Carb Counting

At our last Type 1 diabetes support group meeting we talked about carbohydrate counting, commonly referred to as carb counting.

The group was made up of people who practiced carb counting, people who kind of practiced, people who knew about it but didn't know where to start and some who never heard of it. We were a motley crew.

The topic was introduced by stating that carb counting has been around for a long time in one form or another. When I was diagnosed in 1993 I was introduced to the Exchange List. This was a list of commonly eaten foods such as bread, weetabix, that contained roughly the same amount of carb. For example 1 slice of bread contained approximately 15 grams of carb as did 1 weetabix. The idea was that if you had weetabix for breakfast in the mornings and fancied a change you could switch it for toast.

In today's world we can do carb counting by either weighing our food in grams or using the unit Carb Portion (CP). It's a bit more precise than the exchange list.

We, then, discussed today's methods of carb counting and what exactly it is. "Carbohydrate counting is a method of matching your insulin requirements with the amount of carbohydrate you eat and drink."

If you take insulin, you can use carbohydrate counting to decide how much insulin to take.

The benefits that carb counting can give you are:

• May lead to better blood glucose control and greater flexibility and freedom of lifestyle.

• May be able to predict your blood glucose response to eating different foods and drinks.

• Eat according to your appetite.

• Enjoy a wider variety of foods.

• Enjoy restaurant and takeaway meals.

The only disadvantage to carb counting the group came up with was that you really have to put great deal of time and effort to get those benefits.

Where do I learn more if you live in the Mid-West?

The dietitian at your clinic or any registered dietitian who is knowledgeable in Type 1 Diabetes.

DAFNE (Dose Adjustment For Normal Eating) courses http://www.dafneonline.co.uk/DAFNE is a structured education course delivered in a five day intensive skills based education programme to people with Type 1 Diabetes. In this course, people learn how to adjust their insulin dosage to suit their free choice of food, rather than having to work their life around their insulin doses. DAFNE aims to encourage and equip people who have Type 1 diabetes to manage their insulin regimens actively and independently. This course is available only to patients who attend the Diabetes clinic in University Hospital Galway.

· BERGER course The Berger Programme is a comprehensive diabetes self-care skills course, named after Professor Michael Berger, the eminent Endocrinologist who recognised the value of teaching people how to adjust insulin to match their daily food intake. This programme is designed for people with Type 1 diabetes. People attending this course learn how to adjust their insulin dose depending on their food choice. The course also focuses on enhancing diabetes self-management skills. This course is run in St. John’s Hospital Limerick 061/462271

· BRUCIE - Better Regulation Using Carbohydrate and Insulin Education BRUCIE is an education programme aimed at providing adolescents over 12 years with diabetes the skills to understand the relationship between food, blood results and insulin dose adjustments. The workshop is based on developing practical skills and involves gaining a greater understanding of the effect of diet on their blood glucose levels. Education sessions on carbohydrate counting are also provided for parents of adolescents who attend BRUCIE. A joint session with adolescents and parents is provided at the yearly follow up. BRUCIE is delivered by the diabetes Dietitian and the Advanced Nurse Practitioner in diabetes. This course is available to patients who attend the Diabetes clinic in University Hospital Galway.

· Private Carb Counting Course by Kelly Johnson. The cost of the course is €150 for two full days. Contact information: mobile number: 086 8117676. She is hoping to run a course on 29th Sept and the 6thOctober.

If you don't live in the Mid West you can find out about carb counting courses from your diabetes clinic or from the DAFNE website.

Weighed down by weight issues

I'm getting old! Yep, I'm having that life crisis that happens to even the most optimistc of us as we approach those birthdays that end in zero.

Anyway, this summer when I was trying to squease into the seasonal outfits I thought to myself, "why not just tackle that stone or two once and for all". Wishing for it to happen doesn't make it happen, does it?

My diet is fairly decent; it does have some flaws but nothing catastrophic. I've always trimmed out the fat except for my little treat after my dinner every day which I will not give up! Never! So where the calorie intake is concerned I've decided to cut down on portion sizes and increase portions of salads and veggies.

