Dietitians work with clients to help them develop an understanding of the principles of the basal-bolus insulin concept to achieve optimal blood glucose levels.

A normal-functioning pancreas constantly secretes insulin in two ways: basal and bolus. Basal insulin is secreted to counteract rises in blood glucose due to gluconeogenesis formation of glucose in the liver or hormone fluctuations caused by stressors, activity, or metabolic changes.

Bolus insulin is secreted to counteract rises in blood glucose following meals. Injected insulin is designed to mimic normal pancreatic function. Basal insulin given by injection is long-acting insulin taken once or twice per day.

Some examples include NPH Humulin N, Novolin N, Novolin NPH , glargine Lantus , and detemir Levemir. This type of insulin works to counteract rises in blood glucose that occur independent of meal ingestion. Bolus insulin is given by injection in relation to meals and counteracts the rise in blood glucose from food.

Rapid-acting insulin aspart NovoLog , lispro Humalog , and glulisine Apidra are examples of bolus insulin. They begin working within 10 to 20 minutes of injection, peak within 40 to 50 minutes, and have duration of action of three to five hours. Regular insulin Humulin R also is used as a bolus insulin, although it has a different mechanism of action, beginning to work in 30 minutes, peaking in 80 to minutes, with duration of action of six to eight hours.

Matching bolus insulin to carbohydrate intake using an ICR is optimal for postmeal blood glucose management. Once an ICR is established, patients can adjust their mealtime bolus based on their carbohydrate intake. Indications for Advanced Carb Counting Advanced carbohydrate counting is indicated for the following groups:.

Advanced carbohydrate counting is best suited for this therapy since bolus insulin can be adjusted based on carbohydrate intake to maximize postmeal blood glucose management. Basal is a constant infusion delivered 24 hours per day to mimic pancreatic basal insulin secretion.

Bolus is given as needed or on demand in response to meals or to correct high blood glucose. While those with poor math skills or who are intimidated by math can be taught to identify larger carb vs.

Initially after starting advanced carbohydrate counting, blood glucose readings are taken following a meal about two hours after to assess the ICR. As the ICR is determined to be correct, postmeal readings can then be taken periodically as needed. ICR is the grams of carbohydrate counteracted by 1 unit of rapid-acting insulin, while SF is the amount by which 1 unit of rapid-acting insulin will lower blood glucose measured as milligrams per deciliter.

Tables 1 and 2 demonstrate how to calculate ICR and SF. Table 1: Calculating Insulin-to-Carbohydrate Ratio ICR Using the Rule and Body Weight4.

The optimal amount of calories coming from carbohydrate is a topic outside the scope of this article. Although appropriate calories to promote weight management goals are essential, macronutrient composition will depend on individual preferences and metabolic status eg, lipid profile, renal function.

Because incorrect insulin dosing can occur when patients are learning about and employing carbohydrate counting, they should be counseled on the signs, symptoms, and treatment of hypoglycemia. As mentioned, whether patients are taught to count carbohydrate grams or choices should be based on their abilities and preferences.

Some patients find it easier to round carbohydrate grams eaten to the nearest carb choice, while others prefer to take into account each gram of carbohydrate consumed.

Once their meal plan has been developed, patients should be taught to identify carbohydrate foods and serving sizes. Carbohydrate foods are starches, sugars, and sugar alcohols, including grains, starchy vegetables eg, corn, potatoes , fruits and fruit juices, milk and yogurt products, and sweets.

Table 4 outlines carbohydrate foods and serving sizes. These serving sizes usually are measured after cooking. Table 4: Carbohydrate Foods, Serving Sizes, and Carbohydrate Grams Per Serving6. This information likely will be the most accurate estimation of the total carbohydrate content of particular foods.

Moreover, many products assumed to contain one serving per package are listed as containing two or more servings. Patients should be cautioned that if they eat more than one serving as listed, they will need to increase accordingly the total carbohydrate grams as listed on the label.

Dietitians should point out that the number in parentheses next to the serving size is the weight of the product at the serving size listed, as some patients may mistake this number for the carbohydrate grams.

Another common patient mistake includes counting only sugar grams or adding sugar grams to the total carbohydrate grams. Dietitians should inform patients that the total carbohydrate grams listed on the label include dietary fiber, sugars, starches, and sugar alcohols.

