As a diabetes educator and insulin pump trainer I request that my patients keep several days of food records prior to assessment visits.
I request that they not only log the food items consumed but also the portion size and carbohydrate gram count if they know it. For patients who utilize insulin to carbohydrate ratios, this carbohydrate count determines their meal insulin bolus.
I recently evaluated records brought in by a patient who had exhibited postprandial hypoglycemia on a continuous glucose monitor (CGM). I questioned some carbohydrate gram counts for waffles because they seemed higher than expected.
It was then that I learned that he had erroneously used the product gram weight (represented next to the serving size on the nutrition label) rather than the number of grams listed next to the “Total Carbohydrate” on the food label. As a result he was nearly doubling the carbohydrate estimate and the subsequent bolus amount. After a label reading review, he was back on track properly estimating his carbohydrate intake.
Review and reeducate patients regarding accurate carbohydrate counting and how to read a nutrition label. Have your patient read different labels and calculate the meal insulin bolus.
Kathleen C Jones RN, MSN, CDE
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