Carbohydrate counting is the method of estimating carbohydrates from your meal and adjusting insulin dose to keep blood sugar levels under control. It is easy and very effective specially for children with type 1 diabetes. It offers variety and flexibility in the diet at the same time improves blood sugar profile.
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Carbohydrate Counting for insulin dose adjustment
1. Carbohydrate Counting
Tejas Limaye
M.Sc. (Dietetics), RD
Certified Diabetes Educator
Diabetes Unit,
KEM Hospital - Pune
2. What is Carb Counting?
Estimate carb
content of the food
Adjust the insulin
dose to match the
amount of carbs
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 2
Pune
3. Why carb counting?
Offers variety, flexibility & freedom!
Aids blood glucose control
Sound nutritional recommendations
can be incorporated
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 3
The Diabetes Educator 1994, 20(5)
Pune
4. Why just carbs?
Carbs are converted to glucose faster than fats / proteins.
7th Dec 2014 4
Curr Diab Rep. 2001;1(2):177-86
Tejas Limaye (M.Sc. RD), KEM Hospital,
Pune
5. Carb Counting
Step 1
Know the sources of
carbs
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 5
Pune
6. Which foods contain carbohydrates?
Examples
• All Fruits, dry fruits, juices
• All cereals and their products
• All pulses, beans, lentils, dhals
• All roots and tubers
• Milk and milk products
• All sweets
Exceptions
•Non-veg foods
•Eggs, Fish
• Chicken
• Mutton
• Nuts, oils, cream
•Salads
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6
Tejas Limaye (M.Sc. RD), KEM Hospital,
Pune
7. Carb Counting
Step 2
Estimate the carb
content of the food
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 7
Pune
8. Problems in India
Meals are rich in carbohydrates
Serving size is non consistent
Carbohydrate content of many ready to eat foods is
not known
No precise food labeling
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 8
Pune
11. BAJRA FLOUR WHEAT FLOUR
BAJRA BHAKRI WHEAT FULKA
SABUDANA
KHICHADI
15 g carbs
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11
Tejas Limaye (M.Sc. RD), KEM Hospital, Pune
12. 15 g carbs
RICE KANDA POHA
POTATO
POTATO BHAJI
POHA
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 12
Pune
13. 15 g carbs
7th Dec 2014 13
Tejas Limaye (M.Sc. RD), KEM Hospital, Pune
14. 15 g carbs
7th Dec 2014 14
Tejas Limaye (M.Sc. RD), KEM Hospital, Pune
15. Carb content from labels
Look at the ‘Total
Carbohydrates’ figure
Ignore ‘of which are
sugars’ figure
Calculate ‘amount per
portion/ serving’
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Tejas Limaye (M.Sc. RD), KEM Hospital,
Pune
16. Carb Counting
Step 3
Calculate Insulin
required
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 16
Pune
17. IC Ratio
Divide 500 by Total Daily Insulin Dose (TDD)
Example:
Insulin Regimen: 4U BBF – 4U BL – 4U BD – 13U Basal
Total Daily Dose (TDD): 25 Units
IC Ratio: 500 divided by 25 units = 20
7th Dec 2014 17
Tejas Limaye (M.Sc. RD), KEM Hospital,
Pune
18. How Many Units of Insulin?
Idli (2) 30 grams
Sambar 15 grams
Apple 15 grams
TOTAL = 60 grams ½ K sambar
Insulin Dose for the meal:
Total carbs / IC Ratio
60/20
= 3 Units
2 Idli
1 apple
15
30
15
7th Dec 2014
Tejas Limaye (M.Sc. RD), KEM Hospital, 18
Pune
19. Carb Counting
Step 4
Consider pre-meal
blood sugar
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 19
Pune
20. IS Ratio
Insulin Sensitivity Ratio (I:S Factor): Drop in blood sugar
observed after injecting one unit of insulin
Divide 1500 by Total Daily Insulin Dose (TDD)
Example:
