Carbs Ebook

CARBS
COUNT
An introduction to carbohydrate counting

and insulin dose adjustment
1-15_CarbGuideWS2 22/2/12 15:59 Page 1
Contents
Introduction: Carbohydrate counting and insulin d ose
adjustment 3
Chapter 1: Understanding diabetes 7
Chapter 2: Carbohydrates 13
Chapter 3: Insulin 19
Chapter 4: How to estimate the carbohydrate
content of foods and drink 35
Chapter 5: Eating out, takeaways and snacks 88
Chapter 6: Alcohol 92
Chapter 7: Physical activity 95
Chapter 8: Hyperglycaemia and diabetic ketoacidosis 103
Chapter 9: Hypoglycaemia 107
Chapter 10: Structured education courses 113
Glossary 115
References 116
About Diabetes UK 117
This book is aimed at adults with Type 1 diabetes
Carbs count 1
2 Carbs count
Introduction:
Carbohydrate
counting
and insulin dose
adjustment
Carbohydrate counting is a method of matching your

insulin requirements with the amount of carbohydrate
you eat and drink.
For many people with Type 1 This book aims to support and
diabetes, it is an effective way of increase your understanding of
managing the condition, which, this method of managing diabetes.
once mastered, will lead to better
blood glucose control and greater This book will help you to:
flexibility and freedom of lifestyle. • identify those foods that contain
It is an approach that requires a carbohydrate
great deal of time and ef fort. To • calculate the amount of
do it successfully you will need to carbohydrate these foods contain
learn all about carbohydrates, lear n • start looking at how much insulin
how to adjust your insulin and be to take for the amount of
dedicated to monitoring your blood carbohydrate consumed.
glucose levels frequently. You will
We have also provided a pocket-
also need the support of
sized book of carbohydrate values
professionals either in the form
to use in your calculations.
of your diabetes healthcare team
or one of the structured diabetes
education courses available
(see Chapter 10).
Carbs count 3
The benefits
Learning to carbohydrate count (bolus) insulin to cover carbohydrate
and insulin dose adjust takes time, containing food and drink.
professional support, effort and
practice. However, once you are The general principles of
confident you should be able to: carbohydrate counting are the
same for people on insulin pump
• vary the times you eat and the therapy as those on multiple daily
amount of carbohydrate you eat injections. If you are considering
• predict blood glucose responses starting on an insulin pump, it is
to different foods important to understand and be
able to follow the principles of
• enjoy a wider variety of foods. carbohydrate counting beforehand.
Is this book for you? What can you lear n from

This book is for adults with Type 1 this book and is it enough to
diabetes who manage their blood start carbohydrate counting?
glucose levels with a basal bolus
This book has been produced
insulin regimen. A basal bolus
as an introductory guide to
regimen uses a long-acting (basal)
carbohydrate counting and insulin
insulin to keep glucose produced by
dose adjustment. It provides
your liver under control, with
background information on
additional short or rapid-acting
carbohydrates and how to
4 Carbs count
carbohydrate count. It also provides It can also be used as a r efresher

information on the different types or reference guide after completing
of insulin, how they work and how a diabetes structured education
each one should be adjusted course (see Chapter 10).
according to what you eat and
IMPORTANT: The information in
drink and the amount of physical
this book can be used in addition
activity you do. There are examples
to the advice of trained healthcar e
to follow and to do yourself to help
professionals and recognised
you become familiar with this
diabetes education courses
method of diabetes management.
but it should not be used as a
By working with your healthcare complete replacement for either
team, you can use this book to of these.
start carbohydrate counting.
Carbs count 5
6 Carbs count
Chapter 1:
Understanding diabetes
To get to grips with how and why carbohydrate counting

works, you’ll need to have a good understanding of diabetes.
In this chapter you will find out about the following:

• What is Type 1 diabetes?
• Symptoms of high blood glucose levels
• Targets for good blood glucose contr ol
What is Type 1 diabetes? Glucose is used by the body’s cells

for energy. Glucose comes mostly
Having Type 1 diabetes means
from the digestion of carbohydrate
that your body does not pr oduce
containing food and drink as well
any insulin.
as from stores in the liver
Insulin is a hormone which is (see Chapter 2).
produced by the beta cells in the When insulin is not present, glucose
pancreas. Insulin acts like a key cannot enter the cells and it builds
to unlock cells. It allows glucose in up in the blood.
the blood stream to enter the cells.
Type 1 diabetes is always tr eated
with insulin.
Carbs count 7
Type 1 diabetes develops when the diabetes, the amount of insulin

insulin-producing cells (beta cells) in increases and decreases
the pancreas have been destroyed. automatically to keep blood
Nobody knows for sure why these glucose levels steady. Insulin is
cells are destroyed but the most released continually over the
likely cause is the body’s immune course of the day, with extra
system developing an abnormal insulin released when carbohydrate
reaction to the cells (autoimmune). is eaten or drank. However, if you
This may be triggered by a virus, have Type 1 diabetes, this balance
other infection, or environmental needs to be maintained by taking
factors. insulin throughout the day to stop
your blood glucose levels from
Insulin secretion and glucose becoming too high.
regulation in the body is a fine
balancing act. In people without
Type 1 diabetes is different from Type 2 diabetes in the following ways:
Type 1 Type 2
At diagnosis • Quick onset of symptoms • Slow onset of symptoms

• Generally below the age • Possibly no symptoms
of 40 years old
• Generally above the age
• Experience unexplained of 40 years old (or above
weight loss 25 years old if black or
South Asian)
• Ketones present
Physiology • Autoimmune response • Insulin resistance

• No insulin produced • Some insulin produced
Treatment • Insulin • Lifestyle changes (food

and physical activity)
• Diabetes medication
• Insulin
8 Carbs count
The pancreas
In people with Type 1
diabetes, the pancreas does
not produce insulin.
stomach gullet
stomach
liver
pancreas
pancreas
Illustration: Paul Grimes Photography: Blackwell Science Ltd.
microscopic appearance of pancreatic cells
Islet of
cells
Langerhan with
producing
beta cells
pancreatic
secreting
juices
insulin into the
bloodstream
Carbs count 9
Symptoms of high blood • Genital itching or regular

episodes of thrush – the excess
glucose levels glucose in your urine provides
As blood glucose levels rise, you the ideal environment for bacteria
experience the symptoms of to thrive.
diabetes. You might have • Slow healing of cuts and wounds.
experienced some or all of the
following symptoms before you • Blurred vision – molecules of
were diagnosed with diabetes and glucose enters the lens (the fr ont
may experience them now, when part) of the eye and af fect your
your blood glucose levels are vision.
running high.
Good blood glucose control
• Passing lots of urine, especially at
night – because your kidneys try Good blood glucose control means
to flush out the excess glucose. consistently keeping your blood
glucose levels as near to normal
• Increased thirst – to replace the as possible, mirroring those of
increased fluid passed as urine. someone without diabetes. For
• Tiredness – because the glucose adults with Type 1 diabetes this
cannot enter the cells to be used is between 4 –7 mmol/l before
as energy. meals and less than 9 mmol/l two
hours after meals. These targets
• Unexplained weight loss – because can be difficult to achieve but
your body’s fat stores are broken evidence shows that once they ar e
down for energy, producing ketones. reached and maintained they can
10 Carbs count
significantly reduce the risk of 1983 to 1993 but the r esults were
serious diabetic complications later so clear that the study stopped a
on in life. For more information on year ahead of schedule.
diabetic complications such as
cardiovascular disease (heart disease Hypoglycaemia
and stroke); retinopathy (eye One of the other findings of the
disease); neuropathy (nerve disease) DCCT was that keeping tight blood
and nephropathy (kidney disease) glucose control can increase the risk
see the glossary on page 115. of a hypo (low blood glucose level)
Evidence from the Diabetes Control although more recent research has
and Complications Trial (DCCT) shown that this does not have to be
shows that achieving an HbA1c the case.1, 2, 3
(see glossary) of less than 48 Everyone with Type 1 diabetes
mmol/mol (6.5 per cent) reduced is likely to have some hypos and,
the risk of developing the long for some people, an increased risk
term complications of diabetes later of even mild hypos will be
on in life. This involved nearly unacceptable. It is important to find
1,500 people with Type 1 diabetes a way of managing your diabetes,
throughout the USA and Canada. which is flexible enough to suit you
The trial was planned to be but which also reduces your risk
conducted over 10 years from of developing future complications.
Carbs count 11
Please discuss your own personal

blood glucose targets and any
concerns regarding hypoglycaemia
with your diabetes specialist.
Understanding what causes hypos
and being able to recognise the
signs, symptoms and how to best
treat them, will help. For mor e
information on hypos,
see Chapter 9.
Summary
• Diabetes is a condition where the levels of glucose in the
blood are not automatically controlled.
• Glucose comes from the digestion of carbohydrate containing
foods and drinks and is also produced by the liver .
• Insulin is a hormone that acts like a key allowing glucose
into the cells for energy.
• No-one knows for sure what causes Type 1 diabetes.
It is thought to be linked to an autoimmune response.
• The symptoms of diabetes include: passing lots of urine;
increased thirst; tiredness; unexplained weight loss;
thrush or genital itching; slow healing of cuts wounds
and blurred vision.
• Good blood glucose control reduces the risk of long term
diabetes complications, such as heart disease, stroke,
blindness, kidney disease and amputations.
12 Carbs count
Chapter 2:
Carbohydrates
Before you start carbohydrate counting you’ll need to have

a good knowledge of carbohydrate, what it does and what
food and drinks it is found in.

• What is carbohydrate?
• Why carbohydrate is important in the diet
• Foods and drinks that contain carbohydrate
• Foods and drinks that you may not need to count.
What is carbohydrate?
Carbohydrate is a nutrient that is Starchy carbohydrates are foods like
an important source of energy in bread, pasta, chapattis, potatoes,
the diet. All carbohydrates are yam, noodles, rice and cereals.
broken-down into glucose, which
Sugars include table sugar such as
is used by the body’s cells as fuel.
caster and granulated (sucrose), and
Carbohydrate can be classified in can also be found in fruit (fructose),
a number of different ways, but and some dairy foods (lactose). It can
essentially there are two main types often be identified on food labels as
– starchy carbohydrates and sugars. those ingredients ending with –ose.
Carbs count 13
Another type of food that can total carbohydrate to come from

affect blood glucose levels are sucrose.
nutritive sweeteners, including
polyols. If you are unsure what Why carbohydrate is
these are, they tend to end in important in the diet
–ol eg sorbitol, malitol, xylitol
Glucose from carbohydrate is
and mannitol.
essential to the body, especially
The actual amount of carbohydrate the brain, as it is our body’s primary
that the body needs varies source of fuel.
depending on your age, weight
Some carbohydrates may help you
and activity levels, but it should
to feel fuller for longer after eating.
make up about half of what you
High fibre carbohydrates, such as
eat and drink. For good health,
wholegrain and fruit also play an
most of this should be fr om starchy
important role in the health of
carbohydrate, fruits and some dairy
the gut.
foods, with a small amount of your
Food and drink that contain carbohydrate
Carbohydrate is digested at different rates by the body and can

be divided into three main groups – fast, medium and slow acting
(see table).
14 Carbs count
Food and drink that do not contain carbohydrate
Protein Dairy
• Meat, fish (white and oily), • Cheese
seafood, eggs
Vegetables
• Check food labels of sausages • Salad and most vegetables
and burgers as they may contain
carbohydrate Drinks
• Water, sugar free and diet drinks
Fat and squashes.
• Butter, lard, ghee, margarine, oils • Tea and coffee (without milk)
Carbs count 15
16-33_new table 28/3/12 14:09 Page 16
The three main carbohydrate groups

Fast acting carbohydrate – ideal for hypo-treatment
Food and drink How this fits in with

carbohydrate counting
• glucose drinks and tablets
• ordinary soft drinks and squash These foods and drinks cause a rapid
• chewy sweets, gums, jellies, mints. rise in blood glucose levels and may
be good first line hypo treatments
(see Chapter 9). If they are not being
used as a hypo treatment, these
carbohydrates should be matched
with fast-acting (bolus) insulin.
Medium and slow acting carbohydrate
16 Carbs count
16-33_new table 28/3/12 14:09 Page 17

• bread, chapattis By working out the amount of
• potatoes and sweet potatoes carbohydrate in these foods you
• breakfast cereals and oats will be able to control your blood
• rice and pasta glucose levels by matching it with
• flour the right amount of fast-acting
• most fruit (bolus) insulin.
• milk, yogurt and ice cream
• potato products e.g. chips and crisps
• products made from flour, eg
biscuits, cakes, Yorkshire puddings,
pancakes, pastry
• breaded products e.g. breaded fish
and scotch egg
• chocolate
• honey, jam and other conserves
• sugar.
Slow acting carbohydrate

• pearl barley
• peas, beans and lentils Although these foods do contain
• some vegetables, including
some carbohydrate, they are
sweetcorn, squash/pumpkin absorbed very slowly and may not
and parsnips need to be matched with insulin,
• some fruit, including tomatoes,
unless eaten in large quantities.
cherries, grapefruit, lemon and lime
• nuts, Quorn, tofu, soya.
Carbs count 17
Summary
• There are two main types of carbohydrate, starchy
carbohydrates and sugars.
• The vast majority of carbohydrate you eat should be made up
of starchy carbohydrate, fruits and milk; with a small amount
of your total carbohydrate to come from sucrose.
• Different foods and drinks contain dif ferent amounts of
carbohydrate that are absorbed at varying rates.
• Some foods and drinks do not contain any carbohydrate at all.
• Carbohydrate is essential and should not be excluded from
the diet.
18 Carbs count
Chapter 3:
Insulin
Being able to understand how insulin works is one of the

cornerstones of managing diabetes.

