{"id":29835,"date":"2012-07-05T18:41:07","date_gmt":"2012-07-05T22:41:07","guid":{"rendered":"http:\/\/asweetlife.org\/?p=28379"},"modified":"2015-12-27T15:42:48","modified_gmt":"2015-12-27T20:42:48","slug":"cwd-friends-for-life-2012-everything-you-ever-wanted-to-know-about-carbs-2","status":"publish","type":"post","link":"https:\/\/asweetlife.org\/?p=29835","title":{"rendered":"CWD Friends For Life 2012: Everything You Ever Wanted to Know About Carbs"},"content":{"rendered":"<p>The Children with Diabetes Friends for Life conference is well underway in Orlando and I&#8217;m here with my family. \u00a0I have time now only for some quick updates so here it goes. \u00a0<\/p>\n<p>\u00a01.When I first saw Jeff Hitchcock and Laura Billetdeaux, I felt like I was seeing celebrities. \u00a0What they and their team pull off with this conference is amazing, and it&#8217;s really wonderful to see it all in action.<\/p>\n<p>2. Seeing all of the green wristbands on the people with diabetes makes me want to cry &#8211; with happiness and with sadness.<\/p>\n<p>3.The children&#8217;s programs are terrific. \u00a0My kids are having a lot of fun and the other kids seem to be very happy as well. \u00a0<\/p>\n<p>4. The keynote breakfast this morning was in a room whose temperature reminded me of Michigan winters. \u00a0(Note: If there&#8217;s no fridge in your room, store insulin in the ballroom.)<\/p>\n<p>5. The names of the ballrooms &#8211; Crystal, Palms, Cypress &#8211; are making me think of the &#8220;Love Boat.&#8221; \u00a0Aloha deck later tonight, anyone?<\/p>\n<p>6. Jeff Hitchcock&#8217;s welcome speech this morning: &#8220;Why are we here?\u00a0 To make a difference in the life of someone we love.&#8221;<\/p>\n<p>&#8220;We don\u2019t do diabetes for a perfect A1c, but so our kids will grow up happy healthy and dancing on the beach.&#8221; Jeff then showed pictures of his newlywed daughter in her wedding dress and as he teared up said, &#8220;There\u2019s just a little bit of onion in the room here.\u201d<\/p>\n<p>7. Jeff&#8217;s speech was followed by a talk from Tom Karlya, &#8220;Diabetes Dad.&#8221; Some highlights from Tom&#8217;s presentation:\u00a0<\/p>\n<p>\u201cIt\u2019s what you do when the curveball is thrown!\u201d \u00a0<\/p>\n<p>&#8220;It stinks to have this disease in your family and in yourself. But you have to do something about it.\u201d<\/p>\n<p>\u201cThere\u2019s not one person who has made more mistakes at this than me.\u201d (Followed by a story about the time he packed his fourth grade daughter\u2019s lunch and instead of diet cola he gave her a can of Coor&#8217;s Light. \u00a0He learned about his mistake when he received a call from the school.)\u00a0<\/p>\n<p>\u00a0\u201cTeach yourself to learn! Knowledge is power.\u201d\u00a0<\/p>\n<p>&#8220;You need to keep learning because diabetes does not care.&#8221; \u00a0\u201cJust don\u2019t do nothing.\u00a0 It\u2019s not a matter of either\/or\u2026\u201d<\/p>\n<p>\u00a0The welcome sign of CWD\u00a0FFL 2000 said \u201cWelcome children with diabetis\u201d<\/p>\n<p>\u00a0Tom then showed an inspirational video from the\u00a0Barcelona Olympics in 1992, when runner Derek Redmond tore his hamstring mid-race. \u00a0Redmond&#8217;s father, motivated by strong love, left the stands and ran onto the field and helped his son finish the race despite the pain and tears.<\/p>\n<p>&#8220;Are you in the stands or in the race?&#8221;<\/p>\n<p>\u00a0&#8220;Don\u2019t carry your kids the whole time.\u00a0 Give them the tools to stand up on their own and let them finish the race.&#8221;<\/p>\n<p>8. <strong>Jen Block on Carbs:<\/strong><\/p>\n<p>Here are my notes on this lecture. \u00a0I think I hit all of the main points. \u00a0If I forgot anything please add.<\/p>\n<p>-FDA regulation 21 cfr101.9 specifies the variants for class 11 naturally occurring nutrients which includes the total carb content is allowed to be off by 20% (Author&#8217;s note: So, apparently carb counts on labels can be off by 20%, and our meters can be off by 20%. \u00a0The cynic in me is now thinking: Each and every bolus is a total gamble. If you can&#8217;t figure out how to bolus, it&#8217;s not your fault!!!)<\/p>\n<p>\u00a0-There are food scales that are small enough to fit in purses. \u00a0There&#8217;s a smart scale called\u00a0Eat Smart Food Scale.<\/p>\n<p>-Is it practical to weigh all the time? No, but it can be used as a means to gain familiarly with food.<\/p>\n<p>&#8211;<strong>Different ways to estimate carbs:<\/strong><\/p>\n<p>CFM carb factor method<\/p>\n<p>Portion Estimation (e.g. adult\u2019s fist = 1 cup),\u00a0Long sandwich 8 grams per inch,\u00a0Pizza 30 grams per hand sized piece (fingers together)<\/p>\n<p>(Odd slide displayed of fist with slice of cantaloupe, 20g.