My next step is to review my calorie output. Exercise! Auck! I already do a 30 minute brisk walk Monday through Friday. So in an effort to add to that I delved into "The I hate to exercise" book for people with diabetes to look for inspiration.

Now this book has been sitting on my shelf untouched for about 18 months. And if I'm honest the other reason I picked it up was because the previous book I read was so good that I would stay up until the wee hours reading (I needed some sleep).

I open it  and the first line is "well done, you've opened the book". At first, I laughed and patted myself on the back but when I thought about why I was reading it, I stopped laughing. I felt a bit ashamed but then I decided to laugh again. Why not?

So, well done me! I read the whole book. Surprise, surprise. there were no magic cures or quick fixes contained in it because there are none with weight loss. The book was really not targeted at me. It's really written for people who have not included exercise in their lives and may be more advanced in age.

My new next step is to carry on with my reduced carb portions and my 30 minute walk from now til December. Live life as best I can and not to get so weighed down (pun intended). I'll let you know if it works. I will say my blood sugar readings are looking very good with these reduced portions. One step/one day at a time:-)

People with diabetes can be the best of the best

I'm not the athletic type if anything I'm a sporting lost cause. I was never very good at it and therefore never really got into it. So, when the Olympics comes around every four years I notice what makes the news headlines in Ireland but that's about it.

However, in an effort to be a better world citizen I'm paying attention to the London 2012 Olympics and I'm actually quite interested. I have never watched an Olympic Open Ceremony (I know I should be ashamed but I'm not) but I figured I would do my duty and give it a chance. (BTW it was an amazing production that I'm still talking about and loving the music from it).

I became swallowed up in the mystery of who was going to light the Olympic flame even though I didn't think I would have a clue who it was when I first saw them.

Imagine my surprise when the image of the gentleman who was waiting to take the torch from "Becks". I stuttered "Is that Sir, StSteve Regrave?". The commentator confirmed it and also referred to Sir Steve as "one of Britain's greatest Olympians". I felt like yelling "AND HE'S AN INSULIN DEPENDANT DIABETIC". But of course I know that's not what defines him and that only other people with diabetes would be interested in knowing this.

Steve Redgrave bringing the Olympic torch into the stadium represented the idea that talented people with diabetes can be the best of the best despite being lead to believe otherwise by people who wouldn't necessarily know any better. If you are one of these people who has an Olympic dream I would like you to not listen to those people and most importantly not be afraid to push the boundaries because of your diabetes. If you're working hard on your dream then you can figure out your diabetes as you go along. By the time of 2016 you will have learned how to teach your diabetes to allow you to excel.

People with diabetes can be whatever they want to be but a lot of us already know that.

I'm grateful to my diabetes!

Diabetes is a burden, a nuisance and feckin' depressing. But it shouldn't be all of those things all of the time.

You probably think I'm "cracked" when I say that I'm grateful to my diabetes. Let me explain;

There are a number of little things that I'm grateful to my diabetes for and the coolest one is that when I was pregnant with my babies I got loads of ultrasound photos. Seeing your baby on the ultrasound monitor is so "awesome" and pregnant women without diabetes in Ireland are lucky if they see the ultrasound twice in the whole nine months. I got to do it at least 8 times with both of mine.

Another little thing I'm grateful to my diabetes for is my weight - it hardly ever changes because I have to keep track of my carbs. Most of the time my weight never increases. Unfortunately, I would like it to go down by about a stone but I'm truly grateful it's not going up.

A big reason I'm grateful to diabetes is how it has enabled me to broaden my horizons as a person and made me stand up for myself in order to take better care of me. How this came about is a bit of a story - please bear with me.

Before 2007, I was the type of person who sat at the back of a room and listened. I would never in a million years speak up in a crowd. And I had never organised an event or even people.

In the 9 years after my diagnosis, I did what I was suppose to do to take care of my diabetes. I didn't ask questions about why I was doing all of these everyday tasks and how they were making my life better.

