Carbohydrate counting is not as "simple" as it may seem as far as helping to determine a pre-meal dose of insulin ... and ... it may not be the most effective method. More information should be considered before each meal. "Carbohydrate counting" has not been our "favorite" method by which insulin-requiring patients determine a pre-meal insulin dose. We prefer to work with a fixed "best fit" dose for each meal and have the patient adjust to other parameters presented by each individual meal (fat content, fiber content, simple carbohydrates, etc.).
We ask many of our pump patients to turn off the "Bolus Wizard" and prefer they take a few seconds to consider the content of the upcoming meal. Meal consistency, obviously, makes this approach easier to recommend.
The new study, by Jiansong Bao at the University of Sydney in Australia and colleagues, hints the number of carbs alone might not be the best way to go.
Instead, the so-called glycemic load of a food, which also takes into account how quickly it makes the blood sugar rise, might work better. Foods with soluble fiber, such as apples and rolled oats, typically have a low glycemic index, one of the contributors to glycemic load.
"Methods used to assess carbs in persons with type 1 diabetes might benefit from some rethinking," said Dr. Edward J. Boyko, a diabetes expert at the University of Washington in Seattle who wasn't involved in the study.
The method suggested in this most recent study is the inclusion of the "glycemic index", but this may be a bit too complicated for some patients. We try to give them a basic understanding of how the character of the food will impact its absorption rate.
The article does point out that the newly suggested changes may still be speculative.