\u00a0Another odd slide of pizza and a hand with fingers together next to pizza (1 1\/3 hand =40 grams)<\/p>\n<p>\u00a0<strong>Carb counting tools:<\/strong><\/p>\n<p>Calorie King calorieking.com also in a smart phone app (at least half the room uses calorie king)<\/p>\n<p>Lenny the Lion: games aimed at kids, teaches carb counting<\/p>\n<p>\u00a0USDA Food Composition: <a href=\"http:\/\/www.nal.usda.gov\/fnic\/foodcomp\/search\">www.nal.usda.gov\/fnic\/foodcomp\/search<\/a><\/p>\n<p>\u00a0Calsandcarbs.com\u00a0<\/p>\n<p>Audience recommended and Sanofi\u2019s gomeals.com<\/p>\n<p>Nutritiondata.com<\/p>\n<p><strong>Do different carbs impact glucose differently?<\/strong><\/p>\n<p>\u00a0All carbs (except fiber) convert to glucose eventually<\/p>\n<p>Glycemic Index (GI) reflects magnitude of BG rise for first two hours following ingestion<\/p>\n<p>GI number is percent or rise relative to pure glucose 100% glucose is in\u00a0 bloodstream within 2 hours<\/p>\n<p>The GI is based on feeding measured portions of food with 10-50 grams of carb to 10 people without diabetes and monitoring BG response over 2 hours.<\/p>\n<p>Most GI studies were done in Canada and Australia.<\/p>\n<p>Note \u2013 consuming a mixed meal (carb,p rotein, fat) will blunt the post-prandial excursion.<\/p>\n<p>Rates of conversion: moderate GI is 56-69, High is 70 or more<\/p>\n<p>Very few in audience us GI when blousing. \u00a0If they use it, they use Low, Moderate and High, not actual numbers<\/p>\n<p>A banana has a GI of 70.\u00a0 But it changes by how ripe the banana is.\u00a0 \u00a0<\/p>\n<p>Bowl of chocolate ice cream:\u00a0 A low GI food because the fat slows it down. GI is 37<\/p>\n<p>Corn: Gi 60 \u2013 moderate<\/p>\n<p><strong>What about fiber?<\/strong><\/p>\n<p>Fiber can slow down conversion of enzymes that work on starch slowing the conversion to glucose.<\/p>\n<p>If a food contains more than 5 grams of fiber, subtract half the grams of fiber from the carbohydrate grams to get the total carbohydrate grams.<\/p>\n<p>Small amounts of fiber may not make a difference.\u00a0 Need to get to 5 grams<\/p>\n<p>Jen, &#8220;The bottom line: Fiber is good for you.&#8221;<\/p>\n<p>Foods that are higher in fiber have a lower GI<\/p>\n<p><strong>What about fat and protein?:<\/strong><\/p>\n<p>They slow gastric emptying, which means they also slow the digestion of starch.<\/p>\n<p>Jen: \u201cFor everyone, and especially children, carbs are very important energy source.\u201d<\/p>\n<p>\u00a0What are possible causes of variable glucose response?:<\/p>\n<p>Fat and protein content<\/p>\n<p>Fasting, pre-meal BG<\/p>\n<p>Available insulin<\/p>\n<p>Exercise<\/p>\n<p>Degree of insulin resistance<\/p>\n<p>Type and source of carb<\/p>\n<p>Physical form (whole fruit vs.juice)<\/p>\n<p>Type of starch (amylose is lower and amylopectin is faster)<\/p>\n<p>Degree of processing (higly processed foods are digested faster)<\/p>\n<p>Ripeness of food<\/p>\n<p>Food preparation -cooking swells starch molecules and softens foods which speeds up rate of digestion<\/p>\n<p>(Author&#8217;s Note: Everything is a possible cause of variable glucose response)<\/p>\n<p>\u00a0(Source:evert, 2012 and ADA nutrion recommendation and intervitons for diabetes, position statement diabetes care 31 (suppl 1) 2008)<\/p>\n<p>\u00a0<strong>Now you know the carb content\u2026 What Next?<\/strong><\/p>\n<p>Monitor BG with meter\/CGM to assess the impact of the food on BG<\/p>\n<p>Know Your Insulin<\/p>\n<p>The key to achieving post meal BG levels in target range is knowing theimpact of the meal on your BG and how best to match the insulin to the food\u2019s impact on BG<\/p>\n<p>\u00a0Insulin onset time for currentily available rapid-acting insulin is\u00a05-15 minues (so if eating fast acting carbs there might be a mismatch)<\/p>\n<p>\u00a0If you doubt the impact of carbs on glycemic control\u2026\u00a0more than 1 missed meal bolus\/week was associated with \u00bd% increase in A1C<\/p>\n<p>-Burdick, Chase, Pediatrics 113:e221, 2004<\/p>\n<p>\u00a0Insulin&#8217;s peak is between 30-90 minutes<\/p>\n<p>Duration of insulin is 4-6 \u00a0hours<\/p>\n<p>\u00a0Matching insulin to carbs, the real challenge<\/p>\n<p>Study: Glucose three hours after meal was lower with pre-meal insulin given 15 mn prior or immediately before meal rather than after<\/p>\n<p>If low before meal, treat low, then inject meal insulin<\/p>\n<p>\u00a0Timing of premeal insulin should be based on clinical experience and may not be advisable when:<\/p>\n<p>Timing of meal is not certain or carb intake is not predictable (young children who might not eat food given) \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/p>\n<p><strong>Pumps:<\/strong><\/p>\n<p>Bolus caluclators on pumps can track insulin on board \u2013 really helps<\/p>\n<p>Extended\/square wave bolus -give insulin over time, works well for\u00a0low carb meals high in fat\/protein and for gastroparesis<\/p>\n<p>\u00a0Combination\/dual wave bolus<\/p>\n<p>\u00a0What about eating pizza?