an introduction to carbohydrate counting

A practical guide tosupport you through

your diabetestreatment plan

A practical guide tosupport you through

your diabetestreatment plan

An Introduction toCARBOHYDRATE

COUNTING

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AN INTRODUCTION TO

CARBOHYDRATE COUNTINGA practical guide to support you through your diabetes treatment plan

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General information

CHO counting

Basal

Bolus and ICR

Variable factors that affect bolus needs

Adjustments and corrections Trends and ∑

Tre

Trends and testing

Contents• Introduction• Intensive Insulin Therapy and Your Treatment Plan

• Basal

• Bolus

• Do I need to count carbohydrate to follow my treatment plan?

• Steps to your Treatment Plan and Carbohydrate Counting

• What is Carbohydrate?• Types of carbohydrate

• Do all foods contain carbohydrate?

• Carbohydrate Counting• Reading labels

- Packaged foods

- Using weights and measures

• Using cooked and uncooked weights

• Using your own recipes

- My favourite recipes

• The carbohydrate calculator

• Bolus Insulin• What is my insulin to carbohydrate ratio (ICR)?

• How do I work out my ICR?

- My ICR is

- What should I do next?

• How do I use my ICR to work out my bolus?

• Bolus calculator

• Healthy Eating• Other Things to Think About

• Snacks

- What about bedtime snacks?

• Delaying or skipping meals and flexible meal times

• Food choices

IntroductionManaging your diabetes can feel like a juggling act.

Start with the basics and together with your friends and family, you will build skills andconfidence. This will help you to stay in control of your diabetes and enjoy a flexible lifestyle.Your diabetes team will support you to learn and practice the technique that works best foryou.

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Intensive Insulin Therapy and Your Treatment PlanYour treatment plan uses intensive insulin therapy. This allows you to take your insulin in away that mimics the normal secretion of insulin from the pancreas. You do this by having oneor two injections of basal (background or long-acting) insulin a day and injections of bolus(rapid-acting) insulin with foods that contain carbohydrate.

Using this treatment plan with carbohydrate counting will help you to keep your blood glucoseas close to normal as possible. You will adjust your insulin to balance with the carbohydrate inyour meals and snacks, helping you to manage everyday life including activity, sports, school,stress and illness.

BasalBasal meansbackground or long-acting insulin. Your body always needs basal insulin tokeep your blood glucose levels steady and to give you energy.

Your basal insulin is

BolusBolus insulin is rapid-acting insulin that your body needs when you eat carbohydrate.You will take your bolus with meals, and sometimes with snacks. This type of insulin helpsyour body deal with the glucose it gets from the carbohydrate in your food.

Your bolus insulin is

Do I need to count carbohydrate to follow my treatment plan?Carbohydrate counting will help you to get all the benefits from your treatment plan. You willwork out how much carbohydrate is in your meals and snacks then adjust your bolus to keepyour blood glucose within your target range.

It is still important to have a healthy diet, but carbohydrate counting gives you more choice ofwhat, when and how much you can eat. This will help you to worry less about eating to avoidhypos, or snacking when you are not hungry.

Carbohydrate counting is much more than being able to estimate the carbohydrate content offoods. It is also about learning how to adjust your bolus insulin to the food you eat and theactivities you enjoy.

Your diabetes team will help and support you to count carbohydrate and adjust your insulin.Your confidence will grow with practice and soon you will realise that you control yourdiabetes!

Basal

Basal

Basal and Bolus Insulin Effect

Bolus

Insu

linEf

fect

TimeBolus Bolus

Bolus

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Remember:• You always need basal insulin.• You need bolus insulin each time you eat carbohydrate.• Carbohydrate counting will help you get all the benefits from your intensive insulin therapy

treatment plan.

Steps to your treatment plan and carbohydrate countingThis pack will guide you through the steps of your treatment plan and carbohydrate countingto help you get all the benefits it can offer. By working with your diabetes team through eachstage, you will grow in confidence by practicing with the examples provided and making notesto remind you of hints and tips to help you manage your diabetes.

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Step1. Identify which foods contain

carbohydrate in your meal.

2. Calculate or estimate thecarbohydrate in your meal.

3. Calculate your bolus to coverthis carbohydrate.

4. Consider factors which mayaffect the timing and amount ofbolus you need, such as:• Your current blood glucose level.• The amount of activity you

have had.• The type of food in your meal.

5. Give your bolus, adjusting theamount and timing as appropriate.

6. Keep records of your bloodglucose, carbohydrate intakeand activities.

7. Look out for trends in your bloodglucose to ensure that you aretaking the right amount of basal andbolus insulin to keep optimal control.

