Dietary Carbohydrate, Protein and Fat for People With Glucose Metabolism Disorders. Just What is Optimal?

Dietary Carbohydrate, Protein and Fat for People With
Glucose Metabolism Disorders. Just What is

A collection of research, studies, science, facts, and opinions.

Dr Katharine Morrison.
February 2005.

DOWNLOAD: Dietary Carbohydrate, Protein and Fat for People With

How To: Count Carbohydrates

This section is necessary for everyone to read at least once. When you understand the complexities of carb counting you need to ask yourself if you need to learn it or not.

If you are an insulin user who wants to eat higher carb meals even just sometimes you do have to learn and become highly proficient at this skill.

If you are not on insulin you may prefer to have a “done it for you” sort of diet such as Dr Annika’s, the Life without bread diet or coming later in the How To: Follow Dr. Bernstein's Dietary Plan section.

If you are an insulin user who would prefer not to carb count you will still need to have some idea of what sorts of relative amounts of carb different foods have. Whether you choose Dr Annika’s, LWB or Dr Bernstein’s diet you are still going to have to cut your carbs gradually and be very consistent particularly in the run in phase when insulin doses are reducing. You need to give this carb counting a very good effort. When you are eventually stable on a low carb eating plan that suits you it is entirely possible to keep to doing what you know works and hardly carb count after that point.

There are several methods of carbohydrate counting that are commonly used.

1. Lists.

2. Exchange method.

3. Carb factors.

4. Nutritional labels.

5. Nutritional scales.

6. Eyeballing.

These all have their pros and cons. You need equipment or information sources for some of them. No matter how accurate you try to be you are likely to end up with an approximation of the carb content. The more of these methods you become comfortable with the more versatility you will have under different circumstances. In all cases you need to make the best estimate you can and notice the results you get. What would you change next time if your post meal blood sugars are not within your particular target range? By giving it your best guess and then testing you can build up a profile of how your body, medication doses,  and insulin can cope with that particular meal at that particular time of day.



Carb lists of food items can come from various sources. There are published books, web based resources and chain restaurants will often publish leaflets to give you an idea of the carb count or have the information on a web site.

One of the difficulties however is knowing what portion size they have actually measured. Sometimes a food is listed by the amount of carb in 100g which is a little over 3 ounces. Other times cups, tablespoons, handfuls or  the number of items eg grapes are listed with carb count. The most accurate way is when you have a standardised and individually packaged portion.

The website resources section in the metabolic syndrome section has some carb counting sites to help you get started. In addition here is list from some fast food and other restaurants.  To put these figures into context the Atkins diet ranges from 20-120g of carb a day.

Burger King
Whopper 48g
Cajun Chicken deli wrap 48g
Large fries 53g
Sachet ketchup 4g
Chocolate ice cream sundae 26g

Big Mac 44g
French fries regular 28g
BBQ dip 12g
Apple pie 27g
Regular vanilla milkshake 63g

Kentuky Fried Chicken
Original recipe chicken drumstick (one) 7g
Chicken fillet burger 36g
Corn 11g
Crispy strip (one) 6g

One medium slice Italian pizza 27-38g
Portion of lasagne 63g
One slice of garlic bread 11g

One portion of boiled basmati rice 110g
Chicken tandoori 2g
Chicken korma 16g
Vegetable curry 15g
Beef curry 6g
Naan bread 80g

Canteen/Bar food
Baked potato 70g
Chicken pie for one 32g
Meat pie for one 33g
Shepherds pie for one 37g
Battered fish 21g
Sweet and sour pork 34g
Chips/Fries small 31g
Chips/Fries medium 50g
Chips/Fries Large 73g



The exchange method of carb counting was used for many years. Diabetics and their carers were taught what quantity of a carbohydrate containing food amounted to 10g, 12g or 15g of carbohydrate.  The Life Without Bread Diet which I have described in the Metabolic section uses a certain number of 12g carb portions a day.

In general this method can be more accurate than the list method. For instance a third of a cup of cooked rice is around 15g versus about 110g for your average Indian restaurant rice portion. It is still subject to some error of course.

