Nutritionists are needed – By Emma

Diabetes can often feel like a full time occupation and at times it can be very easily neglected. Ensuring that you are always counting your carbohydrates accurately can feel like a never ending chore and we can often slip into the habit of estimating the carbohydrates.

My nutritionist summed it up very well last week; we all have busy lives, full of priorities, stress and events. Having diabetes often feels like an added stress or irritation and sometimes through no fault of our own it can fall to the bottom of our priorities. As my nutritionist said, this is completely normal and instead of beating ourselves up about the poor control, unhealthy diet or lack of exercise we need to focus on what we can do to improve that.

I feel that I cannot emphasis enough the importance of having a good nutritionist to support you with your diabetes. Nutritionists don’t just focus on your food or lecture you on why you shouldn’t have eaten that bar of chocolate before bed last night; they can support you in many different ways. When on an insulin pump you have to ensure that you have the correct basal and correct bolus rate to establish good blood sugars.

Food Diaries

As many of you are probably aware, food diaries are the most annoying, irritating things to complete. When asked to complete them we all sigh with annoyance. However, over the past few years I have found them to be one of the most effective ways of re-establishing good blood sugars.

Completing a food diary makes you more aware of what you’re eating, when you’re eating it and what effect that food is going to have on your blood sugar levels. I always find it really interesting to see how sensitive I am to carbohydrates at different times of the day and how resistant I am to insulin in the mornings. For anyone who has not previously kept food diaries it is something very interesting and effective to do. It is also important to note times that you feeling stressed or physically ill as this too, as we know, can have a large impact on our blood sugars. Food diaries allow us to analyse our carbohydrate to insulin ratios and adapt them accordingly.

Basal Testing forms

More recently, since being on an insulin pump, I learned about basal testing. Basal testing is where you have a specific period of the day when you do not eat carbohydrates, morning, lunchtime or evening mealtime. During those periods of carbohydrate fasting it is essential that you only eat foods/drinks that do not contain any carbohydrates, for example a salad, omelette and/or a black tea/coffee. You must then test your blood sugars approximately every hour and record the result. This is a really effective tool as it allows you to observe the effect that your background insulin is having throughout that period. You must not basal test following exercise or if you have had a hypo in the last day. These tests allow you to work out if your basal rates are correct or need tweaking.

Although this may feel like an additional job you have to do, these tools are really effective at helping you focus on your blood sugars and why they may be out of control or following their current pattern. If anybody else has any interesting ways at re-establishing blood sugars control, I would love to hear about them.

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I found this very interesting about basal testing and variations in insulin resistance. I eat a low or slow carb diet and carry out basal testing on a regular basis to get my levermir dose accurate. I manage my BG very well com

I’ve done basal testing (or carbohydrate fasting as my diabetes team called it) since I went on the pump. It is really helpful, but is so time consuming. I’m on my 3rd day of missing breakfast this week cause I still can’t get my levels stable in the morning. I’m two years post islet cell transplant and it still a lot of hard work. In fact sometimes more stressfull cause you are worrying that high levels are killing of the cells that have been transplanted. Also I have a cgm but I still do the blood sugars – they are more accurate. My cgm can say I’m hypo but on finger pricking I’m not. I use the cgm to look at trends and warn of high or low sugars, but before changing basal levels or giving bolus I always check with a finger prick.

This is really interesting, I am especially interested in the basal testing because it is something I have wondered about (although I did not know the proper name for it). What surprising is that you did not have a Continuous Glucose Meter (CGM) for the testing. I expect it would reduce the impact on your life as well as improving the readings and time which you could do it. For example, I would like to know my basal readings throughout the night but know the stress of having to wake every hour would impact the results. A CGM would allow me to sleep through the testing and have less impact on teh results.

Good points Emma. Even harder if you’re only 8 yrs old (like my lad Max) and you rely on busy parents. I try to use ‘My Fitness Pal’ a great app for calculating your carbs. If there are no labels and you have wifi and a modern phone just take a pic of the bar code its whizzes of into the internet collects all it needs and put the info right in front of you. A very good UK food search engine too. Try to catch it out it’s very difficult.