Evidence-based guidelines from the Academy of Nutrition and Dietetics recommends education on carbohydrate counting using insulin-to-carbohydrate ratios ICRs for persons taking multiple daily insulin injections or insulin pump therapy.

Insulin-to-carbohydrate ratios estimate how many grams of carbohydrates are covered with 1 unit of short-acting or rapid-acting insulin. For normal-weight adults, a typical starting point for ICR is , meaning 1 unit of rapid-acting insulin is estimated to cover 10 grams of carbohydrate.

Carbohydrate intake records, insulin doses, and blood glucose record keeping before and two hours after eating a meal are all necessary to fine-tune your ICR.

Your ICR may be different for breakfast than for lunch. It may also change at different stages of life.

No two people have the same ICR. Another tool that can help manage blood glucose for individuals taking multiple daily doses of insulin or using an insulin pump is an insulin sensitivity factor ISF.

The insulin sensitivity factor is also called a correction factor. This is used to calculate how much insulin you need to take to bring your glucose level down to a pre-determined target range.

A sensitivity factor is either subtracted from or added to the pre-meal insulin dose. As with the ICR, the ISF is different for different people.

How sensitive you are to insulin and your body size affects your ISF. An ISF of is typical for an average weight adult with type 1 diabetes. A person with type 2 diabetes is generally less sensitive to insulin than someone with type 1 diabetes.

Physical activity, illness and hormones can all affect your sensitivity to insulin. If you use an insulin pump or take multiple daily doses of insulin, work with your health-care team to determine your ICR and ISF for better blood glucose control. Using ICRs can provide more flexibility in carbohydrate choices as you are dosing your insulin according to how much carbohydrate you actually eat at each meal.

Depending on whether you use rapid-acting or regular short-acting insulin, your health care provider or registered dietitian-certified diabetes educator will use a formula to help you determine your ICR and ISF.

If you are generally struggling with high values, always start by checking whether the basal insulin dose is sufficient to keep values stable within the target range without meals as well. The next step is to test the carbohydrate ratios. Start the test when your glucose value is significantly elevated and you can wait a few hours until your next meal.

Food containing small amounts of protein such as a few nuts, a little cheese or a boiled egg can be eaten during the test. But it is worth the effort as it allows you to optimize the insulin therapy and get the abnormal glucose values back into the target range.

Test the new factors for a couple of days and check whether the target range is reached after correcting elevated glucose values. Be patient, even if higher values persist. Give the insulin time to take effect. Applying multiple corrections quickly one after the other means the dose effect curves will overlap and there may be a risk of hypoglycemia.

The insulin sensitivity is also an important parameter that you need to program a bolus calculator. A bolus calculator can provide useful support in your everyday life, particularly when using changing insulin sensitivity factors!

Auflage , Mainz [2] Walsh, John et. Pumping Insulin, everything for success on a pump and CGM. Auflage , San Diego [3] Warshaw, 2nd edition, Practical Carbohydrate Counting: A How-to-Teach Guide for Health Professionals, American Diabetes Association, p. The mySugr website does not provide medical or legal advice.

mySugr blog articles are not scientific articles, but intended for informational purposes only. Medical or nutritional information on the mySugr website is not intended to replace professional medical advice, diagnosis or treatment. Always consult a physician or health care provider with any questions you may have regarding a medical condition.

Michèle Hofer is our Principal Diabetes Coach and has been a dedicated mySugr monster tamer since She is a certified dietician and certified diabetes educator DDG German Diabetes Association and studied Health Care Management at WU Executive Academy in Vienna on a part-time basis.

Michèle found her specialization early on in diabetology. She has supported people with diabetes in all forms of therapy for many years already. Before diving into building up the online coaching department at mySugr, she gained editorial experience working for Burda Publishing House.

You can listen to her talk about the mySugr coaching project in an episode of the German Zuckerjunkies podcast. Although diabetes is a medical condition, it is really a lifestyle as people work to manage their blood sugar. People make lifestyle changes all the time to be more healthy.

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Talk to your provider about the best insulin dose for you as this is a general formula and may not meet your individual needs. If your body is very resistant to insulin, you may require a higher dose.

If your body is sensitive to insulin, you may require a lower insulin dose. This example above assumes that you have a constant response to insulin throughout the day.

In reality, individual insulin sensitivity varies. Someone who is resistant in the morning, but sensitive at mid-day, will need to adjust the insulin-to-carbohydrate ratio at different meal times. In such a case, the background insulin dose would still be approximately 20 units; however, the breakfast insulin-to-carbohydrate ratio might be breakfast grams, lunch grams and dinner grams.

Also, there are many variations of insulin therapy. You will need to work out your specific insulin requirements and dose regimen with your medical provider and diabetes team. Self assessment quizzes are available for topics covered in this website.

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Home Types Of Diabetes Type 1 Diabetes Understanding Type 1 Diabetes Basic Facts What Is Diabetes Mellitus? What Are The Symptoms Of Diabetes? Diagnosing Diabetes Treatment Goals What is Type 1 Diabetes? What Causes Autoimmune Diabetes? Insulin-to-carbohydrate ratios estimate how many grams of carbohydrates are covered with 1 unit of short-acting or rapid-acting insulin.

For normal-weight adults, a typical starting point for ICR is , meaning 1 unit of rapid-acting insulin is estimated to cover 10 grams of carbohydrate.

Carbohydrate intake records, insulin doses, and blood glucose record keeping before and two hours after eating a meal are all necessary to fine-tune your ICR. Your ICR may be different for breakfast than for lunch. It may also change at different stages of life.

No two people have the same ICR. Another tool that can help manage blood glucose for individuals taking multiple daily doses of insulin or using an insulin pump is an insulin sensitivity factor ISF.

The insulin sensitivity factor is also called a correction factor. This is used to calculate how much insulin you need to take to bring your glucose level down to a pre-determined target range.

A sensitivity factor is either subtracted from or added to the pre-meal insulin dose. As with the ICR, the ISF is different for different people.

How sensitive you are to insulin and your body size affects your ISF. An ISF of is typical for an average weight adult with type 1 diabetes. A person with type 2 diabetes is generally less sensitive to insulin than someone with type 1 diabetes. Physical activity, illness and hormones can all affect your sensitivity to insulin.

If you use an insulin pump or take multiple daily doses of insulin, work with your health-care team to determine your ICR and ISF for better blood glucose control. Using ICRs can provide more flexibility in carbohydrate choices as you are dosing your insulin according to how much carbohydrate you actually eat at each meal.

Depending on whether you use rapid-acting or regular short-acting insulin, your health care provider or registered dietitian-certified diabetes educator will use a formula to help you determine your ICR and ISF. These factors are an initial educated guess or starting point.