Diabetes Self-Management Blog

Last week we talked about two types of diabetes meal planning tools: the exchange system and the plate method. While both of these approaches can work well, today, more and more people with diabetes are turning to carbohydrate counting.

Carbohydrate, or “carb”, counting, really isn’t all that new. In fact, Dr. Elliott Joslin taught carb counting to his patients back in the early part of the 20th Century: “In teaching patients their diet,” he said, “I lay emphasis first on carbohydrate values, and teach to a few only the values for protein and fat.” Patients who came to Joslin Clinic in those days were taught by Dr. Joslin himself, and today, the walls of Joslin Diabetes Center are lined with pictures of folks from that period sitting in a classroom with gram scales in front of them for the purpose of weighing their food. Since those days, many aspects of diabetes care have changed for the better, but carb counting has made a comeback as an effective yet simple approach to help people better manage their diabetes.

There are actually two types of carb counting. The first type, often called basic or consistent carb counting (or, as one of the doctors at Joslin likes to say, “CC”), is usually what most people with diabetes learn about these days. Basic carb counting isn’t a diet, but rather a tool to help you better plan meals and learn how your food choices affect your blood glucose levels.

As you may know, most of the carbohydrate we eat turns to glucose (sugar) during digestion. Our bodies then use this glucose for energy. Let’s review the types of foods that contain carbohydrate:

  • Bread, pasta, cereals, rice
  • Starchy vegetables (corn, peas, potatoes, lima beans)
  • Fruit and fruit juices
  • Milk and yogurt
  • Sweets and desserts
  • (Non-starchy vegetables, such as broccoli, green beans, and carrots have a little carb, but not enough to affect blood glucose levels unless you eat large amounts.)

    Many people “count” carbs using grams. One carb choice, or serving, is the amount of food that contains 15 grams of carbohydrate. Whether you eat 15 grams of carb from a piece of bread or 15 grams of carb from a cookie, the effect on your blood glucose level is about the same. (It’s a common misconception that eating sweet foods causes your blood glucose level to climb higher than if you eat a starchy food.) You can learn how much carbohydrate is in your foods by reading food labels for serving size and total carbohydrate, as well as using a carb counting book that you can buy in any bookstore.

    The goal with basic carb counting is to aim to eat a consistent amount of carbohydrate at your meals on a day-to-day basis. If you eat more carbohydrate than usual at a meal, for example, you’ll probably have a high glucose level later on. Eating a certain amount of carbohydrate at meals, along with getting regular physical activity and taking your diabetes medicine as prescribed, is an effective way of controlling blood glucose levels.

    How do you know how much carb you should aim for at your meals? A dietitian is the best person to help answer this. A dietitian takes into account your medication, food likes and dislikes, eating schedule, weight goals and overall diabetes control to come up with a carb amount that’s best for you. If you’re interested in trying carb counting, you might aim for about 45 to 60 grams of carbohydrate (or three to four carbohyrate choices) at each meal until you meet with a dietitian. On reviewing your individual needs, the dietitian may recommend eating more or less carbohydrate.

    The next type of carb counting is really more like the next “level” of carb counting. Sometimes it’s called advanced carb counting, although it has nothing to do with how smart you are! Advanced carb counting is a very flexible way of meal planning that can be used by people who take fast-acting insulin (lispro, aspart, glulisine or Regular) before meals, whether by injection or via an insulin pump (you can’t do advanced carb counting if you take only diabetes pills or long-acting insulin). Here’s how it works: Right before you eat a meal, you figure out how much carbohydrate you’ll be eating. Then, using something called an insulin-to-carb ratio, you calculate how much insulin you need to take to “cover” the carbohydrate in your meal. Let’s say you have an insulin-to-carb ratio of 1:15. This means that you need to take 1 unit of your fast-acting insulin to cover every 15 grams of carb you eat. So, if you plan to eat 45 grams of carb at your meal, how much insulin would you need? If you guessed 3 units, you’re right! Pretty easy to do!

    Of course, you need to keep a few things in mind. First, your health-care team (usually your dietitian) should help you figure out your own insulin-to-carb ratio. Ratios vary from person to person, and you may even need different ratios for different meals. Second, be prepared to keep food records and check your blood glucose levels after meals for a while to make sure your ratio is correct. Third, if your blood glucose level is too high before a meal, you need to take extra insulin, along with the insulin to cover your carbs. This extra insulin is called a correctional dose and also needs to be calculated with the help of your health-care team. Finally, while advanced carb counting really gives you the flexibility of eating as much or as little carb as you want while still maintaining good diabetes control, don’t forget that you still want to eat a variety of foods and not load up on empty calories found in desserts and snack foods. Also, it’s not uncommon for people to gain weight when they start adjusting their insulin for their food intake. If you’re trying to lose or maintain your weight, you still may want to aim for a certain amount of carb at your meals, along with keeping portions of protein and fat foods in control, too.

    Carb counting is another meal planning tool that can help you manage your diabetes. Many people with diabetes find that carb counting helps them eat more like a person without diabetes because it’s more flexible than other meal planning methods. If you think you’d like to try this approach, make an appointment with a dietitian to learn more about how carb counting can work for you.

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    Comments
    1. Background: Type 1 for 45 years on pump.
      When traveling and eating out for breakfast especially, I think I’ve counted right, but sometimes I misjudge carbs - then my blood glucose snowballs for the next 4-5 hours. Testing post-eating is the answer, I know, but it’s not always possible. What causes the snowball effect? My blood glucose readings are so high prior to the next meal that it shocks me - I couldn’t have misjudged that much!

      Posted by bpc |
    2. There could be several reasons why your blood glucose “snowballs” after eating out for breakfast. First, keep in mind that when you eat away from home, portions tend to be much larger than you might think - in other words, you might be getting more carb than you bargain for. Second, is your breakfast high in fat? Fat can delay digestion of carbs, causing high glucose levels several hours later. Third, it’s possible that the types of foods you’re eating at breakfast have a high glycemic index, which can raise blood glucose levels higher and faster. Finally, since you’re on a pump, you might need to use a different insulin-to-carb ratio on days when you eat breakfast out. It would be helpful if you could check a 3-hour post-meal blood glucose after eating breakfast out, just to get a sense of what’s happening with your glucose at that time.

      Posted by acampbell |
    3. As a new diabetic and a new user to your site I would suggest a “print article” option to to your list of options.

      Posted by LandSDistribu |
    4. Any recommendations for helping a 10 year old getting control, She runs 250 - 350 at 11:30 am prior to lunch. She doesn’t keep records, I have to teach her everything, she’s not working with a nutritionist & Mom just tells her how much insulin to take prior to lunch!

      Posted by Lifelong commitment |
    5. Hi Lifelong commitment,
      It’s great that you’re so concerned about this child. I’m not sure how receptive or motivated the child is, but one of the real issues is getting her mom (and dad, if he’s around) on board with the importance of diabetes management. While she’s not too young to be doing some things herself for her diabetes care, she definitely needs the support of her mother. If you haven’t already, you might try talking to her mom, expressing your concerns, especially about her high blood glucose readings. Give her some literature to read, or recommend a local diabetes class or a dietitian appointment. You might also mention that her daughter will physically feel better and will do better in school if her glucose levels are better controlled. If you know another parent with a child who has diabetes, suggest the parent talk to this child’s mother, if both are willing. I hope all works out.

      Posted by acampbell |
    6. What is your preferred way of calculating insulin:carb ratios…from your practice do you find pattern mgmt or the 500 rule works better.

      Thanks

      Posted by New DM RD |
    7. Hi New DM RD,

      There are actually several ways to figure out an insulin-to-carb ratio for someone. I typically use the 500 rule, as I’ve found this tends to be a little more precise than basing the calculation on typical food intake and insulin doses. But, this is more of an art than a science, so either method can work. The most important part is to follow-up with the patient for fine-tuning of the ratio, as it almost always needs to be tweaked a little. And don’t forget that people can have different ratios for different meals. Hope this helps!

