If you could see into a diabetic's mind for just a day or even just a meal you would probably be overwhelmed. The truth is, diabetics have a lot to think about beyond the fact of, "Am I hungry?" or "What do I feel like?" Whether it is a conscious or unconscious process going on, diabetics are converting carbs into insulin units, deciding if certain food is 'worth it' and deciding if an extra 'just for good luck' unit needed for the said meal.
Of course doctor's don't go by gut feelings and I highly doubt they would be on my side on this one, but for me, I feel like sometimes I know a specific amount of insulin isn't going to cut it, or based on what I have done earlier, I know that it will be too much. It is all about knowing your body and accepting when you fail.
I was really interested when I had the job of helping a young boy out for his lunch time insulin. He was on a sliding scale, which basically means, based on his blood sugar he was given a specific amount of insulin. I guess this is similar to pump settings when you think about corrections etc. however, it interested me that he was not himself carb counting - that I know of. I was taught carb counting, more so a point system, being that every 15 grabs of carbs equaled on unit of insulin. But, as I slipped out of the honeymoon phase I needed more insulin to cover the carbs and those ratios changed.
In a way it is frustrating because as we all know food isn't what causes high blood sugars always. Of course if you're going to indulge in a doughnut than you have to take credit for the high blood sugar, but stress, weather all of those extras that we can't control nor predict also alters the blood sugars. Carb counting is simple to learn, simple to use, but a lot of work. For most diabetics it comes natural after awhile, while others don't carb count at all and stick to routines. Whatever you do, make sure you're giving yourself a break letting your unconscious count the carbs while you enjoy the taste of your meal.