Go toWhat is carbohydrate? Introduction toCarbohydrate Counting (page 5).

• Reading labels and the carbohydrate calculator.Introduction to Carbohydrate Counting(page 7, 21).

• Carbohydrate Tables.

Bolus insulin. Introduction to CarbohydrateCounting (page 25).

Carbohydrate Counting, The Next Steps(workbook 2).

Carbohydrate Counting, The Next Steps(workbook 2).

Diary.

Carbohydrate Counting, The Next Steps(workbook 2) and Diary.

What is Carbohydrate?Carbohydrate is a nutrient and source of energy found in foods such as potatoes, rice, pasta,cereals, milk, fruit, sweets and sugary drinks.

Types of carbohydrateDifferent foods contain different types of carbohydrate.

• Starchy carbohydrate – potatoes, rice, pasta, noodles, bread, cereals, couscous, lentils,beans and products made from flour.

• Fructose – fruit and fruit juice.• Lactose – milk, yoghurt, ice cream, custard.• Sucrose – table sugar, syrup, sweets and sugary drinks.

During digestion your body breaks down the carbohydrate from the food you eat into glucose.This glucose enters your bloodstream and causes your blood glucose to rise. Your body needsinsulin to use this glucose for energy. The more carbohydrate you eat, the more insulin you willneed to keep your blood glucose within your target range. Therefore, knowing how muchcarbohydrate is in the food and drink you take will help you estimate how much insulin youneed.

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For a healthy diet most of your carbohydrate should come from starchy foods, fruit and somedairy foods. Smaller amounts should be from sugar and sweet foods. Different people needdifferent amounts of carbohydrate. The amount of carbohydrate that your body needsdepends on your age, activity levels and weight. In general carbohydrate should make upabout half of your energy (calorie) intake each day.

Do all foods contain carbohydrate?No. Some foods contain very little or no carbohydrate, including:• most vegetables• meat• fish• eggs• cheese• butter, margarine and cooking fats and oils.

These foods need little or no insulin but should be included as part of a healthy balanced diet.You will find more information in Healthy Eating on page 26.

Remember:• Different foods contain different types of carbohydrate.• Try to have most of your carbohydrate from starchy foods.• Some foods contain very little or no carbohydrate.

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Carbohydrate CountingReading labelsAll packaged food labels have nutritional information for the main nutrients, including energy(kcal/kJ), protein, carbohydrate (CHO) and fat. This is usually given per 100g and sometimes perportion.

The portion figure works well for foods like biscuits, bars, yoghurts and ready meals where youtend to eat the suggested portion size. However, if you have a different amount, you will needto calculate the amount of carbohydrate in your portion. This is common for foods like pizza,pasta, breakfast cereal and desserts.

Carbohydrate on food labelsNutritional labels often show different carbohydrate details. It can be noted in one, twoor three parts:

1. Carbohydrate (always included)2. of which sugars (often included)3. of which starch (sometimes included).

When you are counting carbohydrate, you must always use the largest carbohydratefigure. This is the total amount of carbohydrate in the food, and includes both the‘of which sugars’ and ‘of which starch’ amounts.

Follow the steps below to help you work out how much carbohydrate is in your portion, thenpractice with the examples provided.

Packaged foodsSometimes the labels show how much carbohydrate is in an example portion, for example:

This label shows that one slice of wholemeal bread has 19.8g of carbohydrate in total.

If you ate 2 slices of bread, you would need to multiply the amount of carbohydrate in oneslice of bread by 2.

19.8 x 2 = 39.6g of CHO

Wholemeal Bread

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Typical values Per slice Per 100gof product

Energy 102kcal 218kcal

Carbohydrate 19.8g 42.0g

of which sugars 1.3g 2.8g

Fat 1.1g 2.4g

The label tells you that 3 fish fingers contain 14.0g carbohydrate in total.

If your portion is a different size, you need to change the calculation a little to work out howmuch carbohydrate you have.

If you want to eat a different amount:1. Work out how much carbohydrate is in one fish finger.2. Multiply this amount by the number of fish fingers you are going to have.

1. Divide the total amount of CHO in each portion (3 fish fingers) by 3 to find the amount in 1fish finger.

3 fish fingers = 14.0g CHO14.0 ÷ 3 = 4.6g CHO per fish finger.

2. Multiply this amount by how many fish fingers you want.

1 fish finger = 4.6g CHO

2 fish fingers = CHO

4 fish fingers = CHO.

Fish Fingers

Jaffa Cakes

The labels below show suggested portion sizes of different foods. Compare your portion sizeto those suggested on the labels.

How much carbohydrate is in your portion?