• The normal workings of the pancr eas
• Basal insulin
• Adjusting basal insulin, including examples
• Bolus insulin
• Calculating bolus insulin doses
• Adjusting bolus insulin, including examples
• Correction doses
The normal workings of the

pancreas
In people without diabetes, blood of insulin are released slowly over
glucose levels are automatically the whole day, with larger amounts
controlled by the release of insulin released to deal with the glucose
from the pancreas. The picture on absorbed at mealtimes from food
page 20 shows that small amounts and drink.
Carbs count 19
Normal insulin release

Insulin levels in blood
Insulin produced by pancreas
Breakfast Lunch Dinner
Meal time (hr)
In Type 1 diabetes, no insulin is Basal insulin

released from the pancreas at all,
and so the aim of insulin tr eatment Basal insulin (long-acting insulin)
is to mimic normal insulin pr oduction deals with the glucose produced by
as in someone without diabetes. your liver. If you skip a meal or eat
a carbohydrate-free meal, your
There are two main groups of basal insulin alone would be able
insulin: to keep your blood glucose levels
stable.
• Basal insulin
The majority of people would use
• Bolus insulin one of two types of basal insulin
These may be human (actually • Isophane or
made from bacteria), animal or
analogue (genetically engineered). • Long-acting analogue insulin.
20 Carbs count
Isophane insulin
0 1 2 3 4 5 6 7 8 9 10 11 12.......................24 hours
Isophane insulin, eg Humulin I, Insulatar d or Insuman Basal, works

to keep your blood glucose levels under contr ol between meals and
overnight. It usually works hardest between four and twelve hours after
injecting and generally lasts from eight to 24 hours. Isophane insulin
is usually given twice a day when carbohydrate counting.
Long acting analogue insulin
0 1 2 3 4 5 6 7 8 9 10 11 12.......................24 hours
Long-acting analogue insulin, eg Lantus or Levemir, is injected once

or twice daily at the same time each day , and may work evenly up
to 20–24 hours, without peaking.
Carbs count 21
How much basal insulin do is correct. If the pre-evening meal

I need? blood glucose level is in target then
this would indicate you are taking
Speak to your healthcare team who the right amount of basal insulin.
can help you work out a starting
dose of basal insulin that will Adjusting basal insulin
match needs.
If your blood glucose levels ar e
How do I know I have the lower or higher than the target
range before bed and/or before
right amount of basal insulin?
breakfast on three consecutive
A good way to check if your basal days, your insulin dose may need
insulin dose is correct is to monitor adjusting. You should always make
your blood glucose levels before only small adjustments and monitor
bed and when you wake up. If their effect. Your diabetes team will
your bed-time blood glucose level be able to advise you on adjusting
is between 6 – 8 mmol/l and your your basal insulin dose. If your
waking glucose levels are within blood glucose levels are above the
the target range of 4 – 6 mmol/l, ideal range it is likely you will need
you are likely to be having the to increase your basal insulin dose
correct dose of basal insulin. to compensate. Conversely, if your
However, your pre bed-time blood blood glucose levels are below the
glucose level may also be af fected desirable level, you are likely to
by the amount of insulin injected need to reduce the amount of
with your evening meal. basal insulin. While establishing
your insulin regimen, it is a good
Some healthcare professionals also idea to try testing your blood
recommend having a carbohydrate glucose levels in the middle of the
free and bolus free lunch as a way night, around 2am to 3am, to
of checking if the basal insulin dose
22 Carbs count
ensure you are not having a night- after making an adjustment to your
time hypo before making any basal insulin before making any
adjustments to your basal insulin. further changes. You should,
however, make an exception to this
You should concentrate on getting
rule if you are having night time
your basal dose correct before
hypos and adjust immediately.
adjusting bolus insulin doses. Make
sure you wait at least four days
Example 1
Name: Jane
Jane has her basal insulin once a day in the
evening. Looking at Jane’s diary, how do you
think her basal insulin should be adjusted?
Does she need more or less basal insulin?
Blood glucose level (mmol/l)
Date Before Before Before Before During

breakfast lunch evening bed the night
meal
16/11 10.9 10
17/11 9.3 10 9
18/11 9.7 11
19/11 10.5 12
20/11 12.3 11
Answer:
You can see if Jane’s basal insulin dose is corr ect by looking at her blood
glucose levels before breakfast and before bed. We can see that Jane has
Carbs count 23
blood glucose levels above the target of 4 – 6 mmol/l before breakfast and
higher than 8 mmol/l before bedtime. This shows that Jane needs mor e
basal insulin to bring those levels into the target ranges. Subsequently ,
Jane has made a small incr ease to her basal insulin (long-acting insulin)
and continues regular blood glucose monitoring over the next few days
to see what difference this makes.
Example 2
Name: Bob
Bob has his basal insulin twice a day .
Looking at Bob’s diary, how do you think
his basal insulin should be adjusted?
Does he need more or less basal insulin?

meal
9/5 3.1 6.2 3.8
10/5 3.6 7.5
11/5 4.1 6.9
12/5 2.9 7.2
Answer:
Although Bob is going to bed with blood glucose levels between 6 –8 mmol/l,
he is still waking up with levels below 4 mmol/l. T o prevent him from
having low blood glucose levels, Bob needs to r educe his dose of basal
(long-acting) insulin. Bob decides to make a small r eduction in his basal
24 Carbs count
insulin tomorrow evening and continue monitoring his blood glucose

levels closely over the next few days to see how this af fects his diabetes
control. Remember that Bob doesn’t have to wait another four days
to make further insulin adjustments if he is still experiencing hypos.
More information about hypos can be found in Chapter 9.
Example 3
Name: Shazia
Shazia has her basal insulin twice a day .
Looking at Shazia’s diary, how do you
think her basal insulin should be adjusted?
Does she need more or less basal insulin?

meal
26/3 6.0 7.2
27/3 5.5 6.5 6.4
28/3 5.6 7.5
29/3 4.9 7.8
Answer:
Shazia is going to bed with blood glucose levels in the target level of
between 6 –8 mmol/l, her blood glucose levels r emain in target over night,
not changing significantly and are within the range of 4–6 mmol/l in the
morning so she does not need to adjust her basal (long-acting) insulin.
Carbs count 25
Example 4
Name: Albert
Albert has his basal insulin once a day in the
evening. Looking at Albert’s diary, how do
you think his basal insulin should be
adjusted? Does he need more or less insulin?

meal
25/10 10.5 6.2
26/10 12.6 6.4
27/10 11.6 8 3.5
28/10 15.0 7.4 3.2
Answer:
Albert is waking up with high blood glucose levels despite going to bed
with blood glucose levels within the r ecommended 6–8 mmol/l. Albert is
having too much basal (long-acting) insulin, which is causing him to have
night time hypos, which in tur n appear to be rebounding (when the liver
releases stored glucose into the blood str eam), giving high blood glucose
levels on waking. Albert decides to r educe his basal insulin dose by a
small amount. Albert continues to monitor his blood glucose levels closely
over the next few days to see what ef fect this has. More information on
hypoglycaemia can be found in Chapter 9.
26 Carbs count
Bolus insulin
While basal insulin influences your There are two main types of bolus
blood glucose levels in between insulin
meals, it is the bolus (fast-acting)
insulin that deals with the • Rapid acting analogue insulin
carbohydrate consumed from • Short acting or soluble insulin
your food and drink.
Rapid acting analogue insulin
0 1 2 3 4 5..........................................................................24 hours
Rapid acting analogue insulin, eg Apidra, Humalog, or Novarapid, has

been developed to try to mimic what your body would normally do
following a meal and works quickly to lower your blood glucose levels.
This insulin can be given just befor e, with or just after food. It has its
peak action within one to two hours and can last up to five hours.
Short acting or soluble insulin
0 1 2 3 4 5 6 7 8 9 10....................................... 24 hours
Short acting or soluble insulin, eg. Actrapid, Humulin S or Insuman Rapid,

is usually given 15 to 30 minutes befor e a meal to cover the rise in blood
glucose levels that occurs after a meal. It has its peak action within two
to six hours and it can last for up to eight hours.
Carbs count 27
Calculating bolus insulin Your insulin to

doses carbohydrate ratio
How much bolus insulin Insulin to carbohydrate ratios vary
do I need? from person to person, so you will
have your own personal ratio.
Bolus insulin is usually taken before, Eventually, you may even have a
during or sometimes just after you different insulin to carbohydrate
have eaten. To work out how much ratio for each meal.
bolus insulin you need, you will
Carbohydrates can be counted
need to know:
in two ways, in grams or as
1. Your own ‘insulin to carbohydrate carbohydrate portions. One
ratio’. (This is the amount of carbohydrate portion (CP) is usually
insulin you need to inject for a equal to 10g of carbohydrate.
certain amount of carbohydrate). Some diabetes centres use CPs,
while others work in grams of
2. How much carbohydrate you are carbohydrate. It is important that
eating and drinking. you find the method that works best
In a nutshell, the more carbohydrate for you. This book illustrates all of
you eat and drink the mor e bolus the examples in both CPs and grams
insulin you will need and the less – see Chapter 4. Please note that
carbohydrate you eat and drink, the there may be differences between
less bolus insulin you need. Similarly the amount of insulin stated in the
if you have a carbohydrate fr ee two different methods – this is not
meal, you will not need any bolus a mistake. No matter which method
insulin at all. you use, with time, you will be able
to adjust your insulin to carbohydrate
This section deals with ‘insulin to ratios to take this into account.
carbohydrate ratios’. You will find
out how to calculate the amount of Most adults tend to start with a
carbohydrate in different food and ratio of around 1 unit of insulin for
drink in the next chapter. every 10g of carbohydrate or 1 unit
of insulin for every CP. This is
written as:
1 unit insulin : 10g carbohydrate
1 unit insulin : 1CP or
To work out the most suitable
starting ratio for you, it is important
to talk to your diabetes team.
28 Carbs count
Adjusting bolus insulin

Insulin to carbohydrate
If the ratio is correct and you have ratios in grams
estimated the amount of
carbohydrate correctly, you would Units of Grams of
expect to see your blood glucose insulin carbohydrate
levels before the next meal to be
within the target range of 4–6 mmol/l. 1u 15g
Some people like to test their blood 1u 12.5g
glucose levels two hours after meals
to see whether their levels are 1u 10g
returning to the target range.
1u 7.5g
It is important not to make changes to
your insulin regimen based on one 1u 5g
blood glucose reading or experience
alone. If you can see an obvious tr end, 1u 4g
where your blood glucose levels are 1u 3g
generally lower or higher than the
target range, you can make small
changes to your bolus insulin ratio.
Insulin to carbohydrate
The tables opposite shows you how ratios in CPs
to adjust your ratio up and down.
You might want to make one Units of Insulin CPs
change at a time, focusing in on
one particular mealtime. 0.5u 1 CP
The tables and following examples 1u 1 CP
give you an indication of potential 1.5u 1 CP
changes but you should discuss your
own results with your diabetes team. 2u 1 CP
If you regularly experience hypos 2.5u 1 CP

shortly after your meals, you may 3u 1 cP
want to consider reducing the ratio
for those meals the next day. That is,
reducing the amount of insulin per high. You could have a carbohydrate-
10g of carbohydrate or CP, depending free and bolus insulin free meal to
on the system you are using. If you test if you are taking the correct basal
are regularly experiencing hypos at dose during the day. Speak to your
any other times of the day, it might be diabetes team for more information
because your basal insulin dose is too on how and when to do this.
Carbs count 29
Example 5: Working in grams of carbohydrate

Name: Bob
Bob takes 1unit of bolus insulin for every 10g of
carbohydrate at each mealtime. This means that
if Bob has 60g of carbohydrate, he gives himself
6 units of bolus insulin. Looking at Bob’ s diary,
how do you think his ratio should be adjusted?
Which meal ratio needs adjusting?

meal
18/4 5.4 4.3 12.3 8
19/4 5.1 5.2 13.6 8.5
20/4 4.6 6 11.9 8.7
21/4 4 5.9 11.6 7.5
22/4 4.3 4.2 12.4 10
Answer: Bob’s blood glucose results are within target at breakfast and
lunchtime, but they are above the target of 4 – 6 mmol/l before his evening
meal. As Bob knows that it is his lunchtime insulin that af fects these results,
he decides to increase his insulin to carbohydrate ratio at this time to 1u : 5g
of carbohydrate, to help lower his blood glucose levels befor e his evening
meal. So now if Bob has 60g of carbohydrate, he will give himself 12 units
of bolus insulin.
60 = 12 units of insulin
5
He monitors his blood glucose levels closely over the next few days to see
what affect this adjustment has had.
30 Carbs count
Example 6: Working in CPs
Name: Jane
Jane’s ratio is worked out so that she takes 1 unit
of bolus insulin for each CP at each mealtime. This
means that if Jane has 6 CPs, she will need 6 units
of bolus insulin. Looking at Jane’s diary, how do
you think her insulin to carbohydrate ratio should
be adjusted? Which meal ratio needs adjusting?

