the 'what ifs' of diabetes

I've been following several diabetes blogs over the last several months and yesterday I read one that I felt did a really great job demonstrating how frustrating the experience of carb-counting can be. The original post is by Catherine Price and can be found here and I have excerpted the pertinent bit below:

An example: we learn the basics of carb counting. One ounce of bread, for example, has roughly 15 grams of carbs. If you’re using a 1:15 insulin-to-carb ratio, then you’d take one unit of insulin for each one ounce of bread. Easy enough. 

But then . . . what if you’re eating that slice of bread in the morning instead of in the afternoon? Your reaction will be different. What if you’re eating it in the morning and you exercised vigorously the night before? Your reaction will be different. What if you’re sick? What if you’re tired? What if you have your period? What if you walked up the stairs to your office right before eating the bread — or were lazy and took the elevator instead? What if you had a lot of coffee (boosting your adrenaline) or took Sudafed (ditto) before you ate that slice of bread? What if someone cut you off on the freeway? What if you’re on vacation? What if you ate the bread with cheese melted on top? What if you’re planning on exercising after you eat it? What if that exercise is aerobic? What if it’s weight-lifting? What if the bread is high fiber? What if the carb count listed on its label is actually wrong? What if your pump set isn’t properly attached to your body, so whatever insulin you end up giving yourself doesn’t actually make it into your body? What if your tubing has an air bubble and you don’t notice it? What if you accidentally didn’t give yourself the entire bolus? What if you decide, half-way through eating the bread, that you don’t want to finish it? What if you catch a stomach bug and throw the bread up?

It’s enough to make you not want to eat the damn bread. And it brings up why I always feel so exhausted at the end of diabetes workshops: there is no perfect answer for anything with diabetes. There’s plenty of textbook information out there and we’ve all heard it before — but when it comes to applying that information to our bodies, everything gets screwed up. (To their credit, the nutritionists and diabetes educators I’ve worked with all recognize this – I would think it’s particularly frustrating from their standpoint.)  I never liked my science classes, but I did learn that if you’re doing an experiment, you need to control the variables. And if diabetes has taught me one thing, it’s that the human body is not a good place to do a controlled experiment.

So so true. For example, John and I recently did a presentation in L's class to show her classmates the effects of sugar on her body versus ours. So she and John and I all tested our glucose. Then we each ate 5 Skittles and waited 15 minutes, then tested again.  The results were not what we expected.

           Blood glucose before Skittles                            After Skittles

L                         262                                                            265
John                     92                                                              95
Me                      140                                                            127

These numbers made absolutely no sense, and didn't go along with our prepared presentation at all.  Luckily, L had the perfect explanation for her classmates: "As you can see, blood sugars can be very unpredictable!"

Amen, sister.