If you ate 3 jaffa cakes, you would need to multiply the amount of carbohydrate in one jaffacake by 3.

7.6 x 3 = 22.8g CHO

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Typical valuesPer portion (3 f

ish fingers) Per 100g

Energy170 kcal

183 kcal

Carbohydrate14.0g

15.1g

of which sugars0.6g

0.7g

Fat7.1g

7.9g

Typical values Per Jaffa cake Per 100g

Energy 42 kcal 370 kcal



Fat 1.08.8g

Now try a few on your own to practice:

What size is your portion?

Foods like pizza, pasta bake or cakes are often shared between people. For example, the labelbelow shows the nutritional values for 100g and for of a quiche.

You are going to have a of the quiche. You can work out how much is in your portion byfollowing the steps below.

1. Work out how much CHO is in the whole quiche.Multiply the CHO in the quiche portion by 3 to work out the CHO in the whole quiche.

15.1 x 3 = 45.3g2. Work out how much CHO is in your portion.

Divide the CHO in the whole quiche by 4 to work out the CHO in .

45.3 ÷ 4 = 11.3g CHO in your portion.

Yorkshire Pudding

You have eaten two Yorkshire puddings. How much carbohydrate have you had?

Remember only use the higher CHO value for the total amount of CHO.

41/

31/

41/

31/

Quiche

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QuicheFRESH AND TASTY

Typical values Per portion ( quiche) Per 100g




Fat 16.5g 12.4g

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You ate pizza, how much carbohydrate have you had?31/

You have 2 biscuits from the pack. How much carbohydrate is in your portion?

Pizza

Fruit Biscuits

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FruitBiscuitsSUITABLE FOR VEGETARIANS

Typical values Per pack (3 biscuits) Per 100g




Fat 2.7g 6.4g

Typical values Per pizza Per 100gEnergy 445kcal 281kcalCarbohydrate 48.9g 30.9gof which sugars 4.3g 2.7gFat 21.1g 12.7g

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Using weights and measuresFor foods like breakfast cereal, cooked rice or pasta it is often easiest to weigh your portionand work out how much carbohydrate it has using the ‘per 100g’ information from the label.

The steps below will help you calculate the carbohydrate in your portion.

1. Weigh your portion.

2. Look at the label and check theamount of carbohydrate per 100gof product (remember it is thetotal carbohydrate (CHO) not the‘of which sugars/starch’.

3. Divide the amount of100g by 100 to tell you how much is in 1g.

4. Multiply this amount by the weight of yourportion to tell you how muchis in your portion.

This quick equation is:

(CHO per 100g ÷ 100) x weight of your portion= CHO in your portion.

1. Weigh your portion.

2. Look at the label and check the amount ofcarbohydrate in 100g of the product(remember it is the largest value that showsthe total carbohydrate not just the ‘ofwhich sugars/starch’).

3. Work out how much carbohydrate is in 1g.Divide the amount of CHO in 100g by 100 totell you how much is in 1g.

4. Work out how much carbohydrate is in yourportion.

Multiply the CHO in 1g by the weight of yourportion to tell you how much CHO is in yourportion.

1. 40g2. 75g CHO per 100g

3. 75 ÷ 100 = 0.75g in 1g

4. 0.75 x 40 = 30g CHO

For example, a bowl of Cheery Cereal:

carbohydrate in

carbohydrate

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If you are calculating the amount of carbohydrate in liquids, use the same equation usingcarbohydrate in a certain volume rather than weight. For example, a milk label shows theamount of carbohydrate is in 100ml.

1. Measure your portion to find out how much you’re going to have.

125ml2. Check the label to find out how much CHO is in 100ml.

5g CHO per 100ml3. Work out how much CHO is in 1ml.

5 ÷ 100 = 0.05ml in 1ml of milk4. How much CHO is in your portion?

0.05 x 125 = 6.25g

You have 40g of Instant porridge with 250ml of semi-skimmed milk at breakfast.How much carbohydrate do you have?

1. Weigh your portion of Instant porridge.

40g2. Check the label to see how much CHO is in 100g of porridge.

58g3. Work out how much carbohydrate is in 1g of Instant porridge.

58 ÷ 100 = 0.58 CHO/g

Instant porridge

Typical values

Energy

Carbohydrate

of which sugars

Fat

Per 30g of Instant porridge with180ml semi-skimmed milk

280kcal

26.4g

9.3g

4.2g

Per 100g ofInstant porridge

359kcal

58

1.0g

8.7g

Typical values

Energy

Carbohydrate

of which sugars

Fat

Per 100ml of Semi-skimmed milk

48kcal

5.0g

5.0g

1.6g

Semi-skimmed milk

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FAT2LESS THAN

SEMI-SKIMMED

%Typical values Per 100ml of Semi-skimmed milk

Energy 48kcal

Protein 3.3g

Carbohydrate 5.0g

of which sugars 5.0g

Fat 1.6g

Using uncooked and cooked weightsSome food's weight changes significantly when it is cooked. Foods with starchy

noodles, couscous and pulses all have differentuncooked and cooked weights. This is due to the amount of water they absorb or lose

For example:• Pasta absorbs water when it is cooked.

