Getting Real about Carb Counting

A peek inside my thought process

Jul 14, 2022

(Please note the new name change of my newsletter to better reflect the content and services. Also please remember that nothing in this email constitutes medical advice.)

Growing up as a T1D, carb counting education focused solely on carbohydrates. It assumed constant access to Calorie King or some kind of nutrition spreadsheet. And it never took into consideration anything else that was going on (like previous activity, planned activity, hormones, illness, etc.)

One of the biggest issues that I see when working with coaching clients is that they are given a list of “what you should do,” but the implementation of these instructions is left wanting.

Now that I’m in my 30s, and a mom of two small kiddos, I know that it’s not very realistic for me to break out my scale or carb app every single time I eat something. My children would riot. It also isn’t realistic or desirable for me to eat a really rigid, restricted diet of only a few pre-approved items, or things that are super low carb.

Instead, I have developed a slightly different process that I walk myself through when I’m eating something that doesn’t have an accessible nutrition label.

How to Build Carb Confidence

My main goal when working with clients (and myself) is to establish and increase what I call “carb confidence.” That means that when you are inputting a carb amount into your insulin-carb calculator, how confident are you that the dose provided is correct? I assess this on a scale of 1 (extremely low confidence) to 5 (very high confidence). The reason I focus on this is because it’s very easy to record on your pump or in your log book that you ate 45g of carbs, but did you really eat 45g or do you just think you did? There is a big difference in that answer.

Some ways that you can assess your carb confidence:

Is there accessible nutrition info?
Have I eaten something similar? How often do I eat this kind of food?
How does this quantity compare with other meals?
What else am I eating besides carbohydrates?
Can I reasonably anticipate what might happen to my blood sugars based on what I’ve eaten before?

The list of questions probably seems a little overwhelming but the answers come pretty quick with practice.

What we are establishing with these questions are familiarity and evidence. Are you comfortable with this kind of food, do you have a general sense of how this type of food could or would affect your blood sugars in other situations, or does it feel like a complete shot in the dark? (Pun oh-so intended).

Let’s take an example. Last Friday, I had lunch with my mom at an Italian restaurant. Even though it was pasta (with bread!), I did not panic.

I immediately knew my carb confidence was not going to be a 5, because there was no nutrition label. No scale. No way to measure anything. It was all visual.

But I have eaten a LOT of pasta in my life, because I don’t believe in diets or restriction. Eating what I want to eat frequently actually helps me manage my blood sugars better because my reference points are more numerous. I have more past experiences to compare to.

A few things that can help you increase your carb confidence are:

Measuring and/or weighing foods at home, even if only occasionally
Reviewing nutrition information on packaged items
Looking up nutrition info for foods you commonly eat on apps

(btw a dietitian is a really amazing resource for this kind of food knowledge; need a rec? I got some.)

You don’t even have to do these things just at meal times, and you don’t have to find exact matches. Even finding things that are close to what you eat will get you so much closer than throwing in a random number. You can practice reviewing nutrition info and looking up nutrition info of your favorite things whenever (such as when you’re mindlessly scrolling social media…). Commit some faves to memory.

Another thing I noted for dosing was that this pasta was served with fibrous vegetables, which would impact the digestion (helping to slow down a spike). You don’t need to micromanage your macronutrients. You just need to have a general sense of if this meal is high fat, high protein, and/or high fiber compared to your other meals and whether or not that could impact your dosing strategy.

And finally, once I consider my carb confidence, I also look at the entire context: what is my current blood sugar trend, what has my insulin sensitivity been like, what do I anticipate it to be later. This helps me use the most appropriate dosing strategy, rather than just a blanket approach that may or may not be the right fit.

So then what? Well, my carb confidence says a lot about how I assess things later. Let’s say I’m eating a coffeeshop danish and my carb confidence is a 2. I have to start with something, and let’s say I do 30g. Knowing that my carb confidence is pretty low, if I see my blood sugars are spiking really quickly, I’m more likely going to correct earlier because my confidence that I took the right amount of insulin is pretty low. If I realize my carb confidence in something is really low and I want it to be higher, than I actually make that a goal and develop a plan. I often work with clients on this process.

You can also use carb confidence to assess whether or not a result is expected. If my carb confidence is high but I still spike, I may realize that my assessment was wrong and I’ll revisit my analysis sooner, rather than waiting 3-4 hours, because I can see that what I had anticipated happening isn’t happening. If my carb confidence is high but so is my BG, it might point to other issues like a bad site.

The lower my carb confidence, the closer I pay attention to the meal afterward, to navigate any “gaps in coverage.”

And my blood sugar 3 hours post-pasta? 135 mg/dl. Which provides BG + insulin data for future pasta encounters and reinforces that this decision-making process works!

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