April 17, 2001
Meal Planning, Food and Diet
Question from Manchester, England
You seem to think that carbohydrate counting is easier than the original method of points or exchanges. I have had diabetes now for nine years, and the fact is that 10 grams of carbohydrate is the equivalent to 1 point or exchange. So, the system that you claim is easier and better is actually the same as has been being practiced for years. My point is that you seem to want to make changes and adjustments to things that don't need changing and would make no difference to the way people deal with their diabetes. It is also the point that it is not the carbohydrate counting system that would allow you to eat what you like within reason, but the regimen that the patient is on in terms of how many injections they give per day and the type of insulin. Since I am on NovoRapid and Insulatard, these are the most effective insulins for the majority of people who lead a varied lifestyle along with Humalog and Ultralente. The point is that there seem to be errors in the site that you are broadcasting across the net and giving people the wrong impression.
There are some differences among approaches from country to country which may be part of the reason for what looks like a conflict between your approach and what we often talk about on the site. As I read your comments, I think we are actually in complete agreement. First of all, there is no reason to change something that is working for you. Often people come to the chats or send questions asking for information and advice specifically because they do not have a workable approach, and I think that is the context in which information is usually provided. From a nutritional point of view, the diabetes food management system is simply not as important as the outcome, in my opinion. We want it to be sufficiently precise to be effective, but without placing an undue burden on the user. Carbohydrate management approaches (whether carbohydrate portion counting [and we follow 15-gram portions over here, not 10 as you do in the UK and much of Europe], Carbohydrate gram Counting, or Carbohydrate points) seem to give people great results without the extra issues inherent in old Exchange Meal Plans -- more flexibility, less guilt, restraint, etc. Your experience with Points is similar to the experience of many patient here in the States who use carbohydrate portion or gram counting. They are really just different ways to do the same thing. If we seem to promote carbohydrate management on the site, it is because it is still, woefully, common for patients here to be given structured meal plans. I've done some speaking in the UK, and, in talking to healthcare providers there, it seems that the same holds true in your country. However, there are glimmers of hope in both of our countries -- your experience and that of the DAFNE (Dose Adjustment for Normal Eating) Project being conducted by Dr. Simon Heller in Sheffield, for example. I think most members of our Diabetes Team would be delighted to see every person with diabetes getting the kind of practical and effective training you've obviously received. Your points about insulin regimens are "right on the money." Physiologic insulin therapy is now the gold standard (using one of the rapid-acting analogs for meals), but, as you know from your own experience, you need a way to quantify your food intake to take advantage of the benefits of Humalog and Novorapid (Novolog over here). So, we are brought back to a way to quantify carbohydrate intake to enable you make rational decisions about insulin doses. Of course, one final point. Not all who come to the sites (Diabetes123, Diabetes Monitor, and Children with Diabetes) have type�1 diabetes. People with type�2 diabetes can also use carbohydrate management approaches to great benefit, even when they are not adjusting a meal insulin. Thanks again for your thoughtful remarks. I hope this helps clarify our position. BB