Ask the Diabetes Educator Archive

Q:

Do most diabetics count 'carbs' or grams of carbohydrate when they are determining the amount of insulin to take? Our 4 year old was recently diagnosed with type 1 and we are getting 'mixed signals' and 'mixed recommendations' from our diabetes educator?

A:

When determining insulin dose, we count grams of carbs. The starting point for dosage calculations is based on 1 unit of insulin for every 15 grams of carbs. My experience is that most people may require more. It is not uncommon for the AM insulin requirements to be higher than the PM requirements due to Dawn Phenomenon or other factors denoting higher insulin resistance.

An example of this is 1 unit for every 10 grams of carbs at breakfast, and 1 unit for 17 grams at dinner. This is best determined by keeping accurate blood sugar records with grams of carbs eaten/units of insulin taken. In time, a noticeable pattern may evolve based on a division of the grams of carbs eaten by the number of units of insulin taken. A breakfast of 1 cup of unsweetened cereal, one small fruit, one cup of milk and one piece of buttered toast is approximately 50 grams of carbs. If your blood sugar goal 2 hours after eating is 150, and it takes 5 units of short acting insulin to achieve this, your insulin needs are a ratio of 1:10: one unit of insulin for every 10 grams of carbs. You got this by dividing 50/5. It is not always so easy to arrive at a pattern, especially if foods eaten vary a lot.

This can be difficult with children. It is important that you establish blood sugar goals with your practitioner, and communicate with your Educator WHERE clarification is needed. You will need both tolerance and patience for you and your child. Adjustments can take a long time.

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