9225Introduction to CHOCounting.pdf - NDR-UK

A practical guide to
support you through
your diabetes
treatment plan
An Introduction to
CARBOHYDRATE
COUNTING

AN INTRODUCTION TO
CARBOHYDRATE COUNTING
A practical guide to support you through your diabetes treatment plan
C o n t e n t s
• I n t r o d u c t i o n
• Intensive Insulin Therapy and Your Treatment Plan
• B a s a l
• B o l u s
• 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 A b o u t
• S n a c k s
- What about bedtime snacks?
• Delaying or skipping meals and flexible meal times
• Food choices
p a g e
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G e n e ral information B a s a l
Variable factors that affect bolus needs Trends and testing
CHO counting Bolus and ICR Adjustments and corrections Trends and ∑
Tre
2 2

I n t r o d u c t i o n
Managing your diabetes can feel like a juggling act.
Start with the basics and together with your friends and family, you will build skills and
c o n f i d e n c e. 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 for
y o u .
1 00

Intensive Insulin Therapy and Your Treatment Plan
Your treatment plan uses intensive insulin thera p y. This allows you to take your insulin in a
way that mimics the normal secretion of insulin from the pancreas. You do this by having one
or two injections of basal (background or long-acting) insulin a day and injections of bolus
( rapid-acting) insulin with foods that contain carbohydra t e.
Using this treatment plan with carbohydrate counting will help you to keep your blood glucose
as close to normal as possible. You will adjust your insulin to b a l a n c e with the carbohydrate in
your meals and snacks, helping you to manage everyday life including activity, s p o r t s, s c h o o l ,
stress and illness.
B a s a l
B a s a l means b a c k g r o u n d or l o n g - a c t i n g i n s u l i n . Your body always needs basal insulin to
keep your blood glucose levels steady and to give you energy.
Your basal insulin is
Basal and Bolus Insulin Effect
Insulin Effect
Basal
Bolus
Basal
Bolus
Bolus
Bolus
Time
B o l u s
B o l u s insulin is r a p i d - acting insulin that your body needs when you eat carbohydra t e.
You will take your bolus with meals, and sometimes with snacks. This type of insulin helps
your 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?
C a r b o h y d rate counting will help you to get all the benefits from your treatment plan. You will
work out how much carbohydrate is in your meals and snacks then adjust your bolus to keep
your blood glucose within your target ra n g e.
It is still important to have a healthy diet, but carbohydrate counting gives you more choice of
w h a t , when and how much you can eat. This will help you to worry less about eating to avoid
h y p o s, or snacking when you are not hungry.
C a r b o h y d rate counting is much more than being able to estimate the carbohydrate content of
f o o d s. It is also about learning how to adjust your bolus insulin to the food you eat and the
activities 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 your
d i a b e t e s !
00 2

R e m e m b e r:
• You always need basal insulin.
• You need bolus insulin each time you eat carbohydra t e.
• C a r b o h y d rate counting will help you get all the benefits from your intensive insulin therapy
treatment plan.
Steps to your treatment plan and carbohydrate counting
This pack will guide you through the steps of your treatment plan and carbohydrate counting
to help you get all the benefits it can offer. By working with your diabetes team through each
s t a g e, you will grow in confidence by practicing with the examples provided and making notes
to remind you of hints and tips to help you manage your diabetes.
Step
1. Identify which foods contain
carbohydrate in your meal.
2. Calculate or estimate the
carbohydrate in your meal.
3. Calculate your bolus to cover
this carbohydrate.
4. Consider factors which may
affect the timing and amount of
bolus 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 the
amount and timing as appropriate.
6. Keep records of your blood
glucose, carbohydrate intake
and activities.
7. Look out for trends in your blood
glucose to ensure that you are
taking the right amount of basal and
bolus insulin to keep optimal control.
Go to
What is carbohydrate? Introduction to
Carbohydrate Counting (page 5).
• Reading labels and the carbohydrate calculator.
Introduction to Carbohydrate Counting
(page 7, 21).
• Carbohydrate Tables.
Bolus insulin. Introduction to Carbohydrate
Counting (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.
3 00

