To successfully implement flexible meal-time insulin dosing, you will need to learn the following:
Carbohydrates are a major macronutrient in a balanced diet, alongside proteins and fats.
Carbohydrates are categorised as follows:
1. Sugars
These are simple carbohydrates that are rapidly absorbed, leading to quick increases in blood sugar levels. Common sources include sugar-sweetened beverages like sodas, packet drinks and sweets.
2. Starches
These are complex carbohydrates that are broken down into simple sugars upon digestion.
Refined grains are starches which have undergone processing and have lower fibre and nutrient content. They tend to can cause quick spikes in blood sugar levels. Examples include white rice, corns flakes, and products made from white flour, such as white bread.
Whole grains, being less processed and higher in fibre, are the preferred choice, as they help to stabilise blood sugar levels. Examples include brown rice, whole grain bread and oats.
3. Fibre
These are complex carbohydrates that are indigestible and do not contribute to blood glucose increases. They can also slow down the digestion and absorption of sugars.
Although carbohydrates (sugars and starches) are the main contributors to post-meal glucose rise, avoiding carbohydrates may lead to excessive protein and fat consumption and potentially cause weight gain. A balanced meal following the healthy plate concept offers long-term health benefits and is more sustainable over time.
You might already be familiar with basic carbohydrate counting using the carbohydrate exchange system. This approach groups foods based on their carbohydrate content, with each exchange equating to 15 grams of carbohydrates.
Advanced carbohydrate counting goes a step further, focusing on counting carbohydrate intake more accurately in grams. Accurate carbohydrate counting leads to a more accurate dosing of quick-acting (bolus) insulin and thus better glucose control.
In order to accurately estimate the amount of carbohydrates, you will need the following:
1. Measurement of serving size of the food item you are planning to eat
Measuring can be done by weighing the food item or using household measures such as cups, spoons, or bowls.
For example:
2. A reference of how much carbohydrates (in grams) per portion size of the food
We have compiled information on the average carbohydrate content of commonly consumed foods for your reference.
If the food items come with nutrition labels, do refer to it for more accurate carbohydrate counting.
In addition, you can also refer to online reference databases (see next section).
Grains, Cereals & Breads
Food Item | Portion Size (Weight of food) | CHO (g) | CHO exchange (1 exchange = 15g of carbohydrate) |
---|---|---|---|
Rice (white or brown), cooked, tightly packed | 1 rice bowl (200g) | 60g | 4 |
Porridge | 1 rice bowl (260g) | 30g | 2 |
Beehoon, plain, cooked | 1 rice bowl (180g) | 45g | 3 |
Kway teow, plain, cooked | 1 rice bowl (150g) | 42g | 3 |
Noodles, egg, cooked | 1 cup (160g) | 38g | 2.5 |
Spaghetti, plain, boiled | 1 cup (140g) | 43g | 3 |
Cornflakes | 1 cup (30g) | 26g | 2 |
Oat, rolled, raw | ½ cup (45g) | 27g | 2 |
Chapatti | 1 piece (45g) | 21g | 1.5 |
Plain Thosai, small | 1 piece (45g) | 18g | 1 |
Idli | 1 piece (75g) | 16g | 1 |
Bread, wholemeal | 1 slice (30g) | 12g | 1 |
Cream crackers | 3 pieces (23g) | 14g | 1 |
Food Item | Portion Size (Weight of food) | CHO (g) | CHO exchange |
---|---|---|---|
Potato, raw, with skin | 1 whole, medium (150g) | 20g | 1 |
Mashed potato | ½ cup (120g) | 19g | 1 |
Sweet potato, raw, peeled | 1 piece (65g) | 12g | 1 |
Pumpkin, boiled | 1 cup (245g) | 9g | 0.5 |
Corn on cob, raw | 1 whole (300g) | 32g | 2 |
Food Item | Portion Size (Weight of food) | CHO (g) | CHO exchange |
---|---|---|---|
Baked Beans, canned | ½ cup (125g) | 22g | 1.5 |
Sambar, dhal curry | 1 cup (285g) | 21g | 1 |
Chickpeas, boiled | ⅓ cup (50g) | 14g | 1 |
Red kidney beans, raw | ½ cup (90g) | 56g | 4 |
Food Item | Portion Size (Weight of food) | CHO (g) | CHO exchange |
---|---|---|---|
Milk, plain, low fat or skim | 1 cup (250ml) | 13g | 1 |
Low fat natural yoghurt | 1 small tub (200g) | 12g | 1 |
Food Item | Portion Size (Weight of food) | CHO (g) | CHO exchange |
