Stumble It!
Betting Our Lives on Guesses
How many diseases do you know of where patients are required to calculate exact dosing, up to half-a-dozen times a day, of a medicine so potent that mistakes could literally knock them out or kill them? I hate to be fatalistic, but after a few serious insulin flub-ups lately, I just can’t seem to get this thought out of my mind.
Of course we’re all just winging it. Carb-counting isn’t particularly exact, nor are our carb-to-insulin ratios. And as my esteemed co-author Dr. Richard Jackson likes to point out, there isn’t any solid clinical data supporting the effectiveness of carb-counting. Is that true? Oy vey.
I know it’s not exact science. But heck, it’s the best method we’ve got right now, was my retort. It’s at least a place to start as we all scramble to figure out which foods kick off which BG reactions for each of us individually.
Yeah, except confession time here: Most of the time when I eat, I have very little freakin’ idea how many carbs are in that plate of food. I’m just taking one “educated guess” after another. I’ve been lucky that 1) most of the time I estimate reasonably well, 2) my pump helps me easily “correct” for underestimating my insulin needs, and 3) I’m very hypoglycemic aware, so I start sweating and getting a feeling I call “scratchy” long before I get low enough to start acting crazy-pants or pass out. But No. 3 won’t always be the case, and that’s what scares me.
“Those new insulins push glucose levels around a lot quicker, so the risk is a lot higher,” said a diabetes technology expert I was interviewing recently. “Older people are having tremendous problems with them — but you knew that.” Did I know that? Did I want to know that? Sometimes this disease just makes makes me want to bury my head in the sand.
I’m so grateful for the advent of this insulin that keeps us alive. But sometimes I’m also angry and upset when I think about how we’re all just betting our lives on guesses.
I can’t imagine managing diabetes without carb counting. An acquaintance suggested we get Chinese tonight and I didn’t mention it but my first thought was, “Are you kidding? I don’t want to spend the next 8 hours worrying about my sugar level.” I have yet to eat a regular meal from the same Chinese restaurant, consequently I have no reliable rules of thumb for managing the fat content.
Posted by: David | December 7th, 2009 at 9:15 amIndeed, it does feel like a big guessing game sometimes and depending on everything, some days are better than others. Like you, I often don’t know how many carbs I’m putting in my mouth – although years and years of guessing food to insulin have made me somewhat adept. What really gets me is that insulin potency can vary bottle to bottle and the accuracy of our home bs monitors can also be off – That’s CRAZY, especially in light of the fact that if you very insulin sensitive, as I am, that a little too much insulin based on that BS result can kill you. So far I’m still alive, but it really makes me mad that the tools we have are allowed to be off by the percentages they are. WTF?
Thanks for posting on this!
Posted by: saramy | December 7th, 2009 at 9:38 amI have never thought about it in such terms but what you said is so true.
Thanks for putting it into words and to think I have been controlling this on my own since I was 12… kind of scary when you think about it.
I have often thought about the fact that this is the only disease that is so controlled by the patient. We make all the dissensions right or wrong. I often feel that is were a lot of guilt comes from. If things go wrong I have nobody to blame except myself.
Posted by: Nikki | December 7th, 2009 at 9:42 amLately I have been second guessing myself. I wonder, “Meri, where the heck do you get all this confidence from to just GUESS carb amounts like a hundered times a day!” (I have 3 little diabetics, and it really does feel like a hundred times a day.) I’ll often get phone calls at lunch with questions like, “I ate 1/3 of my sandwhich, 4 chips and 5 bites of my apple…how many carbs, mom?” UHG! I guess it’s just one of those things where we just have to put one foot in front of the other and not think about too much. Afterall…we have done a good job so far…everyone is alive and kicking…but ya, how scary is it that one wrong “guess” could turn everything upside down. You hit the nail on the head with this one friend.
Posted by: Meri | December 7th, 2009 at 10:16 amWhile as a type 2 i dont have to count my carbs as you guys, I have decided to eliminate most of them from my diet, the big D is a lot about experimentation as anything else, the effect of one food might not be the same as another, I still to this day eat a certain food just to see how high it will raise the BG, eventually it kinda get tiresome though. until technology catches up with diabetes management educated guesses will be the way to go unfortunately…
Posted by: the poor diabetic | December 7th, 2009 at 3:58 pmLately I’ve been studying TAG (Total Available Glucose) of not only carbs, but protein and fat too. It’s a much better and more accurate way of bolusing for T1 than just counting carbs. I have a pump, so I do extended boluses for all but small meals and snacks. That seems to work better too.
The one thing that also drives me crazy is the inaccuracy of meters. Thank heavens we have them, but really, by now they could be much more accurate. The other one is that I wonder sometimes how some manufacturers get to their carb counts on food packs. I’m sure sometimes they’re just guessing.
