How do you carb count?

Very few doctors spend much time studying and less time thinking about nutrition. Licensed dietitians spend more time than doctors studying nutrition and being formally tested on what they were taught.

Much of what they remember being taught is dogma that isn’t based on science or fact, but opinion and inadequate clinical trials that were never substantiated. They haven’t the time or interest to keep up with valid research that contradicts their entrenched beliefs.

They do seem to have time and interest in what pharmaceutical reps and commercials say about the latest stuff they are selling so they can answer when you "ask your doctor about - ".

Hi, @JakeVA. To borrow from @wadawabbit, I go with, whatever you’re doing, how is it working for you?, because I’ve noticed that fiber from different sources need to be treated differently for me, and it drives me stark raving bananas.

If I look at cans of 4 different plant-based-type foods and they all have the same carbs and fiber and fat, they will need different amounts of insulin. I try my best to remember which ones are the ones that really need to be treated like “a carb is a carb” (any pasta sauce including my local low-sodium, no-sugar brand), and which I need to ignore carbs altogether on (100%-almonds almond butter, supposedly 7gm carb / 3 gm fiber per Tbsp).

That’s for me. As far as I can tell, times when I’ve tried other diabetics’ rules of thumb, I learn (again) that my body doesn’t operate the same say.

I will say, I have various food issues starting with dairy, gluten and shellfish, although not nearly as many as other people in my family. My aunt had to remove almost everything from her diet, and has to stay away even from some non-gluten grains including rice!!

I have a favorite brand of special mushrooms that claims to be 12 gm carb, 10 gm fiber. If anything, when I put them in rice I need to debate lowering the insulin I take for the rice, but I certainly don’t add any for the mushrooms. Other mushrooms don’t do that. Why? Beats me.

Meanwhile, I don’t eat them at all any more because they’re such a nightmare to dose for, but I used to love to have one “sugar-free” chocolate-covered caramel after dinner. The package said 5 gm of carb. I had to dose as if it had 15 gm, and still my blood sugars would run high for a while longer than after most meals. But 2 caramels would not require twice as much insulin as for 1. It was on an utterly different scale than the 1 caramel. I don’t know what it is about caramel as a substance, I have the same problem whether they’re any brand of sugar or sugar-free, but even though chocolate-covered caramels are probably my most fantasy of fantasy foods, I don’t touch them any more.

I know I’m not helping. Very sorry.

Some artificial sweeteners like sugar alcohols (-ols) are metabolized but take longer than sugar. So are starches.

Sugar free is a marketing label. The way it is used by most food companies they could claim that 100% pure maple syrup was “sugar-free” or “no added sugar” on the label, and include it in the carb numbers without blushing.

We don’t subtract fiber. I think that as long as you don’t go too high or low, either is fine.

Thought I’d follow up on my tracking of my ratios.

I have kept a log of what I’ve ate and dosed, 2 hour numbers, 3 and four hour numbers, level of activity, type of food, the macros nutrient makeup, and, specifically, the carb ratios for both with and without counting fiber.

I found that, overall, subtracting fiber lead to more consistent carb ratios for me. For example, I’d have different meals on different days each having 30 net carbs (or carbs minus all fiber) and I followed a 1:9 ratio. My post BG was in my target majority of the time. The total carbs, however, would have given me different ratios like 1:11, 1:15, 1:10. So for me, net carb seemed to be more accurate. Please note I emphasize the word seemed as there are still so many variables I cannot account for. But with 2 months of data, this was a trend I saw.

I was never perfect with any ratio or with either method of total vs. net. And this only works for me. I have friends who have pumps and they total count as it’s easier and their pumps have control-iq / sensor integration. I use pens.

Again, just sharing if anyone finds it interesting. Not creating an argument for or against. I will say, taking the time to track and review my data was very helpful for me in general.

I’ve only gotten close to perfect results using a fixed ICR with a simple carb meal, which is the way that the ICR was originally defined. The concept doesn’t match real meal response, but is a practical compromise.

For my first decade with diabetes (the 1980s), I had problems with hypo and hyper. A1C wasn’t generally available, insulin and BG tests weren’t covered by insurance - when I could get it. The best I could do was feel good on the average. I could never match insulin in my meals. I had to change my meals to match insulin and how my body digested food. This worked pretty well for me for decades.

That stopped being the case as I developed autonomic neuropathy and gastroparesis. I responsively adjusted meals first and then insulin dosing, but I continued to trend toward wider variation in my BG and my A1C.

After I started using a CGM and could see how my BG fluctuated - when I wasn’t eating - I started to get a better handle on dosing. ICR was an average. Basal rate was an average. A1C was an average. None of these matched how my body responds hour by hour, minute by minute.

The way that insulin is administered- even with a hybrid closed loop pump uses averages. A healthy person’s blood glucose level isn’t regulated by averages. It’s dynamic, adaptive, and the pancreas doesn’t guess what’s coming. It’s reactive, and not just with insulin. A companion hormone tells the other organs to not convert stored fat to glucose. It does it real time, releasing these hormones into the blood.

The CGM showed me that average parameters don’t match my diurnal cycle. So I made changes to simplify things until I had better control. I’m lucky that my lifestyle and my spouse allow me to do controlled experiments like this for months at a time.

We now prepare my meals from fixed menus with carbs between 35 and 42 grams. I know within 2% how many grams of carbs are in every meal, and less precisely, how many grams of fat and protein. I have CGM and BGM data from a hundred identical breakfasts, dozens of identical lunches and dinners.

My 35 gram carb breakfast BG response to the same insulin dose varies from day to day. Not a lot over 5 hours, my pre-lunch BG is within 10 mg/dL of desired, but the height of the peak and the shape vary widely. I initially thought it was from timing the bolus, so I purposely eliminated that variable for a week. The relative peak still varied, within one infusion site and between infusion sites by more than 20 mg/dL. My average ICR is 1:9, my CF is 1:30.

For my lunches and dinners, which have progressively more protein and fat than breakfast, with a “simple” pump a fixed ICR doesn’t work for all three meals. The diffusion rate of the insulin doesn’t match my digestion. The bolus is gone before the carbs after dinner.

A higher fat/protein meal requires both a small ICR and a square wave extended bolus of 3 hours with Basal IQ or Control IQ turned off. Basal IQ will dump the balance of an extended bolus if BG drops enough suddenly at any time, Control IQ doesn’t permit extended boluses longer than 2 hours.

Now I have a basal profile, with an ICR and CF that vary by average meal, and extended boluses to accommodate fat and protein loads, I still need to do small corrections 3-5 hours after most dinners to get my BG before bed to my target.

SInce “upgrading” to Control IQ I still need to watch postprandial peaks. Control IQ doesn’t give a bolus after meals to prevent going over 180. It gives it no sooner than an hour after a meal bolus ends, to blunt the rise. It has never raised my basal rate as I cross past 160 after a meal. It seems that those parts of the algorithm aren’t for persons with carefully managed blood glucose, but for ones who haven’t - between meals.