\u00a0It takes a lot of work!<\/p>\n<p><strong>Summary:<\/strong><\/p>\n<p>Carbs are main factor in diet impacting glycemic control<\/p>\n<p>Carbs are an efficient source of energy for the body (\u201cwe need them\u201d)<\/p>\n<p>GI:different carbs impact glucose differently<\/p>\n<p>Fast and protein slow down gastric emptying and thus slow down digestion of starch<\/p>\n<p>If you simply count carbs and not fat protein you may gain weight.<\/p>\n<p>\u201cWhat you\u2019re doing every day is challenging and it\u2019s challenging for a lot of reasons!\u201d<\/p>\n<p>9. I attended a session on Pregnancy and Motherhood with T1D led by Kelly Close (Diatribe), Kerri Sparling (sixuntime), and Melissa Balland (Sweetlyvoiced). \u00a0I will report on that when I have time.<\/p>\n<p>10. I love meeting all of you. \u00a0Being here is an amazing experience.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&hellip;<\/p>\n","protected":false},"author":8,"featured_media":53098,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1501],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v22.9 (Yoast SEO v22.9) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Children with Diabetes Conference: All About Carbs<\/title>\n<meta name=\"description\" content=\"The Children with Diabetes Friends for Life conference is well underway...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/asweetlife.org\/?p=29835\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jessica Apple\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/asweetlife.org\/?p=29835\",\"url\":\"https:\/\/asweetlife.org\/?p=29835\",\"name\":\"Children with Diabetes Conference: All About Carbs\",\"isPartOf\":{\"@id\":\"https:\/\/asweetlife.org\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/asweetlife.org\/?p=29835#primaryimage\"},\"image\":{\"@id\":\"https:\/\/asweetlife.org\/?p=29835#primaryimage\"},\"thumbnailUrl\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2021\/01\/ASL-Social-Big-Square-3.jpg\",\"datePublished\":\"2012-07-05T22:41:07+00:00\",\"dateModified\":\"2015-12-27T20:42:48+00:00\",\"author\":{\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/1f33fe649de04a31a493d746b6e72607\"},\"description\":\"The Children with Diabetes Friends for Life conference is well underway...\",\"breadcrumb\":{\"@id\":\"https:\/\/asweetlife.org\/?p=29835#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/asweetlife.org\/?p=29835\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/asweetlife.org\/?p=29835#primaryimage\",\"url\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2021\/01\/ASL-Social-Big-Square-3.jpg\",\"contentUrl\":\"https:\/\/asweetlife.org\/wp-content\/uploads\/2021\/01\/ASL-Social-Big-Square-3.jpg\",\"width\":1280,\"height\":1280},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/asweetlife.org\/?p=29835#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/asweetlife.org\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CWD Friends For Life 2012: Everything You Ever Wanted to Know About Carbs\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/asweetlife.org\/#website\",\"url\":\"https:\/\/asweetlife.org\/\",\"name\":\"ASweetLife\",\"description\":\"The Diabetes Magazine\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/asweetlife.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/1f33fe649de04a31a493d746b6e72607\",\"name\":\"Jessica Apple\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/asweetlife.org\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/c10409e04c60ee9e1a01fbe9c4a704b9?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/c10409e04c60ee9e1a01fbe9c4a704b9?s=96&d=mm&r=g\",\"caption\":\"Jessica Apple\"},\"description\":\"Jessica Apple grew up in Houston. 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She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica\u2019s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)","sameAs":["https:\/\/asweetlife.org"],"url":"https:\/\/asweetlife.org\/?author=8"}]}},"_links":{"self":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/posts\/29835"}],"collection":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29835"}],"version-history":[{"count":0,"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/posts\/29835\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=\/wp\/v2\/media\/53098"}],"wp:attachment":[{"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29835"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29835"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/asweetlife.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29835"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}