The American Diabetes Association have come up with a rough quantity guide to help you. This is for a woman’s hand.

one clenched fistful = one cup

palms sized quantity = 3 oz

thumb tip = one teaspoon

handful = 1 or 2 oz of snackfood

whole thumb size = 1 oz

With all the inbuilt imprecision that this method of counting has you will always have to compare what you think you ate versus the results you got. When you do have such items as nutritional scales or relatively accurate portioned control amounts it is helpful to compare what they look like versus your usual portion size to improve your eyeballing accuracy.

American cup sizes are used throughout.

All of these portion sizes amount to about 15g of carbohydrate unless stated otherwise.

Easy Averages

1/2 cup beans
one small slice bread
1/2 cup cereal
one cup milk = 10g
1/2 cup cooked pasta
1/3 cup cooked rice

one large apple
5 small apricots
6 apricot halves in juice drained

one small banana
half a large banana
20 blackberries or blueberries

32 cherries
3 medium clementines or satsumas

3/4 cup fruit salad

one medium grapefruit
ten large grapes or 20 small grapes

2.5 kiwi fruit

3/4 of a medium mango
2 slices of melon

one large nectarine

one large orange

2 medium peaches
7 slices of canned peaches in juice drained
one medium pear
3 pear halves in juice drained
3 slices of pineapple
3 medium plums
4 dried prunes

1.5 tablespoons of raisins
1/2 cup raspberries

one tablespoon sultanas

One medium slice of bread 24g
one slice of french bread 1.5 cm in length

1.5 bridge rolls
1/2 medium sized roll

one slice currant or raisin bread

1/4 cup breadcrumbs

1/2 medium chapati

one toasted crumpet
1/2 currant bun
1/2 English muffin

2 small slices garlic bread
one medium hamburger bun 24g
one large hamburger bun 42g

1/2 hot cross bun

1/5 naan bread

1/2 sweet pancake 15cm diameter

2 large poppadoms
one pitta bread

one small scone

2 taco shells
1/2 corn or flour tortilla

For most breads a 30g serving has 15g of carb

2 tablespoons canned sweetcorn
one small corn on the cob
120g roast parsnips
1/2 cup frozen peas

1/2 small baked potato
one very small boiled potato
10 crisps
2 tablespoons mashed potato

For most vegetables

1/2 cooked = one cup raw = 5g carb
1 and a half cooked = 3 cups raw = 15g carb

1/2 cup of cornflakes, fruit and fibre or rice krispies

2 tablespoons muesli
1 cup puffed cereal
1/2 cup rolled oats made with water
one biscuit of weetabix

For most cereals a 20g serving has 15g of carb

Apple juice 150mls
drinking chocolate powder 20g
unsweetened grapefruit juce 180mls
Lucozade 85mls
unsweetened orange juice 170mls
unsweetened pineapple juice 150mls
soft drink 140mls

1/2 cooked barley
1/3 cup bulgar wheat
1 and a half teaspoons cornflour
1/3 cup couscous
2 and a half tablespoons wholewheat flour
2 tablespoons white flour
1/2 cup pasta
1/3 cup cooked rice
1 and a half tablespoons dried rice
1/2 cup tinned spaghetti

3 tablespoons baked beans
1/2 cup kidney beans
2 heaped tablespoons lentils or split peas

3/4 cup custard
3/4 cup evaporated milk
1 and a half cups milk
1/2 cup vanilla ice cream
2 heaped teaspoons sweetened yoghurt

1/2 standard bounty bar
25g bar of chocolate
1/3 standard mars bar
1.5 small milky way
1/2 snickers bar
3 fingers of kit kat
one finger of twix

3 cream crackers
3 crispbread

120g peanuts
3 cups cooked popcorn
25g packet of crisps

one penguin biscuit
two ginger nuts
one 9g shortbread biscuit

one 5cm square cake without icing
one 2.5 cm square cake with icing
one mr kipling french fancy 19g
one choc chip cookie 8g
one small slice chocolate cake

2/3 large croissant
one danish pastry
1/2 jam donut

1/2 slice fruit cake
one jaffa cake 9g

3 level teaspoons jam

one small slice madeira cake
1/2 an individual jam tart
1/2 mince pie

2 oatcakes

3 level teaspoons sugar

one small slice swiss roll
one small waffle

For most dry biscuits and cakes a 25-30g serving will have 15g of carb

For most sweets a 10-20g serving will have 15g of carb.



