A practical guide to

support you through

your diabetes
treatment plan

An Introduction to

CARBOHYDRATE
COUNTING

AN INTRODUCTION TO

CARBOHYDRATE COUNTING
A practical guide to support you through your diabetes treatment plan

Contents

page

Introduction
Intensive Insulin Therapy and Your Treatment Plan
Basal

2
2
2

Bolus
Do I need to count carbohydrate to follow my treatment plan?
Steps to your Treatment Plan and Carbohydrate Counting

2
3

What is Carbohydrate?

Types of carbohydrate

Do all foods contain carbohydrate?

Carbohydrate Counting

Reading labels

- Packaged foods
- Using weights and measures
Using cooked and uncooked weights
Using your own recipes

10
12
16
17

- My favourite recipes

20

The carbohydrate calculator

Bolus Insulin

22

What is my insulin to carbohydrate ratio (ICR)?

22

How do I work out my ICR?

- My ICR is

22
22

- What should I do next?

22

How do I use my ICR to work out my bolus?

23

Bolus calculator

24

Healthy Eating
Other Things to Think About

26
28
28

Snacks

28

- What about bedtime snacks?

Delaying or skipping meals and flexible meal times

28

Food choices

28

General information
CHO counting

Basal
Bolus and ICR

Variable factors that affect bolus needs Trends and testing

Adjustments and corrections Trends and
Tre

Introduction
Managing your diabetes can feel like a juggling act.

Start with the basics and together with your friends and family, you will build skills and
confidence. This will help you to stay in control of your diabetes and enjoy a flexible lifestyle.
Your diabetes team will support you to learn and practice the technique that works best for
you.

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Intensive Insulin Therapy and Your Treatment Plan

Your treatment plan uses intensive insulin therapy. This allows you to take your insulin in a
way that mimics the normal secretion of insulin from the pancreas. You do this by having one
or two injections of basal (background or long-acting) insulin a day and injections of bolus
(rapid-acting) insulin with foods that contain carbohydrate.
Using this treatment plan with carbohydrate counting will help you to keep your blood glucose
as close to normal as possible. You will adjust your insulin to balance with the carbohydrate in
your meals and snacks, helping you to manage everyday life including activity, sports, school,
stress and illness.
Basal
Basal meansbackground or long-acting insulin. Your body always needs basal insulin to
keep your blood glucose levels steady and to give you energy.
Your basal insulin is

Insulin Effect

Basal and Bolus Insulin Effect

Basal

Basal
Bolus

Bolus

Bolus

Bolus

Time

Bolus
Bolus insulin is rapid-acting insulin that your body needs when you eat carbohydrate.
You will take your bolus with meals, and sometimes with snacks. This type of insulin helps
your body deal with the glucose it gets from the carbohydrate in your food.
Your bolus insulin is

Do I need to count carbohydrate to follow my treatment plan?

Carbohydrate counting will help you to get all the benefits from your treatment plan. You will
work out how much carbohydrate is in your meals and snacks then adjust your bolus to keep
your blood glucose within your target range.
It is still important to have a healthy diet, but carbohydrate counting gives you more choice of
what, when and how much you can eat. This will help you to worry less about eating to avoid
hypos, or snacking when you are not hungry.
Carbohydrate counting is much more than being able to estimate the carbohydrate content of
foods. It is also about learning how to adjust your bolus insulin to the food you eat and the
activities you enjoy.
Your diabetes team will help and support you to count carbohydrate and adjust your insulin.
Your confidence will grow with practice and soon you will realise that you control your
diabetes!

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Remember:
You always need basal insulin.
You need bolus insulin each time you eat carbohydrate.
Carbohydrate counting will help you get all the benefits from your intensive insulin therapy
treatment plan.

Steps to your t reatment plan and ca rbohydrate counting

This pack will guide you through the steps of your treatment plan and carbohydrate counting
to help you get all the benefits it can offer. By working with your diabetes team through each
stage, you will grow in confidence by practicing with the examples provided and making notes
to remind you of hints and tips to help you manage your diabetes.

Step

Go to

1. Identify which foods contain

carbohydrate in your meal.

What is carbohydrate? Introduction to

Carbohydrate Counting (page 5).

2. Calculate or estimate the

carbohydrate in your meal.

Reading labels and the carbohydrate calculator.

Introduction to Carbohydrate Counting
(page 7, 21).
Carbohydrate Tables.

