Carb Counting - Other Options?

New-ish T1D, diagnosed two years ago in my early thirties. I get that we are suppose to CARB count, but I’ve noticed that if I eat 5 things with the same amount of carbs, my insulin needs are vastly different. I’m sensitive to the fat, protein, my activity level, amount of sleep/stress in my system, etc. I tend to group foods by sugar/fat and dose based on that. For example, if I eat an apple I don’t take anything, but if I have a cup of grapes (more sugar) I take a unit of bolus. Does anyone else do this? Or something other than count carbs? My A1C is great and I’m in range most of the time, but my doctor is frustrated that I don’t count carbs.

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I count them as precise as possible. Sometimes if im grabbing a quick snack and its minimal carbs, i will not dose. Especially if im about to be active

Talk with your dietitian about glycemic indexes. Some foods hit your system quickly and cause a rapid rise in BG (followed by a subsequent fall), while others have a “gentler effect” on BGs and tend to keep them more level. Did with the she can count but different glycemic index values can have very different effects. I looked into the GI several years ago and don’t really follow it now but you might find it helpful to check into.

Good advice Joseph @marinekeeper.

Before taking any dose of insulin, we must consider all activity, or inactivity - BEFORE and AFTER taking food or insulin.

The ‘artificial intelligent’ technology for assisting us calculate is really good but in no way does it replace our natural intelligence AND awareness.


@amyv Hi Amy and a Warm Welcome to the JDRF TypeOneNation Forum! Thank you for posting and I hope that you will find here information that will help.

You are observant in seeing that all carbohydrates are not the same and can affect your BGL [body glucose level] in differing ways. Keep in mind too that identical foods and quantities may affect your body differently than they do mine - we are all unique. Generally “protein carbs” are slow acting and their effect on your BGL may not even be noticeable; a larger amount of certain fats, than you usually eat, can slowdown or delay the release of glucose into your system - such as a really awesome pizza.

As for your doctor’s frustration about carb counting. From the little that you wrote, I can see that you ARE counting your carbohydrates - but maybe not the way it was written in the book your doctor read; There are many ways for each of us to effectively balance our food, activity and insulin needs. For instance, I had lived with autoimmune diabetes [T1D] for at least 45 years before the term “Carb Counting” came into being; somehow I managed this feat and lived - including the work I contributed to what is called MDI [multiple daily injections] in the 1970’s before the advent of digital glucose meters.

Best of life for you!

Thank you, Dennis! This is really helpful. I provided two months of careful food/insulin tracking for her, but she wasn’t happy when I couldn’t answer the “what is your carb-to-insulin ratio” question. At my next appointment I will explain to my Doctor that I do count carbs, just not in the way she is familiar with. I am super duper sensitive to insulin, so if I started treating all carbs the same I would end up with a lot of lows! Thanks again!

I used to treat carbs similarly, but 2 years ago when I got pregnant I did a lot more research about the different types of carbs and how the effect you blood sugar. The glycemic index is something to watch for sure. Also, whenever you’re eating something with high fat content (pizza, Mexican, etc.) it takes longer for your body to get through the fat to digest the carbs, so often you may have to do like half of your insulin prior to eating, half afterwards or experiment with what works for you. Another crazy thing I’ve noticed since getting back into a regular workout routine is how much this can impact my sugar levels - often 7-12 hours after working out! Unfortunately, I’m not as regimented about counting carbs either, but after 14 years, I feel like I have a pretty good idea at guessing and have had my A1C around 6 for the past several years. I also need more insulin in the morning for my carb ratio than the rest of the day.

Thanks, Mariah! I’m glad to hear there are others that are successful and not strict carb counting. I had to switch endocrinologists and the new doctor said she won’t prescribe an insulin pump until I “master carb counting”. Carb counting doesn’t work well for me, especially being so sensitive to insulin. I’ve been diabetic now for 3 years and my A1C is always around 6.5, which I, and my previous endo, were happy with. I was hoping to get a pump soon, so I wasn’t happy to hear this ultimatum.

I’ve definitely noticed the pizza phenomena and I’m actually the reverse of you, I need less insulin in the morning and more at night. But I also take basal in the morning (I think most take it in the evenings). Exercise has been difficult since I can’t adjust in real time, hence why I was hoping to switch to the pump.

That was probably a lot of unnecessary information! It just felt good to rant. :wink: Thanks again for this!

Yes, I think after a while you just get good at guessing! No worries on the rant. It is always so interesting to me to hear about others. The funniest thing is I feel like I constantly go through spells where insulin needs change. It is always something!

Glycemic Index and understanding complex carbs is key. When you get a pump, you’ll also learn about extended boluses. Also A1C isn’t the be all, end all. It’s basically an average. If you have huge swings, your A1C may be acceptable, but you’re still damaging your body. Ratios are always important as a starting point, but with pump and CGM, it’s important to be both predictive and reactive. I have 2 kids with T1D, and one is 6’1”, 240, the other is <5’, ~80 lbs, so I’ve also learned that all body types are different, and react differently.

Lots of stuff thrown at you. Good luck!

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Thanks, Jason!

Good point on the A1C not being the whole picture. According to my meter, I’m in range 85% of the time and my standard deviation is +/- 38, so I’m not swinging too high or too low. So that paired with the A1C value should be a decent argument for staying course. There is still room for improvement for sure, but shifting gears to a whole new system doesn’t seem necessary at this point and hopefully my doctor will see that next time. I appreciate the response!

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My husband’s father is type 1, my husband is type 1 and my son was just diagnosed as type 1. 3 generations. I’m worried about my daughters. How often did you do screening?

@Momofthebestkidever Hi Kellyann and a warm welcome to the JDRF TypeOneNation Forum! I hope you find at the JDRF site information that you need and that you will offer your suggestions to others affected by TypeOne.

Often when succeeding generations, or siblings, are diagnosed with autoimmune diabetes [T1D] they actually have a “genetic diabetes” currently referred to as MODY, a monogenic form of diabetes. The good news, if there can be any, is that TypeOne and MODY are usually managed in almost the same manner.
Being involved in the diabetes world, I assume that you have established good medical advisers so I suggest that you ask these people about your daughters; I’m not a practicing refrain from providing medical information other than what I’ve experienced in my 60+ years living with diabetes.
I recall from something Dr. Elliot Joslin, MD was teaching in the 1950’s that from his more than 50 years of operating a diabetes clinic, that he could see in a pattern of diabetes [[classifications of diabetes types did not come about until 1978] being passed through generations it appeared that the female was the “carrier” of a particular gene. Currently, there isn’t any way for preventing either autoimmune or genetic diabetes so my thought is to encourage your daughters to live full, active and healthy lives, and for you and your daughters, as they get older, to be observant .

You can do free annual screening through TrialNet for kids under 18. It’s a win-win, because it helps their research.