Before you start the course, try completing the quiz (by clicking on the 'self assessment quiz' link below). 

When we eat carbohydrate, it is broken down in the gut into glucose. Glucose moves from the gut into the blood causing the level of glucose in the blood to rise.

 In a person without type 1 diabetes, a rise in blood glucose triggers the release of insulin. The insulin helps to keep blood glucose within the body’s usual range.

 As you know, when you live with type 1 diabetes your body no longer produce insulin on its own. This is why it is important to inject the right amount of insulin to stop the glucose in your blood rising after eating carbohydrate food.

 Carbohydrate counting is a key skill that can help you to manage your blood glucose levels.

 Counting the carbohydrate in food and drink helps you to match your quick acting insulin with your meals and snacks.

 Carbohydrate counting can help you to get the blood glucose level that you want without increasing the risk of severe hypos or putting on weight.

 Some people living with type 1 diabetes find that carbohydrate counting can give them more freedom around the food that they choose to eat and more flexibility around when they choose to eat. Freedom and flexibility can help some people feel better about living with type 1 diabetes and improve their quality of life.

As you know, foods contain a variety of nutrients. The three main groups of nutrients are:

• Carbohydrate
• Fat
• Protein 

Your body needs carbohydrate to give you energy. Carbs are like fuel for a car, you need carbohydrate for your body to function properly.

Carbohydrate is also an important food group because it provides calcium, iron and vitamin B. 

Carbohydrate is in a lot of the foods you eat. 

These include starchy foods, like: 

• bread
• chapatti
• pasta
• rice
• potato
• noodles
• cereals
• foods made with flour

Carbohydrate is also found in sugary foods such as: 

• biscuits
• cakes
• chocolate
• foods containing added sugar.

Some foods also contain natural sugar like: 

• fruit
• milk
• yogurt.

Some foods which contain mostly fat or protein, do not contain carbohydrate.

These include foods like:

• Meat
• Eggs
• Fish
• Tofu
• Nuts
• Oil
• Butter
• Ghee
• Cheese

It is important to know that different foods containing carbohydrate have different effects on your blood glucose levels. 

You may have heard of the term 'glycaemic index' or 'GI'. the glycaemic index of a food is the speed of which it breaks down in the body and affects your blood glucose levels. 

The glycaemic index lists foods as ‘low GI’ (carbohydrate that will be digested very slowly), ‘high GI’ (carbohydrate that will be digested rapidly) and carbohydrates that will have a ‘normal’ rate of digestion.

The rate at which carbohydrate foods are digested may be affected by the cooking and preparation methods, as well as by the addition of other ingredients (often fat and protein).

For example, many people think cake and chocolate will be rapidly digested, but in fact they have a slower digestion rate than expected because they also contain fat. Cake and chocolate are not the best choice for treating a hypo because they are not rapidly digested.

To treat a hypo you will need to take 15-20g of quick-acting carbohydrate.

Here are some good examples of quick-acting carbohydrate which are useful for treating hypos: 

Some carbohydrate foods are digested very slowly and may have little or no effect on your glucose levels. These foods include:

• all vegetables (except potatoes and sweet potatoes)
• pulses (lentils, beans, chickpeas)
• grapefruit
• nuts
• barley
• cherries
• nuts
• sweetcorn
• peas

If you adjust your insulin dose around carbohydrate food you may want to consider taking less insulin, or not covering these foods at all.

What are sweeteners?

Sweeteners are added to food to make them taste sweetener.

There are a number of different sweeteners on the market.

Some them will affect your glucose levels and some of them wont – see table below:

Sweeteners made of sugars contain carbohydrate and therefore will affect your glucose levels unless covered with insulin.

Sweeteners made from non-nutritive sweeteners do not contain carbohydrate therefor do not affect your glucose levels.

Sweeteners made from nutritive bulk sweeteners do contain carbohydrate called a ‘polyol’, but do not affect your glucose levels.  These sweeteners are broken down and excreted through your gut without being absorbed. These are often found in foods marketed as ‘diabetic foods’.

How to read a food label containing polyols?

Nutritive bulk sweeteners or polyols can make it confusing when look at food labels which contain nutritive bulk sweeteners – see example below:

This food label for ‘diabetic chocolate’ suggests that there is 54g of carbohydrate per 100g of chocolate.

However, on the label (underneath ‘of which is sugars) you can see that 39g of the carbohydrate in the chocolate comes from polyols (nutritive bulk sweeteners).

This means that 39g of the total carbohydrate amount won’t affect your glucose levels and should not be covered with insulin.