3. Calculate your bolus to cover

this carbohydrate.

Bolus insulin. Introduction to Carbohydrate

Counting (page 25).

4. Consider factors which may

affect the timing and amount of
bolus you need, such as:
Your current blood glucose level.
The amount of activity you
have had.
The type of food in your meal.

Carbohydrate Counting, The Next Steps

(workbook 2).

5. Give your bolus, adjusting the

amount and timing as appropriate.

Carbohydrate Counting, The Next Steps

(workbook 2).

6. Keep records of your blood

glucose, carbohydrate intake
and activities.

Diary.

7. Look out for trends in your blood

glucose to ensure that you are
taking the right amount of basal and
bolus insulin to keep optimal control.

Carbohydrate Counting, The Next Steps

(workbook 2) and Diary.

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What is Carbohydrate?
Carbohydrate is a nutrient and source of energy found in foods such as potatoes, rice, pasta,
cereals, milk, fruit, sweets and sugary drinks.

Types of carbohydrate
Different foods contain different types of carbohydrate.
Starchy carbohydrate potatoes, rice, pasta, noodles, bread, cereals, couscous, lentils,
beans and products made from flour.
Fructose fruit and fruit juice.
Lactose milk, yoghurt, ice cream, custard.
Sucrose table sugar, syrup, sweets and sugary drinks.
During digestion your body breaks down the carbohydrate from the food you eat into glucose.
This glucose enters your bloodstream and causes your blood glucose to rise. Your body needs
insulin to use this glucose for energy. The more carbohydrate you eat, the more insulin you will
need to keep your blood glucose within your target range. Therefore, knowing how much
carbohydrate is in the food and drink you take will help you estimate how much insulin you
need.

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For a healthy diet most of your carbohydrate should come from starchy foods, fruit and some
dairy foods. Smaller amounts should be from sugar and sweet foods. Different people need
different amounts of carbohydrate. The amount of carbohydrate that your body needs
depends on your age, activity levels and weight. In general carbohydrate should make up
about half of your energy (calorie) intake each day.

Do all foods contain carbohydrate?

No. Some foods contain very little or no carbohydrate, including:
most vegetables
meat
fish
eggs
cheese
butter, margarine and cooking fats and oils.
These foods need little or no insulin but should be included as part of a healthy balanced diet.
You will find more information in Healthy Eating on page 26.
Remember:
Different foods contain different types of carbohydrate.
Try to have most of your carbohydrate from starchy foods.
Some foods contain very little or no carbohydrate.

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Carbohydrate Counting
Reading labels
All packaged food labels have nutritional information for the main nutrients, including energy
(kcal/kJ), protein, carbohydrate (CHO) and fat. This is usually given per 100g and sometimes per
portion.
The portion figure works well for foods like biscuits, bars, yoghurts and ready meals where you
tend to eat the suggested portion size. However, if you have a different amount, you will need
to calculate the amount of carbohydrate in your portion. This is common for foods like pizza,
pasta, breakfast cereal and desserts.
Carbohydrate on food labels
Nutritional labels often show different carbohydrate details. It can be noted in one, two
or three parts:
1. Carbohydrate (always included)
2. of which sugars (often included)
3. of which starch (sometimes included).
When you are counting carbohydrate, you must always use the largest carbohydrate
figure. This is the total amount of carbohydrate in the food, and includes both the
of which sugars and of which starch amounts.
Follow the steps below to help you work out how much carbohydrate is in your portion, then
practice with the examples provided.
Packaged foods
Sometimes the labels show how much carbohydrate is in an example portion, for example:

Wholemeal Bread
100g
Per slice Per
of product
cal
102kcal 218k
Energy
42.0g
19.8g
Carbohydrate
2.8g
1.3g
of which sugars
2.4g
1.1g
Fat

Typical values

This label shows that one slice of wholemeal bread has 19.8g of carbohydrate in total.
If you ate 2 slices of bread, you would need to multiply the amount of carbohydrate in one
slice of bread by 2.

19.8 x 2 = 39.6g of CHO

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The labels below show suggested portion sizes of different foods. Compare your portion size
to those suggested on the labels.
How much carbohydrate is in your portion?

Jaffa Cakes
Typical values
Energy
Carbohydrate
rs
of which suga
Fat

Per Jaa cake

42 kcal
7.6g
6.0g
1.0

Per 100g
370 kcal
67.6g
53.3g
8.8g

If you ate 3 jaffa cakes, you would need to multiply the amount of carbohydrate in one jaffa
cake by 3.

