DAFNE (Dose Adjustment For Normal Eating) is a course that incorporates teaching carbohydrate counting for people with Type 1 diabetes.

Counting carbohydrates

Counting carbs is a tool that many diabetics use to try and gauge how many carbohydrates they are about to eat as it helps with working out how much insulin is needed. It is not a direct match necessarily, but it’s a very good guide. 

You will work out with your doctor what your initial medications and doses will be, but it may take some trial and error to get the balance right for you. 

The body cannot process carbohydrates unless insulin is present, so it’s likely that if you are having a snack of more than 20g of carbohydrates you may (if you’re on insuliln) need to take a small shot of insulin as well so that your body can process the carbohydrates. It’s a constant balancing act.

Counting carbs - value of different foods

From Leeds Teaching Hospitals NHS Trust website www.leedsth.nhs.uk/sites/diabetes.

What are carbohydrates?

Carbohydrates are chains of sugar molecules that are hooked together. Smaller chains are known as simple carbohydrates while longer chains are called complex carbohydrates. Simple carbohydrates naturally occur in fruits, vegetables and milk products, as well as in processed sugars such as sweets, honey, sugar and syrups. Complex carbohydrates are starches found in breads, cereals, rice and pastas.

Carbohydrate is broken down into glucose during digestion and this raises blood sugar levels.

Carb counting explained

The following is taken from the Leeds Teaching Hospitals NHS Trust website (www.leedsteachinghospitals.com), which explains carbohydrate counting very well and has excellent resources for diabetics, including carbohydrate reference tables for food.

Carbohydrate counting can help you to adjust your insulin doses or help explain erratic blood sugars. 

The amount of insulin you need per 10g of carbohydrate will vary between individuals – ask your dietician, nurse or clinician. 

More information is available from food labels. Remember, this should be the total carbohydrate content including both starches and sugars. 

It is not an exact science! Rounding up or down to the nearest 5g is acceptable. To help you work out when and where changes are needed, you will sometimes need to keep records of the foods you eat, your blood glucose and your units of insulin. Knowing about the carbohydrate content of the food and drinks you consume will help you to calculate the amount of insulin you need to achieve better blood glucose levels. Important goals for meal planning are about the right amount of calories based on age/sex/level of activity, and healthy food choices. For further information, see www.leedsteachinghospitals.com/sites/diabetes/food/.

There are also guidelines for matching carbohydrate amounts with insulin doses, although these vary widely among diabetics. It does not mean anything specific if you take a certain amount of insulin – people’s needs vary from one individual to another. 

As an example, some people can simply have one unit of insulin for each 10g of carbohydrate (sometimes 10g of carbohydrate is referred to as one carbohydrate exchange). One unit of insulin per 10g of carbohydrate is a 1:1 ratio of insulin: carbohydrate. So, if your meal is just a sandwich, it’s likely to be 50g of carbohydrate, so the insulin dose would be five units. For someone whose ratio is 2:1 (two units of insulin for each 10g of carbohydrate), you would take 10 units of insulin for the same 50g of carbohydrate.

Of course, it’s not that simple for everyone. Most people will learn that they may start the day with a 1:1 ratio, but by lunchtime this will have moved to 2:1 and will be at 1 ½:1 for dinner. 

This is pretty high-end or ‘hardcore’ diabetes theory – it’s taught in the DAFNE courses and is not widely known about.

You might learn that certain foods get digested quite quickly and can make your blood sugars rise fast. Likewise, you will learn about which foods seem to give you a slow, steady energy release, which fits nicely with your insulin or pill release pattern.

Extract taken from Diabetes - The Essential Guide. For more information on carbohydrate counting and DAFNE, take a look at the book - available now in eBook, printed book and large print formats. Buy the printed version and get the eBook free!