsenic a former clinical educator as well as a person living with T1D himself for many years.

Important Things to Know About Carbohydrate Counting

In the beginning there was the carbohydrate exchange. And everyone agreed IT was swell. New diagnosed type 1's were taught to recognize a portion of solid food that contained 15 carbs and were told to inject one unit of insulin for every exchange they consumed to "continue" the repast.

It worked, and some folks calm manipulation this system, but information technology's non without its problems. Chief among them is the fact that not every typewrite 1 of necessity the same amount of insulin for 15 carbs of nutrient, and running a close second is the fact that 15 carbs isn't a real-existence helping of any food or drink connected the planet.

So someplace in the murky evolution of diabetes care a much sophisticated system was formulated. The system is called carb counting, and it's a form of mathematics studied to optimize, personalize, and perfect every shake off of insulin that you take, while retention your rakehell sugar in mark off.

And comparable any form of math there are different levels of complexness.

Let's start with grassroots addition. Job one in carb count is to simply sum up up the carbs in your meal. Well, it sounds simple, simply thither are a number of trap doors to peck with, and the first is how to determine the number of carbs that you're supposed to amount. The primary tool at our disposal is the Food and Drug Administration Nutrition Facts label that pretty much every nutrient in a box, can, operating room bag is required to have. In fact, IT's the Facts label—which was required past law protrusive in 1993— that most prospective gave birth to carb counting. And as an interesting side billet, this label continues to develop, with changes in how added sugars are reported rolling outgoing next year.

So if you eat from a corner, can, or grip, adding up your carbs is comparatively simple-minded, justly? Good… Maybe. Here's the affair: The label gives the carbs for a pre-determined serving of any given food, but the container the food is in might have one, two, three, or even ten servings. Even containers that logically seem to be a single serving, corresponding a can of soda or a lunch-sized bag of potato chips, actually have cardinal servings per container. Or you may not agree along the FDA's notion of what constitutes a serving of a inclined food. And then you ask to use some higher mathematics to work up how many servings you'Re actually exit to eat. This isn't rocket science math, but you do need to be evocative of it.

If you don't eat from a box, can, or handbag (and healthy!), adding up your carbs takes a little more work. But there are any number of books, apps, and web data bases that list carb counts for these free-range foods. Calorie King, who used to print that handy little carb book we all carried in our back pockets earlier smart phones, has both an excellent app and an excellent website. One of the things I like about the app is that I can change the serving size from the canonical serving to what I'm actually going to eat, and the app will ray-crunch the math for me.

Past beware of occult carbs. The average saccharide substitute kinsfolk better-known as sugar alcohols—common in many "sugar unpaid" candies—have a reduced glycemic impact, so you should employ alone half of their carb count in your math problems.

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Thusly much for addition. Now let's verbalise about subtraction. Because here's the matter, the carb count on the label includes fibre, which in reality has no impact on blood sugar—which is what we'atomic number 75 very interested in. So to determine impact carbs, we take to subtract the fiber from the carbs, either from each element of the meal individually, operating theatre for the whole kit at once. The math doesn't care which direction you doh it. This step, ofttimes skipped every bit an annoyance by many an PWDs is actually to a greater extent important than you'd intend. Some foods have enough fiber that it can really bring i a deviation in the ultimate bolus. Fiber is handily listed decent below carbs on the Nutrition Facts judge.

Now it's time for some multiplication. Well division, actually, but partitioning is just multiplication spelled rearwards. At least in a mathematical sentience. Once you make your carb count, you need to divide it by your insulin-to-carb ratio, or IC ratio, to get the sum of money of insulin that you want to take to incubate the meal.

How do you know your IC ratio? The easy answer is that you ask your endo OR your diabetes pedagogue. The to a greater extent complex answer is that if you add up your total daily dose of insulin (basal and fast-acting) and carve up it into 500 you'll get your Cardinal ratio. Where'd the add up 500 derive from? It's the theoretical daily average uptake of food combined with the typical every day liver output of glucose. Assuming that you'Re winning the right amount of insulin in the premier place, this little equation leave get you close to your Cardinal ratio. OR you can use your weight to ball park it.

Now comes algebra, geometry, trigonometry and calculus…

Don't panic. I'm just kidding. But beyond the base summate the carbs, subtract the fiber, and figure the bolus, there are a number of optional enhancements that throne involve carb counting to the succeeding spirit level.

The first of these is adjusting for kayoed-of-target blood glucose, a.k.a. taking a correction. How often is your roue lettuce perfect when you sit to eat? Yea. Don't feel too corked. I think my blood glucose has only if been perfect in front a meal once, and that was ahead I had diabetes. So here's the thing, as you're expiration to get through the trouble of winning insulin for the food anyway, why not take the opportunity to fix your blood glucose at the same time?

If you're above target, information technology's a five-needled matter to use your correction factor to add some more insulin to the meal bolus so you can cover some the food for thought and even off the blood line sugar. If you're infra prey, you can use subtraction to shrink the meal bolus to avoid the danger of having it send you yet bring dow. Don't know your correction factor? Ask your doc, your educator, or divide that number daily dose into 1,800 this time. And, no, I don't have a clue where the number 1,800 came from.

But hold off, thither's more. Blood saccharify isn't a static thing and many of us now have continuous glucose monitors (CGM). You can add glucose trend data to your carb counting for the ultimate in active prophylactic blood sugar corrections. This can be cooked using set percentage adjustments supported the trend arrows, or by making unit adjustments.

Willing for grad school day math? Insulin is like the last guest at a good party; information technology hangs around for a spell. But equal that last guest, its energy winds falling toward the end. Still, it's primed to tie 1 more on if more people suddenly show up. Yes, I'm talking about the risk of insulin stacking, which happens any time you take more than one bolus within a four-minute menstruation. The best way to track this hanger-connected insulin, called insulin on board, Oregon IOB, is with engineering science.

Dealing the onslaught, peak, and duration of insulin action in your head is impossible for all but people. It accustomed cost that you needed a pump to track IOB, but now handy apps like RapidCalc rear end help tremendously. If fact, decently set up, RapidCalc can do a lot of the math we've talked all but today. It's the best $7.99 you'll ever spend on your diabetes.

So I think you can see the problem here. You john spend so some time on the math that your intellectual nourishment is cold and poisonous by the time you figure out how much insulin to take on, and and then there's no point in attractive any at all. This is a problem we didn't have when we used the exchange method acting.

Still, the beauty of carb counting is that you can opt how complex to make it, and you wear't have to use the same level of complexness every day or at every meal.

And we butt all agree that's a good thing, too.

This is non a medical advice chromatography column. We are PWDs freely and openly sharing the soundness of our collected experiences — our been-in that respect-through-that cognition from the trenches. Bottom Line: You still need the guidance and care of a licensed medical professional.