This means a portion of cooked pasta isheavier than its dried weight.

When you calculate the carbohydrate in these starchy foods, it is very important that you usethe correct weight and value in your calculation.

Carbohydrate values for foods can vary by brand, cooking method and time. Always try tofollow cooking instructions and carbohydrate values on foods labels. If this is not possible, usethe average values from Carbohydrate Tables or other reference books.

4. Multiply your portion by the amount of carbohydrate in 1g of Instant porridge.

40 x 0.58 = 23.2g of CHO in your portion5. Check the label to find out how much CHO is in 100ml of milk.

5g CHO per 100ml6. Measure your portion to find out how much milk you’re going to have.

250ml7. Work out how much CHO is in 1ml of milk.

5 ÷ 100 = 0.05ml in 1ml of milk8. How much CHO is in your portion?

0.05 x 250 = 12.5g CHO in your portion of milk9. Add both amounts together to find how much carbohydrate is in your portion of Instant

porridge made with milk.

23.2 + 12.5 = 35.7g CHO altogether

• Baking potatoes causes them to lose water.This means that a baked potato is lighterthan it was when it was raw.

carbohydrates like pasta, rice, potatoes

during cooking.

carbohydrate

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For example, your portion ofcooked pasta weighs130g.

At the top of the label it states ‘75g of dried pasta weighs approximately 170g when cooked’:• the column ‘Each serving 75g when cooked’ refers to 170g of cooked pasta• the column ‘100g’ refers to uncooked (dried) pasta.

If you weigh your portion of pasta before cooking it, your calculation would follow the standardmethod using the details provided in the‘100g’ column.

For example, David has 90g of dried pasta with his dinner. His portion will have:

(72 ÷ 100) x 90 = 64.8g of CHO

However, if you prefer to measure your food once it is cooked, you need a few extra steps towork out how much carbohydrate is in 1g of cooked pasta.

Always carefully read labels that provide carbohydrate values for uncooked and cookedweights. Make sure that you understand the label and are using the correct values in yourcalculation. For example:

1. Weigh your portion ofcooked pasta

2. Look at the label and check theamount of inCHO the cooked pasta.

3. Divide the amount of CHO in 170g by170 to tell you how much is in 1g.

4. Multiply this amount by the weight ofyour portion to tell you how muchCHO is in your portion.

1. Portion weighs130g

2. Label says:

75g makes approx 170gcooked.75g dried provides 54g CHOtherefore, 170g cookedprovides about 54g CHO.

3.54 ÷ 170 = 0.32g CHO/1gcooked pasta

4.130 x 0.32 = 42g CHO

Pasta 75g dried pasta weighs approximately 170g when cooked

Typical values Each serving 75g when cooked 100gEnergy 260kcal 345kcalCarbohydrate 54.0g 72.0gof which sugars 1.5g 2.0gFat 0.8g 1.0g

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Read the label carefully, then use the space below to work out how much carbohydrate is inyour rice if your cooked portion is 80g.

Now think about the rice in the example below.

Rice 60g uncooked easy cook rice weighs approximately 140g when cooked

Typical values 140g when cooked 100g uncookedEnergy 193kcal 383kcalCarbohydrate 43.3g 85.8gof which sugars Trace TraceFat 1.8g 3.6g

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The handy hints below will help you get started:• Keep digital scales, a calculator, a pen and notebook to hand in the kitchen.• Always use the largest carbohydrate figure on nutritional labels. This is the total amount of

carbohydrate and includes both the ‘of which sugars’ and ‘of which starch’ amounts.• When you have weighed food, put it into a cup or bowl so that you know how much food

they hold and you won’t have to use the scales every time.• Don’t confuse uncooked (dry) and cooked weights. Always try to follow packet cooking

instructions and use nutritional labels to count your carbohydrate.• Use a timer to cook rice and pasta to ensure consistent cooked weights.• Try to become familiar with what foods look like on the plate. This will help you judge how

much carbohydrate is in meals and snacks when you are away from home.• Foods are often a mixture of protein, fat and carbohydrate. Remember to count carbohydrate

content in foods such as breadcrumbs on fish, pastry on a meat pie and quiche.