---|---|---|---|
Chicken Rice, with steamed chicken | 1 portion (330g) | 73g | 5 |
Nasi Lemak with fried chicken wing | 1 plate (412g) | 109g | 7 |
Nasi Briyani with chicken | 1 plate (377g) | 102g | 7 |
Lontong with Sayur Lodeh | 1 plate (775g) | 64g | 4 |
Claypot Rice | 1 plate (597g) | 93g | 6 |
Seafood Fried Rice | 1 plate (428g) | 125g | 8 |
Century Egg Porridge | 1 soup bowl (512g) | 34g | 2 |
Ban Mian Soup | 1 portion (648g) | 38g | 2.5 |
Sliced Fish Beehoon Soup (no evaporated milk) | 1 soup bowl (686g) | 48g | 3 |
Mee Rebus | 1 plate (571g) | 82g | 6 |
Mee Siam | 1 plate (655g) | 92g | 6 |
Beehoon Soto | 1 soup bowl (900g) | 31g | 2 |
Chicken Macaroni Soup | 1 soup bowl (480g) | 30g | 2 |
Ang Ku Kueh with Peanut filling | 1 piece (68g) | 26g | 2 |
Deep Fried Carrot Cake | 1 piece (130g) | 27g | 2 |
Chee Cheong Fun, plain, with sauce | 2 rolls (202g) | 51g | 3 |
Curry Puff, potato | 1 piece (107g) | 37g | 2.5 |
Vadai with kacang Hitam | 1 piece (60g) | 10g | 1 |
Vegetable Samosa | 1 piece (75g) | 22g | 1.5 |
Gado Gado | 1 plate (421g) | 44g | 3 |
There are many online references for carbohydrate content available. These include websites and smartphone applications, with some specifically focusing on local foods, which can be more helpful.
It is advisable to cross-reference information from multiple sources to get a more reliable estimate, as different databases or apps might offer varying values.
When using these resources, pay attention to the portion sizes. Makes sure to estimate the carbohydrate amount based on the serving size you are intending to eat.
Here are some resources to start with:
Resource | Format |
---|---|
HPB Energy and Nutrient Composition of Food | Website |
Nbuddy | Smartphone app |
My Fitness Pal | Website, smartphone app |
The insulin-to-carbohydrate ratio or ICR refers to how many grams of carbohydrate one unit of quick-acting insulin can cover.
The ICR varies from person to person and may differ at various times of the day. Working with your healthcare team is key to establishing an accurate ICR for your needs.
When both the ICR and carbohydrate counting are accurate, you will observe that your post-meal blood glucose levels do not rise more than 3 to 4 mmol/L. Additionally, the glucose level should return to pre-meal targets approximately 5 hours after eating (Figure 1).
You can check if your ICR is correct under the guidance of your healthcare team.
If you find that your glucose readings are consistently exceeding the above thresholds after a ameal, then you have given insufficient quick-acting insulin, or underestimated the amount of carbohydrates in the meal.
While carbohydrate content is the primary factor affecting post-meal glucose levels, other food-related aspects also play a role.
The glycaemic index (GI) of a food, for instance, indicates how quickly it can raise blood glucose levels. Foods with a higher GI cause faster increases in blood glucose levels.
Factor | How it affects the post-meal glucose reading |
---|---|
Type of carbohydrate (simple/refined vs complex)
| Simple sugars and refined carbohydrates have a higher glycaemic index (GI) and absorbed more rapidly than complex carbohydrates, which are fibre-rich. For example, opt for brown rice (lower GI) over white rice (higher GI). |
How the carbohydrate is prepared | The glycaemic index of food can be affected by cooking methods such as boiling, frying, baking and roasting. Other food preparation factors / processing methods i.e. long cooking duration, juicing, mashing or grinding could increase the glycemic index of the food and cause blood sugars to rise more quickly.
|
What the carbohydrate is eaten with | Consuming carbohydrates as part of a balanced meal with moderate amounts of protein, fat and fibre can lower the glycaemic index, leading to a slower rise in blood sugar levels. However, a large intake of protein and/or fat with carbohydrates might cause a delayed and prolonged blood glucose increase. Monitor blood glucose trends and consult your healthcare care team for strategies if you notice a pattern of delayed glucose spikes. They can provide advice on managing the combined effect of carbohydrates with high protein or fat meals. |