How to work out your carbohydrate portion in a food containing polyols?

You can work out how much carbohydrate you will need to cover with insulin by taking away the amount of polyol sweetener by the total carbohydrate.

Using the example above, this would be:

54 – 39 = 15

So in a 100g of diabetic chocolate, you would only need to cover 15g of carbohydrate with insulin.

What are food labels?

There are different resources you can use when carb counting. Food labels are one of them. 

Food labels are often found on the back of food packaging and will tell you how much: energy, fat, carbohydrate, protein and salt is in a food.

The amount of carbohydrate in a food is measured by weight, which is shown as grams ('g') on a food label. The 'of which sugars' section underneath carbohydrates tell us how much of the total carbohydrate is made from pure sugar.

You can work out how much carbohydrate is in your portion of food using the information on the food label. Food labels may list the carbohydrate value per portion / serving, or  per 100g.

Using the information 'per portion'

Each food label will tell your how many grams of carbohydrate are in a weight of food. This is often shown on a food label as 'per portion'. 

You can use this information to work out the amount of carbohydrate in the food you want to eat. 

Step 1. 
Look at how many grams of carbohydrate there is 'per portion' on the food label

Step 2. 
Adjust the amount of carbohydrate 'per portion' to match the portion of food you want to eat. 

For example: 
The food label for this packet of biscuits is found on the back of the food packaging. 

On this food label a portion is shown as 'per biscuit'. The food label tells us that there is 9.3g of carbohydrate per biscuit. 

If we are going to eat more then one biscuits, we need to multiply the amount of carbohydrate 'per biscuit' by the number of biscuits we are having. 

For example if we were to eat three biscuits, we need to work out the following sum: 

Carbohydrate per portion x number of portions about to eat = carbohydrate in my portion 

9.3    x    3   =    27.9

If your portion differs to that which is listed on a food label, you will have to weigh your portion and work out the carbohydrate in your serving of food.

For example, a label on a packet of rice will tell you how much carbohydrate there is in 100g. When you weigh your portion, it weighs more than this.

Step 1: Weigh your portion of food using weighing scales. In this example your rice weighs 128g.

Step 2: Divide the total carbohydrate in 100g by 100. This will tell you how much carbohydrate there is in 1g of this particular food.

Step 3: Once you have done this, you can multiply the amount of carbohydrate in 1g by the weight of your own food.

29g ÷ 100g = 0.29g x 128g = 37g carbohydrate 

Using standard measures, such as cups or spoons, can make carbohydrate counting quicker and easier. Although not as accurate as weighing, it is better than estimating weight by eye. 

Cup measures are available online or you can purchase them in supermarkets or home stores. Some cup measures may have slightly different measurements from the ones in this guide. We will be using 1 cup = 250ml and ½ cup = 125ml. Please check that your cups are the same measurements to ensure the correct values are being used.

Carbs and Cals

Carbs & Cals is available as a book and an app. It shows you photographs of a variety of carbohydrate containing foods, the weight of the food and the carb content of the portion.

You can use this book to find the picture which best matches the portion you want to eat. The number in the green circle is the total carbohydrate content and the number below the food picture is the total weight.

If your portion weighs different to the portion in the Carbs & Cals book or app, you can work out the amount of carbohydrate in your portion as follows;

Step 1: Weigh your own portion of the food listed in the Carbs and Cals.

Step 2: Find out the amount of carbohydrate in 1g of a certain food by dividing the amount of carbohydrate by the total weight on the food.

Step 3: Multiply the amount of carbohydrate in 1g of this food by your own portion size.

If your portion of this food weighs 73g, you would use the following calculation to work out the carbohydrate content in your portion:

38g ÷ 45g x 73g = 62g carbohydrate

If you are using the carbs and cals app on your iPhone, you still need to weigh your food portion but you can type the weight of your food directly into the app.

This means the app will recalculate how much carbohydrate there is in the portion your have entered. This saves you from having to do the previous calculation.

You can type in the weight of your portion in the bar at the bottom, once you have chosen the food you are searching for.

For example:

Using the information in the list below, there is 0.16g of carbohydrate in 1g of mashed potato.

Your cooked portion of mashed potato weighs 200g.

The calculation to work this out would look like: 

The 10g rule: 

We know that having only 10g carbohydrate without insulin can increase your blood glucose levels by about 2-3mmols/l.

The more snacks you have, the higher your glucose level will rise. Over time, this can affect your general health and wellbeing.

It is important to cover snacks with more than 10g of carb with insulin.

