Happy Saturday! It's time for another edition of our weekly diabetes advice column, Ask D'Mine, with veteran type 1 and diabetes educator Wil Dubois who tackles all sorts of quirky questions from our D-Community.

This week, Wil's looking at options for weighing food, and also the medical profession's various analogies for diabetes. He's touching on everything from carb-focused apps to diabetes linguistics in this one!

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

 

Darlene, type 1 from Wisconsin, writes: I have been living with diabetes for 41 years, and started on the pump a few years ago. I read labels and use the old, old food-exchanges-measure-and-WAG (Wild Ass Guess) method to calculate carbs for my boluses. In most cases I'm typically right on with my results or guestimations, but recently I purchased a scale just to add another calculation option. A scale is something that I would not utilize every day, but the other day I actually used it to calculate my bolus. I was shocked at the difference in the carbs. What do you find to be the most reliable source of determining the amount of carbs in food? 

Wil@Ask D'Mine answers: I'm still waiting for the CarbSniffer App for my iPod Touch. You know, the one where you wave your smart device over your plate and it automatically counts the carbs with an accuracy of 1/10th of a carb, and then subtracts the fiber for you to boot. Unfortunately, there's not an app for that.

News nuggets from around the diabetes community

NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
Snail Uses Insulin to Poison Fish
New study shows these slow-moving creatures use toxic form of insulin to capture prey.
A New Square Patch Insulin Pump
TouchéMedical's new Bluetooth-enabled patch pump is supposedly the world's smallest and cheapest.

closing banner

(((Sigh)))

Meanwhile, the closest thing is my trusty old Salter Model 1400 nutritional scale. It's my go-to carb counter at home. I bought it at Diabetes Mall years ago. Does anyone remember Diabetes Mall? Does anyone remember malls at all? Here's what I like about the Salter: It's smallish, cordless (it uses a 9 volt battery), measures in either ounces or grams—handy as some food labels use one measure and some food labels use the other—and it has an easy to use "zero" function. That means I can set a bowl on the scale, zero it, then put in cereal or whatever I feel like eating, and get the weight of the food without having to subtract the weight of the container. Then I can use any old calculator to figure out the carbs of my serving (based on the nutrition label). The scale is accurate enough that I can get excellent results even with heavy bowls and light foods.

But it gets even better. The scale also has a telephone-style numerical key pad on the far right hand side. What's up with that, you ask? It has a built-in data base of foods that don't come with nutrition labels. Let's say that I want to eat half a baked potato with my dinner. I can either go to a carb book or data base to find:

Potato, baked, 2 ¼ inch x 4 ¾ inch, with skin = 51 carbs

And then wonder what to do about the fact that my frickin' potato is 2 ¾ inches by 3 ¼ inches instead of the standard size, before dividing by two and worrying about how well I cut it in half....

Or, I can just slap the actual half potato on my scale, enter code number 908 (for potato — you look up foods in the guide they provide), press the carb button and get what I need: 19.44 carbs. Ta-da! Oh, and pressing the fiber button tells me to subtract 1.83 from the total, for the impact carbs. If I were a registered dietitian, I could also press the calorie button to learn that my intended potato serving has 83.9 calories. Additionally, it has buttons that I never use to calculate salt, protein, fat, and cholesterol. The only bummer is that it can only display one thing at a time, but maybe they've fixed that in the newer models.

It is not, however, portable enough to take with me when I'm eating out. For that, I also used to just use the SWAG method (Scientific Wild Assed Guess) of carb counting: Well, that looks like about 35 carbs to me, let's eat.

But recently, my iPod Touch has changed all that. I now have the very good Calorie King app, which actually beats the pants off of the printed book that used to live in the glove box of my Jeep. The book was great for drive-thrus, but of no use when you've forgotten to take it into a restaurant with you, hence the frequent SWAGing.

At the D'Mine Innovation Summit in November, My good friend Bernard introduced me to a new app called, improbably, Figwee. What's cool about this app is that it has photos of various foods and a slider that lets you make the portions either larger or smaller to mimic what's actually in front of your face. As you change the visual size of the portions, the carb data changes, too. They call it a "photographic portion estimator." It's very cool. You can even change the viewing angle on the food. We used it to estimate how many carbs the tiramisu had. How'd that work out? I don't know, you'll have to ask Bernard. I opted for the spumoni, instead.

So there's a lot of technology out there to help us get a better handle on our foods, and I encourage you to use it. When we guestimate, we risk what I call "error creep." A little at a time we get sloppy. Yeah, you think you're pouring a half-cup of corn flakes into that bowl but you're already up to three-quarters of a cup. If you don't believe me, serve yourself what you think is a third-cup of rice onto your plate, then scrape it back off and into a measuring cup to see how much you really served. I'll be its more than you thought it was! And heavily compacting the rice in the cup is cheating.

So to me, the most reliable method to estimate carbs is weight. I think that's the most accurate, and the simplest. But weighing food when you eat out isn't realistic for most of us. So weigh at home, SWAG (with some real science on your side with the help of a friendly app or two) when you are out and about, and you'll be fine most of the time. And for the rest of the time, that's what correction boluses are for!

 

Brad, type 2 from Georgia, writes: I was recently diagnosed and my doctor told me about how insulin is like a key that unlocks a door so the sugar can get into the cell. My question is, what closes the door again once the sugar is inside?

Wil@Ask D'Mine answers: Gah! I hate that stupid analogy. As a way to try to make some very complicated science easier to grasp, the action of insulin is often compared to a key that opens a door. Actually, as I'm sure you know, cells don't have little doors. Instead, via processes that border on magic, cells, with the assistance of insulin, can suck glucose right through their own walls. OK, well that was sloppily worded. Cells use highly specialized transporter molecules to ferry glucose from outside the cell wall to inside the cell wall. It's more like the international space station's arm reaching out and grabbing a cargo capsule, than like a tired commuter fumbling with his keys and unlocking his front door at the end of a long hard day.

The actual process involves words and concepts like "unpaired electrons, transmembrane segments, amino acids, hydrogen bonds, vesicles, signaling peptides, lipid folding," and the thoroughly unpronounceable "activated kinase domain autophosphorylates tyrosine." Oww, this is making my brain hurt. Ummmmm.... OK, like you doctor told you, there are these little tiny keys....

Don't get me wrong, I love analogies. I make them up and break them out every chance I get. I'm just not that fond of this one. It really doesn't do a good job of explaining either the pathophysiology or the defect of insulin resistance that leads to type 2 diabetes, and you've just identified yet another weakness of the whole analogy with your "closing the door" question. The problem is, I'm apparently not smart enough to come up with a better analogy than the cliché "key and door."

You know what? Maybe we're talking about the wrong kind of door. The whole process of getting glucose from the blood into a cell is more like walking through one of those revolving doors you see in public buildings. The door is never really open and never really closed, right? As it spins you can pass through. First you are outside. Then you are inside the door. Then you are inside the building. That's pretty much how glucose molecules pass from the blood into the cell. Now all I gotta do is figure out how to explain what part of the door the insulin is... I dunno... the motor that keeps it spinning? And insulin resistance is a crow bar jammed into the works...?  OK, this is going to require a whole lot more work on my part.

But to answer your original question, the door doesn't need to shut again, because it was never really open. Just like the revolving door, the door for sugar is constantly spinning, grabbing sugar from outside the cell, holding it in the cell wall for an instant, then releasing it into the inside of the cell where it can be burned for fuel.

And now I'm going to shut the door on this whole conversation... I'll see you all next week. Same time, same channel.

 

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.