The carb factor is the percentage of carbohydrate present in a food. If an apple has a carb factor of 0.13 this means that 13% of the weight of that apple is carbohydrate. If your apple weighs exactly 100g this would contain 13g of carb.

To use this method you need a list of carb factors and a set of scales to measure out the weight of your food portion. Nutritional scales have the carb and other factors built into them but you can use any scale provided it is sensitive enough.  Digital scales may therefore be preferable to analogue scales.

John Walsh and Ruth Roberts book, “Pumping Insulin” has a list of about 300 foods at the back.

The site Friends with Diabetes is a site for diabetics who wish to follow a kosher diet. There is lots of helpful information of help to everyone else too.

Also, this site gives you carb content and other nutritional information too.



When you pick up many items of processed food you will find nutritional labels on them. How do you know how much carb is in the portion you intend to eat?

For the purposes of illustration lets say I decide to have a meal of a half can of lobster bisque soup, 3/4 of a can of spaghetti bolognese and half a can of mandarin oranges in light syrup with a dollop of tinned heavy cream.

I look at the lobster bisque. It lists :

Per  100g
Energy  51 kcal
Protein 3.4g
Carbohydrate 4.7g
(of which sugars 1.2g
Fat 2.1g
(of which saturates 1.2g)
Fibre 0.2g
Sodium 0.5g

I want to eat half a can and fortunately the figures for this are listed too.

How to I know how much carb to count? In this case it is easy because it is on the tin. Carbohydrate 9.8g per half tin (of which sugars 3.5g).

The important thing to remember is that it is the carb count and not just the sugar count that matters.

Now for the main course. Tinned spaghetti bolognese. The tin weighs 400g.

I pick up this can and go straight to the carb count.

It says carbohydrate 13.2 per 100g with sugars being 2.4g of this.
Per half can serving there is 26.3g  with sugars being 4.8g of this.

Ignoring the sugar content as usual I see that if I want 3/4 of the can I will need to do a little sum.

Although this is an easy sum to do I would like to go though what your old school teacher called “the working” so that it is easier to do this cross multiplication technique with more awkward amounts.

If 100g weight = 13.2 carbs  what does 300g weight contain?

Write it like this   100g = 13.2
300g = X

Now cross multiply like this:

100g x X = 13.2 x 300g

From algebra you may remember that if you want to know what X is you need to move the 100g to the other side of the equal sign. When you do this it has to go below the 13.2 x 300g sum to indicate that this  is  now going to be divided.

So  you get:

X = 13.2 x 300g

Using a calculator the answer is:


This cross multiplication technique can be used not only for counting how much carb is in a certain weight of food if you have the carb factor or carb count from a list but how much of a certain food you can have to stay within a certain carbohyrate limit.

Now dessert. Mandarin orange segments in light syrup. The can weighs 312g and the drained weight of the can is 170g.

Per 100g for the fruit and the syrup the carb count is  14g of which sugars is 14g.
For half a can the carb weight is 22g of which sugars is 22g. The fibre content is 1g.

This fibre content is pretty low so can be ignored in this calculation.  For certain foods with a significant fibre level you may be best to deduct it from the total carb count. Fibre affects the bulkiness of the meal but as it passes throught the gut without being absorbed you don’t need insulin to cover it. Because bulk can affect blood sugars through the effect of glucagon released from gut distention Dr Bernstein suggests a compromise by deducting half of the fibre from any given meal.

In this case we can find out how much carb is in half a can just by looking at the label. But what if this information was not supplied? What if the can contents had been shared out and you really had no idea what proportion of the can you had been given?

Lets go back to the carb factor information. 14g of the weight of the 100g of this food is carbohydrate.  If you weigh your portion on an accurate scale and it comes to 156g how much carb is this.