meal
12/12 4.2 12.5 6.0
13/12 5.9 15.1 5.8 6.7
14/12 6.0 11.6 4.6
15/12 4.7 10.9 5.7 7.8
16/12 5.0 13.8 4.9
Answer: Jane’s blood glucose results are within target before breakfast,
but they have risen to well above target by lunch time. Once she has
given herself a correction dose (see page 32) her blood glucose levels ar e
all within target. Jane works out that she needs to incr ease her insulin
to carbohydrate ratio at breakfast to 1.5u : 1 CP tomorr ow, as this is the
ratio that effects her blood glucose levels befor e lunchtime. So now,
if Jane eats 6 CPs at br eakfast, she will give herself 9 units of insulin
6 x 1.5 = 9 units insulin
She will monitor her blood glucose levels closely over the next couple of days
to see what affect this adjustment has had.
Carbs count 31
Correction doses • in times of stress as this can

increase blood glucose levels.
What is a correction dose?
Correction doses should always be
A correction dose is an additional given with caution and generally
amount of bolus insulin to bring should only be given before a meal.
down a one-off high blood glucose
level into the target range. Giving a correction dose after
a meal can be difficult to judge.
When should I use and give If you give a correction dose too
a correction dose? soon, the bolus insulin that you
have already given may not have
These are the typical times when you finished working, therefore
might want to use a corr ection dose: increasing the risk of a hypo.
• following a snack earlier in the When should I not use a

day that wasn’t matched with correction dose?
any insulin at the time
It is not advised to give a
• if you underestimated the correction dose after drinking
amount of carbohydrate alcohol, and it should only be
consumed or underestimated given with extreme caution
the amount of insulin to be taken following physical activity, due
at a previous meal or snack to the increased risk of a hypo
at these times.
32 Carbs count
How do I work out my insulin as you may be mor e insulin

correction dose? resistant.
Most people will have a formula
Correction doses differ from person
of 1 unit of bolus insulin to r educe
to person and can vary by the time
blood glucose levels by 2– 3 mmol/l.
of day. Your diabetes team can
help you work out your personal Correction doses are added to the
correction dose formula. The calculated amount to match your
formula will tell you by how many carbohydrate intake at a meal,
mmols your blood glucose levels so you only need to have the one
will fall for each unit of bolus injection. See example 7 for how
insulin given. The only time when this works.
this may not apply is when your
blood glucose levels are above If you frequently need correction
14 mmol/l, for example during doses, you may need to look at
illness, when you may need mor e your overall insulin regimen.
Example 7: Correction doses
Shazia is aiming for a blood glucose level

of 4–6 mmol/l before her meals. When she
tests before lunch, she finds that her
blood glucose level is 10 mmol/l.
To get her blood glucose levels in the target
range of 4–6 mmol/l, she needs to reduce
her blood glucose levels by 4 –6 mmol/l.
Shazia’s diabetes team helped her work
out that 1 unit of bolus insulin lowers her
blood glucose levels by 2.5 mmol/l.
2 units would therefore reduce her blood
glucose levels by 5 mmol/l.
Shazia decides to add this extra insulin
to her mealtime insulin dose so she only
has to inject once.
Carbs count 33
Summary
• In people without diabetes, insulin is released automatically
in response to increasing blood glucose levels.
• In Type 1 diabetes, insulin treatment is used to mimic normal
insulin release as closely as possible.
• There are two main types of insulin, basal and bolus insulin.
Different insulins vary in how quickly they start working,
when they peak, and how long they work for .
• Basal insulin is taken once or twice a day .
• Basal insulin can be adjusted to ef fect blood glucose levels
before bed and on waking.
• It is important to concentrate on getting basal insulin doses
correct before adjusting bolus insulin doses.
• Bolus insulin is taken either before, during or just after eating
carbohydrate.
• Start by asking your diabetes team to help you calculate your
basal dose of insulin and your insulin to carbohydrate ratio.
• Insulin to carbohydrate ratios can be expressed as:
units of insulin : grams of carbohydrate
or
units of insulin : CPs.
• Insulin to carbohydrate ratios vary from person to person and
you may have a different ratio for each meal. You will need
to adjust your insulin to carbohydrate ratio depending on
your blood glucose patterns.
• Correction doses are used with caution for ‘one-of f’ high
blood glucose levels.
34 Carbs count
Chapter 4:
How to estimate
the carbohydrate
content of food
and drink
Estimating the amount of carbohydrate you eat and drink

allows you to adjust your insulin to manage your blood
glucose levels more effectively.
This chapter helps you to develop your own set of tools,
which will allow you to estimate the amount of carbohydrate
you eat and drink.

• The carbohydrate content of food
• How to calculate the carbohydrate content of food using
– carbohydrate reference lists
– food labels
– recipes.
The carbohydrate content stays the same. So, for example, a

of food portion of raw (uncooked) spaghetti
Different foods contain different may contain about 50g of
amounts of carbohydrate. Regardless carbohydrate. When this is boiled
of the type or amount of cooking, and served, it will still contain 50g
the carbohydrate content of a food of carbohydrate, even though it
Carbs count 35
will weigh more as it has absorbed It is important to be awar e of this

water during cooking. because otherwise it would be very
easy to over or underestimate the
Although cooking does not affect carbohydrate content of a food,
the carbohydrate content of the which could mean giving too much
food, different cooking methods will or too little bolus insulin.
affect the weight and volume of
the food depending on how much So, where possible, count the amount
water it has lost or gained. So, for of carbohydrate in raw food rather
example, if a raw potato weighs than cooked.
200g, after it has been baked it will
weigh less because water has been The following examples illustrate
lost in the cooking process. However, the effect that cooking has on pasta,
if that same potato were boiled it potatoes and rice.
would weigh more because it will
have absorbed water during the
cooking process.
Example 1: Pasta
Each of these plates of pasta contains the same amount of carbohydrate

(55g). The difference in the volume of pasta on each plate is due to the
amount of water absorbed during the cooking pr ocess.
36 Carbs count
Example 2: Potatoes
Each of these plates of potatoes contains the same amount of carbohydrate

(55 grams). The difference in the volume of potato on each plate is due to
the amount of water absorbed or lost during the cooking pr ocess.
Carbs count 37
Example 3: Rice
Each of these plates of rice contains the same amount of carbohydrate

(40g). The difference in the volume of rice on each plate is due to the
amount of water absorbed during the cooking pr ocess.
How do I start to calculate 3. Scales, cups and spoons – it is

the amount of carbohydrate worthwhile investing in a good
in a food? set of scales that are flat based,
digital and that can be zer oed.
Carbohydrates can be counted in It is also important that your
two ways, in grams or as carbohydrate scales are accurate to within 5g.
portions. One carbohydrate portion There are some scales available
(written as CP) is equal to 10g of that can help you to work out
carbohydrate. the carbohydrate content of
foods. These are fine to use but
There are various tools that can make sure they specifically use
help you work out how much British food.
carbohydrate you are eating –
these are: 4. Reference books, eg calorie
counters.
1. Carbohydrate reference lists
(provided with this book). 5. Restaurant websites.
2. Food labels. 6. Food photographs.
38 Carbs count
7. Further information provided by If you round each individual food

your healthcare team. it will not be as accurate. Most
of the time, deciding if the figur e
To start with, weighing food and should be rounded up or down
using household measuring cups will be relatively straight forward.
or measuring spoons will help you Sometimes it might be more difficult
to get an idea of your own typical to know what to do, so use the
serving sizes. As time passes and table below to help you decide
your experience grows you will whether to round up or down.
become more familiar with the
amount of carbohydrate in the Using carbohydrate
food and meals you typically eat reference lists
– and even those you eat out.
Some people find it helpful to The carbohydrate reference list
make a note or list of their usual provided with this book gives you
meals for future reference. some of the most commonly eaten
You can add these to the space carbohydrate-containing food
provided at the back of your and drink, along with their
carbohydrate reference list. carbohydrate content in both
grams and CPs. Each food is listed
Rounding up and down in a number of handy measur es,
such as, a slice of br ead, a piece
After measuring the carbohydrate of cake or a cup of cer eal, but it is
accurately, sometimes you will need important to realise that everyone’s
to round the figure up or down. typical serving can vary, so you
Make sure you only round your need to ensure that you consider
calculations once you have worked this when estimating how much
out the total amount of carbohydrate carbohydrate you are eating.
for the whole meal.
Grams
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9
Round Round
down up
Round Round
Round to 1/2 CP
down up
0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9
CPs
Carbs count 39
IMPORTANT: Rounding up and down. In the following examples you

may find that, when working out how many units of insulin to give, we
have given the option to r ound both up and down when the value is
0.5 of a unit, eg r ounding 8.5 down to 8 or up to 9. This is because,
when working out how much insulin to give, you need to consider a
few things such as, what your curr ent blood glucose levels are, whether
you have been or are planning to be physically active that day or whether
you are or will be drinking alcohol. Thinking about these things will help
you decide how many units of insulin to give yourself.
IMPORTANT: Which method

are you using?
Method 1 works in carbohydrate
portions (CPs). Follow the
green boxes
Method 2 works in grams of

carbohydrate (g). Follow the
blue boxes
Example 4: Using a carbohydrate reference list
Jane has chosen to have a bagel

with jam, and a medium banana,
with a large mug of tea with milk
for her breakfast.
40 Carbs count
Method 1: Carbohydrate portions

Jane works out, using the carbohydrate r eference list, that she will
be eating 8.5 CPs. She came to this conclusion because:
Bagel = 4 CP
2 heaped teaspoons of jam = 2 CP
Medium banana = 2.5 CP
Milk in tea has a negligible amount = 0 CP
of carbohydrate
Total = 8.5 CP
Jane has an insulin to carbohydrate ratio 8.5 x 1 = 8.5 units
of 1 unit of insulin for each CP.
This is rounded to the nearest
whole number. = 8 or 9 units
Jane works out that she will need to give herself
8 or 9 units of bolus insulin.
Method 2: Carbohydrate in grams

Jane works out using the carbohydrate r eference list that she will
be eating 85g of carbohydrate. She came to this conclusion because:
Bagel = 40g
2 heaped teaspoons of jam = 22g
Medium banana = 23g
Milk in tea has a negligible amount
of carbohydrate = 0g
Total = 85 g
Jane has insulin to carbohydrate ratio 85 = 8.5 units
of 1 unit of insulin for every 10g 10
of carbohydrate.
Jane works out that she will need to give herself
Carbs count 41
IMPORTANT: Different methods may give different results. Different

methods of carbohydrate counting can give dif ferent units of insulin. Make
sure you stick with one method and do not alternate between the two.
Osa has a 30g serving of Crunchy

nut cornflakes with 100ml milk.

Using the carbohydrate reference list, Osa works out that he will be
eating 3 CPs. He came to this conclusion because:
30g Crunchy nut cornflakes = 2.5 CP
100ml milk = 0.5 CP
Total = 3 CP
Osa has an insulin to carbohydrate ratio
of 1.5 units of insulin for each CP. 3 x 1.5 = 4.5 units
Osa works out that he will need to give himself
42 Carbs count

Using the carbohydrate reference list, Osa works out that he will be
eating 43g of carbohydrate. He came to this conclusion because:
30g Crunchy nut cornflakes = 24g
100ml of milk = 5g
Total = 29g
Osa has an insulin to carbohydrate ratio 29 = 3.9 units
of 1 unit of insulin to every 7.5g 7.5
of carbohydrate.
whole number. = 4 units
Osa works out that he will need to give himself
4 units of bolus insulin.
Bob gets a traditional cooked br eakfast with

a strong black coffee at his local café on his
way in to work. He has a fried egg, 1 rasher
of bacon, a grilled tomato, mushr ooms and
a slice of black pudding.
Carbs count 43
Working out the carbohydrate content

By looking at his plate, Bob works out which foods contain carbohydrate.
Eggs x
Bacon x
Tomato
Mushrooms x
Black pudding x
Coffee x
By referring to Chapter 2, Bob discovers that although tomatoes contain
some carbohydrate, it is a slowly absorbed carbohydrate and does not
need to be matched to any insulin.
Bob does not inject any insulin for this meal.
Shazia has chosen to fast for Ramadan.

She gets up very early to have
breakfast before sunrise. She has
leftovers from last nights meal, 1 large
chapatti, with a heaped teaspoon of
mango chutney and a pot of low fat
natural yogurt. She also has a cup of
chai made with half a cup of milk.
44 Carbs count

Using the carbohydrate reference list, Shazia works out that she will
be having 6CPs. She came to this conclusion because:
1 large chapatti = 3.5 CP
1 heaped teaspoon mango chutney = 1 CP
1 pot low fat natural yogurt = 1 CP
100ml milk = 0.5 CP
Total = 6 CP
Shazia has an insulin to carbohydrate 6 x 2 = 12 units
ratio of 2 units of insulin for every CP.
Shazia works out that she will need to give herself

Using the carbohydrate reference list, Shazia works out that she will be
having 56g carbohydrate. She came to this conclusion because:
1 large chapatti = 33g
1 heaped teaspoon mango chutney = 9g
1 pot low fat natural yogurt = 9g
100ml of milk = 5g
Total = 56g
Shazia has an insulin to carbohydrate 56 = 11.2 units
ratio of 1 unit for every 5g 5
of carbohydrate.

Shazia works out that she will need to give herself
Carbs count 45
Now you try 1

Albert has his porridge with a heaped dessert
spoon of honey every morning after having
bought his daily newspaper.
His porridge comprises of half a cup of raw
oats, 100ml of milk and a dessert spoon of
honey, with a 200ml glass of orange juice.