My handy hints

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Total CHO/serving 106.2 ÷ 2 = 53.1

Using your own recipesChecking ready meal labels can help you to estimate the carbohydrate in homemade versions.However, it is worth working out the carbohydrate content of your favourite recipes to makesure you have accurate values.

To work out carbohydrate in homemade foods:1. Write down all the ingredients. Note:

a. the amount of carbohydrate each ingredient has per 100g (CHO/100g)b. the weight of each used ingredient in the recipe (g).

2. Work out how much carbohydrate is in each ingredient using the method described inUsing weights and measures (page 10).(CHO per 100g ÷ 100) x weight = CHO

3. Add all the ingredients’ carbohydrate values together. This is the total amount ofcarbohydrate in the whole recipe.

4. Divide this total by the number of portions to give the amount of carbohydrate per portion.

The examples below show you how to work out the carbohydrate for two recipes.

Sultana Scones – Makes 8 scones

Ingredient CHO/100g Weight (g) Calculation CHO/ingredient

Flour 78 200 (78 ÷ 100) x 200 156

Margarine - 50 - -

Sugar 100 50 (100 ÷ 100) x 50 50

Milk 5 125 (5 ÷ 100) x 125 6.25

Egg - 1 egg - -

Sultanas 69 50 (69 ÷ 100) x 50 34.5

Whole recipe 230.75

Total CHO/scone 246.75 ÷ 8 = 30.87g

Macaroni Cheese – Serves 2

Ingredient CHO/100g Weight (g) Calculation CHO/ingredient

Macaroni 75 75 (75 ÷ 100) x 75 56.25(uncooked weight)

Cheese - 150g - -

Flour 78 40 (78 ÷ 100) x 40 31.2

Margarine - 40 - -

Milk 5 375 (5 ÷ 100) x 375 18.75

Whole recipe 106.2

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My favourite recipesUse the space below to make work out how much carbohydrate is in some of your favouriterecipes. You can add the values to your Carbohydrate Tables as a quick reminder.

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Using carbohydrate reference tables and the carbohydrate calculatorWhen you are out and about, it may not be possible to weigh your foods and calculate howmuch carbohydrate your food has. There are lots of books and resources available to help youwork out the carbohydrate in foods. The Carbohydrate Tables pocket guide in this pack willhelp you count carbohydrate when you are out and about.

Using the method and examples shown earlier with your Carbohydrate Tables to work outhow much carbohydrate is in:• 2 slices of wholemeal toast with jam• your usual cereal and milk with a medium banana• one of your favourite foods or drinks.

What happens if you change the portion size?

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Think of more meals and snacks that you like. Use the space below to work out how muchcarbohydrate is in your normal portion.

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The carbohydrate calculatorThis chart will help you calculate how much carbohydrate is in a specific portion size of foodsusing packet labels.

• Look on the label for how much carbohydrate is in 100g – remember to use the TOTALCARBOHYDRATE, not the ‘of which sugars/starch’ figure.

• Weigh your portion so you know how much you are going to have.• Read along the bottom (purple) to the amount of carbohydrate/100g,

weightthen up the side (black)

to the of your portion.• Where the lines meet is the amount to carbohydrate in your portion.

Carbohydrate calculator10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200

9 17 26 35 44 52 61 70 79 87 96 105 114 122 131 140 149 157 166 175

7 15 22 30 37 45 52 60 67 75 82 90 97 105 112 120 127 135 142 150

7 14 21 28 35 42 49 56 63 70 77 84 91 98 105 112 119 126 133 140

6 13 19 26 32 39 45 52 58 65 71 78 84 91 97 104 110 117 123 130

6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120

5 11 16 22 27 33 38 44 49 55 60 66 71 77 82 88 93 99 104 110

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

5 10 14 19 24 29 33 38 43 48 52 57 62 67 71 76 81 86 90 95

5 9 14 18 23 27 32 36 41 45 50 54 59 63 68 72 77 81 86 90

4 9 13 17 21 26 30 34 38 43 47 51 55 60 64 68 72 77 81 85

4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80

4 8 11 15 19 23 26 30 34 38 41 45 49 53 56 60 64 68 71 75

4 7 11 14 18 21 25 28 32 35 39 42 46 49 53 56 60 63 67 70

3 7 10 13 16 20 23 26 29 33 36 39 42 46 49 52 55 59 62 65

3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

3 6 8 11 14 17 19 22 25 28 30 33 36 39 41 44 47 50 52 55

3 5 8 10 13 15 18 20 23 25 28 30 33 35 38 40 43 45 48 50

2 5 7 9 11 14 16 18 20 23 25 27 29 32 34 36 38 41 43 45

2 4 6 8 10 12 14 16 18 20 22 45 26 28 30 32 34 36 38 40

2 4 5 7 9 11 12 14 16 18 19 21 23 25 26 28 30 32 33 35

2 3 5 6 8 9 11 12 14 15 17 18 20 21 23 24 26 27 29 30

1 3 4 5 6 8 9 10 11 13 14 15 16 18 19 20 21 23 24 25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 2 2 3 4 5 5 6 7 8 8 9 10 11 11 12 13 14 14 15

1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10

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5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

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Carbohydrate/100g (shown

Wei

ght

of

foo

d(g

)

on label)* Negligible

(black)

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For example

• You have a bowl of bran flakes that weighs 45g.