      Posted by acampbell |
    8. hi,
      i am a pediatrician. i have an indian pt.in my office who happens to have type1 diabetes. can you please suggest a book or web site to calculate carb content of indian food.
      thanks
      gunpreet singh

      Posted by dr gunpreet singh |
    9. dr gunpreet singh: go to http://www.mendosa.com/gilists.htm . scroll all the way to the bottom of the page. then slowly scroll up and the glycemic index and load for international foods, including Indian, will appear. it’s not carb counting, but should be of help.

      Posted by barry |
    10. What is the amount of fiber where you can subtract from the carbs. Example Fiber One
      1/2 cup 25 grams Carbohydrate
      14 grams of Fiber
      I heard you subtract from carb any amount greater than 5 carbs.
      So for Carb counting of Fiber One
      25-14=11. Is that how many carbs to bolus for?

      thanks

      Posted by glwfood |
    11. Hi glwfood,

      The “newer” guideline for subtracting fiber is this: if a food has more than 5 grams of fiber, subtract half those fiber grams from the total carb. Then, bolus for the resulting carbs. Therefore, in your example, you’d bolus for 18 grams of carb. Same applies to grams of sugar alcohols - subtract half those from the total carb, and then bolus for that amount. Confusing, isn’t it?!

      Posted by acampbell |
    12. What the heck does “bolus” mean?

      Posted by eileenmechler |
    13. Hi Eileen,

      An insulin bolus refers to the dose, or amount, of rapid/short acting insulin that you’d give before you eat a meal, or when you’re correcting for a high glucose level. You can give a bolus with a syringe, insulin pen, or insulin pump.

      Posted by acampbell |
    14. Hi, I was wanting to know if you can help me. I am very newly diagnosed with type 1 diabetes and I do have an appt. scheduled with the dietetion for the end of August because they are pretty booked. I believe I got the insulin to carb ratio understood. My doctor wants me to take insulin to carb ratio of 1:10. Just an example-if I plan on eating 50g. carbs then I would take 5 units, correct? He also gave me a correction of 1:25. So what I am having trouble with is this part. Could you help me figure out on the above example how much extra I will need after the 5 units?
      Thanks,
      Bonnie

      Posted by bmadams |
    15. Hi Bonnie,
      Glad to hear you’ll be meeting with a dietitian. You’re correct about how to use your insulin to carb ratio. In order to use your correction factor, you need to know two things: what your current BG level is and what your target BG is. For example, let’s say your pre-meal BG is 200 and your target is 150. You know you need to come down 50 points. You then divide your correction factor, 25, into 50 and you get 2. That means you need 2 units of insulin to “correct” for your high BG. But be sure to add that to the insulin you need to cover your food. If you were taking 5 units to cover your carbs, you’d add 2 units to correct, for a total of 7 units. Of course, make sure you use your own BG and target levels! Hope this helps.

      Posted by acampbell |
    16. Hey Amy,

      Thanks for the reply for the correction factor. So tonight before supper my Blood Glucose was 210, and my goal is 140. I ate 35 carbs for supper so I need 3.5 units for an insulin to carb ratio of 1:10, and for the correction of 1:25 I need 2.8 units. so I will needed 6.3 units total. Is this right? Just making sure. I don’t want to get too low or high and have problems. Any how it’s really hard to do the 6.3 so what do I do for the 10ths? Just go a little over or would 6 units be ok?
      I really appreciate all your help and thank you again for the reply.

      Bonnie

      Posted by bmadams |
    17. Hi Bonnie,

      Yes, your calculations are right on! Unless you’re on an insulin pump, you really can’t bolus 6.3 units, so I would round down to 6 units. It’s also good to be on the conservative side when you first start carb counting. Be sure to check your blood glucose about 3 hours after your meal to see how things worked out. When you meet with the dietitian later this month, make sure he or she reviews how to check the accuracy of both your insulin to carb ratio and your correction factor. Also, keep in mind that you may have different ratios for different meals. Be patient, keep good records and don’t get too frustrated if you don’t always see the numbers that you want. All in all, this is a flexible and practical meal planning and insulin regime.

      Posted by acampbell |
    18. Hi Amy,
      My 9 year old was diagnosed last Christmas and we just got him on an insulin pump about 2 weeks ago. We are having a really hard time with his BG at recess now - which is about 2 1/4 hours after breakfast. We have always had him test before his snack at recess, but now he is really running high, close to 300. We have raised his basal rate from 7am-11am from .35 to .375 to .4 and also hid I:C ratio from 15 to 12. I think when he was on lantus his BG was about 80-100 and his BG target right now is 120. I am working with the endo and pump folks, but it is so frustrating. How do I know what we should change next his basal or IC? Any thoughts?
      Thanks,
      Bevin

      Posted by Bevin |
    19. Hi Bevin,

      I can imagine how frustrating it is for you and your son to see these high glucose readings. What may be helpful is to focus initially on your son’s basal rates to be sure they’re correct. Most people focus first on the overnight basals (because they’re easier to start with!)and then move on to the morning basal(which means skipping breakfast and morning snack), and so forth. If the basals aren’t correct, it’s then hard to establish the insulin to carb ratio. Your son’s team may take a different approach, but I’d suggest you and your son focus on one thing at a time, starting with basal evaluations.

      Posted by acampbell |
    20. I really like your site. I appreciate the fact that you seem to get back to the people in need of help very quickly. Good to see someone so interested in helping diabetics learn how to help manage their own disease (along with the help of their diabetes team). I have been diabetic for 26 years and have been on the pump for 10. For me all of the carb counting and dosing and options for improvement seem so natural, second nature almost. But I have a newly diagnosed brother in law (type 1) earlier this year. He has been to a family practice dr. a few times, and had an appt. for an endo for over 6 mos. But they tend to keep moving his appt. farther in the future. He is very out of control. He takes 70/30 2x per day (morning and dinner) and Lantus 40 u at bed. We will be having Thanksgiving dinner and he is worried because of the inablity to “stop” after just enough. So he asked that I help him with a dose of humalog to cover dinner. I am somewhat worried because of such a range of dosing he has already. But he typically runs 400+mg/dl and sometimes at night dips down to 40 mg/dl or so. I keep telling him to get to an endo…but they keep putting him off. I was wondering if 1:15 ratio would be safe with me there with a glucogen kit? and then retest 2-3 hrs post meal and correct 1:50 over 150 mg/dl. I will be there more than 24 hrs after the meal and humalog dosing. But still somewhat worried that I will make him go too low. (Because of the nph, regular/lantus mix flowing through his body already) Please, any advice would be so helpful. Sincerely, MrsBB

      Posted by MrsBB |
    21. Hi MrsBB,
      Your brother is certainly lucky to have you help him! I wish he’d been able to see an endo a lot sooner. Unfortunately, I can’t give you advice on insulin dosing. However, one suggestion is to see if anyone else in the endo’s office (such as a nurse practitioner, nurse educator or dietitian) might be able to squeeze him in for a quick visit or even speak to him on the phone to discuss how he might handle his insulin on Thanksgiving. If not, I’d suggest that your brother aim to spread out his food intake over Thanksgiving day and, as hard as it can be, not eat too many carb foods at one time. Suggest he focus more on turkey and vegetables and a little less on stuffing and potatoes! Also, the more active he can be during the day, such as walking after the meal, the better. It’s a little risky to have him use Humalog (although a logical idea), given the 70/30 mix he’s already taking. Finally, is there another endo nearby who might be able to see him a little sooner? I wish I could help more. Please let me know how things work out.

      Posted by acampbell |
    22. Hi. Is there any damage done to the body by having hypos? (besides the risk of passing out, and by hypo, I mean in the 40’s range)

      Posted by Henely |
    23. Hi Henely,

      Some studies have indicated that people who have repeated episodes of severe hypoglycemia are at a higher risk for cognitive impairment (memory loss, confusion, distractability). And people who have had diabetes for a long time, particularly those who also have neuropathy, are more likely to have cognitive impairment as a result of hypoglycemia. However, the good news is that a follow-up study to the Diabetes Control and Complication Trial (DCCT), a landmark diabetes clinical trial, found no link between hypoglycemia and cognitive impairment. The one catch is that people in this study didn’t have hypoglycemia unawareness, or inability to sense lows. So we’re not sure if there’s a link in those with hypo unawareness. For those who have hypo unawareness, symptoms of hypoglycemia can be restored.