The exception to this might be during exercise. You burn more carbs when we are exercising and might need some carbs before/during/after exercise to help maintain blood glucose levels. If you are unsure, speak to you diabetes team. The advice on will depend what exercise you are doing and when you are doing it.

Carb free options:

If you want a snack but don’t want to take insulin, here are some ideas of carb free/lower carb things you can eat:

• Salad/raw vegetables with a dip – hummus, soft cheese, salsa
• Sugar free jelly
• Cooked meats ie- ham,chicken, salami, pepperami (processed meats are high in fat/salt)
• Nuts and seeds – be aware of honey roast/dry roast coatings (unsalted will be healthier)
• Cheese (be aware of fat content if you are watching your weight)
• Eggs – e.g. omelette with cheese and ham, scrambled egg

Lower carb options:

If you are not covering your snack with insulin, be sure to check the food label and aim for no more than 10g carb per snacking “session”.

Here are some examples of low carb snacks:

• Low sugar/sugar free ice poles/lollies
• Low calorie hot chocolate
• Natural Yoghurt
• Diet Yoghurt/fromage frais
• A small portion of fruit – kiwi/small satsuma/funsize apple
• 2 long breadsticks
• 1-2 small crackers
• 1 small plain biscuits

Still hungry?

 …no problem. Top up with carb free snacks or have a larger snack with the correct dose of insulin.

Which snacks are healthy snack?

A healthy diet is important for everyone.

Adding in heathier snacks can be a good way reaching 5 portions of fruit and veg per day, and topping up on calcium.

If you are trying to control your weight, remember that extra snacks mean extra calories. So choosing less snacks or healthier snacks can help keep your weight down.

Healthy carb free snack options include:

• Vege sticks (carb free) and low fat hummus
• Sugar free jelly (carb free)
• Eggs – cooked without added fat (carb free)
• Unsalted nuts and seeds

Examples of healthy snacks which will need some insulin

• Wholegrain cereal and low fat milk
• Toast
• Low fat/diet /natural yoghurt and fruit
• A piece of fruit
• Crackers and low fat soft cheese
• Breadsticks and a salsa dip
• Rice cakes
• Plain Popcorn
• Glass of low fat milk
• Crumpets/English Muffins

Top tips: 

• Snacking is not an essential part of diabetes.
• Remember to cover snacks containing more than 10g of carb with insulin
  
• High sugar foods may be better eaten straight after a meal to prevent spikes in blood sugar levels
  
• Aim to make your snacks healthy 
• If you are having to eat extra carbs to keep your blood glucose levels up, then your doses of insulin are not right (see next section)

How do my different insulins work?

Basal Insulin (e.g. Humulin I, Insuman Basal, Lantus, Levemir, Degludec, Toujeo)

If you are on injections, you will take a basal insulin once or twice a day.

The role of this insulin is to provide 24-hour cover. This should keep your glucose levels within target range when you haven't eaten any carbs or taken any quick acting insulin. This means that if you miss a meal your glucose levels should not rise or fall 

If you are on a pump, your background insulin is given via the pump, controlled by different basal rates through the day and night

Quick acting insulin (e.g. NovoRapid, Humalog, Fiasp, Actrapid) 

Quick acting insulin has three jobs:

To prevent the rise in your glucose levels after eating carbs

To correct a glucose reading out of target before meal time or before bed

To prevent or treat ketones in your blood

You may have been given insulin:carb ratio. These ratios allow you to work out the correct dose of insulin to cover carbohydrate food at meal times. 

For example, a 1unit:10g ratio suggests you need - 1 unit of quick acting insulin per 10g of carbohydrate.   

What if I need to snack to prevent a hypo?

When you have diabetes, you and the diabetes team spend a lot of time making sure your doses of insulin are right for you.

If you find your blood sugar levels are dropping between meals and you have to eat extra even when you don’t want to, it probably means one of the doses mentioned are not right for you.

What do the patterns in my glucose levels mean? 

Looking at patterns in your blood sugar levels will help you to work out which dose of insulin might need adjusting.

If you are always dropping low within 4 hours of taking quick acting insulin with a particular meal, you may need a lower insulin:carb ratio with that meal.

If you are always dropping low after correcting a high blood sugar, you may need a weaker correction factor. 

If you are always dropping low overnight or more than 4 hours after taking quick acting insulin, your basal rate or basal insulin dose may be too high.  

Some extra things to consider:

You might also want to be sure your carb counting is accurate. If you overestimate your carbohydrate intake, this could also be the cause of a hypo after meals.

If you can’t work out which insulin needs to change, speak to your diabetes team for some help.