What is Carbohydrate?
C a r b o h y d rate is a nutrient and source of energy found in foods such as potatoes, r i c e, p a s t a ,
c e r e a l s, m i l k , f r u i t , sweets and sugary drinks.
Types of carbohydrate
Different foods contain different types of carbohydra t e.
• Starchy carbohydrate – potatoes, r i c e, p a s t a , n o o d l e s, b r e a d , c e r e a l s, c o u s c o u s, l e n t i l s,
beans and products made from flour.
• F r u c t o s e – fruit and fruit juice.
• L a c t o s e – milk, y o g h u r t , ice cream, c u s t a r d .
• S u c r o s e – table sugar, s y r u p, 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 needs
insulin to use this glucose for energy. The more carbohydrate you eat, the more insulin you will
need to keep your blood glucose within your target ra n g e. T h e r e f o r e, knowing how much
c a r b o h y d rate is in the food and drink you take will help you estimate how much insulin you
n e e d .
00 4

For a healthy diet most of your carbohydrate should come from starchy foods, fruit and some
dairy foods. Smaller amounts should be from sugar and sweet foods. Different people need
different amounts of carbohydra t e. The amount of carbohydrate that your body needs
depends on your age, activity levels and weight. In general carbohydrate should make up
about half of your energy (calorie) intake each day.
Do all foods contain carbohydrate?
N o. Some foods contain very little or no carbohydra t e, i n c l u d i n g :
•most vegetables
• m e a t
• f i s h
• e g g s
• c h e e s e
• b u t t e r, 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.
R e m e m b e r:
• Different foods contain different types of carbohydra t e.
• Try to have most of your carbohydrate from starchy foods.
• Some foods contain very little or no carbohydra t e.
5 00

Carbohydrate Counting
Reading labels
All packaged food labels have nutritional information for the main nutrients, including energy
( k c a l / k J ) , p r o t e i n , c a r b o h y d rate (CHO) and fat. This is usually given per 100g and sometimes per
p o r t i o n .
The portion figure works well for foods like biscuits, b a r s, yoghurts and ready meals where you
tend to eat the suggested portion size. H o w e v e r, if you have a different amount, you will need
to calculate the amount of carbohydrate in your portion. This is common for foods like pizza,
p a s t a , breakfast cereal and desserts.
Carbohydrate on food labels
Nutritional labels often show different carbohydrate details. It can be noted in one, t w o
or three parts:
1 . C a r b o hy d rate (always incl u d e d )
2 . of which sugars (often incl u d e d )
3 . of which starch (sometimes incl u d e d ) .
When you are counting carbohydra t e, you must always use the largest c a r b o h y d r a t e
f i g u r e. This is the t o t a l amount of carbohydrate in the food, and includes both the
‘of which sugars’ a n d ‘of which starch ’ a m o u n t s.
Follow the steps below to help you work out how much carbohydrate is in your portion, t h e n
p ractice with the examples provided.
Packaged foods
Sometimes the labels show how much carbohydrate is in an example portion, for example:
Wholemeal Bread
Typical values Per slice Per 100g
of product
Energy 102kcal 218kcal
Carbohydrate 19.8g 42.0g
of which sugars 1.3g 2.8g
Fat 1.1g 2.4g
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 one
slice of bread by 2.
19.8 x 2 = 39.6g of CHO
00 6

The labels below show suggested portion sizes of different foods. Compare your portion size
to those suggested on the labels.
How much carbohydrate is in y o u r p o r t i o n ?
Jaffa Cake s
Typical values Per Jaffa cake Per 100g
Energy 42 kcal 370 kcal
Carbohydrate 7.6g 67.6g
of which sugars 6.0g 53.3g
Fat 1.0 8.8g
If you ate 3 jaffa cakes, you would need to multiply the amount of carbohydrate in one jaffa
cake by 3.
7.6 x 3 = 22.8g CHO
Fish Fingers
Typical values Per portion (3 fish fingers) Per 100g
Energy 170 kcal 183 kcal
Carbohydrate 14.0g 15.1g
of which sugars 0.6g 0.7g
Fat 7.1g 7.9g
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 how
much 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 1
fish finger.
3 fish fingers = 14.0g CHO
14.0 ÷ 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.
7 00