      Posted by acampbell |
    24. My 4 year old stepdaughter was recently diagnosed with type 1. She lives with us full time. Her dad and I both work weekends, so my mother in law keeps her for us. This is all new to us, but we are established with an endocrinologist and they have done a fantastic job teaching us, answering questions, and being available 24/7 to answer any questions we have. Our daughter’s school has been fantastic also, in being very proactive on getting educated and trained to help take care of Jade. Now for the problem, mother in law is a type 2, but from the beginning daughter’s diagnosis, mother in law has had a know it all atitude. We cannot make her understand there is a difference between type 1 and type 2! She takes very good care of our daughter, but thinks we are being to overprotective and overeacting to this situation. Our deal is we are teaching Jade to be very compliant and she thinks we are to rigid. Here is an example: Mother in law was babysitting for us. When my husband got off work, he called to check on Jade and his mom told him they were at cafe in town eating, husband told her Jade had already eatin and it was not time for her to eat again. She told him Jade wasn’t eating very much. Husband asked her what blood sugar was before she let her eat and mother in law informed him that she had forgotten the bag (containing glucometer, insulin, glucose tabs, glucopen, and juice and crackers)at home. We could not believe it! She acted like it was no big deal. How do we convince her that this is to be taken seriously at ALL times? Right now, until we get more family members trained, we do not have an alternative means for babysitting. Jade was diagnose in Nov. 08. So we are still learning about this. Can you help?

      Posted by pscifres |
    25. Hi pscifres,
      You have a tricky situation on your hands. How much do you think your mother-in-law knows about type 1 diabetes? It might help to sit down with her and perhaps review some education materials that better explain the difference between type 1 and type 2 (she may not have a good understanding of her own diabetes, either). Another suggestion: invite her to come to one of your daughter’s appointments with her endocrinologist or diabetes educator. She might be more receptive to a healthcare professional’s advice.

      Posted by acampbell |
    26. HI LEIGH HERE CAN YOU TELL ME WHAT BOOK WOULD BE GOOD FOR CARB COUNTING.

      Posted by leigh |
    27. Hi Leigh,

      There are several good books on the market, but the one I tend to like the most is The Calorie King Calorie Fat & Carbohydrate Counter. This book is small so you can easily take it with you, and contains all sorts of info on food, including restaurant and fast food. Plus, you can also access the food database for free at .

      Posted by acampbell |
    28. Hi,

      I’ve had diabetes for 28 years and just was introduced to Sensitivity Factor and Carb:Insulin Ratio. Curious about lowering a high sugar based upon this program. If a person has a level of say 250, and they take a certain amount of insulin to lower it….what is the time frame to have the level back to normal? Is it to lower it within a couple of hrs or is it to lower it enough prior to the next meal?

      Thanks,
      Howard

      Posted by Howard |
    29. Hi Howard,

      Good questions! But there’s not necessarily one right answer. Hopefully you’ve established your target blood glucose goals with your provider, meaning that you know the range for your fasting, 2–3 hour postmeal, and bedtime blood glucose targets. With that said, using your example: If your premeal blood glucose is 250, and you use your sensitivity factor to correct for the high blood glucose, your goal at 2 hours may be 180. At 3 hours, your goal may be 140–160. But by 4–5 hours (which is perhaps close to the time of your next meal), you should ideally be back within your premeal target range (for example, 100). Of course, various factors can affect this, such as what you eat for a meal. And rapid-acting insulins may “peak” anywhere from 30 minutes to 3 hours after injecting or bolusing. I’d suggest you discuss your premeal, 3 hour postmeal, and bedtime goals with your provider so you can gauge how well your sensitivity factor is doing.

      Posted by acampbell |
    30. Hi my son is a diabetic and I am learning how to do the ratios. His lunch ratio is 1:10 but what i dont understand is the Correction Insulin for high blood sugar. The Dr has written down use the following correction formula BG-100/40 (for pre lunch blood sugar over 150). How do I calculate this? Also it says if BG is gretaer than 300 and its been two hours since last dose give half of the correction formula noted above Say his blood sugar at lunch is 200 and he had 30 grams of carbs. I know that he gets 3 units of insulin but how do I do the correction for him being over his target range of 150

      Posted by Karen |
    31. Hi Karen,

      Your son’s correction factor is 1:40, meaning that one unit of insulin theoretically drops his BG 40 points. So, using your example, plug the numbers into the formula: 200 (current BG) minus 100 (goal BG) = 100 (how many points he needs to come down to reach his goal). Divide this by 40 and you get 2.5. This means he’d have to take 2.5 units of insulin, in addition to the 3 units for his carbs, for a total of 5.5 units. He may need to round up from 2.5 to 3, unless he’s using a pump. If his BG is greater than 300 two hours after the last dose, use the same formula and then take half of that dose. For example:
      320-100 = 220. Divide 220 by 40 which is 5.5 units. Then divide the 5.5 by 2, which is 2.75, or 3 units. You divide by 2 because it’s only been 2 hours since the last dose and the insulin from the earlier dose is still working. If you gave the full dose, your son could go too low. I hope this makes sense for you. It gets easier the more you do it!

      Posted by acampbell |
    32. Hi

      Do you have any recommendations on what books for health care professionals to learn more about Advanced Carbohydrate Counting to help with their diabetic clients? Thank you

      Posted by Esther |
    33. Hi Esther,

      While not necessarily a professional resource, you could try the Complete Guide to Carb Counting by Hope Warshaw and Karmeen Kulkarni. Also, Smart Pumping by Howard Wolpert. Hope Warshaw has also written a book called Practical Carbohydrate Counting: A How to Teach Guide for Health Professionals. All are published by the American Diabetes Association.

      Posted by acampbell |
    34. Hi, My dad has type 2 diabetes. He is 72 years old. He has had it now for about 30 years. The doctor who is attending my father now wants he’s blood sugar levels between 90 and 100 in the mornings (which I personally think unrealistic). My father has a problem with low blood sugar. He does not realize when he is low. Currently he is on Novolin 70/30 40 units a day. He takes his insulin before breakfast and before dinner. He needs to have better control of his diet. If he has high numbers for a week ( around 180) the doctor will increase his insulin the problem is he doesn’t eat like that all the time, this is the reason he’s blood sugar has a tendencacy to go low. My question is do you think carb counting will work when taking the 70/30 type of insulin twice a day.

      Thank you
      Russell Williams

      Posted by Russell Williams |
    35. Hi Russell,

      It certainly does seem like your father needs more lenient glucose goals. Have you talked with his doctor about this? Or might there be a diabetes educator that your father could meet with to help intervene on his behalf? Your father can do carbohydrate counting with 70/30, but the goal would be to aim for a consistent amount of carbohydrate at each meal and each snack. You really can’t adjust this type of insulin for the amount of carbohydrate because this insulin is a mixture of a fast-acting and longer-acting insulin; if you adjust this insulin, you not only affect the fast-acting part, you also adjust the longer-acting. However, eating a fixed amount of carbohydrate at meals can certainly help limit the lows. Perhaps your father would be willing to meet with a dietitian to discuss this further?

      Posted by acampbell |
    36. I see a lot of posts about correction factors (you are calling it correction ratios) and calculating doses and I must point out one problem, at least it is for me. When your blood sugar is high, you may not be thinking straight. I tried doing some dosage calculation to correct a high blood sugar while my blood sugar was high. I felt that I was thinking clearly. After my blood sugar came down I looked at my calculations again and boy was I wrong!!! Luckily I hadn’t overdosed. (My BS wasn’t normal but was better so that I obviously was thinking more clearly.)

      It seems that we are less able to make math calculations with high blood sugar. This can make sense since, although all of that sugar is there, there may not be enough insulin for the sugar to get to our brain.

