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From Pennsylvania, USA:

I am a 59 year old male who has had type 1 diabetes for 38 years. How do you handle fats when counting carbohydrates? I've been told it is a slow acting carbohydrate, but nothing on how to figure it into the count. Do you convert the calories to carbohydrates and use this value? What about the slow acting time?


Answer from Betty Brackenridge, diabetes dietitian:

I can understand your confusion because it sounds as if you may have gotten some inaccurate information. There are four major nutrients that provide calories (energy) in some form. They are carbohydrates (the starches and sugars found in bread, fruit, cereal, pastas, beans, table sugar, and so on), proteins (found in meat, poultry, fish, cheese, beans, lentils, tofu and so on), fats (found in oils, butter, sour cream, margarine, animal fats, and so on), and alcohol. The exact effect of each of these nutrients varies somewhat from person to person and is effected by the overall amounts and combinations of foods eaten. However, most people can get excellent blood glucose control counting only carbohydrates. Blood glucose monitoring before and after meals is your best tool to figure out your own exact relationship between insulin taken and carbohydrate covered.

Carbohydrate is the nutrient that has the greatest effect on blood sugar level, especially right after eating. Counting carbohydrates lets you more accurately coordinate insulin doses with the demand created by the foods you eat.

Fats are fats. They are not converted to carbohydrates and so are not counted with carbohydrates. However, a very high fat meal can change your body's ability to use the insulin you take. Because of this, some people will have very high blood sugars several hours after eating a very high fat meal. Blood glucose monitoring will show you when this happens. When you find one of these situations (we see it most often in relation to meals with lots of fried foods, with pizza, and with Mexican food), you may need to give more insulin, give it later, or split the dose into an "early" and a "late" bolus in order to keep your blood sugars under control.

About 50% of protein is converted to carbohydrate, but most people don't need to count it when figuring their meal-related insulin dose because the glucose from protein appears in the blood stream slowly, several hours after eating. Unless the person is unusually sensitive or eats very large amounts of protein, this glucose is usually handled by the background insulin, not the meal-related dose of either Humalog or Regular. Pure alcohol does not require insulin for its use and so is not figured into carbohydrate counts. Any carbohydrate-containing mixer used with alcohol (such as fruit juice or regular soda pop) may need to be counted, however.

Blood glucose monitoring is your best tool for figuring out any ways in which your particular response to specific foods varies from these general guidelines. We recommend to our clients that they test before eating and two hours after eating, keeping track of insulin doses, and times, foods eaten, and blood sugar results. This will help you learn exactly what's working and what isn't. The goal we recommend is keeping the blood glucose level below 180% after eating without causing a low blood sugar before the next meal. This may require reviewing not only your carbohydrate intake and meal-related insulin dose, but also your background insulin (such as NPH or Ultralente).

For more detailed information about carbohydrate counting, you might want to read the American Diabetes Association's series of three brochures on the topic.


Original posting 21 Nov 1998
Posted to Meal Planning, Food and Diet


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Last Updated: Tuesday April 06, 2010 15:09:02
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