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Advanced Carb Counting

Aug 28, 2012

Recently, I was asked to talk to a group of physicians about what we refer to as “Advanced Carb Counting.” I have one physician who frequently refers diabetes patients to me for Advanced Carb Counting counseling, but it seems I never get referrals from the other physicians in the facility. We hosted a training together and she talked to the physicians about how to calculate insulin to carb ratios, correction factor and target blood glucose. I then explained to them what I discuss with patients. I was very surprised that many of the physicians were taking notes and had a lot of questions - which is of course not judging their training- but it just got me thinking that maybe this is something that is not covered regularly or extensively in medical school?

I highly recommend Advanced Carb Counting to the patient who is good with their diabetes record keeping (e.g., food diaries and blood sugar log books) and wants to take their diabetes control to the next level by potentially getting closer to euglycemia or blood sugar levels similar to someone without diabetes. For the general practice physician doing this referral, it may mean a little more follow up and close monitoring that they may be used to with a new medication change. This is where the role of the diabetes educator can really help. After receiving the referral, I try to see the patient (outpatient) as soon as we can or within two weeks and then I write a follow-up letter to the physician to let them know they came to their appointment and some of the patient’s goals. In the clinic I work in, I would like to be able to set weekly appointments, but many times my schedule is already booked. I just try to see them within a few weeks. After that, I will schedule regular monthly appointments (patient willing) to follow up with progress and communicate to the physician trends in blood sugars to help them with insulin adjustments.

As an educator, I see so many benefits to Advanced Carb Counting. Many times, however, I think the general practice physician may have some hesitations or fears about switching to Advanced Carb Counting and switching to insulin to carb ratios and correction factors. Initially, it may be so much easier to prescribe a set dose of insulin or two shots a day. I’d love to hear how you have increased your Advanced Carb Counting referrals in your facility or the challenges you see with physicians referring.

7 comments

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  1. Sep 21, 2012

    Where have you been able to find training materials for counting carbs? I am just starting out. Linda
  2. Sep 17, 2012

    Do you have or know of a webinar or site to become more proficient at advanced carb counting? Thanks, Teresa
  3. Sep 17, 2012

    I too find it a topic that most HCP-Primary Care do not fully understand but are eager to learn-in time and with time.
  4. Sep 07, 2012

    As an educator, I have used Advanced Carb counting with people on multiple daily injections and insulin pumps. When a person is using Advanced Carb counting, they can obtain and maintain great control. As we know, there can still be some unexplained ups or downs, but in general the process works well. In my area, Upper Peninsula of Michigan, the physicians don't get specific about ordering Advanced Carb counting, actually we still get orders that call for ADA diabetes diet. They aren't putting the calories to it, letting that for the dietitians. They let the educators determine what level of carb counting the person with diabetes can handle at that time. Thanks for the interesting blog on Advanced Carb counting.
  5. Sep 02, 2012

    Amy: There is not doubt that this is not taught in medical school. Primary care docs and have no notion of carb counting, even at a basic level. And sadly, many endocrinologists do not utilize it. I have medicine residents rotate through my office for a month at a time. They are doctors already but joining me to learn more about diabetes/endocrine management. They spend some time with our RD CDE and are always pleasantly surprised to see what they don't know.
  6. Aug 31, 2012

    We teach Advanced Carb Counting here in our private practice at the pace and level which the insulin-user can handle. Most of our referring physicians leave it up to us to assess and then get back to them with our recommendations about self-care goals and/or meds. Sometimes we have recommended a change from 75/25 or 70/30 insulins to basal-bolus insulins if we find that the client is capable of advancing in carb counting skills.
  7. Aug 29, 2012

    I would like to see how you present the info for determining Carb Ratio and Insulin Correction factor. Too many numbers and formulas confuse most patients. Steve Freed, R.Ph.

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