      What I have done is to use a spread sheet to calculate my insulin dose for a range of blood sugar levels using my correction factor. (You can use a calculator, if you wish.) I printed it out and I keep it with my diabetic kit. No more calculating or the possibility of making a math error regardless of my state of mental confusion.

      I didn’t see this article at first. Just today I made several posts about empirically deriving a custom sliding scale based on your own body’s resistant to insulin through lots of testing. I also posted on how to determine insulin dosage based on carb counting and your body’s resistance to insulin. This was a comment in reply to the article, “How much Lantus should you take?” You should first read my post on testing because these scales are developed empirically and can only be determined by lots and lots of testing. I describe how often and when you should test.

      Posted by Dale |
    37. Thanks, Dale. You make a very good point about how either too high or too low a blood glucose can sometimes impair the ability to think (and calculate) clearly. Preestablished insulin dosing scales can certainly be helpful for some, although, as you mention, it does require time and patience to customize.

      Posted by acampbell |
    38. I have had an upset stomach and running low. I am on a pump. I got some regular pop and it said total 28 grams carbs and sugars 25 granms so do I add the two together to figure how much sugar I am getting. thanks

      Posted by james juks |
    39. Hi James,

      No, the grams of sugar are included in the grams of total carbohydrate. So, when you read a food label, look at the serving size and the total carbohydrate, not the sugar.

      Posted by acampbell |
    40. Can the correction bolus be a negative number? If so, should I subtract the number from my indicated bolus? I have just recently started to use ICR and ICF. Thanks.

      Posted by Lorne Smith |
    41. Hi Lorne,

      Yes, your correction bolus could be a negative number if your glucose is below your target. For example, let’s say your target BG is 120, but your current BG is 80 and you’re about to eat a meal. If you take your insulin dose based only on your I:C ratio, you will likely end up taking too much insulin and as a result, can have a low BG. So, using your correction factor, you’d do what is called a “reverse correction” and subtract insulin from your bolus. Also, if you are low before you take your bolus (meaning, your BG is under 70), you should treat that low first with some carbohydrate.

      Posted by acampbell |
    42. hi Amy. I’ve been T2 35 yrs now. I take 64 units of lantus, 32 in am and 32 at bedtime. I use A LOT of Humalog…can’t seem to figure out my carb to insulin ration but i use 1:6 right now. sometimes my bg is as high as 270 - 280 so i take a shot and will use 15-20 units. I’ve seen about 3-4 nutritionists and can’t seem to catch on. I’m really afraid of going low so i keep my count around 100. I’m all confused about this and just can’t lose weight either. help

      Posted by ginny |
    43. Hi Ginny,

      I’m sorry it’s been so confusing for you. Carb counting isn’t an exact science, as you’re figuring out. I’m not sure what the other RD’s have reviewed with you but a few things to consider: If your fasting BGs are high, you may need more Lantus. If your premeal BGs are high, you need to use a correction factor (that’s different from your insulin:carb ratio). Make sure you count your carbs (and watch your servings) as carefully as you can. Talk to your provider about taking Symlin, which can help improve glucose readings and may even lead to some weight loss. Also, keep detailed BG and food records for several days. If you can, revisit the dietitian and bring the records with you. Let me know how you make out.

      Posted by acampbell |
    44. I have recently been diagnosed as type 2 diabetic and I’m on oral medication and I am confused about the carb counting so can someone please help me with a meal plan of between 1600 and 1700 calories per day please!!!

      Posted by Dorothy |
    45. Hi Dorothy,

      Carb counting can seem confusing at first, as can meal planning, in general. Would you consider meeting with a dietitian to learn more about eating with diabetes? A dietitian can create a meal plan with you that’s better suited to your lifestyle, more so than a meal plan that you might find on the Internet, for example. And chances are good that your health plan will cover the visit. It’s a good investment in your health! Your doctor should be able to give you a referral to a dietitian in your community.

      Posted by acampbell |
    46. I have a son that is 10 he hs been diagnosed sense he was 2 and his nutritionist has him on a 1:15 correction factor and his target is 80-120
      at breakfast for example I would give him
      48g of cereal
      12g of milk
      which would equal 60g in total this is the intake that he is suppose to take according to his dietician. I would divide 60/15
      and I would give 4units around 7:30am but when I check him around lunch 12:30pm he would be around 140 but not at the range he is suppose to be.
      Can someone tell me what I a doing wrong.

      Thanks,
      Luz

      Posted by Luz |
    47. Hi Luz,

      Your math is correct! But there may be a few reasons why your son’s glucose isn’t at target range at lunch time. First, you mentioned that 1:15 is his correction factor — but I think you mean his insulin-to-carb ratio. A correction factor is the amount the glucose will drop with 1 unit of insulin. You should check with his dietitian about that. Also, the insulin that you give for the milk and cereal only covers the carbohydrate in those foods. You don’t mention what your son’s glucose level is at breakfast. If it’s above 120, he may need extra insulin to help bring his blood glucose down. Otherwise, he’ll be high at lunchtime. This is where the correction factor comes in. Double-check the portions of milk and cereal that you’re giving him. One cup of milk contains 12 grams of carbohydrate but you’d need to be sure you’re giving him exactly one cup. It helps to occasionally measure out portions of foods and beverages just to be sure. Finally, it’s possible that your son needs a different insulin-to-carb ratio, such as 1:12. He may just not be taking enough insulin to cover his carbs correctly. So, you’re almost there! Just double-check his portions and check what his correction factor is, and don’t forget to check his glucose at breakfast in case he needs insulin to correct for a high glucose reading.

      Posted by acampbell |
    48. I have a daugther that is 6 years old she has been diagnosed last December 2009. Current treatment Lantus 3 units at bedtime and different IC ratio, Breakfast 1:12, Lunch 1:30, Dinner 1:25.
      My worries are the values post meal. Let’s start with breakfast.
      She ate for breakfast:
      8.7gr = 2/3 cup Milk Lactaid 1%
      19gr = 1 package Oatmeal original(Publix)
      2.5gr = 1/4 cup blueberries
      1 package Splenda
      cinnamon
      TOTAL CARB = 30.7gr and I administered her Humalog 2.5 units
      Her values at 6:30am are between 90-120. then Lantus is ok, BUT 2 hours after breakfast her BS is between 180-210 and at school lunch time 10:30am she is low, under 70. Is this ok?
      Right now we are giving her an snack 3 hours after breakfast in order to avoid low at lunch.
      I am worry about the spike after two hours. I would like to know what do you suggest? I would like to know what method to use for adjust IC ratio. I first adjust the basal, but I am not sure how to adjust IC ratio
      thanks in advance

      Posted by betsy |
    49. My mother is 85 and frail and type II diabetes that is managed by diet alone. She has trouble swallowing and has been on hospice care for 6 months. She is taking a number of medications and I want to add more fiber to her diet without upping her carbs and still have it really pleasant to eat. She has been more constipated since we cut back on how many fruits she was eating when her blood sugar was going up around 200. I thought we had enough vegetables to compensate, yogurt to help with the gut keeping things regular and 48 ounces of liquid a day. I’m going to look for some sugar free but high in fiber cookies as something pleasant and am curious for other ideas. She can’t swallow really dry things easily. Thanks for any ideas. Best, Marilyn

      Posted by Marilyn Prehm |
    50. Hi betsy,

      There are a few possible options to try. One is that it may be her Lantus that is causing the mid-morning low; therefore, a possibility is to split her Lantus dose so that she takes it twice a day (morning and night). But this would mean an extra injection. You could also try giving her Lantus later at night (but may have to wake her up to do so). You could also try adding some fat to her breakfast which may lessen the post-meal spike and prevent the low at 10:30. Nuts, an egg, cheese, or peanut butter are some ideas. She actually could benefit from a little more Humalog at breakfast (try a 1:11 or 1:10 ratio), but rather than increase her dose right now, you could give her the Humalog 15–20 minutes before she eats. If nothing else, making sure she has a snack at 10:30 to prevent the low is a safe bet, as well. You’ll have to try different things to see what works!