• Bran flakes have 65g CHO per 100g.

• Read along the bottom (purple) line to 65 and up the side (black) to 45.

• Where the lines meet is the amount to CHO in your portion (29g).

200 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200

175 9 17 26 35 44 52 61 70 79 87 96 105 114 122 131 140 149 157 166 175

150 7 15 22 30 37 45 52 60 67 75 82 90 97 105 112 120 127 135 142 150

140 7 14 21 28 35 42 49 56 63 70 77 84 91 98 105 112 119 126 133 140

130 6 13 19 26 32 39 45 52 58 65 71 78 84 91 97 104 110 117 123 130

120 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102 108 114 120

110 5 11 16 22 27 33 38 44 49 55 60 66 71 77 82 88 93 99 104 110

100 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

95 5 10 14 19 24 29 33 38 43 48 52 57 62 67 71 76 81 86 90 95

90 5 9 14 18 23 27 32 36 41 45 50 54 59 63 68 72 77 81 86 90

85 4 9 13 17 21 26 30 34 38 43 47 51 55 60 64 68 72 77 81 85

80 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80

75 4 8 11 15 19 23 26 30 34 38 41 45 49 53 56 60 64 68 71 75

70 4 7 11 14 18 21 25 28 32 35 39 42 46 49 53 56 60 63 67 70

65 3 7 10 13 16 20 23 26 29 33 36 39 42 46 49 52 55 59 62 65

60 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

55 3 6 8 11 14 17 19 22 25 28 30 33 36 39 41 44 47 50 52 55

50 3 5 8 10 13 15 18 20 23 25 28 30 33 35 38 40 43 45 48 50

45 2 5 7 9 11 14 16 18 20 23 25 27 29 32 34 36 38 41 43 45

40 2 4 6 8 10 12 14 16 18 20 22 45 26 28 30 32 34 36 38 40

35 2 4 5 7 9 11 12 14 16 18 19 21 23 25 26 28 30 32 33 35

30 2 3 5 6 8 9 11 12 14 15 17 18 20 21 23 24 26 27 29 30

25 1 3 4 5 6 8 9 10 11 13 14 15 16 18 19 20 21 23 24 25

20 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

15 1 2 2 3 4 5 5 6 7 8 8 9 10 11 11 12 13 14 14 15

10 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10

5 * 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

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21 00

Bolus InsulinWhen you start on your treatment plan, your diabetes team will advise you what bolus youneed.

There are some important things* you need to know when working out how much bolusinsulin you need. For example:

• the carbohydrate content of your meal

• your insulin to carbohydrate ratio (ICR)

• your current blood glucose level.

*Other factors such as activity are considered in greater detail in Carbohydrate Counting, The Next Steps (workbook 2).

What is my insulin to carbohydrate ratio (ICR)?Your ICR is the number of grams of carbohydrate covered by a certain amount of bolus insulin.

This ratio varies between people. It is affected by how long you have had diabetes, yourweight, age, how much exercise you take or if you are ill. Some people have different ICRs fordifferent meals or meal times throughout the day.

How do I work out my ICR?Your diabetes team will help you to work out and check your ICR*.

My ICR is *Variable ICRs are considered in greater detail inCarbohydrate Counting, The Next Steps (workbook 2).

What should I do next?Now that you know your ICR and have learned how to accurately count the amount ofcarbohydrate in your meals and snacks, you can calculate how much insulin you need at eachbolus.

Your diabetes team will work through examples with you until you are confident working outyour bolus by yourself.

Your diabetes team will help you to work out and check your ICR*

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Look at the example below.

Meal Carbohydrate ICR Calculation Bolus

Breakfast 50g 1:10 (50 ÷ 10) x 1 = 5 5

Lunch 60g 1:15 (60 ÷ 15) x 1 = 4 4

Dinner 90g 1:15 (90 ÷ 15) x 1 = 6 6

Now try and work it out for some of your own meals in the table below:

Meal Carbohydrate ICR Calculation Bolus

Breakfast

Lunch

Dinner

How do I use my ICR to work out my bolus?

