Who doesn't sometimes need help navigating life with diabetes? That's why we offer Ask D'Mine, our weekly advice column, hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil takes on the questions of whether it's OK to start using an insulin pump without consulting a healthcare professional, and when it comes to  the proper amount of carbs, what is and isn't a fairy tale?

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Trisha, type 1 from Colorado, asks: Would it be a mortal sin to go ahead and start my insulin pump on my own? All the stuff is here, but the pump trainer can't see me for three weeks!

Wil@Ask D'Mine answers: I'm more of a diabetes expert than a sin expert, so I touched base with my contacts at the Vatican to see what they had to say about this. What? Doesn't everyone have contacts at the Vatican?

Anyway, they told me the Pope doesn't have any opinions on insulin pumps. Neither, apparently, does the Archbishop of Canterbury, so I think I'm on safe ground saying that it's not a mortal sin. It might be a minor sin, like sort of Sin Lite. But you're already in diabetes hell, anyway, so an extra sin or two isn't likely to make much of a difference.

Innovation 2015

OK, seriously, while hooking up a pump without the guidance of a certified trainer is certainly no sin, and not even illegal, it might or might not be a good idea. On one end of the spectrum, if you're a virgin pumper, I think you should not hook up before you're trained. There's simply too much you need to know to do it safely; I don't think you'll get it all right just using the manual.

An insulin pump is like a loaded gun. If you point it in the wrong direction it will kill you as quickly as it will kill the intruder you had intended to shoot. If you're new to this, please wait for the firearms safety course before programming it, loading it with insulin, and attaching it to your body. In the meantime, however, by all means get to know your pump. Play with it. Put a battery in it. Try loading it up with insulin. Dick around with the infusion sets. Hell, you can even wear the pump to get the feel of it. Do you like it on your belt? In your bra? Play away, but don't go "live" with insulin until after your training, OK?

On the other side of the spectrum, it might be heresy, but I think if you're a long-term pumper who's just upgrading to the latest model of your favorite brand of pump—and you're using the same style of infusion sets you always have—it would be perfectly safe for you to break it out of the box and get it running. Of course, you should read the manual first. Oh, and make sure you record all your settings from the old pump and transfer them to the new one. Your new pump probably has some features the old one didn't, but basic functionality is universal. To program a pump you just need to know your basal rates, your insulin-to-carb ratios, your insulin sensitivity (a.k.a. correction factor), and how many hours fast-acting insulin lasts in your body. Everything else is pretty much icing on the cake, so to speak.

In all likelihood, some of those numbers are "off" and need to be adjusted, but if you copy your existing rates and ratios over to the new pump, you'll be no worse off tomorrow than you were yesterday.

Now if you're an ex-pumper re-starting, or if you're switching pump brands, then it gets dicier, and the advice gets a little fuzzier. For instance, if you are transitioning from a traditional tubed pump to a tubeless pump there's a lot that changes. Can you figure it out? Probably. But the learning curve is steeper than you think it is. Yeah. Insulin pumps aren't rocket science, but they aren't kindergarten arithmetic either. The less familiar the new pump is, the more I think you should wait for your trainer.

And speaking of sin, we have a question about gluttony today...


Rose, type 1 from Nebraska, asks: What do most type 1s consider a normal amount of carbs for meal? I know type 2s are supposed to have between 45-60 carbs per meal. Is that something they should eat or something that they have as a top range? Does this apply to us type 1s? I have a really hard time getting under 50 carbs at dinner. I work all day, can't snack because I'm on other medication three times during the day that has to be taken on an empty stomach, and I'm hungry when I get home. I also have 63 years of Italian/Scandinavian food culture, habits and history to break myself of. I am not overweight.

Wil@Ask D'Mine answers: A lot of different numbers get tossed around about how many carbs you can and can't — or should and shouldn't — have in a meal. The truth is there is no answer because the number of carbs your body needs depends - first, on your gender; second, on your weight and desired weight; and third, on how many meals you eat per day.

Men, 'cause we're generally larger than women, can eat more carbs. Well, we need to eat more carbs, actually. Baby Bear, Momma Bear, and Papa Bear isn't just fairy tale crap. Different sizes of people, just like bears, need different amounts of food.

And I mean "need" literally. Your body requires a certain level of fuel to keep the lights on. Beyond that, if you eat more carbs than your body burns, you gain weight. If you eat less than you need, you lose weight. So how many carbs you should be eating also depends on your weight and whether or not you are happy with it.

Of course, your body also needs an average number of carbs in a day, so the number of meals you eat has a big impact on the number of carbs you should be eating in a meal. You need a very different amount of carbs in each meal if you eat two meals per day than if you eat four meals in a day.

All of that said, the pair of numbers I hear most often is 45-50 carbs per meal for ladies and 55-60 for gentlemen. That carb count is based on a typical three-meal-a-day eating pattern. Those numbers apply to all people.

You also asked about us type 1s versus type 2s. For type 2s, the carb count you mentioned would be a top number. Most, but not all, type 2s also struggle with weight issues, so lower carb counts can lead to weight loss. As for us type 1s, our bodies need and burn fuel just like type 2s and sugar-normals, but for us, there's a second problem. And that deals with the spike in blood sugar that follows a high-carb meal. While you're the exception to the rule, for most type 1s, a 50 carb+ dinner would spell diabetes disaster in terms of very high blood sugar in the hours following the carb-a-thon. Common (notice I didn't say "normal," even though that's what you asked about—there's nothing normal about this disease) type 1 carb totals run quite a bit lower in general. Many type 1s find that we need to eat more frequent, smaller meals in the 20-30 carb range to keep the blood sugar in check while supplying our bodies with the fuel we need to function.

And as you're surely aware, many type 1s in particular believe that sticking to a strict low-carb diet is the best way to manage blood sugars. Heard of Dr. Richard Bernstein and his book "The Diabetes Solution"? Some folks in the diabetes community are pretty adamant about following his ultra-low-carb advice.

Bottom line for you, Rose, is that the choice is yours. You've told me you're not overweight, so as long as you can control your blood sugar with a bigger influx of carbs, there's no reason not to enjoy your Italian/Scandinavian dinner with its 50-carb load.

After all, it would be a sin to give up meals like that if you don't have to.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.