This desperation came to a head in 2007. I started to struggle with coping with my diabetes and I felt that I wasn't getting the kind of health care I had become used to living in America. I had just moved home and I wasn't going to be force to pack my bags again just because the healthcare service was letting me down.

I refused to believe that just because things are the way they are; doesn't mean they can't change.

I needed to reach out to someone but I didn't know who. I saw a piece in the local newspaper about a diabetes information meeting that I had been too nervous to attend. I took a deep breath and phoned the number; not knowing who was going to answer. I needn't have worried because I found a friend at the other end. I didn't know the woman who answered but she had type 1 diabetes, was in the same age decade as me and echoed every feeling I had about living with diabetes.

I came to the realisation that the way forward for me was to connect with more just like me and that the way I could do that was to set up a support group. This is how I became an active member of Diabetes Ireland.

The local branch was relatively new at the time and was bursting with ideas on how to provide support and information to all people with diabetes. I took it upon myself to make sure that those ideas didn't fall into a big black hole. I reminded the others of what they had volunteered to do and I gradually began to step more and more out of my comfort zone to expand it.

In 2007, fear of rejection meant I didn't like calling strangers on the telephone, especially health care professionals, who wouldn't be expecting my call, about what we're were trying to do but I did it.

Today, I'm a confident person who is not afraid to ask questions no matter who they are directed too. I give presentations to groups of people and I'm not as bad at them as I was in the beginning. Today, it's not unusual for health care professionals to call me asking for information on diabetes events and resources.

The support groups have grown and grown and the feedback we get is that everyone who attends gets something out of it. I'm so proud that they have been sucessful.

The achievement I'm most proud of is the editing of a Type 1 Diabetes guide for adults which was published in March 2012. My previous diabetes voluntary endevours meant that I had become comfortable contacting health care professional to review and ammend this book to ensure the information was relevant to irish people with diabetes. However, when it came to finding a big chunk of "change" to pay for it's printing - that was a new area for me. I found myself talking to regional managing directors of multimillion dollar companies, telling them why this was a excellent investment opportunity!!!

The skills I've developed and the (mostly) confident person I have evolved into today has made be deeply grateful to my diabetes and my one-time desperation of it. And I've found the health care in Ireland that I had become used to when living in America:-)

I wish more people could benefit in the ways that I have. 

P.S. I couldn't have done any of the above if my husband didn't tell that I'd be well able to.

Checklist of “stuff to do” within the first month.

Once you have been discharged from hospital after your diagnosis of type 1 diabetes you are probably wondering what to do next! Well, here’s some help in the form of suggestions from the Starter Kit; a guide for Adults with Type 1 Diabetes. It’s comforting to know that there is a list.

Find out who you can call in an emergency. Your endocrinologist or diabetes nurse specialist might give you their mobile number. Most major public hospitals will have an endocrinologist on call, so you could call and ask for them to be paged. In a serious emergency, call an ambulance. But whatever it is, make sure you have a number in your wallet or programmed into your mobile phone because you can guarantee it will be 3am on a Sunday when you have an urgent dilemma!

 If you have Drivers’ License notify your local Motor taxation office; this is required by law.  The Motor Tax Office will ask you to submit an application for another license, with a GP or specialist’s report and two photos.  A new license will be issued to you at no extra cost.  It will now have a ‘101 restriction’ – all this means is that you will have to submit a medical report when you renew your license on the next occasion – there will be no reference to diabetes on your license.

If you are applying for a drivers’ license for the first time or renewing, your GP or specialist will fill in a medical form which accompanies your application. Essentially what they’re looking for is that you haven’t had a bad hypo (low blood sugar) recently and you get heaps of warning symptoms when one’s coming along - so the doctor basically needs to write ‘no hypoglycaemia unawareness’ in the comments section.

Notify your car insurance company as soon as you can after you have been diagnosed. Don’t worry they cannot increase your insurance premium because of your diabetes unless they can show that you, as an individual, are more at risk than you were prior to your diagnosis, which is virtually impossible. However, if you do not inform them that you have diabetes and you do make a claim the insurer can invalidate your cover.

