Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-99

Undesired weight gain could have a negative impact on lipid levels and blood pressure, as well as lead to negative emotions that may result in non-adherence to healthy eating. It is important to discuss the potential for weight gain with all those considering initiation of IT and to discuss possible strategies to prevent or minimize weight gain for those who intend to initiate IT. Strategies include increasing insulin sensitivity through diet modification, exercise or insulin sensitizing medications. Precision of carbohydrate count ing People who do not take insulin to manage their diabetes will not require the same level of precision with carbohydrate counting as those who take insulin. For those that take insulin, it is not uncommon to have a carbohydrate:insulin ratio that is less than 5 g:1 u. For these people, the need for increased precision in carbohydrate counting becomes more important. Example: Accuracy in quantifying portion sizes is very important. For this person, the insulin dose would have been underestimated by 3 units. As well, aiming for within 5 g of goal carbohydrate will make it more challenging to meet glycemic targets; if the carbohydrate:insulin ratio is 3 g:1 u, then this person will be missing nearly 2 units of insulin. Using carbohydrate choices (15 g carbohydrate portions) will not provide the necessary precision. For example, 250 mL of 1% milk has 12 g of carbohydrate and is listed as 15 g of carbohydrate using the carbohydrate choice system; the difference of 3 g carbohydrate is equivalent to 1 unit of insulin if the carbohydrate:insulin ratio is 3 g:1 u. People should be encouraged to use food labels when available. Very few people choose to weigh and/or measure their food for general interest. But for those who need to carefully monitor their food intake to make appropriate insulin dose decisions, it may be a necessary task. As an educator, it is easy to choose not to recommend the use of food scales because weighing foods seems so onerous. However, people who have been frustrated by fluctuating BG levels have found nutritional scales to be indispensable.