7.6 x 3 = 22.8g CHO

Fish Fingers
Typical values
Energy
Carbohydrate
of which sugars
Fat

Per portion (3
170 kcal
14.0g
0.6g
7.1g

fish fingers)

Per 100g
183 kcal
15.1g
0.7g
7.9g

The label tells you that 3 fish fingers contain 14.0g carbohydrate in total.
If your portion is a different size, you need to change the calculation a little to work out how
much carbohydrate you have.
If you want to eat a different amount:
1. Work out how much carbohydrate is in one fish finger.
2. Multiply this amount by the number of fish fingers you are going to have.
1. Divide the total amount of CHO in each portion (3 fish fingers) by 3 to find the amount in 1
fish finger.

3 fish fingers = 14.0g CHO

14.0 3 = 4.6g CHO per fish finger.
2. Multiply this amount by how many fish fingers you want.
1 fish finger = 4.6g CHO

2 fish fingers =

CHO

4 fish fingers =

CHO.

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What size is your portion?

Quiche
Foods like pizza, pasta bake or cakes are often shared between people. For example, the label
below shows the nutritional values for 100g and for 1/3 of a quiche.

Quiche
FRESH AND TASTY

Per portion (1/3 quiche)

Typical values
251kcal
Energy
.1g
15
e
Carbohydrat
g
3.2
ars
of which sug
.5g
16
Fat

Per 100g
188kcal
11.3g
2.4g
12.4g

You are going to have a 1/4 of the quiche. You can work out how much is in your portion by
following the steps below.
1. Work out how much CHO is in the whole quiche.
Multiply the CHO in the 1/3 quiche portion by 3 to work out the CHO in the whole quiche.

15.1 x 3 = 45.3g
2. Work out how much CHO is in your portion.
Divide the CHO in the whole quiche by 4 to work out the CHO in 1/4 .

45.3 4 = 11.3g CHO in your portion.

Now try a few on your own to practice:

Yorkshire Pudding

You have eaten two Yorkshire puddings. How much carbohydrate have you had?
Remember only use the higher CHO value for the total amount of CHO.

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Fruit Biscuits

Fruit
Biscuits
RIANS
SUITABLE FOR VEGETA

Typical values
Energy
Carbohydrate
of which sugars
Fat

Per pack (3 biscuits)

165kcal
32.7g
16.2g
2.7g

Per 100g
381kcal
75.2g
37.4g
6.4g

You have 2 biscuits from the pack. How much carbohydrate is in your portion?

Pizza
Typical values
Energy
Carbohydrate
of which sugars
Fat

Per 1/2 pizza

445kcal
48.9g
4.3g
21.1g

Per 100g
281kcal
30.9g
2.7g
12.7g

You ate 1/3 pizza, how much carbohydrate have you had?

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Using weights and measures

For foods like breakfast cereal, cooked rice or pasta it is often easiest to weigh your portion
and work out how much carbohydrate it has using the per 100g information from the label.
The steps below will help you calculate the carbohydrate in your portion.
1. Weigh your portion.
2. Look at the label and check the
amount of carbohydrate per 100g
of product (remember it is the
total carbohydrate (CHO) not the
of which sugars/starch.
3. Divide the amount of carbohydrate in
100g by 100 to tell you how much is in 1g.
4. Multiply this amount by the weight of your
portion to tell you how much carbohydrate
is in your portion.
This quick equation is:

(CHO per 100g 100) x weight of your portion

= CHO in your portion.
For example, a bowl of Cheery Cereal:
1. Weigh your portion.

1. 40g

2. Look at the label and check the amount of

carbohydrate in 100g of the product
(remember it is the largest value that shows
the total carbohydrate not just the of
which sugars/starch).

2. 75g

3. Work out how much carbohydrate is in 1g.

Divide the amount of CHO in 100g by 100 to
tell you how much is in 1g.

3. 75

4. Work out how much carbohydrate is in your

portion.

4. 0.75

CHO per 100g

100 = 0.75g in 1g
x 40 = 30g CHO

Multiply the CHO in 1g by the weight of your

portion to tell you how much CHO is in your
portion.

