Everything Counts – Successful Control in Type 1 Diabetes—Part 1

First I have to begin by saying that I am NOT a doctor, or nurse or nutritionist. I have no professional training. I am a mother of a child with type 1 diabetes. All of my training has been in the trenches of real life—the day-in and day-out management of type 1 diabetes. When we left the hospital after my daughter’s diagnosis, we were given folders and books and pamphlets about what to eat and what not to eat. It was overwhelming. The hospital staff was very helpful; our doctor is very supportive. But you realize they aren’t always around--now it’s now up to YOU. You just have to get in there and do the work.

Sometimes if you do the hard work, it pays off. For us it has. My daughter’s A1C scores since her diagnosis have been in the 6 range. This is considered excellent for someone with diabetes. It indicates that the disease is under tight control which will lessen the risk of complications later in life. The A1C is a blood test done with a finger stick which gives an average blood glucose level over the previous two to three months. Red blood cells live in our bodies for approximately 120 days. During this time, glucose in the blood will attach itself to part of the red blood cells, and the A1C test measures this level. Doctors use the A1C score to help determine if the diabetes is under control.

What I mean by hard work is—everything counts. Living with a disease that involves what you eat encompasses one of life’s most basic needs. We need oxygen, water, sustenance and protection from the elements to survive. Living with diabetes means food—our source of energy, nourishment, comfort, and basic component in many of our cultural rituals—can now become an adversary. This adversary challenges our body with everything we eat. Insulin is the hormone that the healthy pancreas makes to process this food into energy. The pancreas of someone with type 1 diabetes is not healthy and can no longer produce that vital insulin. Without insulin, the person with type 1 diabetes has no way of adequately processing the food he/she eats. The blood sugar can rise to unhealthy levels. These high quantities can be dangerous in the short term—coma and death. Poor blood glucose management also has serious long term consequences. Not all cells in the body need insulin to process glucose, but others do. Those which do not need insulin are the most vulnerable to damage from high blood glucose numbers. Cells in the eyes, kidneys, and nerves are examples of this.

So I say again—everything counts. When we eat, we must have insulin to process the food. With type 1 diabetes there is no insulin being produced by the pancreas, so it must be artificially introduced into the body through an injection or with an insulin pump. But, and here’s where it gets a bit tricky. There is no standard insulin “dose”. It’s not like taking a pain pill for a headache or a teaspoon of cough medicine for a cough. The insulin dose (called a bolus) must be gauged to what you eat. When determining an insulin dose, you look at the carbohydrates in a meal or snack. Everything counts—because everything you eat has the potential to raise your blood sugar. The correct bolus is determined through the number of grams of carbohydrates eaten. Proteins and fats aren’t counted but can affect blood sugar values as well. The number of grams of “carbs” is then plugged into a formula that helps calculate the dose of insulin for that meal or snack. Not all formulas are the same. Each formula is unique to each person with diabetes. The doctor gets you started on your formula, but you refine it through trial and error. The time of the insulin bolus is also important. This depends on the blood sugar levels before the meal is eaten. A high number before a meal means the insulin must be calculated and administered well before eating—perhaps 20-30 minutes. A low number means the bolus can be given closer to actually sitting down to the table.

Diabetes gives new meaning to the phrase I sometimes hear “mindful eating”. With diabetes there MUST be mindful eating. There can be no casual munching. Everything must be counted and calculated before eating so the accurate insulin dose can be given.

There are many excellent books that I have read to learn about type 1 diabetes. One that I highly recommend is Type 1 Diabetes by Ragnar Hanas.

In Part 2 of this hub I will explain specifically how I count carbohydrates, adjust for fats, and determine portion sizes to accurately calculate carbohydrate grams. It sounds like a great deal of work—it is. But you adjust, and it becomes a normal part of life. And it is SO WORTH IT when we get that great report from my daughter’s doctor.