What size is your portion?
Q u i c h e
Foods like pizza, pasta bake or cakes are often shared between people. For example, the label
1
below shows the nutritional values for 100g and for / of a quiche.
Quiche
FRESH AND TASTY
You are going to have a 4 of the quiche. You can work out how much is in your portion by
following the steps below.
1 . Work out how much CHO is in the whole quiche.
1
Multiply the CHO in the / quiche portion by 3 to work out the CHO in the whole quiche.
15.1 x 3 = 45.3g
2 . Work out how much CHO is in your portion.
1
Divide the CHO in the whole quiche by 4 to work out the CHO in /4 .
45.3 ÷ 4 = 11.3g CHO in your portion.
Now try a few on your own to practice:
Yo r k s h i re Pudding
1 /
3
3
1/ 3
Typical values Per portion ( quiche) Per 100g
Energy 251kcal 188kcal
Carbohydrate 15.1g 11.3g
of which sugars 3.2g 2.4g
Fat 16.5g 12.4g
You have eaten two Yorkshire puddings. How much carbohydra t e have you had?
Remember only use the higher CHO value for the t o t a l amount of CHO.
00 8

Fruit Biscuits
Fruit
Biscuits
SUITABLE FOR VEGETARIANS
Typical values Per pack (3 biscuits) Per 100g
Energy 165kcal 381kcal
Carbohydrate 32.7g 75.2g
of which sugars 16.2g 37.4g
Fat 2.7g 6.4g
You have 2 biscuits from the pack. How much carbohydrate is in your portion?
P i z z a
Typical values Per
1 /2 pizza Per 100g
Energy 445kcal 281kcal
Carbohydrate 48.9g 30.9g
of which sugars 4.3g 2.7g
Fat 21.1g 12.7g
You ate
1 /3
p i z z a , how much carbohydrate have you had?
9 00

Using weights and measures
For foods like breakfast cereal, cooked rice or pasta it is often easiest to weigh your portion
and 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 the
amount of carbohydrate per 100g
of product (remember it is the
t o t a l c a r b o h y d rate (CHO) not the
‘of which sugars/starch’.
3 . Divide the amount of carbohydrate in
100g by 100 to tell you how much is in 1g.
4 . Multiply this amount by the weight of your
portion to tell you how much carbohydrate
is in your p o r t i o n .
This quick equation is:
(CHO per 100g ÷ 100) x weight of your portion
= CHO in your portion.
For example, a bowl of Cheery Cereal:
1 . Weigh your portion.
2 . Look at the label and check the amount of
c a r b o h y d rate in 100g of the product
(remember it is the largest value that shows
the total carbohydrate not just the ‘ o f
which sugars/starch’).
3 . Work out how much carbohydrate is in 1g.
Divide the amount of CHO in 100g by 100 to
tell you how much is in 1g.
4 . Work out how much carbohydrate is in your
p o r t i o n .
1 . 40 g
2 . 75g CHO per 100g
3 . 75 ÷ 100 = 0.75g in 1g
4 . 0.75 x 40 = 30g CHO
Multiply the CHO in 1g by the weight of your
portion to tell you how much CHO is in your
p o r t i o n .
00 10

If you are calculating the amount of carbohydrate in liquids, use the same equation using
c a r b o h y d rate in a certain volume rather than weight. For example, a milk label shows the
amount of carbohydrate is in 100ml.
SEMI-SKIMMED
THAN
2
LESS
%
FAT
1 . Measure your portion to find out how much you’re going to have.
1 2 5 m l
2 . Check the label to find out how much CHO is in 100ml.
5g CHO per 100ml
3 . Work out how much CHO is in 1ml.
5 ÷ 100 = 0.05ml in 1ml of milk
4 . 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?
Instant porridge
Typical values
Typical values Per 100ml of Semi-skimmed milk
Energy 48kcal
Protein 3.3g
Carbohydrate 5.0g
of which sugars 5.0g
Fat 1.6g
Per 30g of Instant porridge with
180 ml semi-skimmed milk
Per 100g of
Instant porridge
E n e r g y
C a r b o h y d ra t e
of which sugars
Fa t
280 k c a l
26 . 4 g
9.3 g
4 . 2 g
359 k c a l
58
1 . 0 g
8 . 7 g
Semi-skimmed milk
Typical values
E n e r g y
C a r b o h y d ra t e
of which sugars
Fa t
Per 100ml of Semi-skimmed milk
48kcal
5 . 0 g
5 . 0 g
1 . 6 g
1 . Weigh your portion of Instant porridge.
4 0 g
2 . Check the label to see how much CHO is in 100g of porridge.
5 8 g
3 . Work out how much carbohydrate is in 1g of Instant porridge.
58 ÷ 100 = 0.58 CHO/g
11 00