Looking at the carbohydrate reference list, calculate the number of CPs
Albert is having.
Half a cup (45g) of raw oats = CP
100ml of milk = CP
1 dessert spoon of honey = CP
200ml orange juice = CP
Total = CP
Albert has an insulin to carbohydrate ratio
How much bolus insulin does he need? = units
Answers on page 80
46 Carbs count
Now you try 1 (continued)

Looking at the carbohydrate reference list, calculate the amount of
carbohydrate Albert is having in grams.
Half a cup (45g) of raw oats = g
100ml of milk = g
1 dessert spoon of honey = g
200ml orange juice = g
Total = g
of 1 unit of insulin for every 10g of
carbohydrate.
Answers on page 80
Using food labels carbohydrate you are planning to eat

and drink. You need to:
Using food labels is another good
way of finding out the carbohydrate • Find the serving size and the grams
content of food and drink. of total carbohydrate per serving
size.
Over the years food labels have
become a lot more comprehensive • Decide how many servings you ar e
and clear. Most food labels include having.
nutrition information like energy,
• Work out the number of servings
fat, protein, carbohydrate and salt
you are eating multiplied (x) by
or sodium.
grams of carbohydrate per serving.
Food labels contain information to This is the total amount of
help you work out the amount of carbohydrate you will be eating.
Carbs count 47
Or 27 = 2.7 rounded down to 2.5 CP

10
• Calculate how much you will be
eating by weighing the food or 32
drink. = 3.2 rounded down to 3 CP
10
• Using the per 100g value for
carbohydrate calculate the amount
of carbohydrate you will have. For
Whereas, if you convert them in to
example, if you know the food
CPs after adding them together and
contains 20g carbohydrate per
then round up or down, you will get
100g and you plan to eat 50g
a more accurate figure for example:
50
20 x = 10g carbohydrate
100 59 = 5.9 rounded up to 6 CP
If you work in CP’s, you will need 10
27g + 32g = 59g.
to convert the number of grams
of carbohydrate by dividing by 10.
Only do this after adding together
all the amount of carbohydrate in There are some additional points
each food you are eating, so that to consider when using food labels
you keep the figures as accurate to work out the amount of
as possible. carbohydrate you are eating and
drinking:
For example, if you convert both
27g of carbohydrate and 32g of • The amount of carbohydrate
carbohydrate into CPs before adding you should count is the ‘Total
them together, you would get: carbohydrate’ rather than the
Crunchy nut cornflakes (Example of a food label)
Nutritional Information
Typical values Per 100g Per 56g serving
Energy Kcal/KJ 397/ 1681 222/ 941
Protein (g) 6 3
Carbohydrate (g) 82 46
of which sugars (g) 35 20
Fat (g) 5 2.8
of which saturates (g) 0.9 0.5
Fibre (g) 2.5 1.4
Sodium (g) 0.45 0.25
48 Carbs count
‘of which sugars’ (see label). Is it a food that contains a lot of

very slowly digested carbohydrates,
• It is often useful to note whether such as beans or tomatoes?
the label shows the amount of Ordinarily you would not consider
carbohydrate in the raw or cooked these foods for carbohydrate
product, especially with foods counting as they are absorbed very
containing pasta or rice. If both slowly into the blood stream, but
are specified, the raw figures tend the label will count them. You can
to be the most accurate. get a sense for how much of these
• Check that you agree with the ingredients are in the product by
amount of carbohydrate stated on looking at the ingredients list.
the label. Occasionally errors can The ingredients are listed from
be made so a visual cr oss reference most to least. So if tomatoes or
is usually a good idea. pulses are listed towards the top
of the list, it may mean that the
• Consider what ingredients make product contains a large amount
up the product you are looking at. of these ingredients. In these
situations use your own experiences
to judge what proportion of the
carbohydrate on the label you
match to bolus insulin.
• If the product contains a nutritive
sweetener, like a polyol,
(see Chapter 2) you may need to
counta smaller amount of carbohydrate
than stated on the label. This will
vary from person to person.
Carbs count 49
Example 8: Using food labels
Jane goes out from work

to buy a pasta salad and
yogurt from the shop
around the corner.
Chicken pasta salad
Typical values Per 100g Per half pack
Energy Kcal 271/1085 190/760
Protein (g) 15.8 11.1
Carbohydrate (g) 20.4 28.6
of which sugars (g) 7 4.9
Fat (g) 5 3.5
Fibre (g) 5.1 3.6
Sodium (g) 0.4 0.28

The label tells Jane that half a pack contains 28.6g of carbohydrate.
Jane eats a whole pack. To calculate the amount of carbohydrate she
has eaten, she multiplies 28.6g by 2 = 57.2g.
50 Carbs count
Creamy raspberry yogurt (125g)
Typical values Per 100g Per pot
Energy Kcal 106/424 133/530
Protein (g) 3.9 4.9
of which sugars (g) 14.6 18.3
Fat (g) 2.7 3.4
Fibre (g) 0.6 0.75
Sodium (g) 0.07 0.09

The label tells Jane that for each pot of yogurt, she is eating
20.5g of carbohydrate.

To find out the total amount of carbohydrate in her meal, she needs
to add up the amount of carbohydrate fr om each item.
Chicken pasta salad = 57.2g
Creamy raspberry yogurt = 20.5g
Total amount of carbohydrate = 77.7g rounded to 78g
Now it is time to convert into CPs.
To work out how many CPs, 78 = 7.8 CP
divide by 10. 10
rounded to 8CP
Jane has an insulin to carbohydrate ratio 8 x 1 = 8 units
Jane works out that she needs to give herself

Carbs count 51

To find out the total amount of carbohydrate in her meal, she needs
Vegetable pasta salad = 57.2g
Creamy raspberry yogurt = 20.5g

Jane has an insulin to carbohydrate ratio 78 = 7.8 units
of carbohydrate.
This is rounded to the nearest = 8 units
whole number.
This means that Jane needs to give herself
Osa goes back to his halls of residence for

a mini pizza, a packet of microwave chips
and a 200g tin of spaghetti hoops, with a
can of diet coke.
52 Carbs count
Mini pizza (170g)
Typical values Per 100g Per pizza
Energy Kcal 267 / 1068 45 / 1816
Protein (g) 11 18.7
Fat (g) 11.3 19.2
of which saturates (g) 5.3 9
Fibre (g) 1.5 2.6
Sodium (g) 0.5 0.9

The label tells Osa that each mini pizza contains 51.3g of carbohydrate.
Microwave chips (105g)
Typical values Per 100g Per pack
Energy Kcal/KJ 156 / 656 164 / 689
Protein (g) 2.3 2.4
Fat (g) 4.5 4.7
Fibre (g) 2 2
Sodium (g) 0.08 0.08

The label tells Osa that each pack of micr ochips contains 27.7g
of carbohydrate.
Carbs count 53
Tinned spaghetti hoops ( 200g)

Typical values Per 100g Per serving
Energy Kcal/KJ 64 / 273 128 / 546
Protein (g) 1.9 3.8
of which sugars (g) 5.5 11
Fat (g) 0.4 0.8
Fibre (g) 0.7 1.4
Sodium (g) 0.42 0.84

The label tells Osa there is 28.2g of carbohydrate in the tinned
spaghetti hoops.
Diet coke ( 330ml can)

Typical values Per 100g Per can
Energy Kcal 0.4 / 1.6 1.3 / 5.3
Protein (g) 0 0
Carbohydrate (g) 0 0
Fat (g) 0 0
of which saturates (g) 0 0
Fibre (g) 0 0.13
Sodium (g) 0.04

The label tells Osa that his diet Cola contains no carbohydrate and
so will not need to be matched to any insulin.
54 Carbs count

To find out the total amount of carbohydrate in his meal, he needs to add
up the amount of carbohydrate from each item.
Mini pizza = 51.3g
Microwave chips = 27.7g
Spaghetti hoops = 28.2g
Diet coke = 0g

divide by 10. 10
This is rounded to the nearest 1/2 CP 10.5 CP
whole number.
Osa has an insulin to carbohydrate ratio 10.5 x 1.5 = 16 units
of 1.5 units of insulin for each CP.
Osa works out that he needs to give himself 16 units of bolus insulin.

To find out the total amount of carbohydrate in his meal, he needs to add up
the amount of carbohydrate from each item.
Mini pizza = 51.3g
Microwave chips = 27.2g
Spaghetti hoops = 28.2g
Diet coke = 0g

Osa has an insulin to carbohydrate ratio 107 =14.3 units
of 1 unit of insulin for every 7.5g 7.5
of carbohydrate.

whole number.
Osa works out that he needs to give himself 14 units of bolus insulin.
Carbs count 55

Bob has managed to find time to
pick up a large cornish pasty and a
danish pastry all washed down with
a carton of orange juice.
Cornish pasty (260g)
Typical values Per 100g
Energy Kcal/KJ 255/ 1066
Protein (g) 6.2
Carbohydrate (g) 21.6
of which sugars (g) 1.3
Fat (g) 15.5
of which saturates (g) 7.5
Fibre (g) 1.9
Sodium (g) 0.5

The label above tells Bob that the pasty contains 56g of carbohydrate.
260 = 56g
21.6 x
100
56 Carbs count
Danish pastry (71g)
Typical values Per 100g Per pastry
Energy Kcal/KJ 368/ 1540 263/ 1100
Protein (g) 5.3 3.8
Fat (g) 18.3 13.1
Fibre (g) 1.8 1.3
Sodium (g) 0.35 0.25

The label above tells Bob that the pastry contains 33.4g of carbohydrate.
Orange juice (200ml carton)
Typical values Per 100g Per 200ml carton
Energy Kcal/KJ 36/ 153 72/ 306
Protein (g) 0.5 1
Fat (g) 0.1 0.2
Fibre (g) 0.1 0.2
Sodium (g) 0.01 0.02

The label above tells Bob that a carton of orange juice contains 17.6g
of carbohydrate.
Carbs count 57

To find out the total amount of carbohydrate in his meal, he needs
Cornish pasty = 56g
Danish pastry = 33.4g
Fruit Juice = 17.6g
Total amount of carbohydrate = 107g

divide by 10. 10
This is rounded to the nearest whole 10.5
number.
Bob has a an insulin to carbohydrate of
2 units of insulin for each CP. 10.5 x 2 = 21 units
Bob works out that he needs to give himself

58 Carbs count

To find out the total amount of carbohydrate in his meal, he needs
Cornish pasty = 56g
Danish pastry = 33.4g
Fruit juice = 17.6g

Osa has an insulin to carbohydrate ratio 107 = 21.4 units
of carbohydrate.

whole number.
Example 11: Missing lunch

Shazia is fasting for Ramadan
and is not eating during daylight
hours.
As Shazia has not eaten anything
for lunch, she does not need to
give herself any bolus insulin .
Carbs count 59
Now you try 2
Albert has got back from walking his W estie

dog, and has warmed up a tin of whole oxtail
soup and buttered a wholegrain roll followed
by an Eccles cake and a black cof fee.
Firstly, find out how much carbohydrate is in each
part of Albert’s meal
Oxtail soup (400g)

Energy Kcal/KJ 1.6/ 158
Protein (g) 1.6g
Carbohydrate (g) 6.6g
of which sugars (g) 1.7g
Fat (g) 0.5g
of which saturates (g) 0.2g
Fibre (g) 0.3g
Sodium (g) 0.3g
Salt (g) 0.7
60 Carbs count
Wholegrain roll (56g)

Typical values Per 100g Per 56g roll
Energy Kcal/KJ 235/ 999 132/ 559
Protein (g) 9.3 5.2
Fat (g) 2.7 1.5
Fibre (g) 4.3 2.4
Sodium (g) 0.58 0.32
Carbs count 61
Now you try 2 (continued)
Eccles cake (45g)

Typical values Per 100g Per serving
Energy Kcal/KJ 365/ 1535 382/ 1381
Protein (g) 2.8 2.5
Fat (g) 16.6 15
Fibre (g) 1.6 1.44
Sodium (g) 0.3 0.27
62 Carbs count
Now work out how much bolus insulin Albert needs to give himself.

1 tin oxtail soup = g
1 wholegrain roll = g
Eccles cake = g
Black coffee = g
Total = g
Convert into CPs = CP
How much bolus insulin will Albert = units
need?

1 tin oxtail soup = g
1 wholegrain roll = g
Eccles cake = g
Black coffee = g
Total = g
Albert has an insulin to carbohydrate
of 1 unit of insulin for every 7.5g of
carbohydrate.
Answers on page 81
Carbs count 63
Using a combination of food labels and carbohydrate lists

Sometimes, you will need to use a combination of methods to work out the
amount of carbohydrate you are eating and drinking.
Example 12: Using carbohydrate reference

lists and food labels
Jane has got home from work late and
wants to make something quick for
dinner. She decides to make a stir fry
with steak and a black bean sauce, with
a jacket potato.
When working out her carbohydrate
portions, she divides the foods into those
that are counted and those that are not.
Foods counted: Baked potato, black bean sauce

Foods not counted: Vegetables, steak

Jane weighs her raw potato. It weighs 237g. Using the carbohydrate
reference list, Jane can see that 100g contains 1.5CP. Jane works out
how many CPs are in 1g of potato
1.5 CP = 0.015 CP
100
Her potato weighs 237g, so she multiplies this by 237.
0.015 x 237 = 3.55 CP rounded to 3.5 CP

Jane weighs her raw potato. It weighs 237g. Using the carbohydrate
reference list, Jane can see that 100g contains 17g of carbohydrate. Jane
works out how much carbohydrate is in 1g of potato 17 = 0.17g
100
Her potato weighs 237g, so she multiplies
this by 237. 0.17 x 237 = 40.3g
64 Carbs count
Black bean sauce (120g)
Typical values Per 100g Per 60g serving
Energy Kcal/KJ 89/373 53.4/224
Protein (g) 2.8 1.7
Fat (g) 2.0 1.2
Fibre (g) 1.5 0.9
Sodium (g) 1.8 1.1

Jane looks at the label on the bottle of black bean sauce which shows
that there is 8.9g of carbohydrate in half the jar.

Now add up the total number of CPs.
Black bean sauce = 8.9g
Now convert into CPs 8.9 = 0.89 CPs
10
Rounded to the nearest whole number = 1 CP
Potato = 3.5 CP
Total amount of carbohydrate = 4.5 CP

Jane has an insulin to carbohydrate ratio 4.5 x1 = 4.5 units
Carbs count 65

Now add up the total amount of carbohydrate.
Potato = 40.3g
Black bean sauce = 8.9g

Jane has an insulin to carbohydrate ratio 49 = 4.9 units
of 1unit of insulin for every 10g of 10
carbohydrate.
Example 13: Using food labels and the

carbohydrate reference list
Bob has taken a ready meal out of the
freezer. He has a shepherd's pie and heats up
a large tin of baked beans and serves it with
some instant gravy.
When calculating his carbohydrate portions,
Bob identifies those foods that are counted
for carbohydrate counting and those that
are not.
Foods counted: Ready made Shepherd's pie, baked beans

Foods not counted: Gravy
66 Carbs count
Shepherd's pie (400g)

Typical values Per 100g Per 400g
serving
Energy Kcal/KJ 85 / 357 340 / 1428
Protein (g) 4.5 18
Carbohydrate (g) 11.5 46
Fat (g) 2.3 9.2
Fibre (g) 1.2 4.8
Sodium (g) 0.2 0.8

The label tells Bob that ther e is 46g of carbohydrate in his
ready meal.
Baked beans (large tin)

Using the carbohydrate reference list, Bob works out that a large
tin of baked beans has 3 CPs.