      Posted by acampbell |
    51. Hi Marilyn,

      First, if you haven’t done so already, find out what your mother’s glucose goals are. While you don’t want her blood glucose levels to be too high, there is likely some leeway in terms of how strict the goals need to be, given her age and condition. Some suggestions for increasing fiber: bean and vegetable soup, bean dip, lower-carbohydrate fruits such as blueberries, raspberries, and strawberries; oatmeal; also, try adding oat bran or regular bran to yogurt or cottage cheese, or sprinkling on cereal. She could also try a fiber supplement such as Benefiber, which is tasteless and can be added to any beverage, hot or cold. There are also products now that have added fiber, such as yogurt. These may or may not be helpful, but you could certainly try them.

      Posted by acampbell |
    52. Please any comments about spike two hours after breakfast and then 3 -4 hours the BS drop to under 70. Any advice?
      I would like to know if is normal spike between 180-210 two hours after eat?

      Breakfast ratio 1:12, lunch 1:30, dinner 1:25
      thanks
      betsy

      Posted by betsy |
    53. First, thank you so much for your comments. Is very hard for me see high /low blood sugar values after we try to do everything like give her healthy food, exercise, follow up Md orders, etc.
      Please could you recommend me any methodology/formula used to calculate how to adjust the IC ratio?

      Thanks a lot. any advice/comment is very helpful
      betsy

      Posted by betsy |
    54. Hi Betsy,

      Please see my earlier posting which may help answer your questions.

      Posted by acampbell |
    55. Hi Betsy,

      You’re obviously working very hard to help your daughter and you’re doing a great job. Discuss some of the options that I suggested with your daughter’s pediatrician and/or diabetes educator, if she has one. Also, realize that achieving “perfect” glucose levels is next to impossible, and tight control with children is often not the goal. Adjusting the insulin:carb ratio isn’t really a science. Mostly, it’s trial and error. But, as an example, if you think that the 1:12 ratio at breakfast doesn’t provide enough insulin, then change the ratio to 1:11 or even 1:10 (the lower the bottom number, the more insulin you are giving to cover the carb). Then, to test how that works, check a glucose 2–3 hours after eating. If the ratio is correct, the glucose should be within the target range. I hope this helps!

      Posted by acampbell |
    56. I have been diagnosed Type II since 1997 and 5 years ago became insulin dependent. Thing is, I can never get a decent BG reading. I think I have had just 2 in 5 years under 200.

      I take 40 units of Levimir at night and 40 units in the morning. I take the Novolog to adjust based on my BG reading (usually subtract 100 from the reading and divide by 10) and my before meal is 1:10.

      I wind up chasing my BG a lot because I forget to take 1:10 before I eat. I do have a lot of neuropathy in my feet, lower legs and hands.

      Suggestions, ideas, comments. Thanks

      Posted by Doug |
    57. how much time do you have to wait to determine your sensitivity factor…….none of this has ever been explained to me…my primary care doctor has put me on insulin….20 units per meal……..plus 65 units of lantus a day…..and humolog quick pen fast acting…….my sugars are all over the place….would appreciate some input…thank you winnie

      Posted by Winnie |
    58. Hi Winnie,

      Are you new to insulin? It can take a little while to figure out the correct doses that you need. I would suggest that you try as best you can to keep your carbohydrate intake consistent. In other words, eat about the same amount of carbohydrate at breakfast, the same amount at lunch, same amount at dinner. For example, you might eat 45 grams of carbohydrate at breakfast, 45 grams at lunch, and 60 grams at dinner. If you exercise, try to do that at the same time each day. Keeping your food intake and activity consistent for a couple of weeks will help your doctor determine the right amount of insulin for you. You could then ask your doctor to refer you to a diabetes educator to learn advanced carbohydrate counting (this is where the sensitivity factor and insulin-to-carbohydrate ratio come in).

      Posted by acampbell |
    59. Hi Doug,

      First, has your Levemir dose been evaluated? In other words, how are your fasting blood glucose readings? If you skipped a meal what would happen to your glucose? In theory, the Levemir should hold your glucose levels pretty steady overnight and between meals. Secondly, you didn’t mention an insulin-to-carbohydrate ratio. This is the insulin (in your case, NovoLog) that you need to cover your carbohydrate. For example, if you have a 1:12 ratio, you need to count up how many grams of carbohydrate you’ll be eating and divide by 12. That’s the insulin just for the carbohydrate. Then, if your blood glucose is above target before your meal, that’s when you use your sensitivity factor. The sensitivity factor has nothing to do with your food intake; rather, it’s the number of points that one unit of insulin lowers your blood glucose. Both your insulin-to-carbohydrate ratio and sensitivity factor have to be evaluated in order to figure out if they’re correct. If the issue is forgetting to take your insulin before your meal, see if you can figure out a reminder system (like setting an alarm) or even take your insulin right after you eat. If you can, ask your doctor to refer you to a diabetes educator who can help you with all of this because it can sometimes be tricky to figure out on your own.

      Posted by acampbell |
    60. hi my daughter victoria who just turned 9 in may was sick last week n we were just told she has type 1 diabetes and this so upsettin the problem im having is the carb countin i can not get it for anything and it upsets me even more either shes too high r too low at first we had it but as we eat different meals it gets so confusin she on a 45 carbs breakfast lunch dinner n a 15 carb snack one after lunch and after school 330 and then her 30 carbs before bed time i feel i cant do this and its seems that the doctors expect me to kno this i need some help

      Posted by misty |
    61. Hi misty,

      I can certainly understand how overwhelming your daughter’s diagnosis of diabetes is. There’s so much to learn when someone has diabetes. Things WILL get easier, but right now, her doctors are probably trying to best determine how much insulin she needs. But I agree, you do need some help, especially since it’s your child who has diabetes. Ask your doctor to refer you to a diabetes educator and a dietitian. Most doctors don’t have the time or the training to teach you all that you’ll need to know about her diabetes. There may be educators and dietitians who work in the local hospital or diabetes center in your town. If not, the American Association of Diabetes Educators can help you find educators in your area: . You can also call your local branch of the American Diabetes Association (or call 1-800-DIABETES) and they can help you, too. Hang in there and let us know how things work out!

      Posted by acampbell |
    62. thanks for all your comments to people with problems. I am new to this site but I will add it to my favourites.
      I have Type 2 and have recently been trying to count carbs as a means of better BS control and hopefully weight loss. When the nutrition informeation of food includes a fibre count, can I deduct those fibre grams from the carbs?
      I am aiming for 250 grams of carbs per day based on a formula of my desired weight x exercise factor of 13 divided by 8. is that correct?
      Thanks, I look forward to your answers.

      Posted by Angie |
    63. hi.
      could you give me valid references for this blog?iwant to use of this for my conferans,i coldnot find somethin.its important for me.thanks

      Posted by somi |
    64. how can we mach insulin with meals is my title.i want all ways for counting. im confised abut the different type of insulin and this metod

      Posted by somi |
    65. Hi Angie,

      Technically, you CAN subtract the fiber grams from the total carbohydrate. However, this is only really meaningful for people who take mealtime insulin and are basing their insulin dose on their carbohydrate intake. If you take diabetes pills or are controlling your diabetes with diet and exercise, there’s no real benefit in subtracting out the fiber. I am not familiar with the formula that was used to calculate your daily carbohydrate dose, but it certainly could be correct for you, although it seems a little high. Did a dietitian help you with that?

      Posted by acampbell |
    66. Hi Somi,

      I can’t provide you with references here but I can recommend a good resource called Complete Guide to Carb Counting by Hope Warshaw and Karmeen Kulkarni, published by the American Diabetes Associaiton.

      Posted by acampbell |
    67. I’m confused about counting fibre for a type 2 diabetic, diet-controlled. I’ve read that I don’t have to count the fibre, and I’ve also read that I have to count whatever is more than 5g, or is it I count the first 5g?