1. Work out how much carbohydrate iscarbohydrate

in your meal or snack.in your meal or snack2. Divide the weight of carbohydrate by the weight of in your

units of insulin in your ICR.

If your meal has 40g of carbohydrate and your ICR is 1:10, you should have 4 units of bolus

(40 ÷ 10) x 1= 4 units of insulinIf your meal has 60g of carbohydrate and your ICR is 1:7.5 (or 2:15), you should have 8 units of

(60 ÷ 7.5) x 1 = 8 units of insulin((60 ÷ 15) x 2 = 8 units of insulin)

ICR and multiply this by the

insulin.

bolus insulin.

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Bolus calculator

Bolus calculator

The chart below is a helpful tool to quickly work out what your bolus should be when youknow how much carbohydrate you are going to have.

• Work out how much carbohydrate you are going to have.• Read along the bottom (purple) to your ICR then up the side (pink) to the amount of

carbohydrate you are going to have.

• Where the lines meet is the amount of insulin you should have in your bolus*.

20 12.5 10 8.5 6.5 5 4 3.5

19 12 9.5 8 6.5 4.5 4 3

18 11 9 7.5 6 4.5 3.5 3

17 10.5 8.5 7 5.5 4 3.5 3

16 10 8 6.5 5.5 4 3 2.5

15 9 7.5 6 5 3.5 3 2.5

14 8.5 7 6 4.5 3.5 3 2.5

13 8 6.5 5.5 4.5 3 2.5 2

12 7.5 6 5 4 3 2.5 2

11 7 5.5 4.5 3.5 2.5 2 2

10 6 5 4 3.5 2.5 2 1.5

9 5.5 4.5 4 3 2 2 1.5

8 5 4 3.5 2.5 2 1.5 1.5

7 4.5 3.5 3 2.5 1.5 1.5 1

6 3.5 3 2.5 2 1.5 1 1

5 3 2.5 2 1.5 1 1 1

4 2.5 2 1.5 1.5 1 1 0.5

3 2 1.5 1 1 0.5 0.5 0.5

12 1 1 1 0.5 0.5 0.5 0.5

1:5 1:8 1:10 1:12 1:15 1:20 1:25 1:30

1009590858075706560555045403530252015100

Insulin to carbohydrate ratio (ICR)(units of insulin:grams carbohydrate)

*Bolus units are rounded to the nearest 0.5 units.

Car

bo

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info

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(g)

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For example• You are going to have a bowl of bran flakes. You have calculated that this has 30g of CHO.• Your ICR is 1:10.• Read along the bottom (purple) to 1:10 and up the side (pink) to 30.• Where the lines meet is the amount of bolus insulin you should have – 3 units*.

20 12.5 10 8.5 6.5 5 4 3.5

19 12 9.5 8 6.5 4.5 4 3

18 11 9 7.5 6 4.5 3.5 3

17 10.5 8.5 7 5.5 4 3.5 3

16 10 8 6.5 5.5 4 3 2.5

15 9 7.5 6 5 3.5 3 2.5

14 8.5 7 6 4.5 3.5 3 2.5

13 8 6.5 5.5 4.5 3 2.5 2

12 7.5 6 5 4 3 2.5 2

11 7 5.5 4.5 3.5 2.5 2 2

10 6 5 4 3.5 2.5 2 1.5

9 5.5 4.5 4 3 2 2 1.5

8 5 4 3.5 2.5 2 1.5 1.5

7 4.5 3.5 3 2.5 1.5 1.5 1

6 3.5 3 2.5 2 1.5 1 1

5 3 2.5 2 1.5 1 1 1

4 2.5 2 1.5 1.5 1 1 0.5

3 2 1.5 1 1 0.5 0.5 0.5

12 1 1 1 0.5 0.5 0.5 0.5

1:5 1:8 1:10 1:12 1:15 1:20 1:25 1:30

1009590858075706560555045403530252015100

Insulin to carbohyd

Car

bo

hyd

rate

info

od

(g)

rate ratio (ICR)(units of insulin:grams carbohydrate)

*Bolus units are rounded to the nearest 0.5 units.

Remember:• Your ICR is your insulin to carbohydrate ratio.• Use your ICR to calculate how much bolus you need with your meals and snacks.• The bolus calculator can help you to quickly check what bolus you need.

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Healthy EatingThe diet for people with diabetes is not a special diet – it should be a healthy diet that all yourfamily and friends can enjoy. Using your treatment plan with carbohydrate counting enablesyou to balance your carbohydrate intake with your insulin. It gives you greater choice of what,when and how much you eat. You will have more flexibility with this plan, but it is stillimportant to follow healthy eating guidelines. These help you to grow, keep well and avoidgaining too much weight.

