Time To Review Carb Counting (Part 2)

In the second installment of his two-part story on carbohydrate counting, Eric considers what led to the development of his carb-count confidence underestimation creep. (Click here for Part 1.)


I had become pretty good at estimating the amount of carbohydrates in the food on my plate. But what I lost sight of, among other things, was how certain types of foods interact with others and affect the absorption of carbohydrates into my system, thus affecting my blood glucose readings.

You want to know some of those other things I lost sight of? I’d grown a bit sloppy in my counting of carbohydrates when I prepared to bolus for my oft-eaten foods. The breakfast and lunchtime staples, the repeated dinners. Here and there I’d ignore the sauce on something, or the changing of a sandwich size from original to large. Or I’d forget about the extra fruit on a bowl of cereal. The glass of juice: half full? Three-quarters full? Surely there isn’t much difference.

At least, that’s the lie I told myself. Oh, I knew, but I didn’t want to know, and so it became a small thing. Underestimating portion sizes! So easy to do. It’s something that can be dangerous enough for people without diabetes. But for me, I see now that it can be doubly dangerous.

When a portion size changed from one meal to the next, I’d default to bolusing for the amount I’d bolused for in meals past. Oh, yeah, there are many reasons for doing what I’d done before. It was easier, sure; rather than count, rather than think, I could just default to mindlessly punching in a number on my insulin pump.

Why do that? Why knowingly ignore carbohydrates? That’s the heart of this blog entry. I’m human. And, too, by not recognizing extra carbohydrates in the food I was eating (whether it was food or portion size is of no matter), what I was doing was protecting my pride. I’d been deluding myself into a pattern of thinking that went something like this: “Eric, if you aren’t bolusing for it, then you mustn’t really be eating it. Yes! That’s it! You’re eating the same because you’re bolusing for what you always bolus for.” And that kind of reasoning went on in my subconscious for many months (because I didn’t actually hear those voices).

If I said that the serving of mashed potatoes at dinner was only 40 carbohydrates, then they had to be 40 carbs, right? I wouldn’t have put 55 grams of carbohydrates on my plate, would I? And the whole-grain pasta for dinner? That extra scoop wouldn’t show up in my reading a few hours later? Surely not? Another few tablespoons of sauce wouldn’t alter the carb count, would it?

In a self-deluding maneuver that my brain is pretty adept at pulling off, it kinda believed itself and looked the other way rather than deal with some psychological things that it really needs (that I need) to face.

And what I did, that ignoring myself when all I needed was some self-examination, isn’t the kind of infraction that shows up immediately as a problem. At least, not a big one. I won’t get retinopathy or neuropathy from these transgressions. I won’t have a heart attack or stroke or kidney failure next week or month or even next year because I let something like this happen a few times, a few dozen times. Yet at what point is it too much?

At this point.

What I’ve written about here is one of those slow-building, easy-to-overlook nasty habits. In fact, like most things diabetes-related, it’s not the big one-time mistakes you make that get you; it’s the accretion over time of small, singular, seemingly insignificant actions that bite you — and hard — down the road. What’s so wrong with underestimating this meal? Well, not much. But writ large: underestimating five or six meals a week for five or ten years… that’s not going to be good. Not good at all.

I’m going back, then, and refamiliarizing myself with some elementary diabetes education. I’ll know a lot of it, but I’ll also raise my eyebrows about how much I’ve forgotten and how much I have yet to learn. There’s much that I take for granted with this condition, and I shouldn’t.

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  • shinaye

    thank you for your honesty in admitting the under evaluation of your meal carbs.
    Yes, we are all too human in our sloppiness.But there is always hope.I’m there with you. I also need to refamilarize myself w/ some elementary diabetes education.
    You are right when you say “There’s much that I take for granted with this condition,and I should’nt.”

  • CalgaryDiabetic

    Psychologically it is hard to deal with carbs. I think many(if not all) times we will deliberately underestimate to avoid a potential low. It is like the rat programmed not to touch the electrified feeder. This is were Dr.B may shines you just eliminate them. I have been too brainwashed over the years to follow his advice. Becoming more and more insulin resistant his way may be the only way.

  • Pamela Payne-Cramton

    You are so on with this, I try all the time to remember the carbs, I had forgotten! An egg for example, what did I add….salsa? milk? Coffee with a little milk that you sip on all morning! That one gets me all the time(finally learned to use a square-wave bolus for that).

    A must share for those who suffer and fear lows allot…..CGM Continuous Glucose Monitor. This really should be a STANDARD OF CARE!!!!

    Day two for me and it alerted me twice at two in the morning I was dropping hard, (hmm a reason for my midnight munchies in the past…and high morning BG?!) CGM works on “Interstital Fluid” (the fluid the glucose and cells are floating in), giving me a heads up before its really bad! Not to mention I get a 24hr picture of my trends/ effects of things I do and eat, even medication. It works on highs too….so no more low balling the carbs here unless I feel like beeping. I so would rather beep than shake (or worse).

    When I was first diagnosed I was urinating on sticks to measure my progress, this is so freaking cool and so less messy!

  • Tom Hargis

    You are so right Eric,
    It is so easy to fudge on counting carbs.So many times we do not count the carbs in milk or juice for breakfast. Then we don’t understand why we have high glucose later.So we need to do a gut check and be honest and count the carbs.I subscribe to Diabetes Self manangement and I enjoy reading every issue. Everyone keep up the good work.

  • zip

    Really appreciated these posts. I suffer from chronic underestimation, and even when I know the right number, I seem to still want to bolus a little less. I have no idea why. Maybe I’m stubborn, maybe I’m in denial, maybe I hate lows, maybe I’m afraid I’ll gain weight. Any or all could apply at any given meal.

    Thanks for sharing! Good luck.

  • Patricia

    After having one very serious low requiring emergency care, I deliverately carb count less than exact. I adjust my insulin after one or two hourly checks. Sometimes I get lows in the 40’s and it is easy to bring my reading up with orange or other juice. Lows happen if I am out doing yard work, or other activity. Just goes to show that activity really does lower ones sugar.