4 . Multiply your portion by the amount of carbohydrate in 1g of Instant porridge.
40 x 0.58 = 23.2g of CHO in your portion
5 . Check the label to find out how much CHO is in 100ml of milk.
5g CHO per 100ml
6 . Measure your portion to find out how much milk you’re going to have.
2 5 0 m l
7 . Work out how much CHO is in 1ml of milk.
5 ÷ 100 = 0.05ml in 1ml of milk
8 . How much CHO is in your portion?
0.05 x 250 = 12.5g CHO in your portion of milk
9 . 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
Using uncooked and cooked weights
Some food's weight changes significantly when it is cooked. Foods with starchy
carbohydrates like pasta, rice, potatoes n o o d l e s, couscous and pulses all have different
uncooked and cooked weights. This is due to the amount of water they absorb or lose
during cooking.
For example:
• Pasta absorbs water when it is cooked.
This means a portion of cooked pasta is
heavier than its dried weight.
• Baking potatoes causes them to lose water.
This means that a baked potato is lighter
than it was when it was ra w.
When you calculate the carbohydrate in these starchy foods, it is very important that you use
the correct weight and c a r b o h y d rate value in your calculation.
C a r b o h y d rate values for foods can vary by bra n d , cooking method and time. Always try to
follow cooking instructions and carbohydrate values on foods labels. If this is not possible, u s e
the average values from Carbohydrate Ta b l e s or other reference books.
00 12

Always carefully read labels that provide carbohydrate values for uncooked and cooked
w e i g h t s. Make sure that you understand the label and are using the correct values in your
c a l c u l a t i o n . For example:
Pa s t a 75g dried pasta weighs approximately 170g when cooked
Typical values Each serving 75g when cooked 100g
E n e r g y 260 k c a l 345 k c a l
C a r b o h y d ra t e 54 . 0 g 72 . 0 g
of which sugars 1 . 5 g 2 . 0 g
Fa t 0 . 8 g 1 . 0 g
At the top of the label it states ‘75g of dried pasta weighs approximately 170g when cooke d ’:
• the column ‘ E a ch serving 75g when cooke d ’ refers to 170g of c o o k e d p a s t a
• the column ‘100g’ refers to uncooked (dried) pasta.
If you weigh your portion of pasta before cooking it, your calculation would follow the standard
method using the details provided in the‘100g’ column.
For example, David has 90g of d r i e d pasta with his dinner. His portion will have:
(72 ÷ 100) x 90 = 64.8g of CHO
H o w e v e r, if you prefer to measure your food once it is cooked, you need a few extra steps to
work out how much carbohydrate is in 1g of c o o k e d p a s t a .
For example, your portion of c o o k e d pasta weighs130g.
1 . Weigh your portion of c o o k e d p a s t a
2 . Look at the label and check the
amount of CHO in the c o o k e d p a s t a .
3 . Divide the amount of CHO in 170g by
170 to tell you how much is in 1g.
4 . Multiply this amount by the weight of
your portion to tell you how much
CHO is in your portion.
1 . Portion weighs1 3 0 g
2 . Label says:
75g makes approx 170g
c o o k e d.
75g dried provides 54g CHO
t h e re f o re, 170g cooked
p rovides about 54g CHO.
3 . 54 ÷ 170 = 0.32g CHO/1g
cooked pasta
4 . 130 x 0.32 = 42g CHO
13 00

