A new Canadian study finds that a large proportion of diabetics with type 1 diabetes face difficulties in the management of their disease, specifically when it comes to carbohydrate counting, a result which shows a need for better health education strategies and tools for diabetics.
Managing type 1 diabetes, previously known as juvenile diabetes or insulin-dependent diabetes, is a lifelong practice. Along with daily insulin injections, there’s the constant monitoring of blood sugar levels, which can change unpredictably depending not just on food intake but on level of physical activity, stress, hormonal changes and other factors. The currently recommended treatment, called intensive insulin therapy, requires careful glycemic control in order to avoid dosing with too much or too little insulin (resulting in hyper- or hypoglycemia respectively).
Through intensive insulin therapy and the tight control of blood sugar levels, diabetics give themselves the best chance at preventing long-term diabetes complications. But remaining vigilant is a challenge, especially when it comes to carbohydrate counting, a practice which involves, along with a heap of discipline, a well-developed knowledge base concerning the carb content of most foods and an understanding of how carbohydrates interact with other nutrients such as fat, proteins and fibres, interactions which can affect blood sugar.
“Carbohydrate counting (CC) requires a certain knowledge, discipline and precision which implicates identifying carbohydrate containing foods, estimating portion sizes and reading nutrition labels of packaged products,” say the authors of a new study from L’Institut de Recherches Cliniques de Montréal.
The authors point out, for example, that in previous studies, type 1 diabetics were found on average to be 15 grams of carbs per meal off in terms of their estimations, representing 20 per cent of meal content.
Thus, it’s imperative to better understand the strengths and shortcomings in diabetics’ ability to count carbs with a degree of accuracy. To that end, the researchers undertook what was the first study to examine specific difficulties that type 1 diabetics encounter.
Through a survey of 180 adult type 1 diabetics, they found that while a large proportion (78 per cent) reported feeling confident in carb counting, upon further questioning about specific scenarios, many revealed real difficulties. For instance, 43 per cent of those surveyed said that they did not feel able to correctly apply CC when eating out with friends and almost two-thirds (62 per cent) admitted to finding it difficult to give the right amount of insulin with certain types of meals —fat-rich meals like fast foods or protein-rich meals like large servings of meat.
Even more revealing was the finding that a larger proportion of participants with a lower level of eduction (less than a university degree) and a history of depression reported not feeling confident in applying CC.
The results show the need for more education on carb counting for diabetics and especially for education targeted at specific groups within the community of diabetics, say the researchers. “Identifying specific difficulties and needs from patients would be helpful to improve clinicians’ teaching strategies and develop appropriate tools to improve, simplify and facilitate CC,” say the study’s authors.
The new research is published in the journal Diabetes Research and Clinical Practice.