HighLowQualityCounseling/transcripts/high_037

T:	hi my name is Arielle and I'll be your dietician today
C:	hi my name is Emily
T:	nice to meet you Emily what can I do for you today
C:	well my doctor sent me to you because I have diabetes type 1 and I've been struggling with that blood sugar diet
T:	have you been keeping up with your insulin injections
C:	I have actually but I've skipped some a few times because I heard not taking them actually helps you this week
T:	and you have lost weight recently correct
C:	yes
T:	I see well looking at your anyone C value of 12 tells me that your blood sugar for the past few months has been very high we want to try and get that value down to seven when you skip your injections do you notice anything different or do you feel differently
C:	um get headaches sometimes and
T:	okay those are actually symptoms of hyperglycemia or high blood sugar let's caused by a deficiency of insulin in the body do you know what ketoacidosis is okay when there is no insulin in the body the cells cannot get the energy they need to function to compensate that your body begins breaking down fat body this is what is referred to as ketoacidosis and this can be very life-threatening by leading to coma Oren's of your cases even death so those experiencing I'd usually have stomach pain nausea sometimes I have breath that's most fruity or like they say it smells like acetone or they have very labored reading what they call Kussmaul respirations and this is why taking your insulin injections it's very important so without it your body can't function
C:	Oh I dunno about that I knew I was supposed to take them but I thought skipping with you here and there wouldn't be such a big deal
T:	well your body is completely dependent on those injections as without them that glucose gets built up in your blood if continued hyperglycemia will develop which is very detrimental to your body and then it's not corrected quickly it will need to ketoacidosis
C:	if there's so much sugar in my blood then why or whenever I should get my injections then wait
T:	that's a good question my guess is that all the sugar it needs somewhere to go so your body gets rid of it through urine which is why you're always using the bathroom because you're gonna run up someone to fluid
C:	we're going to lose weight
T:	you're basically depleting your wash stores and becoming dehydrated
C:	oh that makes sense now that explains why I'm so thirsty after I just get injections
T:	exactly what we want to focus on is keeping your diet and insulin dosage in check also physical activity can help lower your blood sugar and help you lose weight and healthy weight what is your normal diet look like
C:	well to be honest I pretty much eat whatever I want the whole carb counting is just really okay
T:	well hopefully I can explain carb counting a little more in-depth for you with carb counting our goal is to spread out the consumption of carbohydrates throughout the day in order to normalize your blood glucose so in general 15 grams of carbs equals one serving of carbohydrates so this will make it easier for you and trying to determine how many units of insulin you need to take and after eat a meal so one unit of insulin for 15 grams of carbohydrates at d1 service or however your doctor tells me so how many nails and snacks do you eat today
C:	I need three meals and snack appropriately throughout the day so it's a couple of times
T:	okay so a starting point I would say aim for about 60 grams of carbohydrate or four servings at each meal and then between zero and 20 grams for each snack which would be about one serving of carb and also with each time you're getting your carbohydrate so at each meal make sure that you're dancing that out with some protein and fat as well so for example if you're eating like a piece of toast maybe put some peanut butter on it so that way you're getting your protein and your fat in there as well so do you know what counts as a carbohydrate
C:	bring
T:	yes but there are cards instance of other places you find think up like fruits starchy vegetables milk yogurt and sweets and generally the next Rishon table can tell you how many carbs are in something so I haven't had that for you and on this front and up it shows you the nutrition label and it tells you the total carbohydrates and it kind of helps you break down the steps and like how to do the math so in the total carbohydrates you wants to have sugar alcohols and fiber and because you don't completely absorb those those don't quite count in your total carbohydrate so this helps you do the math on that and it makes it a lot simpler and this basically just breaks it down for you completely on the other side I hat side I have listed the some examples of foods that may not have nutrition labels on them so like fruits like apples and bananas they don't usually come with nutrition labels but on here I have like what a serving would be and we come to cards I would be for that surgery it's like one small half would be 15 grams of cards so does this make any easier
C:	sure does
T:	alright well just be sure to keep track at the top calories and fats are consuming as they can add up really fast and lead to weight gain I also recommend staying active as I can how can you lose weight and lower your blood sugar just be sure to check with your doctor on what you can do and then you should take your is one before changing up your routine
C:	I will check on that thank you for seeing me and explaining everything in such great detail I will give you my carb counting and another counting another chart
T:	my pleasure I look forward to seeing you and our follow up where we'll check on your progress