Now think about the rice in the example below.
R i c e 60g uncooked easy cook rice weighs approximately 140g when cooked
Typical values 140g when cooked 100g uncooked
E n e r g y 193 k c a l 383 k c a l
C a r b o h y d ra t e 43 . 3 g 85 . 8 g
of which sugars Tra c e Tra c e
Fa t 1 . 8 g 3 . 6 g
Read the label carefully, then use the space below to work out how much carbohydrate is in
your rice if your c o o k e d portion is 80g.
00 14

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 c a r b o h y d r a t e figure on nutritional labels. This is the t o t a l amount of
c a r b o h y d rate and includes both the ‘of which sugars’ a n d ‘of which starch’ a m o u n t s.
• 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 carbohydra t e.
• 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 carbohydra t e. Remember to count carbohydra t e
content in foods such as breadcrumbs on fish, pastry on a meat pie and quiche.
My handy hints
15 00

Using your own recipes
Checking ready meal labels can help you to estimate the carbohydrate in homemade versions.
H o w e v e r, it is worth working out the carbohydrate content of your favourite recipes to make
sure you have accurate values.
To work out carbohydrate in homemade foods:
1 . Write down all the ingredients. N o t e :
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 in
Using 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 of
c a r b o h y d rate 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
I n g r e d i e n t C H O / 100 g Weight (g) C a l c u l a t i o n C H O / i n g r e d i e n t
F l o u r 78 200 (78 ÷ 100) x 200 156
M a r g a r i n e - 50 - -
S u g a r 100 50 (100 ÷ 100) x 50 50
M i l k 5 125 (5 ÷ 100) x 125 6 . 25
E g g - 1 egg - -
S u l t a n a s 69 50 (69 ÷ 100) x 50 34 . 5
Whole re c i p e 230 . 75
Total CHO/scone 246.75 ÷ 8 = 30.87g
Macaroni Cheese – Serves 2
I n g r e d i e n t C H O / 100 g Weight (g) C a l c u l a t i o n C H O / i n g r e d i e n t
M a c a ro n i 75 75 (75 ÷ 100) x 75 56 . 25
(uncooked weight)
C h e e s e - 150 g - -
F l o u r 78 40 (78 ÷ 100) x 40 31 . 2
M a r g a r i n e - 40 - -
M i l k 5 375 (5 ÷ 100) x 375 18 . 75
Whole re c i p e 106 . 2
Total CHO/serving 106.2 ÷ 2 = 53.1
00 16

My favourite recipes
Use the space below to make work out how much carbohydrate is in some of your favourite
r e c i p e s. You can add the values to your Carbohydrate Ta b l e s as a quick reminder.
17 00

Using carbohydrate reference tables and the carbohydrate calculator
When you are out and about, it may not be possible to weigh your foods and calculate how
much carbohydrate your food has. There are lots of books and resources available to help you
work out the carbohydrate in foods. The Carbohydrate Ta b l e s pocket guide in this pack will
help you count carbohydrate when you are out and about.
Using the method and examples shown earlier with your Carbohydrate Ta b l e s to work out
how 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?
00 18

Think of more meals and snacks that you like. Use the space below to work out how much
c a r b o h y d rate is in your normal portion.
19 00

The carbohydrate calculator
This chart will help you calculate how much carbohydrate is in a specific portion size of foods
using packet labels.
• Look on the label for how much carbohydrate is in 100g – remember to use the TOTAL
C A R B O H Y D R AT E, 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, then up the side (black)
(black) to the weight of your portion.
• Where the lines meet is the amount to carbohydrate in your portion.
Carbohydrate calculator
Weight of food (g)
20 0
17 5
15 0
14 0
13 0
12 0
11 0
10 0
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
10 20 30 40 50 60 70 80 90 10 0 11 0 12 0 13 0 14 0 15 0 16 0 17 0 18 0 19 0 20 0
9 17 26 35 44 52 61 70 79 87 96 10 5 11 4 12 2 13 1 14 0 14 9 15 7 16 6 17 5
7 15 22 30 37 45 52 60 67 75 82 90 97 10 5 11 2 12 0 12 7 13 5 14 2 15 0
7 14 21 28 35 42 49 56 63 70 77 84 91 98 10 5 11 2 11 9 12 6 13 3 14 0
6 13 19 26 32 39 45 52 58 65 71 78 84 91 97 10 4 11 0 11 7 12 3 13 0
6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 10 2 10 8 11 4 12 0
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
* 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
* Negligible
Carbohydrate/100g (shown on label)
00 20