Posted by: Sue Rafati | December 7th, 2009 at 7:10 pmA tighter control without going hypo is the goal of every D-person, I’d guess (tongue-in-cheek). One very obvious thing I’ve discovered again and again, so obvious that we tend to forget it, is that foods which come in their natural state–unprocessed and resembling the original plant, cooked or uncooked–contain fewer carbs. And you can eat a whole lot more of them and feel satiated. Not only do you feel full, you feel good. That’s a good start. I’ve noticed that in the last half of the last century, up till today, diabetes diet is all about carbs. Carbs are so stressed in the diet, that it becomes the omnipresent factor of eating, thus enjoying food. Try something new: try enjoying a diet of vegetables. Cut your starches in half–who gave them so much importance, anyway? (Read Michael Pollan) Why would you want to style your life around the American guidelines for a healthy diet–antiquated and innacurate and profit-driven–look at the average padded citizen.
It’s true, the guessing is so frustrating! I back-slide, too, grabbing the cookies around Christmas time…but with some positivity, with some trial-and-error, it might be possible to get closer to your ideal numbers without plummeting.
Posted by: DS | December 8th, 2009 at 12:50 amThank you for putting into words exactly what creeps to the top of my frustrations list every once in a while – “I’m completely winging this, people! Do you even know or care?” The carb content of our food is a guess. The potency of our insulin is a guess. The reading on our meter is a guess. What the heck all the other hormones in our bodies are doing today is anybody’s guess…
How many diseases do you know of where patients are required to calculate exact dosing, up to half-a-dozen times a day, of a medicine so potent that mistakes could literally knock them out or kill them?
Actually, the only thing that came to mind in answer to your question was that maybe we have more in common with heroin addicts than just the syringes…
Posted by: Val | December 8th, 2009 at 6:27 amI often say managing type 1 diabetes is like flying a plane. A plane is off-course most of the time and the pilot checks his instruments to bring it back on course. That’s type 1 diabetes.
We’re off course most of the time and our carb counts and meters just help us get back on course. The truth is with all our technology it’s still all a guessing game and we’re all just winging it best we can. And yes, when you really think about that, it can be scary as S__T. riva
Posted by: riva | December 8th, 2009 at 11:05 amIt is important to have a balanced diet. We all know that. Yet, it is even more important-in fact crucial, to have blood glucose stay as close to normal as possible.
This means we could all go on an extremely low carb diet and thus only require tiny amounts of insulin with each meal or snack. Small doses of insulin equals small errors equals better control. At this point one would need to make sure the basal setting is right on and should perhaps consider following a workout/exercise routine to also help with control.
Obviously our busy lives and all sorts of different circumstances makes things complicated but, where one can simplify and improve control-one should do so.
The old information given to type 1 diabetics about eating complex carbs at every meal and just properly dosing with insulin is out dated. Substancially reducing carbs has personally been my ticket to a 4.6 A1c.
Posted by: Sysy Morales | December 8th, 2009 at 5:15 pmI don’t guess. I weight, measure, read labels. If I don’t know what it is, I don’t eat it.
Posted by: Khürt Williams | December 9th, 2009 at 11:13 amIt’s amazing to me just how primitive our tools are. Don’t get me wrong, I’m very thankful for them. But in the end we’re squirting some “stuff” into us and bleeding on sticks to see if we guessed right.
Really?
Posted by: Scott K. Johnson | December 10th, 2009 at 12:47 pmMy friends and I call it W.A.G.ing (Wild-Ass Guessing) when we randomly shoot insulin to counterbalance food. I’m with Scott (above) we are very primitive, “it’s an inexact science.” Don’t worry, it’s just my life. (My cartoon looks blurry.)
Posted by: Haidee | December 10th, 2009 at 2:44 pmHaidee – I call it SWAGing – Simple Wild Ass Guess.
I’ve had Type I for 43 yrs. The longer I have it the more I hate it. I just get sick of everything you have to do to stay alive. Don’t get me wrong I’m glad I’m alive but I do have my down times. Sometimes I just cry in my doctors office. Other days I’m fine. I just allow myself the down times to grieve what I’ve lost because of this disease. I’ve had far too many Endo’s who I feel like I’m going to the principals office for. I dread going if my BG’s or A1C’s aren’t perfect.
Posted by: Chrissy Ryan | February 7th, 2010 at 6:50 amActually lately I just do the best I can and if they give me grief I tell them what I think. The amount of things we have to each day just to stay alive is crazy. I wish the doctors had to walk a week in our shoes and see how they feel.
I could go on and on. I do know things are much better than when I was diagnosed thankfully. I still hate it and am sick of it but I’m glad there are things like the pump. I haven’t been in the ER since being on it. Well I’m rambling now so I will stop. It’s nice being here with fellow diabetics who get it.