You can also talk to Diabetes Ireland about this and other insurance cover such as mortgage, mortgage protection and travel insurance.

Get a Long Term Illness (LTI) Book or a GP visit card. Usually, this process has been started for you while you are in hospital but just in case. If you do not have a medical card then you are entitled to a LTI book, which provides all of your diabetes medication and supplies free of charge. You can get an application form from your local health office or your GP, it needs to be completed by you and your doctor and must be returned to your local health office.

During 2012, people who claim free drugs under the Long Term Illness Scheme will  have free GP care. The details for this have not been finalized. Diabetes Ireland will make an announcement when this benefit is available. Watch their website for details.

If you have medical card you are entitled to free GP visits and hospital care, free medication, pens/syringes, lancets and glucose monitoring strips. Most people have to have income below certain limits but if an individual is near the limit and has on-going medical expenses it may be granted. Apply through your community welfare officer at your local health centre.

Work out what sort of hypo supplies work best for you. Some useful places to have some sort of sugar available:

• Glove box of car;

• In your handbag/backpack, or back pocket if going out;

• Desk drawer or locker at work;

• School locker or pencil case;

• Beside your bed;

• At your boyfriend/girlfriend/best mate’s house.

Don’t worry - You are not going to use all these supplies in the first week, it’s just that you can generally guarantee that a ‘hypo’ (especially your first) will take you by surprise and happen when you least expect it.

Blood Glucose Meter. Find one that works for you! (Note: a search on the Internet is likely to also showcase monitors that are only available in the US and Europe). This thing is going to have to go EVERYWHERE with you so choose one that you reckon is easy to use and not too ugly.  They are free and you can usually get them directly from the manufacturer or from your Diabetes Nurse Specialist.

Are you going to be sitting exams this year? If so, make contact with the appropriate person at your education institution and inquire about ‘Special Conditions’ such as being allowed to take in food, for your exam. You should be entitled to these so organise it now as it’s the last thing you want to be worrying about in the lead-up to the exams. If you are a student who is filling out a CAO form you should note that you may be eligible for the Disability Access Route to Education (DARE). You will find more information on this on and

Get yourself a medical alert ID. This helps emergency personnel treat you appropriately should the need arise. If this totally freaks you out, there are a couple of other options, (though a well-known bracelet like Medic alert is the most easily recognisable symbol if you get into trouble). Engrave a piece of jewellery you wear all the time with something like ‘Diabetes on Insulin’. Carry a card in your wallet (available if you become a member of Diabetes Ireland). At the very least, this is the kind of thing that relaxes our stressed-out mammy’s!

Words of wisdom on diagnosis.

It’s been many a year since I was diagnosed as a young one with type 1 diabetes and over the years I have heard some valuable advice that I wish I had been told when I was diagnosed that would have caused me less stress.

I’m taking an excerpt from the Irish version of the Starter Kit; a guide for adults with type 1 diabetes in the hope that people today who are newly diagnosed will be saved the stress and that this information will help the find the path to “I can do this diabetes thing!”.

top 10 things we wish someone told us the day we were diagnosed:

1.    It’s not your fault.

Type 1 diabetes is an autoimmune condition. Something goes whacky and your immune system gets confused. It gets this idea in its head that the very precious islet cells in your pancreas that produce insulin are actually a virus and it turns on them and kills them. We don’t know exactly why. But we do know that it has absolutely nothing to do with what you ate, where you live, who you are or whether your mam stood on her head during pregnancy. There is a genetic link but it’s only one piece of the puzzle - even if your mam or dad had Type 1 diabetes themselves, there’s only about a 5% chance you’d have got it.

2.    You’re not a freak!

Getting Type 1 diabetes when you’re in your 20’s, 30’s, 40’s or even 60’s is way more common than most people (including doctors and nurses) realize. Type 1 was called juvenile diabetes for many years which was misleading. So if someone says “ooohhhhh you’re old to get Type 1!” You’re not alone, and they’re wrong! Half of people with Type 1 diabetes are diagnosed as adults.