All items indented under the total carbohydrate grams are included in the total carbohydrate number, and by counting the total carbohydrate grams, patients are taking into account all of the ingredients that will affect blood sugar.

In advanced carbohydrate counting, correctly estimating carbohydrate eaten means the difference between a correct dose of insulin and postmeal hypo- or hyperglycemia. Food models such as those sold by Nasco are made to represent foods in g portion sizes, and they can help patients visualize how much of certain foods they should consume.

Periodically, dietitians should use food models during follow-up sessions to reinforce portion sizes. Also, measuring cups are essential for quantifying intake, so dietitians may want to consider giving inexpensive measuring cups as rewards for patients who meet their nutritional goals.

Therefore, periodic reinforcement will be necessary. To avoid this problem, dietitians should teach patients to measure foods once per week eg, measure on Tuesdays to reinforce serving sizes and correct quantification. Another tactic is to have patients put their usual portion on their plate then use measuring cups to quantify it, sometimes revealing that a usual portion is two to three times more than previously thought.

Dietitians also can use food scales during counseling sessions. To save time and effort, patients also should keep a list or cheat sheet of the carbohydrate content of foods they usually eat. Also, many restaurants list the nutritional content of their dishes online, so patients can look up and choose their meals before eating out.

Another strategy is teaching patients to eyeball serving sizes by measuring a g portion of carbohydrate food and putting it on their plates or into their cups or bowls. They should note how the measured portion looks on their dishes or where it falls in the bowls or cups.

They will learn what one portion of the food looks like, and this can help quantify their food intake, especially when eating away from home.

In addition, they can estimate portions by comparing them with the size of common household items see Table 5. Calculating Sugar Alcohols Sugar alcohols polyols are FDA-approved reduced-calorie sweeteners, including erythritol, isomalt, xylitol, and hydrogenated starch hydrolysates.

This should be considered another need-to-know tool that can be taught to patients who may benefit from using it based on their eating patterns and blood glucose data.

Modifying ICR and SF Out-of-range blood glucose levels indicate that ICR and SF modifications may be needed, but noninsulin dose variables first must be ruled out as the cause.

Noninsulin variables affecting blood glucose include miscalculation of carbohydrate, delayed or missed boluses, incorrect bolus administration, hormonal affects, growth spurts, high fat or high protein content of meals, exercise and activity, and change of routine.

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Compiled by expert clinicians, this guide is designed to help you manage your diabetes with simple recipes and tips.

Carbohydrate counting for diabetes involves counting the number of carbohydrates you eat and matching it with your dose of insulin and caloric intake. To determine the number of carbs contained in a serving of food, check the food label.

The two items you need to look at are the serving size and the total carbohydrates. There are many tools and apps that will help you determine the number of carbs per serving.

This breaks down to three to five servings of carb foods or drinks per meal, depending on the number of calories you consume. There are three main types of carbs: starch, fiber and sugar.

Of the three types of carbs, starches tend to be the most commonly consumed. Starches can be considered either healthy or unhealthy depending on how processed they are. As a general rule, increasing your intake of less processed foods is better for your health.

Eventually, you will be able to eat and manage your blood glucose around all types of foods, which may decrease nutrient deficiencies and lead to a more whole-food diet. Write down your regular meals including ingredients, carbs per serve, and store them in a note or recipe book.

This can lead to less stressful mealtimes as you will know the carb counts of familiar foods. I sometimes recommend marking recipe books with post-it notes with carb counting for next time.

Once you have a basic understanding and have been doing it for a while - test your memory before going straight to apps etc for carb counts carrot has this much.. so I estimate this much… This will help lead to a new way of eating. He gave me 1click equals 20 carbs Novolog. So I have used my guess on how many clicks I actually use to offset the white food.

Portions are also so important to stick to. Carb Counting Strategies by IBD Medical on November 01, Written by Andi Balog. by Sharon on June 13, LEAVE A COMMENT YOUR NAME.

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Find another store Find a store. Search for stores near:. Find out when it's back ×. Email address. The Pocket Carbohydrate Counter Guide For Diabetes: Simple Nutritional Strategies To Lower Your Blood Sugar Shelby Kinnaird.

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