Back to Diabetes Basics – Part 8

Learn to Count Carbohydrates

Many people say this is too complicated and try to guesstimate. This is a bad habit to get into and should be avoided. Do I guesstimate? Not that often and with eight years plus of calculating carbohydrates I have gotten fairly adept at doing this. I do make mistakes, but not that often. I hope that you will find some tips that you can use.

If you are lucky enough to have a class with a certified diabetes educator (CDE) or a registered dietitian (RD) and they cover how to read and understand food labels, absorb everything they tell you. I did not have either one that knew what they were doing and labels were to be ignored by them. Therefore, I had to learn on my own. Lucky for me a neighbor, at the time, was a nutritionist and she saw me reading labels in the grocery store one afternoon and asked if she could help. I admitted that I was having some success and that I would like to make it easier.

Now let me back up and cover a couple of other things first. Do not go out and buy cookbooks that have the word diabetic in the title. You will find that most are written by someone without diabetes and the recipes are overloaded with carbohydrates. Most are also for foods that few of us can actually afford some of the ingredients in the recipes.

Do consider buying some of the new editions of the standard cookbooks, Betty Crocker's and Better Homes and Gardens that have the nutritional information with each recipe. They also have the servings per recipe making calculations easier. Example: the recipe makes 6 servings and there is 28 grams of carbohydrates per serving, you have the information. Now I would normally say that it made 12 servings and that would mean I would have 14 grams of carbohydrates per serving. Granted, I normally chose servings of four so that I would only have eight servings to eat since at the time I was living alone.

I did cheat and have a gram scale and an ounce scale and still do and I use both. I would always weigh the container in which the food was to be cooked and then I could subtract that from the total weight or have a tare weight. If I wanted the recipe to serve six servings, I would weigh the plate or container to transfer the food to and tare the scale and then I knew how many ounces to transfer and could compute the carbohydrates. I could then add so many ounces of vegetables and compute their carbohydrates.

I do not know what food this label came from, but I will use it for a brief discussion.

Before going further, I need to point out that the FDA allows food labels to vary by 20 percent. This is bad for us with diabetes, but is the reason I always stress that you need to use your meter to see if the numbers are high or low after eating. Then you can have a variance of 20 percent with your meter. Did someone say this is a crap shoot. You may be right, but over time I have discovered that in general most canned foods are fairly close to total weight and carbohydrates. Now recipes in any cookbook with nutritional values may not be as close. There are too many variables for precise accuracy. To begin with when you purchase the ingredients, there may be a difference in the quality you purchased compared to the sample tested to arrive at the figures used in the cookbook.

This label is still a good example to use. Each serving has 40 grams of carbohydrates and only 4 grams of dietary fiber. Since I follow the rule of counting half of the fiber when fiber is 5 grams or more, I do not subtract any grams for fiber.

This is a point of debate by many and my former neighbor said only subtract one-half of the fiber if the total fiber per serving is 5 grams or higher. Some subtract all fiber regardless and others will subtract one-half of any amounts of fiber. Unknown on most labels is whether the fiber is water-soluble or not. The total grams are 275 grams so that if I have a 30-gram serving, then the carbohydrates would be 5 times 40 grams or 200 grams. Multiply 200 by 30 and divide by 275, which equals 21.8 grams of carbohydrates. Or, multiply 40 by 30 and divide by 55, which equals 21.8 grams of carbohydrates.

This is one reason I find the scales so useful as they can resolve carbohydrates amounts very quickly. So with the costs of the scales and a hand held calculator, I have gotten my money out of them many times over. Yes, I do spend a little more time getting this information, but it does allow me to be more accurate and know what I need to cover with insulin. Then my meter reading will confirm this and I will know that the serving size was correct. For oral medications, the meter becomes even more important to determine if the serving size was too large, too small, or just right.

Here are a few tools that you may find useful. First a book by Gary Scheiner M.S., titled The Ultimate Guide to Accurate Carb Counting. I have a different book, but this does come highly recommended. A website that may interest some is this one that has nutritional values that can be determined from a recipe. It is my understanding that you need to join to have access to the information here, and it is free. You may also get the nutritional value from a list of ingredients. There are other websites that you may find by using your search engine.

Diabetes Burnout

Why do people with diabetes have diabetes burnout? There are probably many reasons, but I think a majority of people just get tired of managing diabetes 24/7/365 with no vacation or time off. You test, eat correctly, exercise when capable, take your medications timely when you should and still diabetes is there waiting for you to make a mistake so it can gain the upper hand.

Will Ryan has several blogs and an introduction that often can help with diabetes burnout. His site “Joyful Diabetic” is worth reading and it does reflect his positive attitude. For many a positive attitude with managing your diabetes can help you through a down time and even burnout.

William H. Polonsky Ph.D., CDE, has written a book titled Diabetes Burnout: What to Do When You Can't Take It Anymore. This is one that I will be adding to my library. It is also available on Kindle.

Series 8 of 12

Is Diabetes Causing You Burnout?