Insulin Regimen: 4U BBF – 4U BL – 4U BD – 13U Basal
Total Daily Dose (TDD): 25 Units
IS Ratio: 1500 divided by 25 units = 60
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 20
Pune
21. How Many Units of Insulin?
15 15
Insulin Dose for the meal:
Total carbs / IC Ratio
60/20
= 3 Units
TARGET BSL: 150 mg/dL
Current BSL: 150 mg/dL
Required Dose: 3 Units
½ K sambar
2 Idli
1 apple
30
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 21
Pune
22. How Many Units of Insulin?
15 15
Insulin Dose for the meal:
Total carbs / IC Ratio
60/20
= 3 Units
TARGET BSL: 150 mg/dL
Current BSL: 330 mg/dL
Difference: 330-150 = +180
IS Ratio : 60
Correction dose: +180/60 = +3U
Required Dose: 3+3 =
6 Units
½ K sambar
2 Idli
1 apple
30
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 22
Pune
23. How Many Units of Insulin?
TARGET BSL: 150 mg/dL
Current BSL: 90 mg/dL
Difference: 90-150 = -60
IS Ratio : 60
Correction dose: -60/60 = -1U
Required Dose: 3-1 =
2 Units
15 15
½ K sambar
2 Idli
1 apple
30
Insulin Dose for the meal:
Total carbs / IC Ratio
60/20
= 3 Units
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 23
Pune
24. Case 2
Insulin Regimen: 10U BBF – 15U BL – 5U BD – 20U Basal
Total Daily Dose (TDD): 50 Units
IC Ratio: 500 divided by 50 units = 10
IS Ratio: 1500 divided by 50 units = 30
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 24
Pune
25. How Many Units of Insulin?
Bhakri 15 grams
1 K rice 45 grams
Lefy veg 10 grams
Boiled egg 0 grams
Semai kheer 20 grams
TOTAL = 90 grams 1 K Leafy veg
Insulin Dose for the meal:
Total carbs / IC Ratio
90/10
= 9 Units
1 Small Bhakri
½ K Semai Kheer
1 boiled egg
1 K Rice
10
0
45
15
20
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 25
Pune
26. How Many Units of Insulin?
½ K Semai Kheer
Insulin Dose for the meal:
Total carbs / IC Ratio
90/10
= 3 Units
TARGET BSL: 100 mg/dL
Current BSL: 250 mg/dL
Difference: 250-100 = +150
IS Ratio : 30
Correction dose: +150/30 = +5U
Required Dose: 9+5 =
14 Units
1 K Leafy veg
1 Small Bhakri
1 boiled egg
1 K Rice
10
0
45
15
20
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 26
Pune
28. Only count the carbs that are
actually consumed!
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 28
Pune
29. A vicious circle
Don’t over-correct!
Low reading → eat more →
High reading → give more
insulin → BS goes low → eat
more →BS goes high → give
more insulin
STOP !
Think why
Correct the cause
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 29
Pune
30. Adjusting your Insulin
Do not react to one off high/low sugar
readings
Look for trends and adjust pre meal
insulin accordingly
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 30
Pune
31. Snacking
Small snack <15gms Carbs – no insulin needed
Larger snack over 15gms Carbs - insulin may be required
Consider amount of carbs and glycemic index!
7th Dec 2014 31
Tejas Limaye (M.Sc. RD), KEM Hospital, Pune
32. Portion Size Vs Carbs!
1 gulab-jamun = 1 apple = 1 cup popcorn
= 3 servings of salads
= 15 g of carbs!
Use wisely! 7th Dec 2014 32
Tejas Limaye (M.Sc. RD), KEM Hospital, Pune
33. Timing of insulin for quick or slow meals
Quick (Rice) - inject before meal / Normal Bolus
Slow (Porridge, Ice-cream) - Inject after eating /
Square wave bolus
Mixed (Pizza, Fish & chips) / Not sure how much
you’r going to eat/ multicourse meals – 50% before-
50% after meal / Dual wave bolus
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 33
Pune
34. Scope to Improve
Importance of keeping records
To see how different foods effect blood glucose
levels
Individual effects
Learn from your mistakes
Review what you ate
Check blood glucose to see if insulin was too much
or too little
Correct the ratios if necessary
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 34
Pune
35. THANK YOU!
7th Dec 2014 Tejas Limaye (M.Sc. RD), KEM Hospital, 35
Pune
Editor's Notes
Ask, “What is a carbohydrate?”
Encourage discussion.
Summarize by clicking on slide and bringing up phrase, “anything that grows in the ground”.
Examples: draw attention to anything that has not been previously mentioned and point out the exceptions.