For example
• You have a bowl of bran flakes that weighs 45g.
• B ran 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).
Weight of food (g)
2 0 0
10 20 30 40 50 60 70 80 90 10 0 11 0 12 0 13 0 14 0 15 0 16 0 17 0 18 0 19 0 20 0
1 7 5
9 17 26 35 44 52 61 70 79 87 96 10 5 11 4 12 2 13 1 14 0 14 9 15 7 16 6 17 5
1 5 0
7 15 22 30 37 45 52 60 67 75 82 90 97 10 5 11 2 12 0 12 7 13 5 14 2 15 0
1 4 0
7 14 21 28 35 42 49 56 63 70 77 84 91 98 10 5 11 2 11 9 12 6 13 3 14 0
1 3 0
6 13 19 26 32 39 45 52 58 65 71 78 84 91 97 10 4 11 0 11 7 12 3 13 0
1 2 0
6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 10 2 10 8 11 4 12 0
1 1 0
5 11 16 22 27 33 38 44 49 55 60 66 71 77 82 88 93 99 104 110
1 0 0
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
9 5 5 10 14 19 24 29 33 38 43 48 52 57 62 67 71 76 81 86 90 95
9 0 5 9 14 18 23 27 32 36 41 45 50 54 59 63 68 72 77 81 86 90
8 5 4 9 13 17 21 26 30 34 38 43 47 51 55 60 64 68 72 77 81 85
8 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80
7 5 4 8 11 15 19 23 26 30 34 38 41 45 49 53 56 60 64 68 71 75
7 0 4 7 11 14 18 21 25 28 32 35 39 42 46 49 53 56 60 63 67 70
6 5 3 7 10 13 16 20 23 26 29 33 36 39 42 46 49 52 55 59 62 65
6 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
5 5 3 6 8 11 14 17 19 22 25 28 30 33 36 39 41 44 47 50 52 55
5 0 3 5 8 10 13 15 18 20 23 25 28 30 33 35 38 40 43 45 48 50
4 5 2 5 7 9 11 14 16 18 20 23 25 27 29 32 34 36 38 41 43 45
4 0 2 4 6 8 10 12 14 16 18 20 22 45 26 28 30 32 34 36 38 40
3 5 2 4 5 7 9 11 12 14 16 18 19 21 23 25 26 28 30 32 33 35
3 0 2 3 5 6 8 9 11 12 14 15 17 18 20 21 23 24 26 27 29 30
2 5 1 3 4 5 6 8 9 10 11 13 14 15 16 18 19 20 21 23 24 25
2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
1 5 1 2 2 3 4 5 5 6 7 8 8 9 10 11 11 12 13 14 14 15
1 0 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
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
* Negligible
Carbohydrate/100g (shown on label)
21 00

Bolus Insulin
When you start on your treatment plan, your diabetes team will advise you what bolus you
n e e d .
There are some important things* you need to know when working out how much bolus
insulin 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, y o u r
w e i g h t , a g e, how much exercise you take or if you are ill. Some people have different ICRs for
different 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 in
Carbohydrate 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 of
c a r b o h y d rate in your meals and snacks, you can calculate how much insulin you need at each
b o l u s.
Your diabetes team will work through examples with you until you are confident working out
your bolus by yourself.
00 22

How do I use my ICR to work out my bolus?
1 . Work out how much carbohydrate is in your meal or snack.
2 . Divide the weight of carbohydrate in your meal or snack by the weight of carbohydrate in your
ICR and multiply this by the 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
insulin.
(40 ÷ 10) x 1= 4 units of insulin
If your meal has 60g of carbohydrate and your ICR is 1:7.5 (or 2:15), you should have 8 units of
bolus insulin.
(60 ÷ 7.5) x 1 = 8 units of insulin
((60 ÷ 15) x 2 = 8 units of insulin)
Look at the example below.
M e a l C a r b o h y d r a t e I C R C a l c u l a t i o n B o l u s
B r e a k f a s t 5 0 g 1 : 1 0 (50 ÷ 10) x 1 = 5 5
L u n c h 6 0 g 1 : 1 5 (60 ÷ 15) x 1 = 4 4
D i n n e r 9 0 g 1 : 1 5 (90 ÷ 15) x 1 = 6 6
Now try and work it out for some of your own meals in the table below:
M e a l C a r b o h y d r a t e I C R C a l c u l a t i o n B o l u s
B r e a k f a s t
L u n c h
D i n n e r
23 00

