Diabetes: Carbohydrate Counting Meal Plan

What is the carbohydrate counting meal plan?

Counting carbohydrates is a food plan that adjusts your insulin dose based on the amount of carbohydrates (carbs) you plan to eat.

How is this plan different from other meal plans?

With this meal plan the insulin dosage and carbs are not always the same every day. This plan is more flexible than some other meal plans. It is usually started after you have learned more about your body's responses to food choices and insulin.

How does this plan work?

Carbs affect your blood sugar level more than any other kind of nutrient. Insulin works with carbs to give your body energy. The main goal of this meal plan is to balance insulin with the carbs you eat throughout the day. If you are taking long and short -acting insulins, you will be adjusting only the short-acting insulin doses.

First, you and your healthcare provider need to figure out how much insulin you need to take for the amount of carbs you plan to eat. There are 2 ways to figure this out:

• I/C ratio: Most people use the insulin-to-carbohydrate ratio (I/C ratio). Your dietitian will help you figure out what your I/C ratio should be. You then multiply your I/C ratio by the number of grams of carbs you plan to eat. The I/C ratio multiplied by the grams of carb equals the units of insulin you need.

  An example of an I/C ratio is 1 unit of insulin for every 10 grams of carbs. If your I/C ratio is 1/10 (0.10) and you plan to eat 60 grams of carbohydrate, then you need 6 units of insulin (60 X 0.10 = 6).

• Units per carb choice (exchange): You can also count carbs in portion sizes of 15 grams. This is called a carb choice or an exchange. Your provider will tell you how many units of insulin you need for every carb choice that you eat. Units of insulin per carb choice multiplied by the number of carb choices equals the total units of insulin you need.

  To determine how many carb choices you are eating, divide the number of grams of carbohydrate in a food by 15. For example, if a container of yogurt with fruit has 45 grams of carbohydrate in it, it contains 3 carb choices.

  You will adjust the units of short-acting insulin for every meal to match the number of carb choices you are eating. For example, if you need 1 unit of insulin for every carb choice, then for 3 carb choices, you need 3 units of insulin.

What else does the right insulin dose depend on?

The right insulin dose also depends on planned exercise, blood sugar levels, or other things that may affect blood sugar, such as illness, stress, or menstrual periods. For example, you may need less insulin if your blood sugar level is low (below 70 mg/dL, or 3.9 mmol/L). You may need more insulin if your blood sugar is too high (above 200 mg/dL, or 11.1 mmol/L). You may need less insulin if you use it before strenuous exercise or at bedtime. Your dietitian and healthcare provider will give you guidelines for adjusting your insulin dose.

Which foods have carbs?

Many foods have carbs, such as:

• starchy foods, such as breads, cereals, rice, starchy vegetables, and pasta
• fruit
• milk and yogurt
• sweets.

Most vegetables, meats, and fats are not high in carbs. This means that they affect blood sugar levels less than carbs.

To see a list of carb choices, you can use the booklet titled “Choose Your Foods: Exchange Lists for Meal Planning.” For more advanced carb counting information you may prefer “The Complete Guide to Carbohydrate Counting.” Both are available through the American Diabetes Association at http://www.shopdiabetes.org/Categories/8-Diabetes-Books.aspx or by calling (1-800-232-6455). Nutrition labels on food packages also list the grams of carbohydrate in each serving.

When should I take insulin?

In general, you should take insulin at a time that allows the insulin to start working as your blood sugar starts to get higher. Sugar is absorbed into the blood about 10 minutes after you eat. The peak in blood sugar from food usually happens about 60 minutes after you eat.

• Humalog, NovoLog, and Apidra start working in 10 minutes. The peak activity of this insulin happens 100 minutes (less than 2 hours) after you take it. Take this type of insulin 15 to 30 minutes before you eat (if your blood sugar is above 80 mg/dL, or 4.5 mmol/L).
• Regular insulin starts working in 20 to 30 minutes. Its peak activity is 2 to 4 hours after you take it. Take this insulin 30 to 60 minutes before you eat.

Sometimes you can take the shorter acting insulins (Humalog, NovoLog, Apidra) after you eat. This can help if you often have low blood sugar or a poor appetite. Your healthcare provider and dietitian will help you create a schedule for your meals and insulin doses.

How do I get started?

1. Keep a careful record of food, insulin, blood sugar level, and exercise for at least 3 days. Measure and record your blood sugar before meals and 2 hours after meals. Record all doses of insulin or oral medicines you take.
2. The dietitian will review the report and work with your healthcare provider to decide how much insulin you need to take for the amounts of carbs you eat.
3. Start counting carbs and adjusting your insulin doses. For the first 1 to 2 weeks carefully record the following:
   • the number of carbs you eat at each meal or snack
   • your insulin doses
   • your blood sugar levels (especially 2 hours after meals when levels should be less than 180 mg/dL, or less than 10 mmol/L).
4. After a week or two, review your records with your dietitian to see if any changes need to be made. If your blood sugar values are not in the desired range, then your insulin doses will need to be changed.