00

10

If you are calculating the amount of carbohydrate in liquids, use the same equation using
carbohydrate in a certain volume rather than weight. For example, a milk label shows the
amount of carbohydrate is in 100ml.

SEMI-SKIMMED

LESS THAN

%
FAT

Typical values
Energy
Protein
Carbohydrate
of which sugars
Fat

med milk

Per 100ml of Semi-skim

48kcal
3.3g
5.0g
5.0g
1.6g

1. Measure your portion to find out how much youre going to have.

125ml

2. Check the label to find out how much CHO is in 100ml.

5g CHO per 100ml

3. Work out how much CHO is in 1ml.

5 100 = 0.05ml in 1ml of milk

4. How much CHO is in your portion?

0.05 x 125 = 6.25g

You have 40g of Instant porridge with 250ml of semi-skimmed milk at breakfast.
How much carbohydrate do you have?

Instant porridge
Typical values

Per 30g of Instant porridge with Per 100g of

180ml semi-skimmed milk
Instant porridge

Energy

280kcal

359kcal

Carbohydrate

26.4g

58

of which sugars

9.3g

1.0g

Fat

4.2g

8.7g

Semi-skimmed milk
Typical values

Per 100ml of Semi-skimmed milk

Energy

48kcal

Carbohydrate

5.0g

of which sugars

5.0g

Fat

1.6g

1. Weigh your portion of Instant porridge.

40g
2. Check the label to see how much CHO is in 100g of porridge.

58g
3. Work out how much carbohydrate is in 1g of Instant porridge.

58 100 = 0.58 CHO/g

11

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4. Multiply your portion by the amount of carbohydrate in 1g of Instant porridge.

40 x 0.58 = 23.2g of CHO in your portion

5. Check the label to find out how much CHO is in 100ml of milk.

5g CHO per 100ml

6. Measure your portion to find out how much milk youre going to have.

250ml

7. Work out how much CHO is in 1ml of milk.

5 100 = 0.05ml in 1ml of milk

8. How much CHO is in your portion?

0.05 x 250 = 12.5g CHO in your portion of milk

9. Add both amounts together to find how much carbohydrate is in your portion of Instant
porridge made with milk.

23.2 + 12.5 = 35.7g CHO altogether

Using uncooked and cooked weights

Some food's weight changes significantly when it is cooked. Foods with starchy
carbohydrates like pasta, rice, potatoes noodles, couscous and pulses all have different
uncooked and cooked weights. This is due to the amount of water they absorb or lose
during cooking.
For example:
Pasta absorbs water when it is cooked.
This means a portion of cooked pasta is
heavier than its dried weight.

Baking potatoes causes them to lose water.

This means that a baked potato is lighter
than it was when it was raw.

When you calculate the carbohydrate in these starchy foods, it is very important that you use
the correct weight and carbohydrate value in your calculation.
Carbohydrate values for foods can vary by brand, cooking method and time. Always try to
follow cooking instructions and carbohydrate values on foods labels. If this is not possible, use
the average values from Carbohydrate Tables or other reference books.

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12

Always carefully read labels that provide carbohydrate values for uncooked and cooked
weights. Make sure that you understand the label and are using the correct values in your
calculation. For example:

Pasta 75g dried pasta weighs approximately 170g when cooked

Typical values
Energy
Carbohydrate
of which sugars
Fat

Each serving 75g when cooked

260kcal
54.0g
1.5g
0.8g

100g
345kcal
72.0g
2.0g
1.0g

At the top of the label it states 75g of dried pasta weighs approximately 170g when cooked:
the column Each serving 75g when cooked refers to 170g of cooked pasta
the column 100g refers to uncooked (dried) pasta.
If you weigh your portion of pasta before cooking it, your calculation would follow the standard
method using the details provided in the100g column.
For example, David has 90g of dried pasta with his dinner. His portion will have:

(72 100) x 90 = 64.8g of CHO

However, if you prefer to measure your food once it is cooked, you need a few extra steps to
work out how much carbohydrate is in 1g of cooked pasta.
For example, your portion of cooked pasta weighs130g.
1. Weigh your portion of cooked pasta

1. Portion weighs 130g

2. Look at the label and check the

amount of CHO in the cooked pasta.

2. Label says:

3. Divide the amount of CHO in 170g by

170 to tell you how much is in 1g.
4. Multiply this amount by the weight of
your portion to tell you how much
CHO is in your portion.

