title: From 'pleasure to chemistry': the experience of carbohydrate counting with and without carbohydrate restriction for people with Type 1 diabetes.
abstract: BACKGROUND
  Matching carbohydrate intake with insulin dosage is recommended management for people with Type 1 diabetes. However, international interest in restricted carbohydrate diets is growing. General practitioners and practice nurses need to know how to advise people with Type 1 diabetes regarding low-carbohydrate diets. This study aimed to explore the carbohydrate counting experiences of people with Type 1 diabetes in a trial with and without a diet restricted to 75 g of carbohydrate per day.
  
  
  METHODS
  Eight participants were interviewed by focus group or interview 12 weeks after a carbohydrate counting course with individual dietary choice or the same course with information on restricted carbohydrate eating and a daily maximum intake of 75 g of carbohydrate. Data were analysed using a qualitative thematic analysis approach.
  
  
  RESULTS
  Themes included the need for insulin management skills, impact of the dietary experience, and need for dietary knowledge. The restricted-carbohydrate group encountered mealtime insulin resistance and difficulty managing insulin dosages when transitioning on and off the low-carbohydrate diet. The diet impacted on mood, feelings of satiety and it was reported that food changed from being 'a pleasure to chemistry'. Both groups described feeling empowered to manage their diabetes as a result of the carbohydrate counting course.
  
  
  CONCLUSIONS
  Participants reported increased knowledge and challenging insulin management. The restricted-carbohydrate group reported mealtime insulin resistance and a strong dietary impact. Extra health professional support may be required, especially at dietary transition periods. More research is warranted into the reported mealtime insulin resistance.
authors.affiliation: Endocrine Diabetes and Research Centre, Capital and Coast District Health Board, PB 7902, Wellington South, New Zealand. Pip.Cresswell@ccdhb.org.nz.
authors.forename: Pip
authors.initials: P
authors.lastname: Cresswell
authors.affiliation: Department of Medicine, University of Otago Wellington, New Zealand.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Krebs
authors.affiliation: School of Nursing, Massey University, Wellington, New Zealand.
authors.forename: Jean
authors.initials: J
authors.lastname: Gilmour
authors.affiliation: Endocrine Diabetes and Research Centre, Capital and Coast District Health Board, Wellington, New Zealand.
authors.forename: Aoife
authors.initials: A
authors.lastname: Hanna
authors.affiliation: Endocrine Diabetes and Research Centre, Capital and Coast District Health Board, Wellington, New Zealand.
authors.forename: Amber
authors.initials: A
authors.lastname: Parry-Strong
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy* / Q000188:drug therapy / Q000523:psychology*; D050528:Diet, Carbohydrate-Restricted / Q000379:methods* / Q000523:psychology*; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D057181:Pleasure; D011209:Power, Psychological
chemical_list: D004040:Dietary Carbohydrates; D007328:Insulin