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.