13

75g makes approx 170g

cooked.
75g dried provides 54g CHO
therefore, 170g cooked
provides about 54g CHO.
3. 54 170 = 0.32g CHO/1g
cooked pasta
4. 130

x 0.32 = 42g CHO

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Now think about the rice in the example below.

Rice 60g uncooked easy cook rice weighs approximately 140g when cooked
Typical values
Energy
Carbohydrate
of which sugars
Fat

140g when cooked

193kcal
43.3g
Trace
1.8g

100g uncooked
383kcal
85.8g
Trace
3.6g

Read the label carefully, then use the space below to work out how much carbohydrate is in
your rice if your cooked portion is 80g.

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The handy hints below will help you get started:

Keep digital scales, a calculator, a pen and notebook to hand in the kitchen.
Always use the largest carbohydrate figure on nutritional labels. This is the total amount of
carbohydrate and includes both the of which sugars and of which starch amounts.
When you have weighed food, put it into a cup or bowl so that you know how much food
they hold and you wont have to use the scales every time.
Dont confuse uncooked (dry) and cooked weights. Always try to follow packet cooking
instructions and use nutritional labels to count your carbohydrate.
Use a timer to cook rice and pasta to ensure consistent cooked weights.
Try to become familiar with what foods look like on the plate. This will help you judge how
much carbohydrate is in meals and snacks when you are away from home.
Foods are often a mixture of protein, fat and carbohydrate. Remember to count carbohydrate
content in foods such as breadcrumbs on fish, pastry on a meat pie and quiche.
My handy hints

15

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Using your own recipes

Checking ready meal labels can help you to estimate the carbohydrate in homemade versions.
However, it is worth working out the carbohydrate content of your favourite recipes to make
sure you have accurate values.
To work out carbohydrate in homemade foods:
1. Write down all the ingredients. Note:
a. the amount of carbohydrate each ingredient has per 100g (CHO/100g)
b. the weight of each used ingredient in the recipe (g).
2. Work out how much carbohydrate is in each ingredient using the method described in
Using weights and measures (page 10).
(CHO per 100g 100) x weight = CHO
3. Add all the ingredients carbohydrate values together. This is the total amount of
carbohydrate in the whole recipe.
4. Divide this total by the number of portions to give the amount of carbohydrate per portion.
The examples below show you how to work out the carbohydrate for two recipes.

Sultana Scones Makes 8 scones

Ingredient

CHO/100g

Weight (g)

Calculation

CHO/ingredient

Flour

78

200

(78 100) x 200

156

Margarine

50

Sugar

100

50

(100 100) x 50

50

Milk

125

(5 100) x 125

6.25

Egg

1 egg

Sultanas

69

50

(69 100) x 50

34.5

Whole recipe

230.75
Total CHO/scone 246.75 8 = 30.87g

Macaroni Cheese Serves 2

Ingredient

CHO/100g

Weight (g)

Calculation

CHO/ingredient

Macaroni

75

75

(75 100) x 75

56.25

Cheese

150g

Flour

78

40

(78 100) x 40

31.2

Margarine

40

Milk

375

(5 100) x 375

18.75

(uncooked weight)

Whole recipe

106.2
Total CHO/serving 106.2 2 = 53.1

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My favourite recipes
Use the space below to make work out how much carbohydrate is in some of your favourite
recipes. You can add the values to your Carbohydrate Tables as a quick reminder.

17

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Using carbohydrate reference tables and the carbohydrate calculator

When you are out and about, it may not be possible to weigh your foods and calculate how
much carbohydrate your food has. There are lots of books and resources available to help you
work out the carbohydrate in foods. The Carbohydrate Tables pocket guide in this pack will
help you count carbohydrate when you are out and about.
Using the method and examples shown earlier with your Carbohydrate Tables to work out
how much carbohydrate is in:
2 slices of wholemeal toast with jam
your usual cereal and milk with a medium banana
one of your favourite foods or drinks.

What happens if you change the portion size?

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18

Think of more meals and snacks that you like. Use the space below to work out how much
carbohydrate is in your normal portion.

19

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The carbohydrate calculator

This chart will help you calculate how much carbohydrate is in a specific portion size of foods
using packet labels.
Look on the label for how much carbohydrate is in 100g remember to use the TOTAL
CARBOHYDRATE, not the of which sugars/starch figure.
Weigh your portion so you know how much you are going to have.
Read along the bottom (purple) to the amount of carbohydrate/100g, then up the side (black)
(black) to the weight of your portion.
Where the lines meet is the amount to carbohydrate in your portion.