Using the carbohydrate reference list, Bob works out that a large
tin of baked beans has 29g of carbohydrate.
Carbs count 67
Method 1:Carbohydrate portions

To find out the total amount of carbohydrate in his meal, Bob needs to
add up the amount of carbohydrate fr om each item.
Shepherds pie = 46g
Now convert this into CP 46 = 4.6 CP
10
Round to the nearest 1/2 CP = 4.5 CP
Baked beans = 3 CP
Total amount of carbohydrate = 7.5 CP
Bob has an insulin to carbohydrate ratio 7.5 x 2 = 15 units
of 2 units of insulin for each CP.


To find out the total amount of carbohydrate in his meal, Bob needs
to add up the amount of carbohydrate in each item.
Shepherds pie = 46g
Baked beans = 29g

Jane has an insulin to carbohydrate ratio 75 =15 units
of carbohydrate.
68 Carbs count
Note: When comparing the amount of carbohydrate in baked beans

from the carbohydrate reference list and the amount stated on the
food label, you may notice that the figur es are quite different. This is
because baked beans and other pulses ar e slow acting carbohydrates
and so are absorbed very slowly. This means that they may not need
to be matched with insulin. This has been taken into account in the
carbohydrate reference list, whereas the food label will give the
amount including the beans.
Example 14: Using recipes, food labels and

the carbohydrate reference list
Shazia has Iftari (Sunset meal). She has
4 dates and water to br eak the fast.
Afterwards she has a meal of a r oti, dhal,
lamb curry and a shop bought samosa.
Dates (375g)
Energy Kcal/KJ 305/1293
Protein (g) 2.1
Fat (g) 1.0
Fibre (g) 8.2
Sodium (g) < 0.1
Shazia weighs her 4 dates and now knows they weigh 60g.
Carbs count 69

The label tells Shazia that 100g of dried dates has 71.8g of carbohydrate.
Shazia works out how much carbohydrate is in 1g.
71.8 = 0.718g
100
She eats 60g of dates, so she multiplies by 60
0.718 x 60 = 43g
To make 6 Roti, Shazia’s mum uses:

• 425g chappati flour
• 1 cup water at room temperature
• ghee for brushing the bread
Shazia highlights those ingredients that contain carbohydrate.
Foods counted: Chappati flour

Foods not counted: Water and ghee
Chapatti flour (1kg)
Energy Kcal/KJ 335 / 1426
Protein (g) 9.8
Fat (g) 0.5
Fibre (g) 0
Sodium (g) 0.15
70 Carbs count

The label tells Shazia that 100g of flour provides 77.6g of carbohydrate.
From this Shazia works out how much carbohydrate is in 1g
77.6 = 0.776g
100
To find out how much is in 425g she multiplies by 425.
0.776 x 425 = 330g

This recipe makes 6 Roti’s of which Shazia has only one.
330g = 55g
6
To make the dhal, Shazia’s mum uses a recipe which serves four people:
our
Dahl recipe for f
ned
Puy lentils, drai
400g/14oz canned
1/2 tsp turmeric
ice
1/2 tsp mixed sp
eds
1/2 tsp cumin se
r seeds
1/2 tsp coriande
wder
1/2 tsp curry po
nt, chopped
30g/1oz fresh mi
g/1oz fresh coriander, chopped
30
er
ground black pepp
salt and freshly
Juice of 1 lemon
yogurt
140g/5oz Greek
Carbs count 71
Shazia highlights the ingredients she needs to count.
Foods counted: Greek yogurt

Foods not counted: Puy lentils, turmeric, mixed spice, cumin seeds,
coriander seeds, curry powder, fresh mint, fresh coriander, black
pepper and lemon.
Greek yogurt (450g)
Typical values Per 100g Per 1/2 pot
Energy Kcal/KJ 131/ 548 295 / 1233
Protein (g) 5.5 12.4
Fat (g) 10 23
Fibre (g) 0.1 0.2
Sodium (g) 0.12 0.27

The label tells Shazia that 100g of Gr eek yogurt has 4.6g of
carbohydrate. She works out how much carbohydrate is in 1g.
4.6 = 0.046g
100
The recipe uses 140g, so she multiplies it by 140.
0.046 x 140 = 6.44g r ounded to 6g
Shazia eats 1/4 of the dahl made.

6 = 1.5g
4
This is such a small amount of carbohydrate that it will not need
to be matched by any insulin.
72 Carbs count
To make the Lamb curry Shazia’s mum uses the following ingr edients to
serve four people:
our
Lamb curry for f
600g lamb
garlic
ginger
2 tsp salt.
ric)
1 tsp haldi (turme
la
3 tsp garam masa
ander
2 tsp ground cori
min
2 tsp ground cu
natural yogurt
1/2 pot low fat
er
1 tsp chilli powd
2 onions
matoes
3/4 tin plum to
Shazia highlights those ingredients she needs to count.
Foods counted: Natural yogurt

Foods not counted: Lamb, garlic, ginger, salt, haldi, garam masala,
coriander, cumin, chilli powder, onions, plum tomatoes
Carbs count 73

Using the carbohydrate reference list, Shazia works out that 1 pot
of low fat natural yogurt contains 1CP.
Only half a pot of yogurt is used in this r ecipe, so Shazia knows that
is will provide 0.5 CP.
Shazia eats 1/4 of the curry made.
0.5 = 0.1 CP
4

to be matched to any insulin.

Using the carbohydrate reference list, Shazia works out that 1 pot
of low fat natural yogurt contains 9g of carbohydrate.
Only half a pot of yogurt is used in this r ecipe, so Shazia knows that
is will provide half of 4.5g.
9 = 4.5g
2
Shazia eats 1/4 of the curry made.
4.5 = 1.1 g
4
to be matched to any insulin.
74 Carbs count
Vegetable samosa (450g)
Typical values Per 100g Per samosa

Energy Kcal/KJ 222/ 930 112/ 468
Protein (g) 4 2
Fat (g) 12.5 6.3
Fibre (g) 1.2 0.6
Sodium (g) 0.3 0.2

The label tells Shazia that each samosa has 11.8g of carbohydrate.
Carbs count 75

To find out the total amount of carbohydrate in her meal, Shazia needs
Dates = 43g
Roti = 55g
Vegetable samosa = 11.8g
Total amount of carbohydrate = 109.8 g rounded

to 110g
To work out how many CPs, 110 = 11 CP
divide by 10. 10
Shazia has an insulin to carbohydrate ratio 11 x 2.5 = 27.5 units
Shazia works out that she needs to give herself


To find out the total amount of carbohydrate in her meal Shazia adds
up the amount of carbohydrate in each item of food.
Dates = 43g
Roti = 55g
Vegetable samosa = 11.8g
Total amount of carbohydrate = 109.8g rounded

to 110g
Shazia has an insulin to carbohydrate 110 = 27.5 units
ratio of 1 unit of insulin for every 4g of 4
carbohydrate.
Shazia works out that she needs to give herself
76 Carbs count
Now you try 3
Using recipes, food labels and the carbohydrate

reference list
Albert has taken some pork chops out of the

freezer, which he will grill and serve with a
jacket potato and mashed swede and carrot
served with apple sauce. Albert is quite partial
to a pudding a couple of times a week, so he
has two pancakes with a tablespoon of honey .
For his main meal he uses:
Pork chops
1 pork chop
et potato
1 (360g raw) jack
ine
1 knob of margar
1 carrot
1/4 small swede
ml apple
1 tablespoon/ 15
sauce
100ml gravy
Carbs count 77
Now you try 3
Apple sauce
Typical values Per 100g Per 15ml
serving
Energy Kcal/KJ 107 / 488 16/ 73
Protein (g) 0.2 Tr
Carbohydrate (g) 26.5 4
Fat (g) Tr 0
of which saturates (g) Tr 0
Fibre (g) 1.3 0.2
Sodium (g) 0.1 Tr
For his pudding he uses the r ecipe below, which is enough to make six
pancakes:
Pancakes for six

milk
1/2 pint/ 285ml
g flour
2 tablespoons/ 60
1 egg
blespoon /
Topped with 1 ta
15ml
of honey
78 Carbs count
Follow these steps:

1. Divide the foods into those that are counted and those that are not.
2. Calculate the carbohydrate content of each element that is counted.
3. Calculate the total amount of carbohydrate in Albert’ s meal.
4. Albert has a ratio of: 2 units of insulin for each CP or 1 unit of
insulin for every 5g of carbohydrate. How many units of bolus
insulin will Albert need to give himself?
Answers on page 82–87
Honey (250ml jar)
Typical values Per 100g Per 15ml
serving
Energy Kcal/KJ 359/ 1442 54/ 216
Protein (g) 0.1 <0.1
Fat (g) Tr 0
of which saturates (g) Tr 0
Fibre (g) 0.3 <0.1
Sodium (g) Tr 0
Summary
• There are many ways of estimating carbohydrate, including
carbohydrate reference lists, food labels and calculating recipes.
• The amount of carbohydrate in foods does not change during
cooking.
• Work out the carbohydrate content of the whole meal before
rounding figures up or down.
• Different methods of carbohydrate counting (using CPs or
grams) can result in different units of insulin given. Make
sure you stick with one method and do not alter nate
between the two.
Carbs count 79
Answers
Now you try 1: pages 46–47

To find out the total amount of carbohydrate in his meal, Albert needs
Half a cup (45g) of raw oats = 3 CP
100ml of milk = 0.5 CP
1 dessert spoon of honey = 1.5 CP
200ml orange juice = 2 CP
Total = 7 CP
Albert has an insulin to carbohydrate ratio 7 x 1 = 7 units
Albert works out that he needs to give himself
Method 2: Carbohydrate in grams:

Half a cup (45g) of raw oats = 30g
100ml of milk = 5g
1 dessert spoon of honey = 14g
200ml orange juice = 22g
Total = 71 g
He has an insulin to carbohydrate ratio 71 = 7.1 units
of carbohydrate.
80 Carbs count
Answers

1 tin oxtail soup = 26.4g
Wholegrain roll = 25.9g
Eccles cake = 23.2g
Black coffee = 0g
Total amount of carbohydrate = 75.5g
To work out how many CPs, 75.5 = 7.55 CP
divide by 10. 10
rounded to 7.5 CP
Albert has an insulin to carbohydrate ratio 7.5 x 1.5 = 11.25 units

1 tin oxtail soup = 26.4g
Wholegrain roll = 25.9g
Eccles cake = 23.2g
Black coffee = 0g
Albert has an insulin to carbohydrate ratio 75.5 = 10.06 units
of 1unit of insulin for every 7.5g of 7.5
carbohydrate.
Carbs count 81
Answers
1. Divide the foods into those that are counted and those that are not.
Foods counted: jacket potato, apple sauce, milk, flour, honey

Foods not counted: pork chop, margarine, carrot, swede, gravy, egg
2. Calculate the carbohydrate content of each element that is counted.

Jacket potato
Note: This is a good example of when it is important to be car eful

when working out the carbohydrate content of foods that change
their weight significantly during the cooking pr ocess.

Albert weighs his potato once it has been cooked and it weighs 180g.
By looking at the carbohydrate r eference list he can see that this has
5.5 CPs.
Albert could also have worked this out by finding out how much
carbohydrate his raw potato contained, which weighed 360g. The
carbohydrate reference list shows that 100g raw potato has 1.5 CP .
He works out how much carbohydrate is in 1g.
1.5 = 0.015 CP
100
His potato weighed 360g so he multiplies by 360.
0.015 x 360 = 5.5 CPs
82 Carbs count

Albert weighs his potato once it has been cooked and it weighs 180g.
By looking at the carbohydrate r eference list he can see that this has
57g carbohydrate.
Albert could also have worked this out by finding out how much
carbohydrate his raw potato contained, which weighed 360g. The
carbohydrate reference list shows that 100g raw potato has 17g of
carbohydrate.
He works out how much carbohydrate is in 1g
17 = 0.17g
100
His potato weighed 360g so he multiplies by 360.

0.17 x 360 = 61.2g
This figure is rounded to 61g
Apple sauce (250ml jar)

The label tells Albert that a 15ml serving of apple sauce has 4g
of carbohydrate.
Milk

The carbohydrate reference list shows that 100ml milk has 0.5 CP.
This recipe uses 285ml of milk. Albert works out how much
carbohydrate is in 1g.
0.5 = 0.005 CPs
100
To find out how much is in 285ml, multiply by 285.
0.005 x 285 = 1.43 CP rounded to 1.5 CP
Carbs count 83
Answers
Now you try 3 (continued): pages 77–79

The carbohydrate reference list shows that 100ml milk has 5g
carbohydrate. Albert works out how much carbohydrate is in 1g.
5 = 0.05g
100
This recipe uses 285ml milk.
So he multiplies by 285 0.05 x 285 = 14.3g
Flour

The carbohydrate reference list shows that 1 tablespoon or 30g of
flour is 2 CP. Therefore 2 tablespoons or 60g of flour will have
twice this amount 2 x 2 = 4CP

The carbohydrate reference list shows that 1 tablespoon or 30g of
flour has 20g of carbohydrate. Ther efore 2 tablespoons or 60g
of flour will have twice this amount 20g x 2 =40g
84 Carbs count
Answers
The total amount of carbohydrate in the pancake mix is as follows:
Milk = 1.45CP
Flour = 4 CP
Total = 5.5 CP
This recipe makes 6 pancakes. 5.5 = 1.83 CP
Albert eats 2 pancakes. 3
Rounded to the nearest whole number. = 1.8 CP

The total amount of carbohydrate in the pancake mix is as follows:
Milk = 14.3g
Flour = 40g
Total = 54.3g
This recipe makes 6 pancakes. 54.3 = 18.1g
Albert eats 2 pancakes. 3
Honey (250ml jar)

The label shows there is 12.7g of carbohydrate in 15ml of honey.
Carbs count 85
Answers
Now you try 3 (continued): pages 77–79
3. Calculate the total amount of carbohydrate in Albert’s meal.