      For example, I want to try adding salba to my cereal at breakfast. It has 4.5g carb in 2 Tbsp, and 4.2g fibre. If I add 1/4 cup, do I count the 9g carb or is it basically ‘free’? (I know 9g is less than the 15g serving, but I still want to know if the 9g is part of what my body absorbs.)

      Thank-you very much!
      ruth

      Posted by ruth |
    68. Hi ruth,

      You really only have to “count” or subtract the fiber from a food if you are taking mealtime insulin and are possibly at risk for low blood glucose. Since you’re diet controlled, you don’t need to worry about going low. However, since this is a fairly high-fiber food that you’re planning to eat, what you might do is subtract out half of the fiber (about 4 grams) and only count the 1/4 cup as 4 or 5 grams. Then, I’d suggest you check your glucose 2–3 hours later to see if that “worked” in terms of your glucose. If your glucose is above 180 mg/dl 2 hours later, you didn’t count enough carbohydrate. It’s a bit of trial and error, as you can see.

      Posted by acampbell |
    69. Thank you sooooo much, this information has been very helpful for me.My daughter has type 1 diabetes and this makes a lot of sense to me in counting carbs and how to come up with the right amount of units.

      Posted by monica ceballos |
    70. I find this fascinating and finally realistic. COntrolling the blood glucose really needs to achieve what simple and detailed carb counting do.

      For me (type 2 , I am neither beast or fowl but have a hybrid medication - care approach. I am on Insulin and pills and now working quite well. Humolog shot 1 in am 75/25 to beat pill ingestion delays and liver bump trying to do dawn effect when lsat night metformin charges wears off. Metformin and starlix rest of day. Lantos late at night to get bg numbers down at night and catch last gut digestion glucose results - 6 hours after eating between 11:00 and 12:00am midnight, no snacks after dinner. A couple of small lantos shots better than one large one and prevents crashing blood sugar.

      Also no snacks after 2.5 hours before next meal.

      Simply stated, I start planning meal carbo amounts guess and then back in mediterranean diet( fish, chicken, vegetables, nuts and fruit).

      Diet organized as 1300 gross and net 1500 calorie per day diet.

      Am now losing weight - 330 to 280 and continues.
      Could not loose any weight till idiot liver corraled off of dawn effect with metformin ( mid night BG was 120; 6:30 am was 238. Also behaved like type 1 watching for lows and using Glucose tablets to prevent BG going sub 100 (Doctor’s orders) and triggering liver glucose add that would shove BG to 278-311 french foreign legion death march support. Takes detailed metering at key points.

      Result after may 2010 and on A1C in november 2010 was A1C of 6.9 and daily average bs 155. mY OWN METER AVERAGES said 166 and right now 163.

      Oh yes, organize breakfast for minimum low glycemic breakfast and remove any volumn of carbs till body chemistry back up on meds by 8:00 am (starting at 5:00 am)

      Carb conting - hell yes and necessary. Also active hearty exercise plan required.

      Posted by jim snell |
    71. Is there a ratio for a long acting insulin, like levemir? My Dr. wants me to take 20 units and eat 1800 calories, but thats to much food for me, I was losing weight with a 1200 calorie intake a day.

      Posted by Pamela |
    72. Hi Pamela,

      There really isn’t a ratio for long-acting insulin. This type of insulin, also called basal insulin, should be pretty consistent day to day in terms of the amount that you take. It helps to control blood glucose overnight and between meals. You don’t mention if you take meal-time insulin, but that’s the type of insulin that you might have a ratio for, because you would adjust that based on how much carbohydrate you plan to eat. If you feel that your long-acting insulin dose is too high for you because you are going low, then you might talk to your doctor about cutting back on the dose, as it’s true that you may not need as much insulin if you lose weight.

      Posted by acampbell |
    73. I have type 1 can I do the atkins diet? If so can I reduce the amount of insulin I take. I always run in the high 400s I think if i do atkins i might finally be able to get a lower reading. I have been diabetic since 2003 I have had a lot of doctors and tried all types of insulin nothing works. I now take 40 u of lantus at night and ten units of novolog before breakfast lunch and dinner. thank you for any help you can offer.

      Posted by adasha |
    74. Hi adasha,

      You could try the Atkins diet, which is a fairly high-protein, low-carb eating plan. Some people do well with this approach, but others find it restrictive and hard to stay with. You may want to try a more moderate (and more healthy) plan like the South Beach Diet. It’s a little more balanced in terms of nutrition. Also, if you haven’t already done so, you might meet with a dietitian to discuss your eating plan and what other options are available. You should choose something that is healthy and that you can stay with long term.

      Posted by acampbell |
    75. Real issue which conting carbs address is the calorie load and resulting glucose generated.

      Any one diet may or may not address theis. Key is first calorie load and the backing in your diet - met; aikens; low glycemic etc without disturbibg calories load. nder load and your liver will dump in the extra. If that parts works fine - great. If you have liver dumps to 311; ignoring calorie load will be disaster.

      Article bang on target. I still think the fat police are pain in rear but one only has to watch body in operation with cgms and I alway see fat to glucose dump from gut 6 hours after meal consistently.

      Noodles have 2 to 3 hour digest time and regular controlled meals without the dense carbs usually run one to 2.5 hours max digest time.

      All of this adds many surprises and “what the heck is going on?”

      All adding up to all meals are not neatly contained within a digestion cycle /meal and in fact BG on next meal is sum of last meal plus fats and digest time making all this mch fun and surprises.

      Posted by jim snell |
    76. Hi there. I am not currrently diabetic but did have gestational diabetes with my second pregnancy. It did not require insulin just diet control. However I did meet with a dietician and I was never told of the carb subtract dietary fiber. I still eat like a diabetic with 30 grams of carbs each meal and 15 grams of carbs for my two snacks a day. My question is this, I eat pecans freqeuntly. 19 havles equals 4g of total carbs and 3g of dietary fiber. I normally eat 38 halves of pecans. But I am still eating 8g of carbs not 2g during my snack correct?

      Posted by Emily O'Neil |
    77. Hi Emily,

      While the pecans make a great snack and contain a decent amount of fiber, it’s really not worthwhile for you to subtract out the fiber. This only really becomes an issue when someone is taking mealtime insulin and therefore runs the risk of having a low blood glucose. In your case, since you no longer have diabetes, it’s not an issue. So, yes, you’re still getting 8 grams of carbohydrate!

      Posted by acampbell |
    78. I have been diabetic for over 40 years and have used developed a detailed carb counting procedure to provide my own control. Using a combination of ratios, which vary for each meal, a database for each food item, and by taking my blood sugar before and 2 hours after each meal,provides the needed insulin for each meal. This is my computerized procedure and my be used by anyone on their “java compatible” computer. It primarily applies to Type 1 Diabetic’s, but is valuable for Type 2, as a needed meal planner.

      Posted by Mitch Mans |
    79. Hi, I was diagnosed type 2 at 8 weeks of pregnancy. I am very strict on my carb counting, and insulin regiment. I am now 29 weeks pregnant, and my insulin resistance has skyrocketed. My morning target is 90, but my levels cant seem to drop below 100 anymore. I am taking 105u of lantus, and it seems that as I increase, so does my fasting sugar. Before lunch, I am usually around 82. My after meals also seem to be slowly creeping up as well. I know that the further along in pregnancy, the harder it is to control, but do you have any tips on regaining a little more of the control I had earlier in pregnancy?

      info

      I:C = 1:8
      Lantus dose at 10pm 105 units(taken in 2 different injection sites for smaller absorbtion pool)

      Posted by Preggo mama |
    80. just wanted to confirm that 1 unit given by pen is exactly the same 1 unit when given by pump. that is - i calculate same regardless whether on a pump or injecting. thanks

      ps -this site is really great, very helpful

      Posted by ursula |
    81. Hi ursula,

      Congratulations on your pregnancy! At Joslin Diabetes Center, where I work, we don’t use Lantus in our pregnancy clinic (just as an FYI). It’s not uncommon for insulin resistance to increase during pregnancy. If you haven’t done so already, you might meet with a diabetes dietitian to go over your eating plan and address issues such as bedtime snacking, glycemic index, and the carbohydrate content of your breakfast (some women keep their breakfast carbs to 30 grams, for example). Hopefully you’re working with a diabetes specialist to regulate your insulin doses, too.