Weight of food (g)

Carbohydrate calculator
200 10

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100 110 120 130 140 150 160 170 180 190 200

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97

Carbohydrate/100g (shown on label)

20

For example
You have a bowl of bran flakes that weighs 45g.
Bran flakes have 65g CHO per 100g.
Read along the bottom (purple) line to 65 and up the side (black) to 45.

Weight of food (g)

Where the lines meet is the amount to CHO in your portion (29g).
200 10

20

30

40

50

60

70

80

90

100 110 120 130 140 150 160 170 180 190 200

175 9

17

26

35

44

52

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79

87

96

105 114 122 131 140 149 157 166 175

150 7

15

22

30

37

45

52

60

67

75

82

90

97

105 112 120 127 135 142 150

140 7

14

21

28

35

42

49

56

63

70

77

84

91

98

105 112 119 126 133 140

130 6

13

19

26

32

39

45

52

58

65

71

78

84

91

97

104 110 117 123 130

120 6

12

18

24

30

36

42

48

54

60

66

72

78

84

90

96

102 108 114 120

110 5

11

16

22

27

33

38

44

49

55

60

66

71

77

82

88

93

99

104 110

100 5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100

95
95

10

14

19

24

29

33

38

43

48

52

57

62

67

71

76

81

86

90

95

90
90

14

18

23

27

32

36

41

45

50

54

59

63

68

72

77

81

86

90

85
85

13

17

21

26

30

34

38

43

47

51

55

60

64

68

72

77

81

85

80
80

12

16

20

24

28

32

36

40

44

48

52

56

60

64

68

72

76

80

75
75

11

15

19

23

26

30

34

38

41

45

49

53

56

60

64

68

71

75

70
70

11

14

18

21

25

28

32

35

39

42

46

49

53

56

60

63

67

70

65
65

10

13

16

20

23

26

29

33

36

39

42

46

49

52

55

59

62

65

60
60

12

15

18

21

24

27

30

33

36

39

42

45

48

51

54

57

60

55
55

11

14

17

19

22

25

28

30

33

36

39

41

44

47

50

52

55

50
50

10

13

15

18

20

23

25

28

30

33

35

38

40

43

45

48

50

45
45

11

14

16

18

20

23

25

27

29

32

34

36

38

41

43

45

40
40

10

12

14

16

18

20

22

45

26

28

30

32

34

36

38

40

35
35

11

12

14

16

18

19

21

23

25

26

28

30

32

33

35

30
30

11

12

14

15

17

18

20

21

23

24

26

27

29

30

25
25

10

11

13

14

15

16

18

19

20

21

23

24

25

20
20

10

11

12

13

14

15

16

17

18

19

20

15
15

10

11

11

12

13

14

14

15

10
10

10

10

55

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

95

100

* Negligible

21

Carbohydrate/100g (shown on label)

00

Bolus Insulin
When you start on your treatment plan, your diabetes team will advise you what bolus you
need.
There are some important things* you need to know when working out how much bolus
insulin you need. For example:
the carbohydrate content of your meal
your insulin to carbohydrate ratio (ICR)
your current blood glucose level.
*Other factors such as activity are considered in greater detail in Carbohydrate Counting, The Next Steps (workbook 2).

What is my insulin to carbohydrate ratio (ICR)?

Your ICR is the number of grams of carbohydrate covered by a certain amount of bolus insulin.
This ratio varies between people. It is affected by how long you have had diabetes, your
weight, age, how much exercise you take or if you are ill. Some people have different ICRs for
different meals or meal times throughout the day.
How do I work out my ICR?
Your diabetes team will help you to work out and check your ICR*.
My ICR is

*Variable ICRs are considered in greater detail in

Carbohydrate Counting, The Next Steps (workbook 2).

What should I do next?

Now that you know your ICR and have learned how to accurately count the amount of
carbohydrate in your meals and snacks, you can calculate how much insulin you need at each
bolus.
Your diabetes team will work through examples with you until you are confident working out
your bolus by yourself.

00

22

How do I use my ICR to work out my bolus?

1. Work out how much carbohydrate is in your meal or snack.
2. Divide the weight of carbohydrate in your meal or snack by the weight of carbohydrate in your
ICR and multiply this by the units of insulin in your ICR.
If your meal has 40g of carbohydrate and your ICR is 1:10, you should have 4 units of bolus
insulin.