Cross multiply:

100g = 14g carb

156g = X carb

100 x X = 14 x 156

X = 14 x 156

X =  21.84g carb

Now lets add the cream.  Per 100g the carb count is 3.6g.  For a 50g serving size the carb count is 1.8g.  The can contains 283g so a serving size is  283/50 = 5.66th of the tin. A good couple of tablespoons by the look of this for a very low carb count.

Now add up your meal carb content:

Lobster bisque  9.8
Spaghetti bolognese 39.6
Mandarin oranges 22
Cream   1.8

Total = 73g

Now, you won’t be surprised to hear after what we’ve been telling you  about high amounts of carbohydrate messing up your blood sugar control, weight and metabolism that this menu is for carb counting lessons only. You want to eat much healthier meals that this canned rubbish don’t you?



Nutritional scales come in two main types. The cheaper type has a booklet with food lists and you enter the code of what you are weighing into the machine. More expensive models have an inbuilt computer with the foods listed and you click on the food you are weighing. These tend to have a larger database and can be used without having to have a booklet.

The nutritional scales give you the calorie, salt, protein, fat, cholesterol, fibre and carbohydrate counts for any given weight of food. There are memory features too.

The Salter nutritional scale that I have has 800 foods listed from the USDA database. It cost me £32 from Amazon. If you go onto the USDA site to find an even larger range of foods and have an accurate enough scale you do not really need to have nutritional scales.  I have found it a convenient and useful method and our family even have guessing  games about how many carbs a particular food portion contains. I have even taken it into restaurants to carb count food!



Out of all the carb counting methods I have discussed this is the method subject to the most error and yet it is the most commonly used.

To get success with this you have to practice and practice with the other more accurate methods of weighing out small portions of food and using packaging information, charts or nutritional scales to come to what still is an approximation of the amount.

It has been shown that eyeballing is reasonably effective up to about 30g of carb portions but once the portions get bigger the estimates get considerably less accurate. For this reason you are better to look at your food and even  move it about in your plate a bit try to replicate the portions you use at home with a known carb count and then add them up.

It always amazes me just how much carb potatoes have compared to for instance cauliflower, broccoli and green beans. Some  eye ballings rules are that a golf ball size of mashed potato is 10g of carb and a woman’s fist size of cooked low starch vegetable is 5g.

The lower the carb count of your meal the easier it is in general to figure out the carbs. There is less room for error with what you think is one golf ball size of mash compared to say six such estimated portions which is not unusual in some restaurant meals.  This goes of course for rice, bread, pasta, chips, cakes and sugary sauces too.

Partly for these reasons of difficulty in  carb estimation and also because of the variability in the absorption and effect of insulin injections it is far less troublesome to simply keep these food items to a minimum for insulin users.

Type 2s who don’t use insulin also find that their sugars spike with anything other than modest portions of these items because they don’t have a supply of immediately releasable stored insulin in their pancreases.


Quick Quiz:
Carb counting is not an exact thing. Different breads are sliced to different widths for instance. Cup sizes vary too. In the carb comparison questions one option will have at least twice or half of the relative amounts of the other three options.

1. 12g of carbohydrate is present in all of these except…
a one thin slice of bread.
b one cup of broccoli.
c one cup of rice.
d half a grapefruit.

2. 15g is present in all of these except…
a Half a cup of beans.
b Half a cup of cereal.
c Half a medium roll.
d One hamburger bun.

3. 15g of carb is present in all of these except…
a One large banana.
b One medium pear.
c Three pear halves in juice.
d 3 medium satsumas.

4. 15g of carb is present in all of these except..
a Half of a small baked potato.
b A packet of crisps.
c A small portion of Burger King chips.
d Two tablespoons of mashed potato.

5. 15g of carb is present in all of these except…
a Three fingers of kit kat.
b Half a standard bounty bar.
c One standard snickers bar.
d One finger of twix.

6. 30g of carb is present in all of these except…
a A slice of pizza (the size of the ones with a thin base served at the buffet in Pizza hut)
b A donut.
c Two oatcakes.
d An individual jam tart.