Facilitator tips:
The purpose of this slide is to briefly show the ease of using the plate method for portion control.
This slide also shows how to count Carb choices and grams of Carb. Begin with the milk. Left click the mouse. A question mark appears.
Ask the question: How many grams of Carb are in a glass of milk? Allow for answers. Left click the mouse and the answer appears.
Continue this process with all food groups in the next 2 slides.
At the end of each example, the total grams of Carb will appear for those who choose to count grams of Carb.
Please note: 3 cups or more of raw vegetables or 1 ½ cups of cooked vegetables in a meal count as 1 carb choice according to the American Diabetes Association and American Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes,” 2008. p. 25.
Facilitator tips:
The purpose of this slide is to briefly show the ease of using the plate method for portion control.
This slide also shows how to count Carb choices and grams of Carb. Begin with the milk. Left click the mouse. A question mark appears.
Ask the question: How many grams of Carb are in a glass of milk? Allow for answers. Left click the mouse and the answer appears.
Continue this process with all food groups in the next 2 slides.
At the end of each example, the total grams of Carb will appear for those who choose to count grams of Carb.
Please note: 3 cups or more of raw vegetables or 1 ½ cups of cooked vegetables in a meal count as 1 carb choice according to the American Diabetes Association and American Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes,” 2008. p. 25.
Facilitator tips:
The purpose of this slide is to briefly show the ease of using the plate method for portion control.
This slide also shows how to count Carb choices and grams of Carb. Begin with the milk. Left click the mouse. A question mark appears.
Ask the question: How many grams of Carb are in a glass of milk? Allow for answers. Left click the mouse and the answer appears.
Continue this process with all food groups in the next 2 slides.
At the end of each example, the total grams of Carb will appear for those who choose to count grams of Carb.
Please note: 3 cups or more of raw vegetables or 1 ½ cups of cooked vegetables in a meal count as 1 carb choice according to the American Diabetes Association and American Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes,” 2008. p. 25.
Facilitator tips:
The purpose of this slide is to briefly show the ease of using the plate method for portion control.
This slide also shows how to count Carb choices and grams of Carb. Begin with the milk. Left click the mouse. A question mark appears.
Ask the question: How many grams of Carb are in a glass of milk? Allow for answers. Left click the mouse and the answer appears.
Continue this process with all food groups in the next 2 slides.
At the end of each example, the total grams of Carb will appear for those who choose to count grams of Carb.
Please note: 3 cups or more of raw vegetables or 1 ½ cups of cooked vegetables in a meal count as 1 carb choice according to the American Diabetes Association and American Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes,” 2008. p. 25.
Facilitator tips:
The purpose of this slide is to briefly show the ease of using the plate method for portion control.
This slide also shows how to count Carb choices and grams of Carb. Begin with the milk. Left click the mouse. A question mark appears.
Ask the question: How many grams of Carb are in a glass of milk? Allow for answers. Left click the mouse and the answer appears.
Continue this process with all food groups in the next 2 slides.
At the end of each example, the total grams of Carb will appear for those who choose to count grams of Carb.
Please note: 3 cups or more of raw vegetables or 1 ½ cups of cooked vegetables in a meal count as 1 carb choice according to the American Diabetes Association and American Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes,” 2008. p. 25.
Facilitator tips:
The purpose of this slide is to briefly show the ease of using the plate method for portion control.
This slide also shows how to count Carb choices and grams of Carb. Begin with the milk. Left click the mouse. A question mark appears.
Ask the question: How many grams of Carb are in a glass of milk? Allow for answers. Left click the mouse and the answer appears.
Continue this process with all food groups in the next 2 slides.
At the end of each example, the total grams of Carb will appear for those who choose to count grams of Carb.
Please note: 3 cups or more of raw vegetables or 1 ½ cups of cooked vegetables in a meal count as 1 carb choice according to the American Diabetes Association and American Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes,” 2008. p. 25.
Facilitator Tips:
The purpose of this slide is to show the importance of record keeping and learning from mistakes.
Recommend keeping a food record that lists times eaten, foods and portions.
Record keeping is important since the individual can learn how different amounts of Carb affect their blood glucose levels.
There is always something learned from mistakes:
If blood glucose is above the target range, the amount of Carb eaten in the last meal should be reviewed.
The same meal should be consumed again, but with smaller portions of Carb to see if this helps reach the blood glucose target.