(40 10) x 1= 4 units of insulin

If your meal has 60g of carbohydrate and your ICR is 1:7.5 (or 2:15), you should have 8 units of
bolus insulin.

(60 7.5) x 1 = 8 units of insulin

((60 15) x 2 = 8 units of insulin)
Look at the example below.
Meal

Carbohydrate

ICR

Calculation

Bolus

Breakfast

50g

1:10

Lunch

60g

1:15

Dinner

90g

1:15

(50 10) x 1 = 5
(60 15) x 1 = 4
(90 15) x 1 = 6

4
6

Now try and work it out for some of your own meals in the table below:
Meal

Carbohydrate

ICR

Calculation

Bolus

Breakfast
Lunch
Dinner

23

00

Bolus calculator
The chart below is a helpful tool to quickly work out what your bolus should be when you
know how much carbohydrate you are going to have.
Work out how much carbohydrate you are going to have.
Read along the bottom (purple) to your ICR then up the side (pink) to the amount of
carbohydrate you are going to have.
Where the lines meet is the amount of insulin you should have in your bolus*.

Carbohydrate in food (g)

Bolus calculator
100

20

12.5

10

8.5

6.5

3.5

95

19

12

9.5

6.5

4.5

90

18

11

7.5

4.5

3.5

85

17

10.5

8.5

5.5

3.5

80

16

10

6.5

5.5

2.5

75

15

7.5

3.5

2.5

70

14

8.5

4.5

3.5

2.5

65

13

6.5

5.5

4.5

2.5

60

12

7.5

2.5

55

11

5.5

4.5

3.5

2.5

50

10

3.5

2.5

1.5

45

5.5

4.5

1.5

40

3.5

2.5

1.5

1.5

35

4.5

3.5

2.5

1.5

1.5

30

3.5

2.5

1.5

25

2.5

1.5

20

2.5

1.5

1.5

0.5

15

1.5

0.5

0.5

0.5

10

12

0.5

0.5

0.5

0.5

1:5

1:8

1:10

1:12

1:15

1:20

1:25

1:30

Insulin to carbohydrate ratio (ICR)

(units of insulin:grams carbohydrate)
*Bolus units are rounded to the nearest 0.5 units.

00

24

Carbohydrate in food (g)

For example
You are going to have a bowl of bran flakes. You have calculated that this has 30g of CHO.
Your ICR is 1:10.
Read along the bottom (purple) to 1:10 and up the side (pink) to 30.
Where the lines meet is the amount of bolus insulin you should have 3 units*.

100

20

12.5

10

8.5

6.5

3.5

95

19

12

9.5

6.5

4.5

90

18

11

7.5

4.5

3.5

85

17

10.5

8.5

5.5

3.5

80

16

10

6.5

5.5

2.5

75

15

7.5

3.5

2.5

70

14

8.5

4.5

3.5

2.5

65

13

6.5

5.5

4.5

2.5

60

12

7.5

2.5

55

11

5.5

4.5

3.5

2.5

50

10

3.5

2.5

1.5

45

5.5

4.5

1.5

40

3.5

2.5

1.5

1.5

35

4.5

3.5

2.5

1.5

1.5

30

3.5

2.5

1.5

25

2.5

1.5

20

2.5

1.5

1.5

0.5

15

1.5

0.5

0.5

0.5

10

12

0.5

0.5

0.5

0.5

1:5

1:8

1:10

1:12

1:15

1:20

1:25

1:30

Insulin to carbohydrate ratio (ICR)

(units of insulin:grams carbohydrate)
*Bolus units are rounded to the nearest 0.5 units.

Remember:
Your ICR is your insulin to carbohydrate ratio.
Use your ICR to calculate how much bolus you need with your meals and snacks.
The bolus calculator can help you to quickly check what bolus you need.

25

00

Healthy Eating
The diet for people with diabetes is not a special diet it should be a healthy diet that all your
family and friends can enjoy. Using your treatment plan with carbohydrate counting enables
you to balance your carbohydrate intake with your insulin. It gives you greater choice of what,
when and how much you eat. You will have more flexibility with this plan, but it is still
important to follow healthy eating guidelines. These help you to grow, keep well and avoid
gaining too much weight.
The eatwell plate below shows you the types and proportions of the different foods you need
to have a well balanced and healthy diet.