Have you got it?
1. C. A cup of rice is about 30g. More than twice the carb count of the others.

2. D. A small hamburger bun is around 24g and a large one 48g. The others are about half the carb count.

3. A. A large banana is about 30g.

4. C. A small portion of Burger King chips is about 32g. Even then the consistency between these small portions varies a lot. I know. I’ve sat counting chips to find out.

5. C. A standard snickers bar is 34g.

6. C. Two oatcakes at 7g each are around 15g.

Reference Info:
Jo Sutton an Australian Dietician compiled the carb lists that I have used here.


Where to Next?
We are all now going to move onto the  How To: Do the Atkins Diet diet section.  What? Did I hear this right? Surely everyone in the developed world knows how to do Atkins?  They all think they do! That’s for sure. For a different take on the most famous diet in history I’ll see you there.



How To: Know the Truth About Carbohydrates

This section is for everyone.

What “they” say:

When referring to carbohydrate the terms sugars, starch and fibre are preferred to the terms simple sugars, complex carbohydrates and fast acting carbohydrates as the latter are not well defined.

Carbohydrate exchange systems based on 10g portions do not improve glycaemic control and are no longer used.

Many factors including the type of sugar, nature of starch, method of food processing and cooking, food form, other food components, blood glucose levels, severity of glucose intolerance, can affect patient’s glycaemic response to foods.

The total amount of carbohydrate in the dietary intake seems to be more important than the source or type.

Intake of foods with a low glycaemic index has not been shown to improve glycaemic control in type 2 diabetics but may improve the lipid profile.

Consumption of the sugar sucrose does not increase glycaemia more than isocaloric amounts of starch.

Fibre containing foods such as whole grains, fruit and vegetables, provide vitamins, minerals and other substances important for good health. However both diabetic and non diabetic individuals would need to consume very large amounts of fibre to produce metabolic improvements to glycaemia and lipid profiles.

Intake of foods that contain naturally occurring resistant starch (corn starch) may modify post prandial glycaemic response and reduce more extreme fluctuations in blood glucose levels but there is no published evidence of long term benefits to diabetics.

When calculating optimal intake, greater attention should be paid to the total amount of carbohydrate than to its source or type.

Food with carbohydrate from fibre rich foods, wholegrains, fruits and vegetables and from low fat milk should be included in the diet. There is no evidence to support increasing fibre intake in diabetics above the levels recommended for the rest of the population.

Sucrose or sucrose containing foods should not be restricted for diabetics, but can be used in substitution for other carbohydrate sources in the context of a healthy diet with appropriate hypoglycaemic medication cover.

The expert consensus is that carbohydrate and mono-unsaturated fat together should provide 60-70% of intake, but precise and relative proportions may vary according to individual factors, such as age, activity levels and weight.

What they got right:

Quite a lot of what is said in this carb section is factually correct.

The terms sugar, starch and fibre are better than simple sugars or complex carb or fast acting carb.  The latter terms do tend to confuse people.

Carbohydrate exchange systems on their own do not improve glycaemic control.

Many factors do affect how an individual will respond to a given amount of carbohydrate.

The total amount of carb is indeed a more important consideration than the source or type.

The intake of low glycaemic foods versus high glycaemic foods is insignificant in getting good control when high amounts  of total carb are consumed. I do o not know whether the lipid profile will be better or not on a high total carb/low glycaemic diet.

Sucrose, which is the usual table sugar is certainly no worse than many starches in raising blood sugar levels.

Fibre eaten in palatable amounts has indeed no proven health benefits in diabetics or anyone else.

The consumption of corn starch may indeed result in less post prandial blood sugar drops if a high carb diet is consumed.

The total amount of carb is indeed a more useful consideration than type or source when it comes to glycaemic control.

What they should have said:

Sugar and starch have about the same effect on raising blood sugars. They both raise blood sugars quickly, often within 15- 30 minutes.  Fibre tends to retard the process somewhat.   In addition fibre is remains undigested and does not contribute to the total effect on blood sugar or on calories taken in.

The term complex carbohydrate tends to confuse people the most. Many would assume that brown bread is a complex carb and it is often described as such but most versions of brown bread are made into sugar just as fast as white bread or sucrose.