      Posted by acampbell |
    82. Hi, my 6 year old daughter was diagnosed with type 1 diabetes about a month ago. I’m a little surprised that after two very long sessions with a dietician she never mentioned anything about counting fiber intake. I’ve just sorta heard it thru the grapevine. Doesn’t appear to have as great of affect as what I’ve been told after reading your “newer” calculation.

      We have recently switched from the needles to the pens for her humalog and I’ve noticed that the pens don’t seem to be having the same affect per unit as the needles. We were giving her 1:20 with needles and are now having to give her 1:15 and she is still running higher than with the needles. I’ve been leaving the needles in for a full ten seconds to make sure it all gets in there but she’s still running a little higher than normal. Is this normal? Is she maybe not getting a full unit as she is with the needles?

      There are 6 kids in her very small elementary school who have the same type 1 as she has. There’s only around 350 kids in her school. Isn’t that an extremely high number for this area? When I was a kid at the same school, I didn’t know of anyone who had it.

      Last question, I promise. She was in her phys. ed. class a couple weeks before all the symptoms started showing up and they were playing tag. A boy ran up to her and punched her in the stomach very hard. The teachers said she cried for quite a while. Could that have had something to do with her pancreas stopping production of insulin?

      Posted by Travis |
    83. Hi Travis,

      To answer your question about your daughter’s blood sugars running higher, there actually could be a number of factors for this. First, she’s newly diagnosed, so she may be coming out of what is called a “honeymoon phase” where the pancreas is still producing some insulin. If your daughter is taking half-units of insulin, the pens are not always that accurate for a half-unit dose. Two pens in particular measure in half units: the NovoPen Junior and the HumaPen Luxura. It could be an issue with pen needle length and she could try a slightly longer needle. Keep in mind, too, that she’s growing, so her insulin needs will constantly be changing. I’d suggest you meet with a diabetes educator to discuss this further. Also, it’s highly unlikely that your daughter getting punched in the stomach is what caused her diabetes. Type 1 diabetes is an autoimmune disease, like lupus or rheumatoid arthritis, whereby the body “turns on itself” and attacks cells. As to the increase we’re seeing in cases of Type 1 diabetes — we’re not really sure why that is, unfortunately. Possibly something in the environment.

      Posted by acampbell |
    84. My Husband has a insulin Pen he just stared and he does’nt always take it before a meal sometimes it an hour after we eat. It is suppose to be before the meal is’nt?

      Posted by Teresa |
    85. I have a question. Rather than deal with all this, why not just eat very little carbs?

      Posted by Dawn S |
    86. Hi Teresa,

      I’m assuming that your husband’s insulin pen is for mealtime insulin — is this correct? If that’s the case, yes, mealtime insulin is typically injecting 0 to 15 minutes before a meal, not after the meal. If his pen is for longer-acting insulin, such as NPH, Lantus, or Levemir insulin, that is taken usually at bedtime and sometimes in the morning.

      Posted by acampbell |
    87. Hi Dawn,

      It’s certainly an option to eat very little carbs, and some people choose to do just that. However, it can be difficult for people to follow a low-carb eating plan, since fruits, some vegetables, milk, yogurt, beans, and grains are restricted. Also, carbs are not the enemy. Carbs give the body fuel and provide other important nutrients that one can’t get from eating just protein and fat foods.

      Posted by acampbell |
    88. Hi, I have had type 2 for about 3 years today my bs was 144 I took 5 units of humalog with 38 grams of carbs and 2 hours later I checked it again and it was 166. So with that I should up more humalog? And if my numbers stay in the 100-140 range should I lower the lantus at night? I am taking about 20 units at night. I try and cut out most of the carbs I really have to watch green leafy veggies do to medication for blood clot disorder…I turn 40 and all hell breaks out…lol, and one last thing I work out alot and am at about 260lbs and have been told to drop the weight down to 200-220, my question and I argue with dieticians how much protein do you really need to continue building. I hear that being diabetic it’s dangerous to take in to much protein…I try to take in 150-220 grams a day….can you shed some light here is this dangerous

      Posted by Russ |
    89. Hi Russ,

      It’s a little hard to say if you should increase your Humalog. Part of the answer depends on what your premeal glucose goals are and what blood glucose you would “correct” at, meaning, take additional insulin to help bring your glucose down. Based on the amount of insulin you took for the 38 grams of carbohydrate, you have what is called a 1 to 8 ratio, meaning you take 1 unit for every 8 grams of carbohydrate you eat. You need to make sure this is correct by checking it when your premeal glucose is within your target range, and checking 2 hours later. Usually, a 40–50 point rise in glucose from the premeal glucose means that the ratio is correct. As far as your Lantus dose, you may be able to cut back if your fasting glucose is also within your target range. It’s unlikely that your protein intake is harmful unless you have kidney or liver disease. However, you also really don’t need to eat that much protein, either. Given your current weight, your daily protein requirement is about 80 grams per day. If you are an athlete and doing intense training, then you possibly could need 150 grams of protein per day, but 220 grams is likely more than you need. Don’t forget, too, that excess calories from protein can be stored as fat.

      Posted by acampbell |
    90. My 10 year old daughter was dx almost 6 years ago she has been on the pump for awhile now, her ac1 was between 7 to 7.3 on monday she had her endo appt and her ac1 is 8, her doctor told me she needs more insulin so we change her basals starting at 0.3 and her IC ratio 1:30 it was 1:15 her basals now are 0.5 and she is still runing mid 200’s to 300’s I really think her Ic ratio needs to change any thoughts on that? in almost 6 years we never had a big change like this and i’m so worry trying to find her right dose that I’m confused.

      Posted by Erika |
    91. Hi Erika,

      Since your daughter is growing and nearing puberty, it’s normal for her insulin needs to increase. She may still need her basal rates increased. As far as her I:C ratio, you mentioned that she was 1:15 but now is 1:30 — I’m thinking perhaps you meant just the opposite? Otherwise, she would be getting much less insulin to cover her carbs. To evaluate her I:C ratio (and remember that her ratio can be different for each of her meals), have her eat a meal of which you know the carb content (not a restaurant meal). Also, make sure her premeal glucose is within her target range. If her 3 hour postmeal glucose is also within her target range then you pretty much know that her ratio is correct. This process needs to be done for all three meals. Her correction factor also has to be checked. Randomly making changes will not be helpful and will only add to the confusion. If you’re unsure how to check her ratios or correction factors, see if you can meet with a dietitian for more guidance. Also, keep in touch with her doctor if her glucose levels continue to run high.

      Posted by acampbell |
    92. Thank you very much for your help!Her I:C ratio was 1:15 and now is 1:30 that is why I am so confused because she is not getting enough insulin to cober her meals, she is still running high, Iam still making changes and I am waiting for call back from Doctor

      Posted by Erika |
    93. Hi Erika,

      A 1:30 ratio doesn’t sound quite right, especially if she was using 1:15 before. No wonder her blood glucose levels are high! Anyway, I hope you get this straightened out soon.

      Posted by acampbell |
    94. I have a 6 year that has had diabetes since age 3. He is a very poor eater. He is on a 1-20 carb ratio. He is lucky if he eats 14 carbs at school at lunch. When his BS is under 200 we don’t give him a correction dose. So mom says need insulin at lunch to cover food be it’s under 20 and he has a insulin pen that that doesn’t do 1/2 units to start. I am following Dr’s orders Just want to hear your opinion. jeannie

      Posted by jeannie |
    95. Hi jeannie,

      First, there is an insulin pen that’s allows 1/2-unit dosing. It’s called NovoPen Junior, so it may be something that his mother could look into. Second, it’s hard to say if you should be correcting the boy’s blood glucose or not — it depends on what his 2–3 hour post-meal blood glucose levels are like, how active he will be after lunch (gym class, for example) and his A1C level. It’s also important to double-check and make sure that the 1:20 ratio is correct.