This blog in Diabetes Health is interesting. Yes, diabetes burnout is common and happens more often than we might like. Many people have burnout and wonder why they feel like they do. Some people do not recognize this and have a difficult time dealing with this for a period of time. Others become depressed and know they have something that needs correcting, but it can take time. Some that have depression and don't know they have it. As a result, their management of diabetes takes a vacation. Some of the solutions are unrealistic for many people and others will not be able to consider the solutions offered.

The second article is from About dot com and is a little more realistic. I enjoy this analysis of diabetes burnout. Unlike the first article, the author recognizes that recovery happens, but not all at once. She says rightly so that it often takes baby steps to overcome diabetes burnout. I know this is right because even though I have been blogging consistently, I am fighting burnout myself. I am not enjoying this at all and wish I could say that I have not had depression. The depression is behind me now and I am working on correcting the areas of diabetes management that have suffered for the last two months.

No, this is not easy to write, but it needs to be written about by people that have been through the wringer. What started it, I am not totally sure. I know an argument with a doctor did not help. I can think of a lot of little things that add up and make you want to find something to take it out on. I have a couple of people that are what I term “the food police” and I see them more often than I like. I try to ignore them, but when they are constantly in my face, they are hard to ignore.

There have been other health concerns as of late and until mid June, I won't have an answer. I also know that I had about a week that blood glucose readings got higher than I like and by more than I like, and with a lot of analysis, I could not figure out what or why it happened. This may have been much of the trigger and the food police that just aggravated the situation. Now it is climbing out of the pit I have gotten myself into.

Since I am researching diabetes burnout, I have to say this makes the most sense to me so I will use the points that Elizabeth Woolley lays out and make comments about each.

Accept that you can't be perfect. Being the near perfectionist that I am, makes this almost as bad as the lesson I had to learn when I was diagnosed. What has happened can't be changed so accept it and move on. It is almost behind me and I have got to keep it there.

Remember it's all about you. Yes, I am the only one that can take responsibility and make the changes necessary. I cannot blame anyone else for my errors or shortcomings. I have to get my good habits back in control for better management. I think that a positive attitude helped me from sinking too low, but now I have to recapture this as well.

Become proactive in solving management challenges. I am hoping the fact that in dealing with the medical community I am a proactive person will aid me in being proactive in improving my diabetes management.

Connect regularly to the diabetes world. This will not be difficult, as I will have my appointment next week with the endocrinologist. The A1c will have to be what it is. Approximately two months of poor management can't be corrected in a week. In reviewing my first month’s records, I was doing so well – shame it has to be this way.

Now I wish I had the list that comes next in the article. A couple of them may have made it harder, but I am still using this list so that next time, I may be able to short-circuit some of the problems. Here is the list and my comments.

Take small steps in the right direction. Sometimes this is the best and then if you succeed you are able to celebrate a success. If you fail, you won't have lost a lot of ground. Continue with the small successes and eventually you will have your diabetes management back.

Take a doctor-guided break if needed. I will definitely give this some consideration, as this may be a way to lessen the effect of burnout. Hopefully, this will be possible, communication has been good, and this looks like something I could handle.

Find inspiration. I will have to work on this. Yes, I was reading, but reading for research and blogging. I had to work harder to write blogs and often reread some articles. I missed several of our group meetings and spent much of my time just writing and rewriting when it was not making sense.

Reestablish a connection with the diabetes community. I am hoping that just by continuing to blog will aid me in getting rid of this down feeling or energize me to be myself. According to the author, I am to reconnect with the diabetes social community.

See a diabetes educator. This is not possible. Insurance will not cover at this time and I am in no mood to have mantras shoved at me. This is me and I feel that this would put me back in depression. I know, I know, for some people this will be an advantage and serve them well. What will work for some, will not work for me this time.

Count your blessings. This can be important for many. This will also aid in getting you back to a positive attitude and feeling good about yourself. Give this an honest try.

Make peace with the diabetes police. If you are able, this may go a long way in restoring peace in a family or among your friends. Include the diabetes food police, as they can be worse than the diabetes police. I am in luck with two of these individuals, but with the third person, I am not sure this is going to be possible. I feel this may be one that has to remain at arms length.

Make sure you are not experiencing depression. Sorry, I've already been through a minor depression and have my life back. For anyone reading this, sometimes a person is able to work their way through and out of even a minor depression and at other times, it may be necessary to talk with your doctor or other qualified professional to help you. They can also determine if other means may be needed for the short and long-term.

Depression is not sometime to take lightly and sometimes professional help is the best solution. I admit that I have not needed it, but I am prepared if it becomes necessary and have talked to my doctor about just that. The doctor will give me a referral if needed.

I have several blogs about depression, but I find it a difficult topic to define and the professionals just like their technical jargon and apparently find it difficult to write about it in laymen terms. My attempt may be read here.

How you handle diabetes burnout depends on you and your attitudes. I have found that having a positive attitude about diabetes has generally served me well and made it easier to handle diabetes burnout. Not everyone will react the same. Another article on how diabetes can take a toll on our emotional health may be read here.

There is one important topic missing.  Take your medications, if you are on any.  I feel fortunate that through the burnout and depression something kept reminding me to take my medications.  Yes, often it was after I had gone to bed, but something in the back of my mind would not let me sleep and was saying insulin, insulin, until I got up and took my medications.  I guess after almost ten years, habits are good at times like this.