What is the
counting carbohydrates meal plan?
Counting carbohydrates is a food plan in
which you adjust the insulin dose based on the amount of
carbohydrates your child plans to eat.
How is this
plan different from other carbohydrate meal plans?
This plan is different from other plans
because the insulin dosage and carbohydrates are not always
the same day to day. This plan is more flexible and is
usually started after you are familiar with food choices and
insulin.
How does this
plan work?
Carbohydrates affect your child's blood
sugar more than any other kind of nutrient. Insulin works
with carbohydrates to supply energy for the body. The main
goal is to balance insulin with the carbohydrates your child
eats throughout the day.
First, you and your diabetes care provider
need to figure out how much insulin your child needs to take
in relation to the amount of carbohydrate your child plans
to eat. There are two approaches to take when figuring this
out:
Units per carb
choice (exchange): Count carbohydrates in portion
sizes of 15 grams. This is called a "carb choice" or an
exchange. Divide the number of grams of carbohydrate in a
food by 15 to determine carb choices. For example, if a
container of yogurt with fruit has 45 grams of carbohydrate,
it equals 3 carb choices.
Units insulin are then adjusted at every
meal to match the number of carb choices. To use this
method, your provider needs to tell you how many units of
insulin you need for each carb choice. For example, if your
child needs 1 unit of insulin for every carb choice, then
for 3 carb choices, he would need 3 units of insulin (1 x 3
= 3).
Units of insulin per carb choice X # of carb
choices = units of insulin needed.
I/C ratio:
Most people use an Insulin to Carbohydrate ratio (I/C ratio)
to figure out how much insulin to use. If you use a ratio,
you do not need to convert the number of carbohydrates to
carb choices. An example of an I/C ratio is 1 unit of
insulin for every 10 grams of carbs eaten.
For example, if you plan to eat 60 grams of
carbohydrate and your I/C ratio is 1/10 (.10), then you
would need 6 units of insulin (60 X .10 = 6).
Grams of carb X I/C ratio = units of
insulin.
Your dietitian will help you figure out your
I/C ratio.
Adjustments to the
insulin dose
Changes to the dose may be needed because of
planned exercise, blood sugar levels, or other factors that
may affect blood sugar (such as illness, stress, or
menstrual periods). For example, your child may need less
insulin if the blood sugar level is low (below 70 mg/dl) or
more insulin if the blood sugar is too high (above 200
mg/dl). Your dietitian and health care provider will give
you guidelines for making these adjustments. The insulin
dose calculated from the I/C ratio is usually reduced by
half if it is given before strenuous exercise or at bedtime.
Which foods
have carbohydrates?
Carbohydrates are found in foods such as:
- Starchy foods (such as breads,
cereals, rice, starchy vegetables, and pasta)
- Fruits
- Milk and yogurt
- Sweets
Most vegetables, meats, and fats are not high in
carbohydrates. They have less of an effect on blood sugar
levels. You can adjust your child's insulin dose based on
meats and fats, if needed, after you have learned how to
count carbohydrates.
To see a list of carb choices, you can order
the Exchange List for Meal Planning from The American
Diabetes Association and the American Dietetic Association
(1-800-342-2383). This book lists the carbohydrate content
for lots of foods and is very useful. Nutrition labels on
food packages also list the grams of carbohydrate in a
serving of food.
When should
my child take insulin?
In general, your child should take his
insulin so that it starts working as the blood sugar begins
to rise. Sugar is absorbed into the blood about 10 minutes
after eating.
- Humalog/NovoLog/Apidra:
Starts working in 10 minutes. The peak activity of this
insulin is 30 to 90 minutes after taking. Take this
insulin right before eating.
- Regular
insulin: Starts working in 20 to 30 minutes.
The peak activity is 2 to 4 hours after taking. Take
this insulin 20 to 30 minutes before eating.
Sometimes insulin can be given after eating. Your child's
doctor and dietitian will help you create a schedule for
when to take insulin and when to eat.
How do I get
started?
- Keep a food, insulin, blood sugar
level, and exercise record for at least 3 days. The more
blood sugar tests you can do 2 hours before meals and 2
hours after meals, the better the advice your dietitian
can give you. It is also important to record all doses
of insulin or oral medicines taken.
- The dietitian will review the report
and work with your provider to decide what your child's
Insulin to Carb (I/C) ratio is. Some people can use 1
unit of short acting insulin per 15 grams of carb for
all meals and snacks (an I/C ratio of 1/15). Your
child's ratio may vary from one time of day to another.
For example, a 1/15 ratio for breakfast, a 1/30 ratio
for lunch, and a 1/10 ratio for dinner.
- Start counting carbs and adjusting the
insulin dose accordingly. You need to keep careful
records for the first 1 to 2 weeks of:
- number of carbohydrates your child
eats at each meal or snack
- insulin dose given
- blood sugar levels (especially
levels 2 hours after meals)
- After a week or two, review your
records with a dietitian to check if any adjustments
need to be made. If the blood sugar values are not in
the desired range, then your child's I/C ratio needs to
be changed. If the blood sugar value is always high 2
hours after a meal, more insulin is needed for the grams
of carb in the I/C ratio. For example, your child would
need to change from an I/C ratio of 1/15 to 1/10.
