Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-94

calculating the amount of carbohydrate for a specific amount of food. Weighing and measuring portions helps to “train the eye”, which can help the patient estimate portions when unable to weigh or measure (i.e. at a restaurant). • Add together all the carbohydrate provided for each meal and for each snack. The total carbohydrate for the entire day is irrelevant in terms of bolus insulin dose and impact on glycemic control. • Keeping food records is the best way to count carbohydrate and establish each goal carbohydrate. 3. Set carbohydrate goals. • The decision to include snacks should be individualized (see Chapter 5: Treatment Modalities: Lifestyle). The examples below represent how to determine goal carbohydrate for someone who includes snacks. • If the person uses rapid-acting insulin, then a carbohydrate goal should be set for each meal and each snack. An insulin injection may be required before snacks, in addition to meal insulin. This decision should be based on SMBG results. • If the person uses short-acting insulin, then a carbohydrate goal must be set for each meal period. A meal period is the time between one insulin bolus and the next insulin bolus. It will include the meal and any snack before the next meal. Typically, there are three meal periods in one day: o Breakfast (and morning snack) o Lunch (and afternoon snack) o Dinner (and evening snack) The total amount of carbohydrate at each meal and each snack (rapid-acting insulin) or at each meal period (short-acting insulin) is called the goal carbohydrate .