Reproduced with the kind permission of the Food Standards Agency Crown copyright
material is reproduced with the permission of the Controller of HMSO and
Queen's Printer for Scotland

eatwell plate

Try to eat regularly and choose a variety of foods from the green, yellow, pink and blue groups
every day to provide your body with the nutrients it needs. Foods in the purple group food
and drinks high in fat and/or sugar are not essential and should form the smallest part of
your diet.
Breads, rice, potatoes, pasta and other starchy foods
Make these foods the main part of every meal.
Choose wholemeal, wholegrain, brown or high-fibre versions where possible.
Milk and dairy foods
Try to include these foods every day.
Choose lower-fat alternatives where possible.
Meat, fish, eggs, beans
Aim to eat small portions of these foods at meals.
Try to eat more fish and aim for one to two portions of oily fish such as salmon, herring or
pilchards each week.

00

26

Fruit and vegetables

Aim to have a minimum of 5 portions of fruit and vegetables every day.
Try to choose from a wide variety of fruit and vegetables.
Fatty foods
These foods include butter, margarine and cooking oils and many snack and convenience
foods such as mayonnaise, salad dressings, crisps, nuts, savoury and sweet pastries, ice
cream and chocolate.
These foods should be used sparingly as eating too much can lead to being overweight.
Try to choose spreads and cooking oils which are higher in monosaturated or
polyunsaturated oil, for example olive oil or sunflower oil. Aim to use small amounts of these
as the calorie content is the same as butter or lard.
Grilling, baking, boiling and stir frying are healthier methods of cooking.
Low-fat or reduced-fat alternatives can be a healthier alternative, but ensure that you read
food labels to check the nutritional information.
Sugar and sweet foods
These do not have to be avoided but eating too much of these can lead to tooth decay and
being overweight.
Salt
Salt intake should be kept to a minimum as too much can lead to health problems such as
high blood pressure. Processed foods such as crisps, pastries, ready meals and soups all
contain salt so try not to have these too often.
If you have used a little salt in cooking try to avoid adding any more at the table.
Remember:
Base your meals on starchy foods.
Try to have at least 5 portions of fruit and vegetables a day.
Eat more fish.
Cut down on fatty and sugary foods.
Try to limit salt.

27

00

Other Things to Think About

As you become more confident with your treatment plan, you can think more about your food
choices, mealtimes, activities and lifestyle to give you even more flexibility. Keeping a diary of
these points will help you to spot trends and have better control.
Snacks
You do not need regular snacks on your treatment plan.
If you want a snack, think about when your last bolus was and how much carbohydrate is in
your snack.
If your snack contains more than
g of carbohydrate or is after
your last bolus, you will need to take a bolus of insulin.

hours of

The best way to check if this works is

to regularly check your blood glucose.

You generally wont need to bolus if you take carbohydrate to treat a hypo or for extra energy
during activity. Discuss this with your diabetes team.
What about bedtime snacks?
It can be tempting to avoid a bolus with your bedtime snack if you are worried about hypos
during the night. However, your blood glucose may be high for several hours and only come
down with your basal insulin. Discuss this with your diabetes team.
Remember, you dont really know what your blood glucose is during the night unless you test it
from time-to-time.
Delaying or skipping meals and flexible meal times
It is important to try and have three regular meals a day. Generally, your treatment plan means
that you wont need to stick to set mealtimes. This is most likely to happen on special
occasions, if you are away from home or not at school.
If you delay or even skip a meal you:
should follow your standard ICR when you do have your meal
may need to have an extra bolus if you want to have an extra snack
still need to take your basal insulin at the same time regardless of when you are going
to eat.
Food choices
Not all carbohydrate foods are digested at the same rate. Some are digested quicker and will
raise your blood glucose level faster than others. This is covered in detail in Carbohydrate
Counting, The Next Steps (workbook 2), where you will also consider the timing of your
bolus.

00

28

This information has been produced for SNDR by Registered Dietitians and other relevant health professionals. At the time of publication the information contained
within the leaflet was, to the best of our knowledge, correct and up-to-date. Always consult a suitably qualified dietitian and/or your GP on health problems.
SNDR cannot be held responsible for how clients/patients interpret and use the information within this resource.

SNDR, First Published 12/10, Ref 9225

Reviewed XX/XX, XX/XX
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