Diabetes + Poor Math Skills = Higher A1c

According to a recent study, poor numeracy can explain the association between African American ethnicity and poor glycemic control (high A1c) in patients with type 2 diabetes.

| Oct 2, 2009

Having diabetes involves a lot of  pretty complex arithmetic. You've got to calculate carbs from nutrition labels, total the calories and carbohydrates in a meal, calculate insulin dosage based on insulin-to-carbohydrate intake, and on and on. These tasks aren't simple: They require an understanding of measurement, estimation, time, logic, and multi-step operations, and the knowledge of which math skills to apply to each problem.

But what if you're challenged when it comes to understanding and using numbers and math skills in daily life, otherwise known as having poor numeracy (the math equivalent of literacy)? According to a recent study, poor numeracy can explain the association between African American ethnicity and poor glycemic control (high A1c) in patients with type 2 diabetes.

The study, led by Dr. Chandra Y. Osborn and colleagues at Vanderbilt University in Nashville, Tennessee, tested 383 adults with type 2 diabetes on their ability to perform common diabetes-related numerical tasks. The subjects were asked to perform calculations such as this one, from the Diabetes Numeracy Test created by Vanderbilt University: "You have to eat six grams of carbohydrate for each 30 minutes you plan to walk. You are planning to walk for one hour. You have a bag with 12 crackers. Each cracker contains 10 grams of carbohydrate. How many crackers do you need to eat before your walk?"

Overall, the researchers found, patients with the highest test scores had lower A1c's, reflecting better average blood sugar levels over the previous few months. They also concluded that diabetes numeracy can explain the ethnic disparities seen in diabetes. African Americans with diabetes tend to have poorer blood sugar control than whites, as well as higher rates of diabetes complications. But this study found that low diabetes-related numeracy, not ethnicity, was the factor significantly related to poor glycemic control.

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Diabetes Care, September 2009


The Diabetes Numeracy Test, Vanderbilt University

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Categories: A1c Test, Blood Sugar, Diabetes, Diabetes, Insulin, Pre-Diabetes, Research, Type 1 Issues, Type 2 Issues

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Posted by Jerry1423 on 6 October 2009

I am usually a math whiz, and have no problems calculating my carbs to insulin ratio (down to the fraction of a unit) except when my BS is off.

When ones BS gets low it can be very confusing to the diabetic at how many carbs to take to bring it up to a nice level. Doing calculations in your head just doesn't work.

I guess the thing to do would be to have a small card in my wallet telling me what I need to eat when I get to a certain low.

Posted by Keithcrozier on 6 October 2009

The Diabetes Meal Planner software (for PC, Mac, most smartphones, www.glycemicdietsw.com) calculates the overall Glycemic Index (GI) and Glycemic Load (GL) for individual meals and for the entire day to help build a healthy diet for:
diabetes weight loss
sports performance It also provides:
carbohydrate calorie protein fat analysis future meal planning
for food items by meal and day.
The Glycemic Index - a measure of carbohydrate quality based on how quickly food raises blood glucose (blood sugar) levels - is a dietary key to health, say the authors of The New Glucose Revolution. Low-GI foods, by virtue of their slow digestion and absorption, produce gradual rises in blood sugar and insulin levels, and have proven benefits for health.

The Glycemic Index is highly recommended by Atkins, Fat Flush, and South Beach diets. A method of saving historical full meal information for future access allows easy reconstruction of the user's typical meals. Once these favorites are built, it is an easy matter to build a new day’s meal plan, including the ability to modify each favorite for today. Meal planning can be done for the next week. The software also provides a complete history of previous day’s meals to ease current day planning.

Posted by cde on 7 October 2009

Jerry1423...you are right that for adults AND for children, calculating in order to correct for hypos is often difficult, especially if we can't think clearly, we are anxious because of the hypo, and/or we try to use foods for the treatment of hypos.

However, using Dr. Bernstein's helpful calculations as a guide, treatment of hypos becomes the easiest of the many calculations we have to do daily, and results in the most predictable (and normoglycemic) outcomes.

I find that the treatment of hypos works BEST with glucose tablets of 4 (or 5) grams in each...so that the amount of CHO (carbohydrate) eaten is KNOWN exactly.

Each gram of CHO or glucose raises blood glucose by about 5 mg/dL (slightly more for a very small child, slightly less for an obese adult).

Thus, if I am at 50 mg/dL and want (as my personal goal for the treatment of hypoglycemia) to be at 85-90 mg/dL, then each tablet of 4 grams will raise my BG by about 20 mg/dL (4 X 5). So, 2 4-gram glucose tablets predictably bring me to about 85-90 mg/dL.

This calculation and treatment work like a charm, eliminating those 300 mg/dL readings post-hypo (from overtreating with foods, which have iffy or unpredictable quantities of CHO, making calculations even more difficult) and functioning far more RAPIDLY than food items.

For many of the children with DM1, it often produces EXACTLY the result expected...in my office, for example, they may have 40 mg/dL (from walking to get her and too much rapid-acting insulin before coming...in order to have "good" values to show me). By eating 2 4-gram tablets and waiting about 10-20 minutes, they leave (relieved and happy) at 80 mg/dL.

Dr. Stan De Loach
Educador en Diabetes Certificado
México, D. F.

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