3.    You’re not alone.

20,000 people in Ireland have Type 1 Diabetes and with the popularity of the internet and social networking sites such as FaceBook and Twitter you should not at all feel isolated. There are support groups for adults with Type 1 Diabetes starting up all over Ireland. Diabetes Ireland would have contact details to find out if there is a group near you, they also offer support and information to people with diabetes through their website <www.diabetes.ie> or their helpline 1850 909 909.

And there’s this group of young adults in Australia   called Reality Check <www.realitycheck.org.au>. Their website has a forum where you can post any question, read other people’s experiences and really tap into what it’s like to live with diabetes and what real, normal people do.

4.    Insulin is not like taking a pill each day.

You’ll learn how to change the doses, sometimes every day or every hour, to cater for different things going on. But it’s definitely not a case of here’s your insulin, take X units, go home and you’re on your own. Pretty soon you’ll start to get the hang of balancing your insulin dose with how you eat, drink and play - which changes every day, of course.

5.    It’s bloody hard work at first but not the end of the world.

People with Type 1 diabetes have won gold medals (Gary Hall Jnr in the US and Steve Redgrave in the UK), play professional football (Gary Mabbutt), won Oscars (Halle Berry), sung to thousands of people (Marcia Hines, Nick Jonas) and even won Miss America competitions (Nicole Johnson). We’ve backpacked the farthest corners of the world, got awesome jobs, become millionaires and politicians. And then there are the rest of us normal people who go about our lives doing what we want and making diabetes fit in there. You’ll be grand!

6.    It’s actually impossible to keep blood sugars between 4 and 8 all the time.

Really truly! Those numbers were given to you as a guide and the aim of the game is to keep them there. However, until you get yourself a new pancreas, it is just impossible to not get the odd high or low (or lots of them on a bad day.) Highs and lows make you feel crappy enough without you feeling guilty that you’ve stuffed up too. A good tip is to just think of the number that pops up on your blood glucose meter (a.k.a. the blood test lottery) as a Call to Action: if it’s high or low, just do what you need to do, to fix it. But don’t waste your energy thinking, ‘Oh I’m bad, I’m wrong, I’m crap.’ Just fix it and get on with life. (Or if you’re not sure what to do, phone your diabetes team for some help.)

7.    Research is moving ahead at an amazing pace.

You’ll hear a lot about ‘the cure’ for diabetes and while it’s still a little way off, the word on the street is that research has made more progress in the last 5 years, than in the 20 before that. We’re seeing it with better technology and developments all the time. Chat to someone who had diabetes in the 1950s if you want to feel better about your lot - scary glass syringes etc., not good, not good. The JDRF (Juvenile Diabetes ResearchFoundation) website is a good source of news on research developments.

8.    People say really dumb stuff.

You will find that everyone you meet now has an Aunt who had diabetes and either had some amazing home brewed solution to cure it, or died. Just brace yourself that people get weird when they don’t know what to say. We’ve all had times when we want to punch a person who doesn’t have diabetes. It’s the kind of thing you really can’t totally understand unless you’ve got it. So start perfecting your ah-huh, patient nodding and fast exit. (We’ve also included a couple of copies of a one-pager here that you can give to friends and family to save you turning into a broken record.)

9.    Diabetic Chocolate is not an alternative for people with diabetes.

I know that’s a shocker! People assume that if the label says ‘diabetic’ that the contents may be beneficial. Since ‘diabetic’ foods tend to cost more than conventional counterparts or sugar-free and reduced sugar versions this is in effect conning people with diabetes. Diabetic Chocolate – “is sweetened with alcohol sugars, which can cause fluid to build up in your bowels, which can then cause diarrhoea” (Margot Brennan, consultant dietician at the Auburn Medical Centre, Dublin).

Go for normal chocolate in moderation and save yourself the pain!

10.    Pepsi MAX is the best sugar-free coke. Diet Coke's pretty good too. 

The Starter Kit is available for free  to download from http://www.diabetes.ie/wp-content/uploads/2012/02/T1-Starter-Kit.pdf or by contacting Diabetes Ireland on LoCall 1850 909 909 and email info@diabetes.ie