The truly complex carbs are non starchy vegetables such as celery, broccoli or cauliflower that have a cellulose structure that is more difficult for humans to digest so sugar release is quite slow.

Exchange systems can work well if the total amount of carb consumed at each meal is kept moderate to low. Dr Allen and Dr Lutz’s 70g carb diet is an example of this.

Many factors affect an individual’s response to a meal.  Charts and guides can offer some help but experimenting on yourself is the only way to really find out.

The total amount of carb consumed is certainly more important than the type or source when high amounts of carb are consumed. When you lower the amounts it becomes more obvious what the relative glycaemic effects of different carbs are.

Low glycaemic index foods when consumed in moderate to low amounts do tend to produce lower sugar spikes than higher glycaemic foods in equivalent amounts.

Consumption of sugar and starch raises blood sugar fast and predictably high. This can be very helpful when dealing with hypoglycaemia but is less useful when planning meals that are aimed at keeping blood sugars within the normal non diabetic range.

Strictly scientifically no carbohydrates are required to be consumed by humans whatsoever.  Essential fatty acids – Yes.  Essential amino acids – Yes.  Essential carbohydrates – Well, no actually.

In real life, if you are on injected insulin you can’t rely on getting it perfect 100% of the time. So, fast acting sugars such as glucose to deal with hypos IS necessary.

Many people enjoy eating carbohydrates even though their body can function fine without them.  These days we don’t eat the lightly cooked or raw organ meats that our ancestors ate. We therefore could become deficient in certain nutrients eg vitamin C if we did not eat exactly as they did.  Lightly cooked liver has more vitamin C than an apple weight for weight. But what would you rather have in your lunch box?

For a diabetic you would certainly have a lower effect on your blood sugars if you ate the raw liver compared to an apple. So what is the best of both worlds?

Fortunately nature has provided us with a wide variety of non starchy vegetables.
These generally grow above ground.

There is no nutrient present in whole grains, fruit or milk that is not available from either a meat/ egg source or non starchy vegetable. Usually the nutrients are present in much greater quantities too.

And there is no adverse effect on your blood sugars that often occurs with fruit, milk and wholegrains unless consumed in very small quantities, and preferably with a lot of fat added.

Sucrose and starches should be regarded by diabetics as poisonous until proven otherwise.  You can probably get away with eating small quantities of these infrequently. But you are kidding yourself if you think you can eat these as in a five year old’s birthday party and get away with it.

What the ADA and Diabetes UK say about sugar and starch is just plain wrong.  You may not want to believe this. It may be tough.

But do you know how much funding the food and drug industries give national diabetes associations such as the ADA every year? I’m not talking about the organic vegetable and free range chicken farms. I’m talking about sugar, confectionary, soft drink, breakfast cereal, bread , cake,  biscuit and other processed food suppliers give in donations and for endorsement of their products.

You can try to cover high carb/glycaemic items with insulin. Because of the 30-50% injection to injection variation in glycaemic effect you do put yourself at a rather high risk of overly low or overly high blood sugars. This is if your insulin matching and carb ratios are perfect.

Expert consensus about anything just means that a lot of people with common interests agree on something.   I call this “over the garden fence” opinions because they are just as scientifically valid.

They may be right. They may be wrong. But we just don’t know.

We don’t know what evidence they examined.
We don’t know what evaluation process they went through.
We don’t know what evidence they did look at.
We don’t know what evidence they didn’t look at.
We don’t know if they are bright or not.
We don’t know if they are going a bit batty-bat or not.
We don’t know if they took their medication that day or not.
We don’t know what they were offered for agreeing to someone else’s agenda or not.

We don’t know nuthin’ about that decision.

If you are happy to accept consensus decisions that is okay. Please give some tolerance to others who are a bit worried about accepting those decisions.

What is a typical NHS  dietary and insulin regime?