The eatwell plate below shows you the types and proportions of the different foods you needto have a well balanced and healthy diet.

Try to eat regularly and choose a variety of foods from the green, yellow, pink and blue groupsevery day to provide your body with the nutrients it needs. Foods in the purple group – foodand drinks high in fat and/or sugar – are not essential and should form the smallest part ofyour diet.

Breads, rice, potatoes, pasta and other starchy foods• Make these foods the main part of every meal.• Choose wholemeal, wholegrain, brown or high-fibre versions where possible.

Milk and dairy foods• Try to include these foods every day.• Choose lower-fat alternatives where possible.

Meat, fish, eggs, beans• Aim to eat small portions of these foods at meals.• Try to eat more fish and aim for one to two portions of oily fish such as salmon, herring or

pilchards each week.

eatwell plate

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Fruit and vegetables• Aim to have a minimum of 5 portions of fruit and vegetables every day.• Try to choose from a wide variety of fruit and vegetables.

Fatty foods• These foods include butter, margarine and cooking oils and many snack and convenience

foods such as mayonnaise, salad dressings, crisps, nuts, savoury and sweet pastries, icecream and chocolate.

• These foods should be used sparingly as eating too much can lead to being overweight.• Try to choose spreads and cooking oils which are higher in monosaturated or

polyunsaturated oil, for example olive oil or sunflower oil. Aim to use small amounts of theseas the calorie content is the same as butter or lard.

• Grilling, baking, boiling and stir frying are healthier methods of cooking.• Low-fat or reduced-fat alternatives can be a healthier alternative, but ensure that you read

food labels to check the nutritional information.

Sugar and sweet foods• These do not have to be avoided but eating too much of these can lead to tooth decay and

being overweight.

Salt• Salt intake should be kept to a minimum as too much can lead to health problems such as

high blood pressure. Processed foods such as crisps, pastries, ready meals and soups allcontain salt so try not to have these too often.

• If you have used a little salt in cooking try to avoid adding any more at the table.

Remember:• Base your meals on starchy foods.• Try to have at least 5 portions of fruit and vegetables a day.• Eat more fish.• Cut down on fatty and sugary foods.• Try to limit salt.

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Other Things to Think AboutAs you become more confident with your treatment plan, you can think more about your foodchoices, mealtimes, activities and lifestyle to give you even more flexibility. Keeping a diary ofthese points will help you to spot trends and have better control.

SnacksYou do not need regular snacks on your treatment plan.

• If you want a snack, think about when your last bolus was and how much carbohydrate is inyour snack.

• If your snack contains more than g of carbohydrate or is after hours ofyour last bolus, you will need to take a bolus of insulin.

The best way to check if this works isto regularly check your blood glucose.

You generally won’t need to bolus if you take carbohydrate to treat a hypo or for extra energyduring activity. Discuss this with your diabetes team.

What about bedtime snacks?It can be tempting to avoid a bolus with your bedtime snack if you are worried about hyposduring the night. However, your blood glucose may be high for several hours and only comedown with your basal insulin. Discuss this with your diabetes team.

Remember, you don’t really know what your blood glucose is during the night unless you test itfrom time-to-time.

Delaying or skipping meals and flexible meal timesIt is important to try and have three regular meals a day. Generally, your treatment plan meansthat you won’t need to stick to set mealtimes. This is most likely to happen on specialoccasions, if you are away from home or not at school.

Food choicesNot all carbohydrate foods are digested at the same rate. Some are digested quicker and willraise your blood glucose level faster than others. This is covered in detail in CarbohydrateCounting, TheNext Steps (workbook 2), where you will also consider the timing of yourbolus.

If you delay or even skip a meal you:

• should follow your standard ICR when you do have your meal

• may need to have an extra bolus if you want to have an extra snack

• still need to take your basal insulin at the same time regardless of when you are goingto eat.

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This information has been produced for SNDRí by Registered Dietitians and other relevant health professionals. At the time of publication the information containedwithin the leaflet was, to the best of our knowledge, correct and up-to-date. Always consult a suitably qualified dietitian and/or your GP on health problems.SNDRí cannot be held responsible for how clients/patients interpret and use the information within this resource.

Hosted by Glasgow Caledonian University and part funded by theScottish Government and Welsh Assembly Government.A Registered Dietitians’ project, in partnership with other agencies.

© SNDRí, First Published 12/10, Ref 9225Reviewed XX/XX, XX/XXVisit www.gcu.ac.uk/sndri for ordering information and enquiries

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