This document provides information on carbohydrate counting and calculating insulin-to-carbohydrate ratios and insulin sensitivity factors for people with diabetes. It explains that counting carbohydrates allows for flexibility in meal planning while controlling blood glucose. Examples are given for determining carbohydrate servings and exchanging units. The 1500 and 1800 rules are described for calculating insulin sensitivity factors based on a person's total daily insulin dose. Worked examples demonstrate how to use insulin-to-carbohydrate ratios and sensitivity factors to determine corrective insulin doses.

1. Carbohydrate Counting
and Diabetes

2. Why count carbohydrates?
• Primary goal of diabetes management is to normalize
blood glucose concentrations.
• To follow a meal plan.
• To use an insulin-to-carb meal ratio.
• Can allow for more flexibility with eating for people with
type 1 diabetes.
• Encourage a healthy, balanced diet.
• To control portion sizes.
• Carbohydrate counting ensures that you can have variety
and flexibility in your diet and most importantly can follow
your traditional diet

3. To count carbohydrates, look at three things:
• Serving size
• Number of servings per container
• Grams of total carbohydrate per serving

5. Carbohydrate Foods
Starches and grains (15 grams per serving)
• Bread (1 slice of bread)
• Cereals “dalia” (1/2 cup cooked)
• Rice and pasta (1/3 cup cooked)
• Biscuits (2-3)
• popcorn (1/2 cup)
• Chapatti 6’’ diameter
• Biryani/ Pulao (1/2 cup cooked)
• Puris 5’’ (2)

6. Vegetables (15 grams carb)
• Starchy vegetables:
• Beans (1/2 cup cooked)
• Corn (1/2 cup)
• Potatoes (1/2 cup cooked)
• Peas (1/2 cup cooked)
• Non-Starchy vegetables:5 g Carbs
(count if serving size more than 15 g)
• Raw vegetables ( 1 cup)
• Green Beans, beets, cabbage, carrots,
cauliflower, eggplant, okra, onions, spinach,
tomato (1/2 cup cooked)

7. Milk and Yogurt
Skim and Very Lowfat Milk(12 grams per serving)
• Skim Milk (1 cup)
• Plain non-fat yogurt (3/4 cup)
Low Fat Milk (12 grams per serving)
• Low fat milk (1 cup)
• Plain low-fat yogurt (3/4 cup)
Whole Milk (12 grams per serving)
• Whole milk (1 cup)

8. Fresh Fruits (15 grams per serving)
• Apple (1) equal to 4oz
• Banana (1/2 large or 1 baby banana)
• Grape fruit (1/2 large)
• Grapes (15 to 17)
• Orange (1)
• Mango (1/2 cup or ½ small)
• Watermelon (1 cup diced)
• Papaya (1 cup diced)
• Chiku (1 med)

9. Insulin To Carbohydrate Ratio
• Carb counting in exchanges or grams
• ‘500’ Rule
500÷total daily dose or weight
•E.g: 32kg child, total daily dose 30 units
•500÷32=15
•carb ratio=1 unit per 15g or unit per exchange
•E.g: 15kg child total daily dose is 12 units
•500÷15=33
•carb ratio=1 unit per 33g or 2 unit per exchange

10. Meal Pattern Using Carb Ratios
• Carb Ratio=1 unit per 15g exchange
•Breakfast 3 Exch 5 units bolus insulin
•Mid Morning 2 Exch
•Lunch 3 Exch 4 units bolus insulin
•Tea 1 Exch
•Dinner 4 Exch 4 units bolus insulin

11. INSULIN SENSITIVITY
FACTOR

12. Flexible Insulin Adjustment
• Dose of short acting insulin matches amount of carbohydrate
1. Insulin to carbohydrate ‘ratio’
i. Carbohydrates measured in grams or exchanges
ii. Varies with different meals
2. Correction factor
i. ‘Insulin sensitivity factor’ or ‘sliding scale’
• However, MUST take into account timing of
BGL, exercise, illness & other factors

13. Correction Factor/ Sensitivity
• Dose of insulin to bring BGL back to target
• ‘1800 rule’ = 1800 / total daily dose (or weight)
 eg 30 kg child, total daily dose ~30 units
1800 / 30 = 60
1 unit of insulin lowers BGL by 60 mg/dL
Example: BGL is 300, target 100; 3 units needed
 eg 50 kg child, total daily dose ~50 units
1800 / 50 = 36
1 unit of insulin lowers BGL by 36 mg/dL
Example: BGL is 400, target 100; 8 units needed
• For regular insulin ‘1500 rule’

14. HOW TO CALCULATE YOUR INSULIN SENSITIVITY
FACTOR
• Healthcare professionals use the 1500 and 1800 Rules to
calculate an insulin sensitivity factor.
• The 1500 Rule estimates the point drop in mg/dL for every
unit of Regular insulin taken.
• The 1800 Rule estimates the point drop in mg/dL for every
unit of rapid-acting insulin taken.

15. Insulin Sensitivity Factor Correction formula
• Correction Dose: Amount of insulin calculated to correct a BG that is above
target.
(Current BG- BG Target) / ISF = Correction Dose
Example: BG target= 100mg/dL, ISF= 45 mg/dL
 If BG is above target (160 mg/dL):
A positive correction dose is calculated.
(160 – 100) / 45 = 1.3 units
 If BG is at target:
No correction amount is calculated.
 If BG is below target (60mg/dL):
A negative correction dose is calculated and substracted from the food bolus.
(60 – 100) / 45 = -0.9 units

16. Example of 1800 Rule:
• Brian uses Humalog insulin at a ratio of 1 unit per 15
grams of carbohydrate with each meal and snack.
He also takes 36 units of Lantus insulin at bedtime.
Below is the calculation of his estimated TDD.
• Breakfast: 8 units Humalog + Lunch: 5 units
Humalog + Snack: 3 units Humalog + Dinner: 8 units
Humalog + Bedtime: 36 units Lantus TDD: 60 units
• 1800 divided by 60= 30
• * 1 unit of Humalog decreases Brian’s blood glucose
by approximately 30 mg/dL (points)

17. • Example: Brian forgot to take his Humalog at lunch. It
is now 3:00 p.m. and Brian’s blood glucose is 350
mg/dL.
• Current blood glucose= 350 mg/dL – (minus) *
Target blood glucose= 140 mg/dL
• Glucose needs to drop 210 mg/dL (points) 210 (how
far blood glucose needs to drop) divided by 30 = 7
units
• * Brian needs to take 7 units of Humalog to decrease
his blood glucose to approximately 140 mg/dL.