      Posted by acampbell |
    96. hi i just got my 4 year old nephew and he take 1 unit for every 30 carbs he takes in. now if i give him say 35 carbs does that mean i give him one unit or two units becouse it is over the 30 carbs?

      Posted by tammy |
    97. Hi tammy,

      Good question. In order to determine how much insulin to give to “cover” the 35 grams of carbohydrate, you would divide the 35 grams by 30 (as you likely have done). The answer that you’ll get on your calculator (or in your head) is 1.167. Unless your nephew is on an insulin pump which can deliver a bolus in tenths of a unit, you would still give him just 1 unit for the 35 grams of carbohydrate. In other words, you’d “round down” to 1. However, if he were going to eat, say 58 grams of carbphydrate, you’d get an answer of 1.66. In this case, you’d probably round up to 2.

      Posted by acampbell |
    98. I’m a RD and we want to have a carb consistent menu where I work. How much variation in carbs can you have from meal to meal (ie. breakfast to breakfast) for a carb consistent menu? Do you know of any journal articles that discuss this?

      Posted by Regina Martin MPH RD |
    99. Hi Regina,

      I don’t work in an inpatient setting, but here are some links to resources that may be helpful.

      http://www.journals.elsevierhealth.com/periodicals/yjada/article/S0002-8223(06)02286-3/abstract

      http://journal.diabetes.org/diabetesspectrum/00v13n3/pg149f.htm

      resources.aace.com/PDF/…/Swift_EndocrPract_2006.pdf

      http://care.diabetesjournals.org/content/25/suppl_1/s61.full

      Posted by acampbell |
    100. My mom has type 2 diabetes and right now she is undergoing Chemo and radiation for cancer. Our problem is that we are struggling with keeping for diabetes under control. She is spiking before dinner and our minds are overwhelmed with what could be causing it. Late meal,early meal, wrong kind of snack, not enough protein, the list is endless. Any suggestions?
      Thanks Leslie

      Posted by Leslie |
    101. Hi Leslie,

      It’s certainly possible that your mother’s chemo drugs and the radiation are responsible for spikes in her blood glucose. You didn’t mention how your mother is controlling her diabetes (e.g., diet-controlled, pills, insulin). She may need an increase in her diabetes medication dose, rather than having her cut back on her food intake, especially if she has lost weight as a result of her cancer treatments. Speak to her doctor about her diabetes medication. You might also ask her to keep a record of her food intake for a few days which will help you spot “problem” areas, such as too much carbohydrate at a meal. You can also ask a dietitian for assistance, as well.

      Posted by acampbell |
    102. Hi, I am a type 1 diabetic and use a pump. I am curious as to how protein is counted in my carb calculation. Do you subtract half/ add half or nothing at all? Thank you!!

      Posted by Brita |
    103. Hi Brita,

      Handling protein when carb counting is a bit of trial and error. Many people find that they don’t have to “count” protein (meaning, bolus for it) if they eat a small amount (say, under 3 ounces). But other people find that protein may raise blood glucose levels hours after eating. For this reason, they may benefit from using the extended bolus feature on their pump. My suggestion to you is to experiment. Make sure you first have your insulin-to-carb ratios accurate; then, try eating different amounts of protein at your meals and check your blood glucose 3 and then 6 hours later. If you’re not within your target range at these times, you might try using the extended bolus feature and see how that works.

      Posted by acampbell |
    104. What it actually is is the folnlwiog: Being overweight(having excess fat cells) inhibits insulin’s ability to get glucose into the cells where the cells use the glucose as energy to perform the cell’s functions(called insulin resistance!). If a type 2 diabetic loses weight he/she may not need as much medication for their diabetes. Others offered good answers here as wellVince

      Posted by Kristyna |
    105. My experiences have suggeste to me that carb counting is at best an estimation. WIthout spectrometer analysis any hope for stoichimetric supply and mixing of insulin is at best a guess and yes necessary.

      As my pancreas and bolus is still working and I add insulin as boost after eating and delay, I noticed that my body was simply doing a best effortsd guess. That is the body really did not worry about being off as if it added too much, liver was sitting there with its buffer to throw glucose at issue when BG drops sub - 70.

      When i was on insulin and injecting before pancreas back up, I saw I could also make same mistake as pancreas now working and add too much.

      For a normal working liver buffer and control - not a problem. For type 2, this is huge issue because usually T2 cannot trust liver to throw in correct amount of glucose and instead hammer body up to 200+ instead of 120 max.

      Much of what the body does is rough approximations and just like the brain using incredible short cuts to keep energy consumption down to 15 watts or less. And then re adjust on the end process to sneak result to proper control and answer.

      Posted by jim snell |
    106. My daughter has had T1 diabetes for 17 years. She has used four different pumps with success. Lately she has developed a severe alergy to adhesives. She can no longer use the pump and it has been hard for her to go back to shots after the relief of the pump.
      Do you know of any company who sells non-alergenic adhesives? I cannot find any and thought you may have heard of someone who offers it.
      Thanks for any help you can give.

      Posted by Debra Brady |
    107. Hi Debra,

      I asked one of the nurse educators with whom I work and she suggests IV3000 made by Smith and Nephew. Other options include Tegaderm HP, or Micropore or Durapore (which are paper tapes) made by 3M.

      Posted by acampbell |
    108. Hi, I am a type 1 diabetic and have a question regarding my lantus dosage. Recently I’ve been experiencing blood sugar drops 2-3 hours after taking my Lantus injection of 10 units at night. It’s quite frustrating. I’m considering dropping my dosage to 8 units to see how I my body responds.

      Is it safe to say that I’ve been taking too much lantus, or could there be another issue that could be causing this?

      Also as a side note, I’ve been running on the low side for most of the day lately as well. Which is another reason why I suspect my lantus to be the culprit. Any advice would be greatly appreciated.

      Thanks!

      Posted by Travis |
    109. Hi Travis,

      How are you blood glucose levels 3 hours after dinner? If they are running on the low side, it may be more likely that your mealtime insulin dose is too high (and I’m assuming that you’re taking a fast-acting insulin). Also, when you are low during the day, is it happening between meals? If so, it certainly could be that your Lantus dose is too high. You could first try cutting down on your Lantus by just one unit and see how that works. See how your fasting glucose is after doing so and if you continue to be low during the day. Other factors could be at play, too, such as increased physical activity or a change in your food intake (not eating as much as you usually do, for example). But see what happens when you adjust your Lantus.

      Posted by acampbell |
    110. I need to ask about adjusting basal and bolus levels when carb counting and how to figure this out. Basically I was very uncontrolled on Protophane and Novorapid despite very frequent testing and was having numerous hypos and highs. A week ago I moved to a new doctor and a new centre for diabetes to try to get a pump but this will take time. I was then put on Levemir and Novorapid with carbohydrate counting at a 1:10g ratio and a correction factor of 1 unit per 3mmol (aim 6mmol).

      This seemed to be going well the first couple of days - I was still having mild hypos at 03:00am, still having trouble with morning readings and especially with the post meal readings after breakfast, but it was still much better than what had been happening before - my basal was down from 26 units to 20 units (10 in two divided doses) and instead of 11-12 units Novorapid per meal I was now at about 3-4 and no longer going hypo everyday.

      And then I got ill with flu and fever and I also started PMS both at the same time and I lost all control. This morning I could take 5 units of novorapid in the morning and eat 5g of carbs and still not be down to normal readings by lunch time (and only 1 of those units was for correction), my night time readings were all higher than they should have been, my post meal readings seem to be ok, but they are not coming down to normal pre meal levels.

      I realise this is not the ideal thing to be dealing with while learning carb counting and adjusting insulin doses (basal and boluses) at the same time, but could do with some advice on how I can change things to get better control - what type of percentage changes are usual for both these conditions (illness and PMS) and are they additive? Also how will I prevent hypos when my period starts if I have to adjust so much now - when do I change back to normal levels?

      Posted by Bronwyn |

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