To work out the total amount of carbohydrate in the whole of Albert’ s
meal, start by adding up the carbohydrate in grams.
Apple sauce = 4g
Honey = 12.7g

To work out how many CPs,
divide by 10. 16.7 = 1.67 CP
10
rounded to 1.7 CP
Now move on to adding up the CPs
Jacket potato = 5.5 CP
Pancakes = 1.8 CP
Apple sauce and honey = 1.7 CP
Total = 9 CP
Albert has a carbohydrate to insulin ratio 9 x 2 = 18 units
of 2 units of insulin for each CP.
This means that Albert needs to give himself
86 Carbs count

The total amount of carbohydrate in Albert’s meal is as follows:
Jacket potato = 61g
Apple sauce = 4g
Pancakes = 18.1g
Honey = 12.7g

Albert has an insulin to carbohydrate ratio 96 = 19.2 units
of 1unit of insulin for every 5g of 5
carbohydrate.
This means that Albert needs to give himself
IMPORTANT: Different methods may give different results.

Different methods of carbohydrate counting can give dif ferent
units of insulin. Make sure you stick with one method and do not
alternate between the two.
Carbs count 87
Chapter 5:
Eating out, takeaways
and snacks
When eating out it may be more dif ficult to judge how much
carbohydrate you are going to eat at a particular meal.
This chapter covers the following:

• Things to think about when you ar e eating out
• Insulin and snacks
Things to think about when • You won’t have all the tools you
you are eating out use to accurately estimate the
carbohydrate content of foods,
When going out to a r estaurant,
especially if you need to weigh
you may not be planning on having
any of them.
a pudding when you start, but
Carbohydrate reference lists and
sometimes they just look too good.
books will help. They list the
It is not just tempting puddings and amount of carbohydrate in handy
extra carbohydrates at the end of a measures, such as a bread roll
meal that can make it dif ficult to or a scoop of mashed potato.
control your blood glucose levels And some contain pictures for
when eating out. The following comparing too. Remember,
should be considered too: to keep your own notes on
your typical portion sizes and
carbohydrate values.
88 Carbs count
• You might not know exactly what • You may choose foods that ar e
ingredients were used to make higher in fat than usual. Fat
up your meal. This makes it mor e slows down the absorption of
difficult to know what parts of carbohydrate. This can mean that
your meal you need to match when you give your bolus insulin,
with insulin. Roast dinner may it might have finished working
be easy to calculate, but if you before all your carbohydrate has
are trying something with lots been absorbed.
of hidden ingredients, it may One way of dealing with this is
be more difficult. to split your dose of insulin. For
Ask restaurant staff to let you example, giving half of your insulin
know what is in your meal. dose just before or with your meal
Many large chains and takeaway and the other half 30 minutes after
restaurants have websites that your meal, eg with a stuffed crust
state the amount of carbohydrate pizza. Experience and monitoring
in popular dishes. If you have a your blood glucose levels will help
favourite restaurant or takeaway, you to decide in which situations
you could also keep a note of this is right for you.
your insulin doses and blood
glucose levels with various dishes. • Eating out is often a leisur ely
event, which could last a few
• You may drink alcohol when hours.
eating out and alcohol can af fect This means that you will need
your blood glucose levels. to consider when to give your
The effect of alcohol on blood insulin – at the start of the meal,
glucose levels is discussed in in the middle, at the end, or
Chapter 6 and the risk of hypos splitting your dose. These
after alcohol should be carefully decisions should be made on
considered when working out a meal by meal basis, based
how much insulin to give. on past experiences.
Carbs count 89
• Activity and exercise on a night Examples of snacks that

out (eg going out dancing after do not need to be matched
dinner can lower blood glucose to insulin
levels and so must be consider ed
when calculating your insulin The following are unlikely to
dose.) be needed to be matched
More detailed information on with insulin.
physical activity is in Chapter 7.
Beef jerky
• Estimating carbohydrates at these
times can be difficult. Pork scratchings
It is often best to under estimate
the amount of carbohydrate you Vegetable sticks
have eaten and therefore the Berries/ Cherries (not strawberries)
amount of bolus insulin to avoid
hypos, and then give a corr ection Hummous
dose before your next meal to
compensate if necessary. Cheese
Nuts
Insulin and snacks
Pepperoni stick
Insulin should generally be given
with snacks that provide more than Bombay mix
10g of carbohydrate or 1 CP,
however this may differ depending Seeds
on your insulin to carbohydrate Salad
ratio.
Vegetable chips
When calculating how much
insulin to give, use the insulin to Dips
carbohydrate ratio of the closest
meal time. Olives
Gherkins
Pickled onions
Some soups
90 Carbs count
Examples of snacks that contain mor e than 10g of

carbohydrate or 1 CP or mor e. It is likely that these snacks will need
to be matched with insulin.
Food Portion size Amount of CP
carbohydrate
Crisps 1 bag (25g) 13 1 1/2
Snack a jacks 1 bag 23 2 1/2
Yogurt 1 pot (200g) 15 1 1/2
Digestive biscuits 2 biscuits 19 2
Fruit 1 apple (medium) 12 1
Crunchie 1 standard bar 22 2
Rice cakes 2 cakes 15 1 1/2
Tortilla chips 1 bag (30g) 18 2
Choc ice 1 block 15 1 1/2
Crackers 3 water biscuits 15 1 1/2
Summary
• Blood glucose levels tend to be more dif ficult to control when
eating out for many reasons.
• It may be useful to adopt various ways of giving bolus insulin
to help control blood glucose levels.
• Generally only snacks with more than 10g of carbohydrate or
1 CP need to be counted when matching to insulin.
• When eating snacks that you need to cover with insulin, use
the insulin to carbohydrate ratio of the closest meal.
Carbs count 91
Chapter 6:
Alcohol
If you drink alcohol it is important to understand the ef fect

this can have on your blood glucose levels and the
precautions you should take to avoid having a hypo.

• The effect of alcohol on blood glucose levels
• Alcoholic drinks that contain carbohydrate
• How to avoid alcohol related hypos
The effect of alcohol on blood usually experience lower blood

glucose levels glucose levels for some hours after
drinking alcohol.
Alcohol can affect blood glucose
levels in different ways. Depending Alcohol interferes with the normal
on what they drink, some people release of stored glucose from the liver
find that initially their blood glucose and so blood glucose levels can fall if
levels will rise, whilst others find it no extra carbohydrate is eaten. This
falls. Even people who find their interference with the liver increases
blood glucose levels rise initially, the risk of hypos during, a nd for
92 Carbs count
sometime after, drinking. The liver Different drinks contain different units
processes one unit of alcohol each of alcohol. Over the years the alcohol
hour and while it is doing this, your content of alcoholic drinks has
body cannot automatically release continued to increase, so a drink may
glucagon to reverse a hypo contain more units than you think.
(see Chapter 9). Even if you have just a Below is a guide to the number of
few drinks in the evening, you could be units for some typical drinks:
at an increased risk of a hypo all night
and possibly part of the next day too.
Amount Drink Alcoholic Units (approx)

strength of alcohol
(approx) ABV
1 pint Premium strength 5 2.8

lager or cider
1 pint Average strength

4 2.3
lager
1 pint Average strength 4.5 2.6

cider
1 pint Bitter 3.8 2.2
1 pint Stout 4.2 2.4
Medium glass White, red

(175ml) or rose wine 12 2.1
Large glass White, red

(250ml) or rose wine 12 3.0
Single pub Spirits, eg vodka, 40 1

measure (25ml) gin, whisky
You can calculate how much alcohol is in your drink by using the
following formula:
ABV x amount of drink in mls = number of units
1000
Carbs count 93
Alcoholic drinks that contain How can I avoid alcohol

carbohydrate related hypos?
Some alcoholic drinks do contain There are a few general rules to
carbohydrate, such as beers, cider help prevent hypos when drinking
and alcopops and therefore will alcohol:
make your blood glucose levels rise
initially. Due to the risk of hypos, • Avoid drinking on an empty
it is not usually necessary to count stomach.
the carbohydrate content or give • Eat carbohydrate containing
extra insulin. snacks especially before bed,
Extreme caution must be taken without taking any extra bolus
when giving additional doses of insulin.
insulin with alcohol. If you find that • Have some extra carbohydrate
your blood glucose levels are the following morning or reduce
consistently higher after drinking bolus insulin.
alcohol, ask your diabetes team
how much additional insulin you • Monitor your blood glucose levels
need to give. closely.
• Carry hypo treatment with you
at all times.
• Take your diabetes identification
out with you in case of a hypo.
• Make sure that the people you
are with know that you have
diabetes and how alcohol affects
your blood glucose levels.
Summary
• Alcohol lowers blood glucose levels, making hypos more likely .
• Avoid alcohol related hypos by not missing meals, eating
regular snacks and doing additional blood glucose monitoring.
• Although some alcoholic drinks contain carbohydrate, they
should generally not be matched with insulin, because of the
increased risk of a hypo unless otherwise advised by your
diabetes team.
94 Carbs count
Chapter 7:
Physical activity
Physical activity is important for living a healthy life. For

people with diabetes it is essential to understand the ef fect
that any activity has on blood glucose levels and what steps
can be taken to keep them under control.

• What happens to the body during physical activity
• Physical activity and Type 1 diabetes
• Adjusting insulin doses and carbohydrate intake for
physical activity
What happens to the body Initially, energy (glucose) is released

during physical activity from stores within the body’s cells,
but as the activity continues, the
During activity, the body needs
energy is taken from the blood
additional oxygen and energy. To
stream. As this glucose in the blood
achieve this, the heart and lungs
stream is used up, the liver r eleases
work harder and hormones are
stored glucose to maintain blood
released. The heart is pumping
glucose levels.
faster, breathing is deeper and
energy is released from the body In people without diabetes, this
stores, especially from the liver. balance of glucose released from
Carbs count 95
the liver keeps blood glucose levels Recent research has shown that
within a normal range. The glucose some people may find that during
released from the liver is brought anaerobic exercise (see Glossary),
about by a sharp increase in for example sprinting, blood
certain hormones – glucagon, glucose levels actually increase as
catecholamines (including the activity is very intense 4. If this
adrenaline) and growth hormones applies, you may want to discuss
and at the same time insulin levels this with your diabetes team.
are reduced.
High blood glucose levels
Once these stores of glucose are before activity
used up, other energy sources
become available, such as fat fr om Be careful when your glucose level is
fat stores. more than 14 mmol/l. 4 Activity, in
this situation, can raise your blood
Physical activity and Type 1 glucose level even further rather
diabetes than lower it. If this happens, it is
because you may not have enough
In Type 1 diabetes there are insulin circulating in the body.
difficulties with this balance of Consider injecting an extra dose of
hormones. Giving too much insulin bolus insulin (correction dose) and
levels and lower adrenaline levels always check for ketones. If ketones
together can increase the likelihood are present, you need to avoid
of experiencing a hypo either during doing any activity until your ketones
or up to 24 hours after activity. have gone.
To reduce the chances of a hypo More information on ketones can be
happening, you need to plan ahead found in Chapter 8.
where possible and alter your
carbohydrate intake and/or insulin
doses, ie eat more carbohydrate or
take less insulin. W ith planned
activity you have this option. If you
are trying to lose weight, it is
probably best to reduce your insulin
doses in advance. Speak to your
diabetes team for guidance on how
to do this. If you ar e doing
unplanned activity, you will need to
have more carbohydrate. See the
table on page 98 for more guidance
on this.
96 Carbs count
Checklist to avoid problems (see Chapter 9) and try to achieve

during or following physical a blood glucose levels of at least
activity 7 mmol/l, before starting your
activity.
• Test your blood glucose levels
more often, particularly before, • Be prepared to decrease your
during and hourly after activity. insulin, increase your
This will help you understand carbohydrate intake or both.
your body's response. • Be aware that absorption of
• If ketones are present with high insulin may be faster if you inject
blood glucose levels (more into a limb that will be used for
than14 mmol/l), delay exercise activity, such as your leg if you
until you have got rid of the are running.
ketones, as this could lead to • Always carry hypo treatment,
ketoacidosis (see Chapter 8). (see Chapter 9) and medical ID.
• If blood glucose levels are below • Make sure you drink plenty of
7 mmol/l before the activity, take fluids during prolonged activity.
additional carbohydrate, without
matching it to a dose of insulin. • If your activity involves being on
your own, make sure someone
• If you have blood glucose levels knows where you have gone.
of less than 4 mmol/l, you ar e
having a hypo. Make sure you • Teach those with you on how
treat this appropriately to recognise and treat hypos.
Carbs count 97
88-99_newtable 28/3/12 12:47 Page 98
Unplanned activity
The table below is a guide to show how you might adjust your carbohydrate
intake when taking part in unplanned physical activity.
Activity level
Short duration, low intensity
eg 30 minutes of yoga, walking or bicycling
leisurely.
Blood glucose level before activity

Less than 5 mmol/l 5–10 mmol/l 10–14 mmol/l
Add 10–20g No adjustment No adjustment
carbohydrate before needed. needed.
activity.
Activity level
Moderate duration, moderate intensity
eg 30-60 minutes of walking vigorously,
playing tennis, swimming or jogging.