Your advised diet should you be a diabetic in Britain’s National Health Service is us usually something like this:

Consume plenty of starches at each meal.
Try to have wholegrain versions when possible.
Eat sugary foods in low to moderate amounts.
Eat at least 5 portions of fruit and vegetables a day.
Avoid diabetic products.
Drink diet versions of soft drinks.
Fruit juices may be consumed in moderate amounts.
Eat your usual amount of protein especially white meat such as chicken and fish.
You may eat eggs and red meat but only in small amounts.
Eat some oily fish each week.
Avoid saturated fat.
Avoid fried foods.
Avoid butter or lard. Use margarines instead.
Use olive oil in low to moderate amounts.
Drink alcoholic drinks sparingly.

A typical “healthy eating” day could be:

7.30 am

Breakfast cereal, semi skimmed milk.
Toast thinly spread with marmalade.
A glass of tropicana.
A banana.

10.30 am

Small scone with small quantity of margarine and jam. (optional)


Tinned cream of tomato soup.
Tuna sandwiches with margarine and wholegrain bread.
An apple.
Diet coke.


A small quantity of raisins and mixed nuts. (optional)

6.30 pm

Spaghetti Bolognese.


Wholemeal toast and margarine.
A glass of semi skimmed milk.

The insulin regime to cover this could be:

Novorapid at breakfast, lunch and dinner and possibly before snacks.
Lantus at bedtime.

No carb counting is usually taught.

Dose adjustments are made on the trend in the blood sugars.

Blood sugars are preferred to be 4- 8 before meals and on rising.
Blood sugar is preferred to be over 5.0 at bedtime.
If blood sugar is 10 or over three days running at the same time of day the insulin to cover that period of time needs to be raised.

If 7.30 am bs is over 10 raise night Lantus.
If  1pm bs is over 10 raise breakfast insulin.
If  6.30pm bs is over 10 raise lunch insulin.
If  9.30 pm bs is over 10 raise evening meal insulin.

This sort of dietary and insulin regime is commonly used for type ones.

For insulin using type twos simple basal Lantus or other long acting insulin such as Levemir is commonly given on its own. No meal insulin is usually started unless the hbaics are over 8.

Twice daily mixed insulins such as Mixtard, Humalog Mix or Novomix may then be given.

Sometimes type 2s are given separate basal and rapid acting insulins to cover all meals.

The results of following this regime tend to be blood sugars set at a considerably higher points throughout the day and night. This is needed to reduce hypoglycaemia which can occur due to unpredictable absorption and action which is worsened by high amounts of insulin given at each injection.

The amount injected is whatever you have worked out works best and it is given in a single injection. When high carb diets are consumed high amounts of insulin are needed to cover this.

There is usually not enough fat consumed to reduce the speed of digestion of the carbohydrate. Snacking due to hunger results in a need for more insulin injections to cover the snacks. This can still be active when the next meal insulin is given.

This can increase the chances of hypoglycaemia.  Hypoglycaemia can often be overtreated and so blood sugars before the next meal are high.

No strategies such as correction doses, limiting the amount of insulin injected in one shot, using different types of  bolus insulin, timing the insulin injection so it is optimally effective are taught.

No wonder the results that insulin users get are so far away from what your pancreas would do if only it could.

Quick Quiz:
There is no quiz for this section.

Where to Next?
For type twos who don’t use insulin you may have mixed feelings now. The good news is that you have completed the course. Well done!

The more difficult news is that if your diabetes is not managed tightly enough or simply due to having the condition for a long time, you may need insulin in the future and have to come back and do the insulin users section that follows.

Its now time for type twos to start the course from the beginning again. I know. I’m a slave driver! This time you will be familiar with the sections most relevant to you. You can even take lots of time to browse the internet sites available.

Create a good action plan and be consistent and persistent.
We hope you reach your personal diabetes solution very soon.

For type ones and insulin using type twos its not over yet!

Insulin is a very dangerous hormone in overdosage. This is why there has been such an emphasis on waiting till you have completed the whole course and in a particular order before you low carb.

The sections ahead are very detailed. There aren’t many fun sections. It is very serious stuff. I’ll be really narky if I catch you laughing at anything.

Are you ready?  Got your meter steady?  Now Go to the How To: Keep Healthy with Type 1 Diabetes section.