Bolus calculator
The chart below is a helpful tool to quickly work out what your bolus should be when you
know 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*.
Bolus calculator
Carbohydrate in food (g)
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
0
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
Insulin to carbohydrate ratio (ICR)
(units of insulin:grams carbohydra t e )
*Bolus units are rounded to the nearest 0.5 units.
00 24

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*.
Carbohydrate in food (g)
100
95
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
0
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
Insulin to carbohydrate ratio (ICR)
(units of insulin:grams carbohydra t e )
*Bolus units are rounded to the nearest 0.5 units.
R e m e m b e r:
• Your ICR is your insulin to carbohydrate ra t i o.
• 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.
25 00

Healthy Eating
The diet for people with diabetes is not a special diet – it should be a healthy diet that all your
family and friends can enjoy. Using your treatment plan with carbohydrate counting enables
you 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 still
important to follow healthy eating guidelines. These help you to grow, keep well and avoid
gaining too much weight.
The eatwell plate below shows you the types and proportions of the different foods you need
to have a well balanced and healthy diet.
eatwell plate
Reproduced with the kind permission of the Food Standards Agency © Crown copyright
material is reproduced with the permission of the Controller of HMSO and
Queen's Printer for Scotland
Try to eat regularly and choose a variety of foods from the green, y e l l o w, pink and blue groups
every day to provide your body with the nutrients it needs. Foods in the purple group – food
and drinks high in fat and/or sugar – are not essential and should form the smallest part of
your diet.
B r e a d s, r i c e, p o t a t o e s, pasta and other starchy foods
• Make these foods the main part of every meal.
• Choose wholemeal, w h o l e g ra i n , brown or high-fibre versions where possible.
Milk and dairy foods
• Try to include these foods every day.
• Choose lower-fat alternatives where possible.
M e a t , f i s h , e g g s, b e a n s
• 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.
00 26

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, c r i s p s, n u t s, savoury and sweet pastries, ice
cream 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
p o l y u n s a t u rated oil, for example olive oil or sunflower oil. Aim to use small amounts of these
as the calorie content is the same as butter or lard.
• G r i l l i n g , b a k i n g , 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.
S a l t
• 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 all
contain 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.
R e m e m b e r:
• 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.
27 00

Other Things to Think A b o u t
As you become more confident with your treatment plan, you can think more about your food
c h o i c e s, m e a l t i m e s, activities and lifestyle to give you even more flexibility. Keeping a diary of
these points will help you to spot trends and have better control.
S n a c k s
You 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 in
your snack.
• If your snack contains more than g of carbohydrate or is after hours of
your last bolus, you will need to take a bolus of insulin.
The best way to check if this works is
to regularly check your blood glucose.
You generally won’t need to bolus if you take carbohydrate to treat a hypo or for extra energy
during 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 hypos
during the night. H o w e v e r, your blood glucose may be high for several hours and only come
down with your basal insulin. Discuss this with your diabetes team.
R e m e m b e r, you don’t really know what your blood glucose is during the night unless you test it
from time-to-time.
Delaying or skipping meals and flexible meal times
It is important to try and have three regular meals a day. G e n e ra l l y, your treatment plan means
that you won’t need to stick to set mealtimes. This is most likely to happen on special
o c c a s i o n s, if you are away from home or not at school.
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 going
to eat.
Food choices
Not all carbohydrate foods are digested at the same ra t e. Some are digested quicker and will
raise your blood glucose level faster than others. This is covered in detail in C a r b o h y d r a t e
Counting, The Next Steps (workbook 2), where you will also consider the timing of your
b o l u s.
00 28

This information has been produced for SNDRí by Registered Dietitians and other relevant health professionals. At the time of publication the information contained
within 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.
© SNDRí, First Published 12/10, Ref 9225
Reviewed XX/XX, XX/XX
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