Add 10–20g Add 10–20g No adjustment
carbohydrate before carbohydrate for a needed.
activity. blood glucose level of
Add 10–20g 5–7 mmol/l.
carbohydrate before No adjustment
activity. needed for a blood
glucose level of
7.1–10 mmol/l.
98 Carbs count
88-99_newtable 28/3/12 12:47 Page 99
Activity level
Moderate duration, high intensity
eg 30-60 minutes running, high impact
aerobics or kick boxing.

Add 20 – 30g Add 10–20g No adjustment
carbohydrate before carbohydrate before needed.
activity. activity.
Activity level
Long duration, moderate intensity
eg 60 minutes or more of playing team
sports, golfing, cycling or swimming (retest
your blood glucose level after each hour of
activity and add carbohydrate according to
that blood glucose level).

Add 10-20g Add 1 –20g After first hour of
carbohydrate per carbohydrate per activity, add 10–20g
hour of activity. hour of activity. carbohydrate.
Carbs count 99
Example 1
Jane regularly enjoys a morning swim.
Before breakfast, she does 40 lengths of
the local pool (1km), which takes her 30
minutes. Her blood glucose level when she
wakes up is 4.8 mmol/l.
How does Jane need to adjust her carbohydrate intake?
Answer:
Jane does moderate duration, moderate intensity activity and her blood
glucose level is less than 5 mmol/l befor e starting. She needs to have
10–20g of carbohydrate before swimming.
Example 2
Osa is going out on a Friday night to the
students’ union for a night of dancing/
clubbing. He dances for 2 1/2 hours. Osa
does not drink alcohol but always seems
to have a hypo every Saturday morning.
How does Osa need to adjust his carbohydrate intake?
Answer:
Osa does long duration, moderate intensity activity. He needs to have
an extra 10– 20g of carbohydrate per hour of dancing.
100 Carbs count

Example 3
Bob likes to spend the evenings after work
in the gym.
After work he spends 1 hour doing weights
and cardio work. He goes before his evening
meal and his blood glucose level before he
starts is 5.2 mmol/l.
How does Bob need to adjust his carbohydrate intake?
Answer:
Bob does moderate duration, high intensity activity and his blood glucose
level is in the range of 5 –10 mmol/l before starting. Bob will need to have
10–20g of carbohydrate before the gym.
Now you try 4
Albert regularly treats his Westie dog to a days’

walking.
They walk a distance of 12 miles. His blood
glucose level before he starts is 12 mmol/l
How does Albert need to adjust his carbohydrate intake?

Answers on page 102
Carbs count 101

Summary
• Different types of physical activity will af fect blood glucose
levels in different ways.
• The risk of a hypo is increased following physical activity , as
energy stores are replenished.
• Adapting carbohydrate intake and insulin doses before, during
and after physical activity can help to keep blood glucose
levels within range.
• Measure for ketones if blood glucose levels are above
14 mmol/l. Do not exercise if ketones are present.
Important: This chapter is aimed at people doing moderate

activity. People who are very active or training for an event
will need to get individual expert advice from their
diabetes team.
Answers
Now you try 4: page 101
Answer:
Albert does long duration, moderate intensity activity. Albert checks his
blood glucose levels hourly and has an extra 10–20g of carbohydrate
every hour.
102 Carbs count

Chapter 8:
Hyperglycaemia
and diabetic
ketoacidosis
Hyperglycemia and diabetic ketoacidosis (DKA) are

short term complications of diabetes. It is important for
you to understand when and why these may occur and
how to manage them.

• How diabetic ketoacidosis (DKA) occurs
• How ketones effect people with Type 1 diabetes
• When DKA is most likely to occur
• Measuring ketones
• What to do if you have ketones
What is hyperglycaemia? the body begins to use stor es of fat

as an alternative for energy, which
Hyperglycaemia means high blood
in turn produces by-products known
glucose levels above 10 mmol/l.
as ketones which make the blood
In the short term, consistent
acidic.
hyperglycaemia can lead to a
condition called diabetic ketoacidosis How ketones affect people
(DKA). DKA occurs when there is not with Type 1 diabetes
enough insulin in the body to allow
enough glucose to entering the cells. Ketones are very harmful and the
In response to the lack of glucose, body will immediately try to get rid
Carbs count 103

of them by excreting them in the The good news is that DKA can be
urine and exhaling them in the avoided by careful monitoring and
breath. Consequently, when blood adjusting of insulin, by following sick
glucose levels are high and ketones day rules, such as drinking plenty
are present, people often become of fluid, injecting more bolus insulin
increasingly thirsty as the body tries and checking for ketones. DKA can
to flush the glucose and ketones be treated effectively in hospital
out in the urine. If the level of with intravenous fluids, insulin
ketones in the body continues to and glucose.
rise, ketoacidosis develops and
nausea or vomiting may start. When is DKA most likely
In addition, the skin may become to occur?
dry, eyesight blurred and breathing
The high-risk time for developing
both deep and rapid to exhale
ketoacidosis is when you are unwell
ketones in the breath.
or forget to take your insulin. Part of
Unfortunately, vomiting makes the the body's response to illness and
body even more dehydrated and less infection is to release more glucose
efficient at flushing the ketones out, (from the liver) and hormones into
allowing levels to rise even faster. the bloodstream, which stop insulin
As the levels rise, it may be possible working normally. This happens even
to smell the ketones on the br eath – if you lose your appetite or ar e off
often described as smelling like pear your food altogether. During periods
drops or nail varnish. If untreated, of illness, even if you ar e not eating,
DKA can cause death, so it needs insulin is still needed and should
to be treated urgently – in a matter never be stopped.
of hours.
104 Carbs count

Checking your blood glucose levels

when you are ill is very important
and should be done at least every
four to six hours if ther e are no
ketones present or every two hours
if ketones are present. Diabetes UK
recommends that you test at least
four times a day and night (ie at
least eight times over a 24 hour
period). Ask your diabetes team
for help if you are worried.
Measuring ketones
One way of finding out if you have
enough insulin in your body is to What to do if you have
check for ketones either in your ketones
urine or blood. As levels of ketones
rise, the body tries to get rid of them If you get a positive r esult for
in the urine. Ketones in the urine ar e ketones (greater than 1.5 mmol/l on
easily detected by a simple urine a blood ketone meter, or small
test, although there is a delay or more on a urine ketostick), you
between blood and urine levels. should do the following:
People with diabetes should test • Drink plenty of sugar-free fluids.

their urine or blood for ketones if Aim for at least 3 litr es (5 pints) a
their blood glucose is persistently day. This is about 100–200ml per
high (usually over 15 mmol/l) 7 or hour.
if they have any symptoms of
• Keep taking your insulin. You are
ketoacidosis, such as thirst, going
likely to need more insulin even
to the toilet a lot and tir edness.
if you are not eating anything –
discuss how much with your
diabetes team.
• Test your blood glucose and
ketone levels closely.
• If you cannot keep to your normal
meal pattern, replace meals with
frequent carbohydrate containing
snacks and drinks. Match this
carbohydrate with bolus insulin
as usual.
Carbs count 105

Summary
• Hyperglycaemia means high blood glucose levels.
• Ketones are produced when fat is broken down to be used
as energy in the absence of suf ficient insulin circulating in
the blood stream.
• Ketones are poisonous to the body and are excreted in the
urine and breath.
• High ketone levels can result in diabetic ketoacidosis (DKA)
which can be fatal. Contact your diabetes team or GP (or A&E
if your diabetes team or GP are not available) for additional
information and support.
• DKA is most likely during times of illness and missed insulin.
• During illness follow the ‘sick day rules’ and measure for
ketones if blood glucose levels are above 15 mmol/l 7.
106 Carbs count

Chapter 9:
Hypoglycaemia
Hypoglycemia is a short term complication of diabetes.

By understanding when and why a hypo might happen,
you can manage them more ef fectively.

• What is hypoglycaemia?
• When is a hypo likely to happen?
• Symptoms of hypoglycaemia
• Treating hypos
• Hypos at night
What is hypoglycaemia? shuts down the production of insulin

Hypoglycaemia, known as hypo, and starts to produce glucagon
means low blood glucose level – instead. Glucagon encourages the
that is less than 4 mmol/l. Hypos liver to release stored glucose into
are often the one thing that people the blood stream.
are most worried about. In people with diabetes, both of
In someone without diabetes, blood these mechanisms can be affected.
glucose levels are tightly controlled Chapter 1 explains that people with
by both insulin (to lower blood Type 1 diabetes do not pr oduce any
glucose levels) and glucagon (to of their own insulin, and so insulin
increase blood glucose levels). As treatment is given instead.
glucose levels begin to fall the body
Carbs count 107

Once insulin has been given it will

continue to work for the duration Early symptoms, known as
of its action, lowering the blood adrenergic symptoms
glucose levels no matter what they ar e. When blood glucose levels fall,
The mechanism for producing the brain gives you war ning
glucagon is also not as ef fective in signs by releasing adrenaline
people with Type 1 diabetes. Blood and other hormones that
glucose levels can continue to fall produce the symptoms you
below 4 mmol/l and adrenaline is might be familiar with.
released, which in turn causes the These include:
symptoms of a hypo.
• feeling hungry
If a hypo isn’t treated, then blood
glucose levels will continue to dr op, • trembling and shakiness
releasing more hormones (growth
• sweating
hormone and cortisol), which
encourage the liver to release • anxiety and irritability
stored glucose.
• going pale
Eventually, once your insulin has
worn off and the liver has r eleased • pounding of the heart
enough stored glucose, your blood • tingling of the lips
glucose levels will rise again.
• blurred vision.
When is a hypo likely
to happen?
Hypos are an expected side effect of
insulin treatment, but they should
not be frequent, more than 1–3 per Later symptoms, known as
week is too frequent. neuroglycopenic symptoms
The cause of your hypo should
also be easily identifiable. Later effects of hypos, happen
when the storage of glucose
Hypos can happen for many r easons causes disturbance in brain
including: function. These include:
• mismatch of insulin to • difficulty in concentrating
carbohydrate
• vagueness or confusion
• unplanned activity
• drinking alcohol • irritability or irrational
behaviour.
• overestimating a correction dose
108 Carbs count

Symptoms of hypoglycaemia Treating hypos

Symptoms of a hypo can vary fr om Once you start to notice your hypo
person to person and, sometimes, warning signs, take action quickly.
each time you have a hypo. Although most of the time you will
be able to deal with the hypo
Other people may notice these yourself, ask for help if you need it.
symptoms before you do.
Take 10–20g of fast acting
Any hypo that you cannot tr eat carbohydrate that is quickly absorbed.
yourself, whilst still conscious, is A list of possible first line tr eatments
considered to be a severe hypo are listed in the table below.
because, without treatment, it could
progress to unconsciousness. Once you have recovered, follow this
with a further 10–20g of slow-
People with Type 1 diabetes can lose acting carbohydrate.
their hypo warning signs. If this has
happened to you, discuss this with
your diabetes team, who can advise
you on how this can be helped.
First line treatment

Take the simplest food or drink that contains about 10-20g of fast acting
carbohydrate that is quickly absorbed, ideally glucose. This could be:
• a glass of original lucozade

• a glass of non-diet drink eg cola, lemonade, orangeade
• three or more glucose tablets
• five sweets, eg jelly babies or jelly beans
• a glass of unsweetened fruit juice
• Glucogel
The exact quantity will vary fr om person to person and

will depend on circumstances. You may need to repeat this.
You should always carry some hypo tr eatment with you.
Carbs count 109

Follow-on treatment
To prevent your blood glucose level dr opping again, it is important to
follow fast acting carbohydrate with a snack that contains slow acting
carbohydrate or the next meal if it is due. This may not be necessary
if you are using an insulin pump – check with your diabetes team.
These slow-acting carbohydrates include:
• a slice of bread or toast • biscuits and milk
• a piece of fruit • the next meal if due
• a small bowl of cereal
Severe hypos Glucagon, the hormone that releases

If you do not treat a hypo, it will glucose from the liver, can be given
become much worse and you by injection, if the person who is
may become unconscious. Severe with you has been taught how to do
hypos will need to be tr eated by this. It is a very ef fective way of
someone else. reversing a hypo and will bring you
round within five to ten minutes.
If you have become confused and Some people may feel nauseated
unable to treat your hypo, it is immediately after an injection of
important that somebody else knows glucagon. Once you are conscious,
what to do and can step in to help. follow your normal hypo treatment.
IMPORTANT: Do not give You can get glucagon kits on
anything by mouth if unable prescription from your doctor, and
to swallow or unconscious. your diabetes care team will show
Let friends, family and work your carer how to give it to you. Your
colleagues know that if you become carer should feel confident and
unconscious they must never try to comfortable about administering
give you food, drink or even glucagon, knowing where it should
Glucogel because it could cause you be stored and making sure that it has
to choke. If possible they should not gone past its expiry date. Your
place you in the recovery position carer should not give it to you if they
(on your side with your head tilted feel unsure – they should immediately
back), so that your tongue does not call 999 for an ambulance.
block your throat, and call an
ambulance.
110 Carbs count

If you become unconscious and do 4.00am when most night time

not treat a hypo, your body will hypos happen. Set an alarm for
slowly respond by naturally increasing this. Blood glucose levels usually
blood glucose levels, and you will fall to their lowest level ar ound this
eventually become conscious again time. They start to rise again as
as the effect of your insulin wears the effect of the insulin you
off. On very rare occasions, having a injected the day before, wears
hypo has been fatal and some deaths off and the liver releases stored
have occurred as a result of drinking glucose. This is why you may have
large amounts of alcohol. This is a high blood glucose level the next
because the alcohol slows down the morning even if your glucose level
release of glucose from the liver has gone low during the night.
(see Chapter 6).
If you do find that you have mor e
Hypos at night than one hypo at night every month,
contact your diabetes team – you
Many people worry about having a may need to adjust the timing of
hypo at night. Low blood glucose your insulin injection, or the dose.
levels can happen during the night,
but you may not notice them. Keep After a hypo
some hypo treatment by your bed
Following a hypo, some people can
just in case.
feel unwell, perhaps with a
If you have a night time hypo that headache, as well as experience
has not woken you up, you may feelings of anger and /or
wake up in the mor ning feeling very embarrassment. This is quite natural
tired, perhaps with a headache or and you may want to discuss some
with a feeling like a hangover. of these issues with the people
around you or your diabetes team.
The best way of confirming that
you are having night time hypos is If, following a hypo, your blood
to carry out an occasional blood glucose levels are high, do not
glucose test between 2.00am and correct them (see Chapter 3).
Carbs count 111

Summary
• Hypoglycaemia means low blood glucose levels, below
4 mmol/l.
• Normally when your blood glucose level falls too low , various
hormones are released to increase it again.
• The release of these hormones cause the signs and symptoms
of a hypo, including sweating, shaking and tingling of lips.
• A mild hypo should be treated immediately with a fast-acting
carbohydrate, followed by a slow-acting carbohydrate.
• A severe hypo is defined as one you cannot treat yourself.
• A severe hypo may need to be treated with Glucogel or a
glucagon injection, depending on whether you are conscious
or not.
• Never put anything in an unconscious persons mouth as they
may choke. Call an ambulance.
• Many people experience night time hypos. Confirm this by
testing blood glucose levels at 2–4am. If you are having night
time hypos, (see Chapter 3) discuss with your diabetes team.
• Please read the chapters on alcohol and physical activity .
112 Carbs count

Chapter 10:
Structured
education courses
Structured education courses • Healthy eating

Once you have been diagnosed, • Physical activity
living with diabetes becomes • Insulin actions
a lifelong learning process. • Carbohydrate counting
To help with this lear ning process, • Hypoglycaemia (low blood
the Department of Health glucose levels)
guidelines currently recommend
• Hyperglycaemia (high blood
that all people with diabetes ar e
glucose levels), illness and
offered structured education
ketoacidosis
courses. A structured course will
enable you to start effectively using • Blood glucose monitoring
carbohydrate counting and insulin • Long-term complications
dose adjustment as a method of of diabetes
controlling your diabetes. • Building your confidence
for self-management
There are lots of different
education courses available for • Local services available
people with diabetes, which vary in
length and content. These courses Family members, partners and
are often delivered as a group, as friends should be included in the
recommended by National Institute education process if possible.
of Clinical Excellence (NICE)
It is important that the course that
Courses may include topics like you attend meets the criteria that
are set by the Department of
• What is diabetes?
Health6.
• The symptoms of diabetes
Carbs count 113

The criteria are that the course There may be other education
should: courses available in your area, you
can find out about these by
• have a patient centred philosophy contacting your local diabetes
• have a structured, written service, although it is worth
curriculum remembering that they may not yet
• have trained educators meet the recommended criteria.
• be quality assured Diabetes services and people with
• be audited. diabetes are encouraged to share
their experiences of education
When choosing a course you courses by using Diabetes UK’s
should ask the following questions: web-based shared practice
database at
• Is the programme relevant to my
www.diabetes.org.uk/
type of diabetes?
sharedpractice
• Can I commit enough time to
complete the programme in full?
• Is the programme run by qualified IMPORTANT: The information
trained healthcare professionals? in this book can be used in
addition to the advice of
• Am I happy to take a mor e
trained healthcare professionals
involved and proactive role in
and carbohydrate counting
my diabetes care?
courses but it should not
be used as a complete
There is currently no formal replacement for either
accreditation scheme in the UK for of these.
national or local patient education
programmes but there are now
tools available for your diabetes
team to assess whether their
courses are meeting criteria set out
by the Department of Health.
Education courses can be found at:
www.diabetes.nhs.uk/
downloads/Type_1_Education_
Network.pdf
Or to find a DAFNE course visit:
www.dafne.uk.com
114 Carbs count

Glossary and references
Glossary
Aerobic exercise. The word Aerobic means ‘with oxygen’, and the term
Aerobic exercise refers to exercise that involves or improves oxygen
consumption by the body, such as walking, jogging, swimming, cycling etc.
Anaerobic exercise describes a type of activity that does not need
oxygen. These activities are of short duration, high intensity, such as
weight lifting.
Cardiovascular disease can also be called 'heart and cir culatory
disease'. It means all diseases of the heart and cir culation, including
coronary heart disease (angina and heart attack), and str oke.
The Diabetes Education Network (DEN) is a group of over 200
diabetes healthcare professionals involved in structured education
for people with diabetes.
The aim of the network is to support centr es delivering/ planning to
deliver structured education programmes for people with diabetes to
work towards meeting the Department of Health criteria for structur ed
education programmes.
It aims to achieve this by:
• Providing the opportunity to shar e best practice and lear ning
• Developing a common evaluation criteria to support quality assurance
• Supporting access to appr opriate training
• Supporting centres to deliver high quality pr ogrammes
Carbs count 115

Diabetic ketoacidosis (DKA) is a dangerous condition that can occur as

a result of hyperglycaemia and too little insulin. In the absence of insulin,
glucose cannot be used for energy. Fat is used as an alter native energy source
and acidic chemicals (ketones) are released into the blood as by pr oducts.
HbA1c is a blood test showing blood glucose contr ol over the previous
two to three months. It is expressed as a percentage.
Nephropathy is a long term complication of diabetes that causes
damage to the small blood vessels in the kidneys. This damage can cause
the vessels to become leaky or, in some cases, to stop working, making
the kidneys work less efficiently. If the kidneys start to fail they cannot
carry out their job so well which may r esult in the build up of waste
products in the blood, which the body cannot get rid of.
Neuropathy is a long term complication of diabetes that causes damage
to the nerves that transmit impulses to and fr om the brain and spinal
cord, to the muscles, skin, blood vessels and other organs. This includes
erectile dysfunction, damage to the nerves in the feet and stomach
(gastroparesis).
Retinopathy is a long term complication of diabetes that af fects the
blood vessels supplying the retina – the seeing part of the eye. Blood
vessels in the retina of the eye can become blocked, leaky or gr ow
haphazardly. This damage gets in the way of the light passing thr ough
to the retina and if left untreated can damage vision.
References
1 Muhlhauser I, Jorgens V, Berger M et al. Bicentric evaluation of a teaching and
treatment programme for Type 1 (insulin-dependent) diabetic patients: improvement
of metabolic control and other measures of diabetes care for up to 22 months.
Diabetologia (1983); 25: 470-476.
2 Bott S, Bott U, Berger M et al. Intensified insulin therapy and the risk of sever e
hypoglycaemia. Diabetologia (1997); 40 (8): 926-932.
3 DAFNE Study Group. Training in flexible, intensive management to enable dietary

freedom in people with Type 1 diabetes: dose adjustment for normal eating (DAFNE)
randomised controlled trial. BMJ (2002); 325 (7367): 746-749.
4 Nagi D. Exercise and sport in diabetes. 2nd ed. Chichester: John W iley & Sons, 2005
5 High blood glucose and Type 1 diabetes. International Diabetes Institute, 2007
http://www.diabetes.com.au/pdf/High_BG&SickdaysT1_factsheet_IDI2007.pdf
(accessed 17 July 2008)
116 Carbs count

About Diabetes UK and membership
Diabetes UK is the leading UK charity that cares for, connects with and
campaigns on behalf of all people affected by and at risk of diabetes.
• We help people manage their diabetes effectively by providing

information, advice and support.
• We campaign with people with diabetes and with healthcare
professionals to improve the quality of care across the UK’s health
services.
• We fund pioneering research into care, cure and prevention for all types
of diabetes.
• We campaign to stem the rising tide of diabetes.
Did you know?

Diabetes is the biggest health challenge facing the UK today.
This serious condition is on the rise and more than one in 20 people
in the UK have diabetes (diagnosed or undiagnosed).There are
currently 3.7 million people in the UK living with diabetes. 2.9 million
cases are diagnosed and an estimated 850,000 cases are undiagnosed.
As many as 7 million people are at high risk of developing Type 2
diabetes.
• Our website www.diabetes.org.uk has over 4,000 visitors a day.

• We have a network of offices throughout the UK.
• Diabetes UK Careline staff receives nearly 3,000 enquiries a month.
• We spend over £6 million a year on diabetes research.
• We produce a wide range of magazines, books and leaflets covering all
aspect of diabetes.
For more information about the publications we produce visit

www.diabetes.org.uk/onlineshop or call 0800 585 088 to
request a free catalogue.
Carbs count 117

Diabetes UK Careline
The Diabetes UK Careline provides
support and information to people with
diabetes as well as friends, family and
carers. We can provide information to
help you learn more about the
condition and how to manage it.
The Careline is staffed by trained

counsellors who can provide a listening
ear and the time to talk things through.
Call 0845 120 2960 Monday–Friday, 9am–5pm*

Email careline@diabetes.org.uk
Write to Diabetes UK Careline, Macleod House,
10 Parkway, London, NW1 7AA
*Depending on your phone package, calls to 0845 numbers may be
free. Please check with your phone provider. Or call 020 7424 1000
and ask Reception to transfer your call to Careline.
How can you help?

You can be actively involved in the work that Diabetes UK does.
• Become a supporting member

call free on 0800 138 5605
www.diabetes.org.uk/join
• Diabetes Campaigners Network
or details call 020 7424 1000
Email dcn@diabetes.org.uk
www.diabetes.org.uk/dcn
• Fundraising ideas and events
call 020 7424 1000
Email community@diabetes.org.uk
www.diabetes.org.uk/fundraise
• Make a donation
call 020 7424 1010
www.diabetes.org.uk/donate
118 Carbs count

Become a Supporting Member of Diabetes UK

We are a growing community of 300,000 supporters nationwide: people
with diabetes, their friends, family and volunteers.
Our members are at the heart of what we do. We support each other and
share our experiences. The generosity of our members also enables us to
fund essential care, services and research to help improve the lives of
everyone affected by diabetes.
By standing with us, our members make us a far more powerful force as
we campaign to ensure that diabetes care and
research remain at the heart of
the nation’s conversation about
health.
To ensure everyone understands

the best ways to manage diabetes,
we provide relevant and accurate
information to people with the
condition, as well as for families,
carers and healthcare professionals.
Every two months, Diabetes UK members receive a copy of balance, our
magazine designed to be the definitive resource for all things diabetes.
To become a Supporting Member of Diabetes UK,

call 0845 123 2399 or
email supporterservices@diabetes.org.uk or
visit www.diabetes.org.uk/join.
Carbs count 119

Acknowledgements
The content for this book was developed by Jemma Edwar ds, registered dietitian,
with support from the following healthcare professionals: Zoe Harrison,
Penny Jackson, Anna Jesson, Lindsay Oliver, Jane Roche, Candice Ward and
Joy Worth.
Published by Diabetes UK © 2011
120 Carbs count

Macleod House, 10 Parkway, London NW1 7AA

Tel 020 7424 1000 Email info@diabetes.org.uk
Fax 020 7424 1001 Web www.diabetes.org.uk
A charity registered in England and Wales (215199)
and in Scotland (SC039136). © Diabetes UK 2012

Carbs Ebook

Uploaded by

Copyright:

Available Formats

Carbs Ebook

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Carbs Ebook

Uploaded by

Copyright:

Available Formats

CARBS

An introduction to carbohydrate counting

This book is aimed at adults with Type 1 diabetes

Carbohydrate counting is a method of matching your

Is this book for you? What can you lear n from

carbohydrate count. It also provides It can also be used as a r efresher

To get to grips with how and why carbohydrate counting

In this chapter you will find out about the following:

What is Type 1 diabetes? Glucose is used by the body’s cells

Type 1 diabetes develops when the diabetes, the amount of insulin

Type 1 diabetes is different from Type 2 diabetes in the following ways:

At diagnosis • Quick onset of symptoms • Slow onset of symptoms

Physiology • Autoimmune response • Insulin resistance

Treatment • Insulin • Lifestyle changes (food

microscopic appearance of pancreatic cells

Symptoms of high blood • Genital itching or regular

Please discuss your own personal

Before you start carbohydrate counting you’ll need to have

In this chapter you will find out about the following:

Another type of food that can total carbohydrate to come from

Food and drink that contain carbohydrate

Carbohydrate is digested at different rates by the body and can

Food and drink that do not contain carbohydrate

The three main carbohydrate groups

Food and drink How this fits in with

Medium and slow acting carbohydrate

Food and drink How this fits in with

Slow acting carbohydrate

Food and drink How this fits in with

Being able to understand how insulin works is one of the

In this chapter you will find out about the following:

The normal workings of the

Normal insulin release

Insulin produced by pancreas

Breakfast Lunch Dinner

Meal time (hr)

In Type 1 diabetes, no insulin is Basal insulin

Isophane insulin, eg Humulin I, Insulatar d or Insuman Basal, works

Long acting analogue insulin

Long-acting analogue insulin, eg Lantus or Levemir, is injected once

How much basal insulin do is correct. If the pre-evening meal

Blood glucose level (mmol/l)

Date Before Before Before Before During

Blood glucose level (mmol/l)

Date Before Before Before Before During

9/5 3.1 6.2 3.8

10/5 3.6 7.5

11/5 4.1 6.9

12/5 2.9 7.2

insulin tomorrow evening and continue monitoring his blood glucose

Blood glucose level (mmol/l)

Date Before Before Before Before During

26/3 6.0 7.2

27/3 5.5 6.5 6.4

28/3 5.6 7.5

29/3 4.9 7.8

Blood glucose level (mmol/l)

Date Before Before Before Before During